Severe gastric attacks following fundoplication surgery

[msruss]

Gastric Attack Symptoms

In 1999 I was dignosed with short-segment Barret's esophogus (about 6 cm). This has remained stable since then at the same 6 cm.

Since I had a Nissen Wrap operation in November, 1999, I have had attacks of severe gastric distress, as described below, about two or three times per year.  These types of attacks never occurred prior to the operation.

Although these attacks are short-lived, they are extremely distressing when they occur.  They include extremely violent dry heaves, which feel as though my gut is trying to turn itself inside out.  I am concerned that this may cause some damage.

I have discussed this with the surgeon who performed the surgery at USC's private medical center, one of the best in the business; with a GI specialist to which he referred me; with my regular GI specialist, and several other doctors. I have had stool samples tested for parasites, X-rays taken while an attack was in progress, and many other tests. No explanation has been forthcoming.

The attacks come on suddenly, over a period of 5 minutes to 3 or four hours, build to a crisis involving shock and loss of consciousness, and then subside almost immediately, with full recovery within a few hours.  Below are the symptoms and their progression.

ALWAYS:
Severe, explosive diahrrea.
Extremely foul, all-liquid.  This may happen in 6 to 10 separate waves over a period of a few hours.  Accompanied by a feeling of severe abdominal bloating.  Sometimes progresses to the point where the output is just clear water with mucus-like flakes.
Loud noises from the abdomen.  Extremely loud gurgling, and other sounds of fluid movement. Audible to others across a room.

OCCASIONALLY:
Abdominal pain
Sometimes the diarrhea is accompanied by abdominal pain, which is a gnawing sensation like highly-intensified hunger pangs. In this variation, there is a great deal of belching
At other times, there is no belching, and a different type of pain, as if my stomach is about to explode.

USUALLY:
nausea and a feeling of needing to vomit, which I can't do since the Nissen wrap surgery.  This progresses to the production of copious amounts of saliva, and extremely violent dry heaves which produce nothing.  During this phase, I experience cold sweats, light-headedness, and weakness.  These symptoms always occur at the same time as the most extreme, explosive diarrhea attack.  On several occasions, I have lost consciousness at this point. This always takes the form of falling off the toilet in a faint, which lasts a few seconds.

RECOVERY:
After one or two crises as described just above, all the symptoms immediately cease. Within 2 or 3 hours, I have fully recovered, except for some cramping in the extremities, probably due to rapid dehydration and depletion of electrolytes.  I usually then take some calcium and potassium mineral supplements. Shortly I have completely recovered, with no apparent after-effects.

Where can I go from here?

[Kevin Pho, MD]

It is difficult to say without examination.

I would consider the following evaluation of the upper GI tract (if you haven't had them done already).  This can include a repeat upper endoscopy, 24-hr pH study (to definitively rule out recurrent GERD), and a gastric emptying scan (to evaluate for delayed gastric emptying).  The pH study can be done in conjunction with an esophageal motility study - conditions like esophageal motility disorders can lead to some of the symptoms you are describing.  

Malabsorption can also be considered.  Sending out the stool for fat malabsorption, as well as blood tests for celiac disease can also be considered.  

Finally, if the tests continue to be non-revealing, one can consider optimizing treatment for irritable bowel syndrome.

These options 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.
kevinmd_b

[ozark]

maybe you developed a milk intolerance....have you noted if you have dairy that these symptoms occur?

[msruss]

No, I haven't really kept track of what I ate and drank prior to the attacks, but doing so sounds like a good idea.  Since the operation, I have usually been able to eat or drink anything at any time of day or night, so I sort of stopped thinking about it.

Now that I do think about it, before my last attack I had not had my daily half-litre or of orange juice for several days, since we had run out and were snowed in. An hour or so before the last attack, I had a big glass of juice. I'll check into this further.  Thanks for the tip.

[deni20]

Try googling dumping syndrome.  both my daughter and I have fundos, and have this from time to time.

Good luck