Nissen Fundoplication AND PPI?

[cruiser123]

I am a 50 year old male in good health.  I had a Lapro Nissen Fundoplication performed 10 years ago after diagnosis of Barretts.  I have gained about 10 lbs since the operation.  I have an endoscope with biopsy performed every two years; nothing has turned ominous.

The operation was VERY satisfactory, and totally relieved all GERD symptoms.  To this day I am still symptom free, unless I do something stupid like scuba diving after I eat or have pizza late at night.  These "reminders" occur no more than once a year; as it seems that's how long my memory lasts...

The problem I have is that in applying for medical insurance my Gastroenterologist forwarded my medical records to the insurance company.  In those records (that I finally got a copy of from the insurance company) he states that I am on, and SHOULD HAVE BEEN on PPI's (Ie, Prilosec, etc) EVERY DAY, for an indefinite duration.  I left the states shortly after the operation, so I only see the Gastro Guy for my Endoscopes every two years.  He has never mentioned this to me during the last 4 visits in 8 years.

Is this normal?  The Nissen Fundoplication solved all my symptoms.  I do not have ANY acid reflux problems (except brought about by my own occassional stupidity).  Why would I be taking PPI's without experiencing any symptoms?  I barely missed being a Thalidomide baby, (Mom was offerred the drug, but refused, preferring to "tough it out"), so I have a pre-disposition to not taking ANY drug unless it is absolutely necessary.  Everything I have read indicates that the PPI's will never "heal" Barretts, just relieve GERD symptoms.  So with no symptoms, why take the da*n drug?

While not a fanatic, I am watchful of the acid levels I ingest.  For example, I limit myself to one 8 oz cup of coffee each day (half water, half coffee) and then add non-fat milk as a creamer; this gets the ph to 6.2, which is not too far off from water (7.0).  And I NEVER drink Gatorade (ph of 3!) or Coke (ph of 3.5).  It's amazing the things you can learn by buying a ph meter...

[Kevin Pho, MD]

You are correct.  Not all cases of GERD after fundoplication requires PPI therapy.  If there are no symptoms, then no further medications normally are needed.

A study suggests that about 60 percent of those after surgery requires PPIs, but that leaves a considerable amount not taking an anti-reflux medication.  

This question can be discussed with your personal physician or gastroenterologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[TJV]

   Many people with Barretts do not have symptoms because of the tougher intestinal tissue that replaces the  normal esophageal tissue.

   Fundoplication does not stop physiological reflux, nor the progession of Barrett's...  studies are mixed at best.

[surgeon]

given your surgical result and absense of symptoms, there's no reason to be on PPIs, in my opinion (not the "official" forum opinion).