Exercising (years) after Fundoplication

[ChrisB2]

I am a 23 year old male, and I underwent Nissen Fundoplication about 3 yeaars ago. Since then, I have experienced many of the sysmptoms discussed on this forum, including bloating, upper stomach pain, diarrhea, difficulty belching etc.  I have accepted these symptoms, as my life was much worse with reflux.  Before surgery, I was barely able to eat without vomiting, and I lost around 20 lbs before my doctors figured out that acid was my problem.  I went through a number of tests, including 2 endoscopies, upper GIs, blood tests, PH test, sonograms, and others.  I also had my gal bladder removed two years ago after a bout with pancreatitis (ouch!).  Currently, I am not on any medications, but I took Prevacid for a few months before my surgery.
I am also very active, or was before my health declined.  I am now trying to get back into shape, and I am having a very difficult time.  I started jogging about a week ago, in the hopes of building enough stamina to join a soccer team.  As I run, I notice a couple of different symptoms.  Usually I can run with little pain in my stomach, but when I start to cool down then I feel like I am going to vomit, and begin to dry-heave uncontrollably.  The heaves are very deep and strong enough to make me worry about the wrap in my stomach.  This does not happen every time, but often enough to be extremely frustrating.  I have been a runner my entire life and don't plan on quitting anytime soon.  
The other issue is less common, but concerns me even more.  Sometimes I get a very sharp pain in my upper stomach area as I run.  The pain starts out fairly slow, but builds as I run.  It is bad enough to make me stop running, and in some cases I will have to sit down or draw my knees into my chest to try to alleviate the feeling.  The pain is almost comparable to my pancreatic attack.  It will persist after I have stopped running, and sometimes will not go away for around an hour.  This is also followed by uncontrollable and powerful heaves. In the last case, which was the worst so far, I could feel tenderness in my upper stomach the day after.  
I am still running, but am going at a very slow pace, hoping that these symptoms will subside as I get into better shape.  This last episode has frightened me quite a bit.  I am afraid that this condition will prevent me from living the active life that I am accostomed to living.
Do you have any idea as to what is going on with my  stomach as I exercise?
Is there anything I can do to make it stop or make it easier to bear?

[Kevin Pho, MD]

Hello - thanks for asking your question.

The Nissen Fundoplication relieves symptoms in 85-90 percent of patients in studies.  Some of the long term side effects include postoperative dysphagia, esophageal stricture, and paraesophageal herniation.  The incidence of postoperative dysphagia is higher in laparoscopic Nissen Fundoplications.  

Unfortunately despite surgery, in long-term followup studies, up to 60 percent of patients treated surgically reported using anti-reflux medications after 10 years. This data suggest that patients undergoing antireflux surgery should not expect to be free of the need for antireflux medications or that surgery will reduce the incidence of esophageal adenocarcinoma compared to medical therapy.

Since you are having symptoms, I would recommend a complete gastroenterological workup.  Your symptoms may be secondary to the surgery, or it can be a new disease process.  A gastroscopy or 24hr pH study should be discussed to further evaluate your symptoms.

I strongly suggest follow-up with your personal physician or gastroenterologist.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[ChrisB2]

First, thank you for the advice.
However, I am confident that these symptoms are related to the physical exertion that immediately preceeds them.  I have not experienced heartburn since the surgery.
Does anybody else feel my pain?  literally

[surgeon]

sounds to me like you are over-exerting, and need to back off your work-out and begin more slowly. I doubt it has anything directly to do with your surgery. Repeated retching could jeopardize your wrap.

[ljh1971]

This is to a dr who does fundoplications, I had the surgery in  September 2000 (not by laproscopy had to have a hiatel hernia fixed and the surgeon also dialated the stricture I had from the other side) and I have noticed that if I bend over the wrong way I get a pinching feeling from what I guess is the area that the fundoplication was done. Is that normal? Sometimes it hurts if I don't stand back up right away. But the hurting goes away immediatly once I do stand back up.

I joined a gym this past Saturday and tonight the personal trainer had me sit on the floor and reach and touch the floor as far as in front of me as I possilby could, but because of the pinchinig I wasn't able to reach very far. I am also overweight, (my dr wants me to lose 40 to 50 pounds) which is why I am starting this excercising program.

I also noticed that when I was doing push ups tonight (to see how many I could do in a minute) I started burping constantly, the personal trainer asked me if I was ok and I said yes, but I think she was worried I was going get sick. Should I take my prilosec a little while before I execercise to calm the stomach acid down? I think that is why I was burping...

My main concern is if it gets pinched to much will that loosen the fundoplication and cause my acid reflux to come back with a vengence?

A little history on why I ended up having the surgery: My acid reflux was a 4 on a scale of 1 to 4, 4 being the worst according to my dr.  Before the surgery I had 9 endoscopies to dialate the stricture but because of the acid reflux it kept coming back. My first endoscopy was August 1999  and they continued to June 2000 had surgery Sept 2000 and then the surgeon wanted me to have another endoscopy at the end of October 2000 just to see how everything was healing, then in sept 2001 I decided because I was still haveing some problems swallowing I needed to have another endoscopy & the gastroentologist found a small ulcer near the stricture so he told me to take my prilosec every single day instead of as needed like I was doing and he wanted to do another endoscopy in October 2001 and the ulcer was healed and the stricture was totally gone!  I have not had any problems with the acid reflux in my esphogus since the surgery but if I eat something that I should have avoided it bothers my stomach so I still take prilosec.

Lora

[HUMMING BIRD]

DEAR CHRIS,I LIKE YOU, USED TO BE A RUNNER. BUT A YEAR AND A HALF AGO I HAD A NISSEN FUNDOPLICATION, AS WELL AS A HIATAL HERNIA OPERATION. PERFORMED THROUGH LAPROSCOPE.
I WAS IN VERY BAD SHAPE PRIOR TO THE OPERATION. ALL I HAD TO DO WAS LEAN OVER TO PICK UP A PIECE OF PAPER,(W/NO THOUGHT GIVEN)AND MY STOMACH CONTENTS WOULD JUST COME FLOWING OUT. THE LAST YEAR BEFORE MY SURGERY, I WAS IN THE HOSPITAL ON 5 OCCASIONS FOR UP TO A WEEK AT A TIME, FOR THE CONSTANT VOMITING AND THE LACK OF POTASSIUM LEFT IN MY BODY. THE LAST VISIT WAS THE ONE THAT DID IT, FOR A CARDIOLOGIST HAD TO BE CALLED IN AND I WAS PLACED ON A HEART MONITOR AND WATCHED CLOSELY FOR THERE WAS NO MEASUREABLE AMOUNT OF POTASSIUM WHAT SO EVER THIS TIME.
SINCE THE SURGERY I CANNOT DO ANYTHING FOR LONG OUT IN THE SUN, W/O GETTING THE DRY HEAVES. I STAY NAUSEA AT LEAST 3 TO 4 HOURS OUT OF EVERY DAY, AND HAVE BEEN TAKING PHENERGAN SINCE THAT TIME, AS WELL AS THE ACIPHEX. RUNNING IS NOT EVEN A SUBJECT ANY LONGER AND I HAVE LOST 58LBS.WHICH DIDN'T HURT ME,BUT I WASN'T TRYING,MY TEETH ARE ROTTING OUT.BUT TO GO BACK WHERE I WAS BEFORE THE SURGERY? NO WAY,I WOULD BE DEAD BY NOW!IT SAVED MY LIFE AND I'M ONE WHO DOESN'T MIND THE CHANGES! GOOD LUCK TO YOU!!
AND EVERYONE READING THIS POST.DON'T WAIT AS LONG AS I DID, IT COULD MEAN YOUR LIFE!

[chubnik]

My fourteen year old daughter has had chest pains and pressure as long as she could talk to tell me so.  Originally we were concerned about her heart, but with EKG, and a stress test I was told her heart was OK.  After a endoscopy and Barium swallow it was determined that her bottom esophogial valve did not work.  In December she had a funduplication.  The surgeon tried it laproscopicly, but she had some bleeding and her spleen was tucked too far behind her stomach------it had to be done open.  She had a long recovery, but other than healing from the surgery, she had no reflux (she never had "heartburn", just pressure and squeezing).  About 1 1/2 months from the surgery she started having the same chest pains again, along with nausea (which she never had before).  The pains are more often and of longer duration than they ever were.  No reflux medications she has tried helped.  This is very frustrating for us--she is only 14 and should not have these problems.  She has lost about 40 pounds, but she doesn't need to loose anymore--we knew she would get full quicker, but she has an upset stomach much of the time and sleeps alot.

[TomgirlDEL]

Well I had severe acid reflux disease...Had nissen 2 years ago..Last year had reflux back again...had scope done said I had ulcers, so they gave me nexium for two months....now have reflux again got scope done, now they said my wrap had came loose or maybe a stitch has came undone.....So now have to have nissen all over again in two weeks....very confused...just wondering if this happens often or only to me or will this happen again...have so many un answered questions?????? Please if anyone knows the answer let me know.....

                  Thankyou........

[chubnik]

I hope my daughter's wrap did not come undone.  I was told that was not possible.  This would fix her for life.  Were you checked for gall stones?  Her doctor mentioned that they can cause some of the same pains.