Regurgitation of stomach contents

[Woody13]

I take 20 mg prilosec caps twice a day to neutralize the acid in my reflux.  That works.  Not having acid in the reflux has stopped the heartburn.  However, my stomach contents come back up into my mouth at least 50 times a day.  This mini throw-up situation is uncontrollable - I can't stop it. The smell is very obnoxious to those around me. The smell is like vomit (which I suppose it is).

This condition is really off-putting in my relationships with children, grandchildren, friends, business associates etc. My son asks me if my food, the second time around, tastes as good as when it first was chewed. There are endless variations of this theme from wife and daughters. Some don't want to be kissed. Others just move away or try to identify the source of the stunning smell. When the reflux comes up I try to turn my head away from others at first so I don't cast an evil smell upon them. That creates negative body communication. When I talk, open my mouth etc.I'm given away. To me this is a MAJOR problem that I don't want to live with the rest of my life.

Is there a surgical procedure that can keep the LES closed against reflux?  Or is there something else that can be down to stop this constant regurgitation into my mouth?

[Kevin Pho, MD]

Hello - thanks for asking your question.

As you know, the most common symptoms of GERD are heartburn (or pyrosis), regurgitation, and dysphagia. In addition, a variety of extraesophageal manifestations have been described including asthma, laryngitis, and chronic coughing.

Regurgitation is the effortless return of gastric or esophageal contents into the pharynx without nausea, retching, or abdominal contractions. Patients typically regurgitate acidic material mixed with small amounts of undigested food.

Surgery tends to be reserved for patients with complications of reflux such as esophagitis, inability to tolerate medication (including noncompliance), stricture, Barrett's metaplasia, persistent "reflux symptoms" despite acid suppression, or asthma.  The most common procedures (Nissen fundoplication, Belsey Mark IV, and Hill repair) claim about an 85 percent success rate in relieving symptoms and healing esophagitis, although recurrent symptoms may develop in about 10 percent of initially successful cases.

Many surgical approaches focus on restoring a physiologic equivalent to the normal LES.  Reflux is correlated with a lower mean LES pressure, shorter mean intraabdominal LES length, and shorter overall sphincter length. Each of these problems can be corrected by specific surgical approaches:

- Wrapping the distal esophagus circumferentially or partially with a portion of stomach increases the LES pressure.

- Increasing the intraabdominal esophageal length can be accomplished by reduction of hiatal hernia, approximation of the diaphragmatic crura, or tethering of the distal esophagus below the diaphragm.

- In patients with a shortened esophagus, a gastroplasty may sufficiently lengthen the esophagus so that a fundoplication may be placed below the diaphragm.

You may want to consult a surgeon to see if surgery is a consideration for your case.

I strongly suggest continue followup with your personal physician.

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.

[tessa0825]

Hello, I also had severe reflux with erosive esophagitis, strictures, ulcers, and a lg hiatal hernia...Several months ago I progressed into Barretts (precancerous)Esophagus...If you are having that severe of reflux then obviously the medication you are on isnt working very well...You didnt mention, have you had EGDs and biopsies? If not, I would ask my Dr. about doing them to rule out serious complications such as Erosive Esophagitis? Also, theree are 5 differnt PPIs (available in the USA) so if the one you are on isnt working, ask to try a different one..I take Nexium 40mg twice a day and it has almost completely controlled my heartburn, reflux, and within 4 months it completely healed the ulcers...I am having a bit of problems right now because of gallstones which are not good for my Barretts, I'am having surgery next week for that problem...You DO NOT have to live this way..If your Dr. isnt willing to change your medication or help you then I would strongly suggest seeing another Dr. Also of people have very good results with teh fundoplication surgery and you might mention it to him and see what he says...Do you see a GI Spec. if not I would ask to be referred to one....Acid-Reflux can have SEVERE complications if it isnt controlled...Good luck and take care..........Tessa

[tessa0825]

Also, I forgot to add that in my case...I have refused fundoplication surgery (at this point) because I am just to afraid that it would only HIDE the barretts, Changing of the cells in the lower Esophagus from normal squamous cells to a specialized columnar cells) and that it would still be progressing and we just wouldnt know it was progressing because of the surgery...I have talked to alot of people who swear by this surgery as a cure for Barretts and my GI Spec. says there is no cure...Once those cells have changed there is no way to change them back to normal, so, I am more content with it being closer to surface and easier to biopsy and detect changes as they occur.....Most peole NEVER progress to Barretts from acid-reflux and I dont want to scare you but it is a possiblity and I think people take acid-reflux as not being a serious condition but if not controlled it can be...Take care........Tessa

[marygold]

Hey, I have the same problem. I take 40mg of Nexium per day, and that takes care of the acid, but does nothing for the regurgitation. Mine is different than yours, though, in that mine doesn't smell like vomit, or even taste like it. It tastes like weak chocolate milk, and has the same consistancy. There is no acid, since acid production is virtually shut down by the Nexium, so it doesn't hurt. At times I have to swallow every 10 seconds just to keep it down. It's been happening nearly nonstop for the last 6 days now. Usually it calms down after about 4 days, but this episode's on a roll and shows no signs of quitting. I haven't noticed a smell, and nobody else has showed any signs of smelling anything, so I'm lucky in that regard. Nobody wants to do surgery on me. They're still hoping that I'm going to 'outgrow' it with time. I think that's a load of bull. I'm 19, and have had GERD since I was 12. It ain't going away. I've been tested for Barret's and other things. I don't have  Barret's, but I do have some major scarring from being misdiagnosed and untreated for 4 years. I have strictures, healed ulcers, etc. No active ulcers, thank goodness. I just hate having to reswallow my food all the time.

[surgeon]

acid reducing medications can relieve heartburn; but they don't stop reflux as you have clearly discovered. It sounds like you are a strong canditate for antireflux surgery; it is done nowadays laparascopically (using scopes and a few very small incisions). Most people go home within 24 hours of the surgery, and recover rapidly. From your description, I'd expect an extremely high chance of dramatic improvement. If I were you, I'd ask for a referral to an experienced laparascopic surgeon, and hear what he/she has to say about your situation.

[Woody13]

Thank you everybody.  I appreciate your suggestions and insights. I will follow up with a gastroenterologist.  I'll let you know what I find out.

[ROBETTE]

OKAY, I WILL ADD MY TWO CENTS. I HAVE HAD ON GOING REGURITATION FOR ABOUT 4 MO. NOW. UNLIKE U I DON'T HAVE THE ACID REFUX PROBLEM JUST THE REFUX. EVERY TIME I EAT. LET ME EMPHAIZISE EVERY TIME I EAT. I WOULD AGREE WITH EVERYONE INVOLVED. SEE A GOOD GASTRO DR. HAVE THE DR DO THE 24 PH STUDY THAT WILL TELL THEM WHETHER OR NOT U ARE A CANDIDATE FOR SURGERY. IF U ARE REGUITATING U MAY NOT TOLERATE THE PROBE, SINCE U HAVE TO KEEP IT IN YOUR SYSTEM BUT GIVE IT A SHOT. MAKE THEM BELIEVE YOU. KEEP AT IT. I WISH YOU WELL. I DO KNOW HOW YOU FEEL AS I AM STILL NOT FIXED.

[wishingyouwell]

hi, i also have acid reflux disease, tessa has given you the great advice i don't think even the doctor could have done it better. gerd is a serious problem if not controled and the surgery may be a good option for you if meds are not working . find a good gastro/specialest  or gastro/surgeon for better insight on your condition .regular doctors can only help so much considering they are not  specialest in the digestive field,and tessa you are correct about the barretts there is no cure for it,i just did a lot of reading on the subject today (tring to find out what this stupid knot is that popped up on my neck a little over 2 wks ago) .  and the surgery could make much harder for them to keep a eye on it's progression .i hope everything goes well for you and it does not progress any futher .i have read in most cases it does not .you are in my prayers ,god bless. wishing you well

[tessa0825]

thank-you so much for your kind words...Take care.......Tessa

[wishingyouwell]

hi,your more than welcome ,it is refreshing to see someone post something that is of help to us, besides the repetitive jarga that we can all pull up on the web every day .as some have already stressed there is no better info than from the patients that are personaly going through the battles themselves .god bless,wishing you well