esophageal nerves severed in auto accident

[Nancy Jo]

I have a history of GERD, but in July 2003, I was struck on my left by a tractor trailer and had much damage to my left side, including broken pelvis, broken ribs, collapsed left lung, torn diaphragm.  My stomach and intestines had beeen pushed through the torn diphragm and had to be repositioned. My spleen had to be removed.  Since the accident, I have been unable to lie down even on an inclined foam wedge.  I need to be upright. About 4 nights a week, I feel the acid from my stomach push up into my throat and I vomit acid and food with such force, it comes out my mouth and nose.  I am taking 2 Protonix before meals twice a day and eating small bland portions.  An endo. revealed a hiatal hernia, fungal infection and old food in stomach too long.  I just had a Barium Swallow and the doctors showed me how the barium slushed up and down very inefficiently and decided I probably suffered nerve damage to parts of the esophagus. The acid leaks into my lungs also and I can hardly talk the next day, similar to times I have had pnemonia (pneumonia). The attack often starts with coughing that I can't stop.   My throat is raw for a day or two and then it happens again. I am running on 3-4 hours a night of sleep.
I have an appt. with a specialist in Philadelphia on Dec. 12, but am looking for background information about treatments.  My gastroenterologist has told me they will probably order a 24 hour ph monitoring and a motility manometry test. Please tell me what other tests can detect nerve damage of the esophagus and what treatments have been tried and their success rates.  Thanks so much.

[Kevin Pho, MD]

I agree that a 24-hr pH monitor and esophageal motility study should probably be the next step.  

If taking 2 Protonix is not helping your symptoms, the 24-hr pH monitor would document this.  The next step would be surgical consideration for controlling your symptoms.  The procedure for this is known as a Nissen fundoplication.  Essentially the "valve" between the esophagus and stomach is strengthened, thus helping prevent the reflux of acid.  This is done by wrapping the upper portion of the stomach, or fundus, around the bottom of the esophagus.

If the referral suggests continual reflux, the next step would be a surgical referral.

If nerve damage is causing your symptoms, then a neurology referral would be the likely next step.  


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.

Thanks,
Kevin, M.D.

[JackieG]

Hi Nancy Jo:

I empathize with what you are going through. In 1989, I went through a six month period where I had to sleep in a chair to try to control the reflux. Unlike you, I did not have the horrible auto accident that you describe, but rather a completely useless Lower Esophageal Sphincter. I also would have reflux so severe it would sometimes shoot out my nose. I never slept more than 2 hours a night during that 6 month period. If surgery is indicated, try to have the Nissen Fundoplication done laparoscopically if you can, and by all means make sure the surgeon is very practiced in the procedure. When I had it done in 1991, they were not doing it laparoscopically in the US yet, so my surgery required a nine inch incision. As you can imagine, had I been able to avail myself to minimally invasive surgical techniques back then, the healing process, risk, and amount of pain would have been greatly reduced.

Good luck to you. I truly hope they can provide you with the relief I know you are desperately seeking.

Best regards,
Chicken Soup