Indication for Surgery?

[Smiley2000]

Hi there,

I have had GERD since childhood and eventually progressed to Barrets Esophagus and now I have been told that it is due to LES dysfunction and all my ENT symptoms are GERD related and that I am a candidate for surgery.  

I had Manomatry done and Impedance-PH monitor.  According to the report I had 23 episodes of non-acid reflux, whilst on 40mg Nexium treatment since 2006.  DeMeester score: 0.8

Now I am really wondering if I should get a second opinion on going for surgery?????  

Any help please.

[Smiley2000]

Hi,

I had my Gallbladder removed in 2006 and ERCP to fix blockage in duct.  The non-acid relux can be bile, alkaline and other non-acid products.  The Nexium kills the acid in the tummy, thus no acid.  The LES dysfunction is just that the sphincter at the buttom of the esopagus does not close and then all stomach contents refluxes up.

When ENT symptoms start they call it "alarm symtoms" as it then means it has refluxed passed the Barrets lining and up into the UES (upper sphincter).

The Gastro Ent also told me that they can do ablation on the Barrets cells, but that it can cause stricture there and then make matters worse.  The Nissen Fund. only helps with the reflux - Barrets remains untouched until dysplasia comes in.

I hope that clarifies it?

[CalGal]

Smiley, I'm curious about a couple of things you said. Could you clear up my confusion, please? You said you had episodes of non-acid reflux. I assume that indicates you're bringing up bile? If it is bile, has your gallbladder functioning been checked out? Have you considered trying other forms of 'pleating' the LES before you move to have the fundoplication done? Have you considered trying ablation of the esophageal lining done before having a fundoplication? What specifically is the LES dysfunction - a hiatal hernia, or?

[Smiley2000]

The best test to see if you have high acid is the "24 hour PH-Impedance" study.  It is also a pipe-through-the-nose-to-the-tummy-test (horrible!) but it has small probes every few cm's and is much more accurate than just a normal 24hr Ph test.

[Smiley2000]

oh no!!  please don't tell to many people about this remedy!!!!!!!  it is horrible and I think dangerous!  

I had a BARIUM XRAY done once and as part of that test they give you a cup of Bicarbonate soda and water to drink!!!!!!  and then they shove 2 litres of barium liquid down your throat!

The Bicarb soda BURNED LIKE HELL.  I now know what it feels like to be burned alive!!!!!!!!!

[Red_Star]

Have you done the 2c baking soda test? :) My mother did and found she had low stomach acid after being told for 25 years she had high. She stopped nexium and gaviscon immediately and started digestive enzyme supplements (to help with digestion - good for low and high acid conditions) and betaine HCI with pepsin to increase stomach acid. 5 years of severe GERD and LPR gone within a few weeks and 25 years of gastritis 95% better after a year. Not familiar with the tests you have had done but this test is easy lol...

The baking soda test.

Mix 1/4 teaspoon of baking soda (sodium bicarbonate, not baking powder) in an 8 ounce glass and drink it.

If sufficient quantities of acid are present in the stomach, bicarbonate of soda is converted into gas, producing significant bloating and belching within 5 or 10 minutes of drinking the mix.  Little or no belching is suspicious for low stomach acid.

[Smiley2000]

Yip, the procedure is Nissen Fund.

I am a bit scared to have the op done... I have had so many tests (Manomatry, 24hr PH/Impedance, Barium Xray) and then I can also tell you that I have seen 5 different Specialists in 2 years time and they all had different opinions!  the 1 said I must be Bulimic, because she could not find anything wrong in my esophagus but my throat looks horrible with acid burning it away!  I then saw an ENT Specialist who also did his horrible pipe-in-the-nose test and he also said it is REFLUX and then send me to 2nd opinion who said I have Barrets and LES dysfunction and should get surgery - then I didn't go back to that guy as I wasn't ready for any further Surgery, tests.  But I still didn't get better and went to see 3rd Doc, who said everything looked NORMAL - no need for any treatment.  Then back to 4th Specialist that said I have Barrets and LES probs and Gastric inlet patches - but no need to worry.  

They were all South African docs.  Then the 5th doc (moved from South Africa to Adelaide in Aus.) said:  positive Barrets, LES dysfunction, all ENT symptoms due to reflux that I must have had since birth and I need surgery.

So, you can imagine that I don't believe what Doctors tell me anymore.  I have had enough surgeries to last me a lifetime and I really don't want any further surgeries... but it seems like this one can improve my quality of life.

So I basically answered myself:  if I want to get better then I'll have to go ahead with the surgery.

Will let you know what happend...

[patient915]

I assume the surgery you are talking about is a nissen fundoplication?  This is really only a decision you and your doctor can make together.  Only you know how severe and how many problems your GERD and related problems are causing you.  However, I do recommend that you get a second opinion.  I believe that if you have some hesitency for the surgery, that you should see another doctor before you undergo something that could cause you harmful side effects.