Severe gagging/nausea post esophagectomy and chemo/radiation treatment

[gunnie]

47-year old male has mucus buildup which causes severe gagging/nausea/burping every morning and throughout the day; history:  esophagectomy (2 years ago) for removal of cancer in the esophagus/stomach; since surgery, sleeps propped up; recurrent esophageal cancer, stage IV, completed aggressive radiation/chemo treatment about 7 months ago; current CAT and PET scans were negative for cancer, but a positive biopsy was found (by scope) near esophagectomy site of the cellular level; waiting to undergo another scope with more biopsies; looking for any suggestions to curb the mucus/gagging reflex and daily nausea; have tried Joe Barton's reflux remedy (w/apple cidar vinegar, honey, etc.); also tried prescription medications, such as Lorazepan, Anzemet, Compazine, and over-the-counter Gaviscon; nothing seems to work; please advise

[Kevin Pho, MD]

Reflux and heartburn, as well as early satiety, fatigue or dysphagia are long-term complications of an esophagectomy.  

Optimizing treatment with both a PPI and H2-blocker (i.e. Prilosec + Zantac), or adding a motility agent such as Reglan.  

You can consider surgical or endoscopic therapy if the symptoms continue despite optimizing medical therapy.  

These options can be discussed with your personal physician, or in conjunction with a surgical referral.  

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

[JackieG]

Hi Gunnie:

I was diagnosed with EC in July, 2001 and had a transhiatal esophagectomy in August, 2001. There is an internet support group for EC cancer survivors and caregivers with about 1,400 members that I think you may find as a very valuable resource.  It can be found at the following web site:

www.acor.org

I don't think a motility agent, such as reglan, is effective for those of us that have had esophagectomies. As part of the surgical procedure, a full vagotomy is performed, i.e. severing the Vagus Nerve. The Vagus Nerve controls stomach motility, and with it severed, our stomachs no longer have the power to move. Therefore, Reglan is not effective. Unfortunately, you can forget treatments such as Joe Barton's as well. We have newly reconstructed digestive systems, and alternative remedies like Barton's are ineffective.  

Reflux and aspiration are side effects of having the lower esophageal sphincter (the "LES") removed as part of the esophagectomy. We can minimize the impact of reflux, aspiration, etc. by a combination of drugs such as nexium and lifestyle changes, such as traditional GERD treatments like not eating or drinking within at least three hours of going to bed, eating small portions (you probably have no choice here), sleeping in an articulating bed, with the head raised, etc.  I still have problems with aspiration (it happened twice last night!!!), so I don't think we ever return to a completely 'normal' lifestyle after an esophagectomy.  We can, however, manage our situation so that we have a relatively good quality of life.

Frankly, of greater concern to me are the results of your follow up biopsy, which suggests recurrance. I really do suggest that you join the EC List that ACOR sponsors. With 1,400 members, you can post on that site regarding just about any issue and you will find multiple people who have personally faced the situation you are facing.  No sense in going it alone!! I hope you try the ACOR EC Group.

Out of curiosity, at what hospital did you have the esophagectomy?

My thoughts and well wishes are with you.

Best personal regards,
Chicken Soup

[gunnie]

had surgery at Providence Hospital in Southfield, Michigan; now being treated at University of Michigan Hospital in Ann Arbor; thanks so much for the info, will definitely check out website