New Procedures to Fix GERD & Hiatal Hernias

[Rick S.]

I have had GERD, from mild to severe, for the last 8 years.  I have been on Protonix for most of that time.  Recently shifted to Prilosec as the Protonix, while preventing the acid regurgation, was not preventing the belching, and an unusual gergling/regurgitation sound when I sleep, causing issues for my partner.

I had an endoscope several years ago, and they said that I had a hiatal hernia and that my valve was not shutting properly, thus causing the reflex issue.

I have heard that there are some new techniques on the horizon, some less invasive than others...some still being tested....Can you share with me the most effective, least invasive procedure which I can consider to drastically reduce my symptoms and that will allow me to wean myself off of the Acid reducers over time.  I realize I need to make an appointment with a Gastro doctor but I want to know what all of my options may be to treat the problem instead of just the symptoms.. I also do not trust the long term effects of these drugs.  Thanks.   Rick S.

[Kevin Pho, MD]

Long-term studies have suggested that prolonged use of PPIs are safe.  

If the symptoms are continuing, an endoscopic or surgical procedure would need to be considered.  

The most invasive option would be a fundoplication, which may help with the symptoms.  You can also consider endoscopic options.  This can include endoscopic sewing/plication therapies - which have largely been confined to small studies.

Radiofrequency thermal therapies can also be considered, but is new and the results largely confined to small studies.  

These options can be discussed with a gastoenterologist, preferably at a major academic medical center.

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_

[wassupwassabi]

Docs have said that my LES is wide open and providing very little pressure to reduce reflux... I tried the Stretta procedure (radiofrequency energy) a few months ago but I didn't find it very helpful.  All of the studies I've found on the Stretta where people improved were done on people with normal LES pressures but still having reflux... maybe that's the only situation where it actually works?

[StormShadows]

I am having similar symptoms...I have had my gallbladder removed and since been diagnosed with Barrett's esophogus and I've have severe GERD for a long time now. I have been on every PPI there is, Aciphex Protonix, none of them did any good. I am on Nexium now which seems to be better than the others, but I still am having these burping episodes. It feels like I have a "bubble" in my throat and I will burp a bazillion little burps to try to get it out. Sometimes it seems like the "bubble" will move around to another part of my throat and I can actually cause it to do this by pushing on it with my fingers. But it never completely goes away. And sometimes one side of my throat will feel numb. Sometimes when I burp, it is a liquidy, gurgling sound. And sometimes when I burp, especially right after eating, acidy liquid will shoot up into my throat, sometimes even my mouth. (Nasty!) And sometimes, this "bubble" will get "lodged" in my throat in such a way that it completely blocks off my air and I can't breathe until I gag and gag and I guess "dry heave" just like I was vomiting, but instead, this giant belch comes up. This is so awful....its affecting my every day life. It really scares me that I have been reading in these forums that so many have had this for years, with no medical relief.  

[karat1]

is omeprazole or lansoprazole available, these are probably the best acid blokers on the market, and safe to take for many years.

[Spring-02]

I have a very large paresophogical hernia that needs corrective surgery.  However, I am apprehensive of the post surgical complications because of my allergies and reaction to anaesthetic.  I just had an unpleasant experience regarding my breast surgery to remove a complicated cyst.  I was in the recovery room for over 3 1/2 hours, since they had problems regulating my breathing and my hands were as cold as ice. They put me on oxygen supplementation and tried to warm my body up by covering me with heated blankets on my head etc.  They would tell me to take deep breaths but I just couldn't seem to stay awake.  My younger brother had a similar reaction to post surgery when he was twelve as his lungs filled up and they had to take him back into the OR and get his breathing going again.  Should I take the chance of having surgery and risk having possible complications or delay my surgery.  I don't have GERD symptoms and wouldn't have known I had this hernia except that I had a GI bleed last summer from aspirin and pain med use.  I am female, age 60, have allergies to sulfa & penicillin, have minor elevated BP & cholesterol, for which I am taking prescription meds for. I also am having a colonscopsy this week, to rule out any problems in that area.  Would appreciate some feedback to alleviate my concerns.  Thank you.
PS  I had an endoscopy and a series of Upper GI X-Rays which revealed my hernia is very large.