Two Hiatal Hernia surgeries, Scar Tissue, Adhesions and PVC's

[Dr. Erik]

Dear Dr's.
I had an open Fundoplication in 88' and a thoracic fundoplication in 91'. Since the thoracic surgery I have had what first started as sinus Tach. After taking lopressor, prozac and Xanax my symptoms got better. In 94' I started having PVC's quite regularly and have them to this day on a daily basis. Two Gastroenterologists think this may be caused by scar tissue and adhesions from the surgeries. The PVC's seem to come whenever food or gas gets stuck in my esophagus. After making myself burp, the PVC's alleviate. It has always felt as if my stomach is somehow pulling down on my chest, like the two are connected internally from the adhesions. Do you think this is my problem and that I may benefit from laparascopic surgery to remove the adhesions. All cardiac tests are completely normal. Any insight would be greatly appreciated! Thank you for your time.

   Sincerely,   Erik

[Rosanne]

I have suffered from Reflux for the past 6 years, plus as a baby and when pregnant.  I have had a gastroscope which showed gastritis, a barium swallow, which was fine, and a 24hr ph probe.  During this I refluxed 55 times.  I am booked in to have a nissen fundoplication as the medication hasn't eliminated the problems, and at 36, I am not happy to be on this medication for life, as my specialist says I will need to be.  At present I am on 2 omeprazole daily.  I have tried several other meds. but the omeperazole was the most helpful, especially for the first year. I recently added propulsid to the omeprazole, but it didn't help at all.  I ended up with diarrhoea and stomach cramps.  I am a bit concerned as I have read a lot on the internet about the nissen causing additional problems if gastroperesis is the underlying problem, and wonder whether I should consider requesting the test to eliminate this. My specialist doesn't think this necessary as I don't have those symptoms.  I feel nauseas most of the time, have lots of acid reflux, an acidic stomach, need to burp  a lot, and have lot my appetite.  I rarely get constipated. I don't smoke, drink alchol and am of a slim build.  I become stressed easily. Do you think I should get gastroparesis checked out, or am I fairly safe to go ahead with surgery.  What does this test entail?

[debbie]

What is PVC'S

[Valberto]

Hi to all,

I don't know how, I don't know why, but I'm be having PVC's for 20 years and 90% of time, they have a close relation with gases in the final part of the tick intestine.
Generally, the gas elimination stops the PVC's, sometimes, helped for some massage.
My theory is some kind of disturbance in the autonomous system.
I know who I have propensity for PVC's, but the relation with gases is remarkable.
Please Doc's, pay some atentions for this.

Thanks a lot.

[Jeannine ( comment for sue)]

Hi Sue,

I have Gastroparesis and you sound like you
may have it also. I found it very interesting
that you feel better if you relax and lie down
after eating. I am the same way. I need to prop
myself up abit but if I go and walk around and do
stuff I feel terrible and sometimes vomit.I also
never really feel normal hunger. I just know I have
to eat.I have propulsid and take it sometimes but
it dosen't seem to help much at all. (propulsid can
give you a headache but it may go away once you adjust)
I took Domperidone for about a year and had to stop it
because I had to keep increasing the dose and ended up
having side effects that made me have to stop taking it.
In the begining it was helpfull,so I got some relief for
a while.I would definetly get a second opinion and see
a neurologist. The emptying scans can vary, so that result
does not tell the whole story of what is going on.I also
find it VERY benifical to keep the constipation under controll.
If my guts dont move things out, my stomach doesn't work.
The whole system works together so if one part isn't doing
its job the other parts suffer.I have been taking Miralax
for the constp. and its helpfull.I would not consider it for
long term though. It sound like you need to see a Motility
specialist. Try a major hospital in your area, call the
Gastoenterology Dept. and ask who deals with motility disorders.
If you live in the NJ Phila NY city area I can reccomend someone.
Good luck! I hope you are doing better!
(any questions ect. just E-mail me or post here) ***@****
Jeannine

[mark p]

i have had problems after i eat and sometimes throughout the day with reflux, low chest pain, and belching. but the thing that really concerns me is all the P.V.C.s i get especially after i eat.i have had several tests but all came back negative.its been a year now and i am getting frustrated.it feels like a big air bubble in my chest. medicine does not help most of the time.whats going on and what do i do? ***@****

[Rosa]

I've been vomiting for the past 6 months. Everytime I eat something it never semms to stay in.  I can't sleep at nights because of the pain.  Doctors have said I have hiatus Hernia but say surgery may not help. They say there are 2 types it could be.  I have lost nearly 1 stone in 6 months. Can it be something else?

[sue]

I made an appointment today for another opinion. my doctor has
me on propulsid. Do you know anything propulsid. I get dizzy
and have headaches I don't vomit as much with it but I belch
alot more. Does this work like reglin. Since I started taken
propulsid I am not constipatied with propulsid. That is the
only thing i found that would work for me so I'm not constipatied. Before i would eat lots of fiber and it seemed
like it would not make a differance. I read all of these
peoples bad health problems and know I'm worried what it
has done to my Esophagus after 11 years of Regurgitating.
What I'm really wondering is will propulsid fix the problem
or does it only work while I'm on it. If all the tests
show nothing is wrong why am i doing better with it than
without it(propulsid). Do you study medicine you really
seem like you know alot about all of the problems i have
had in the past. Any advice you could give me would be very
helpful. thank you very much for your time.

[sue]

I made an appointment today for another opinion. my doctor has
me on propulsid. Do you know anything propulsid. I get dizzy
and have headaches I don't vomit as much with it but I belch
alot more. Does this work like reglin. Since I started taken
propulsid I am not constipatied with propulsid. That is the
only thing i found that would work for me so I'm not constipatied. Before i would eat lots of fiber and it seemed
like it would not make a differance. I read all of these
peoples bad health problems and know I'm worried what it
has done to my Esophagus after 11 years of Regurgitating.
What I'm really wondering is will propulsid fix the problem
or does it only work while I'm on it. If all the tests
show nothing is wrong why am i doing better with it than
without it(propulsid). Do you study medicine you really
seem like you know alot about all of the problems i have
had in the past. Any advice you could give me would be very
helpful. thank you very much for your time.

[Erik (to Sue)]

Sue-

Propulsid works the same as Reglan. They both speed up the rate at which your stomach digests food. If this is making you feel better, then I would go back to the "Gastroperesis" theory. Even though your gastric emptying test came back normal, it was on the high side of normal. Everybody is different, and everyone reacts differently to certain things. For instance, apparently your body cannot tolerate food sitting in your stomach as long as it does. Which means if the food sits in your stomach for any extra time at all, you are more sensitive to that and will vomit. The fact that you are feeling better with the propulsid is great! You should keep taking it. In the meantime, talk over alternative treatments with your Dr. There may be surgery to correct this problem. But if it turns out you have to take medication to keep you feeling good, then it is worth it to have a better quality of life. Keep me posted.  -Erik

[Sue - to eric]

ERic: will you please reply to my message from sue. I made a
mistake and sent it to soon. thanks for all your advice.
Dated 11-29-99.

                                     sue

[Erik (to Sue)]

Sue-

Have you been to see a Neurologist? The fact that you are fine while sitting or lying down and get sick as soon as you get up suggest you have some other underlying condition. You can rest assured that your stomach is not the problem, especially if you don't get the acid reflux while lying down. Just possiblities are: you may have some kind of vertigo or problem with equillibrium that is causing you to get sick when you are on your feet. You should see a neurologist and be tested. Also, I assume you have had other tests confirming there are no other health problems such as Heart, high blood pressure etc. Get a SECOND OPINION!!!!!  This is your life. You can beat this thing Sue!  Good luck.    -Erik

[sue]

I have had all the tests you mentioned plus many more.
The Gastric empting study was normal (High side of normal).
the valve that is surpose to open and close when you eat.
I understand does not close properly(too weak). I can only
eat very small meals at a time. If I eat too much I fell
stuffed. people always yell at me for not eating enough.
liquid makes matters worse.(Soups, water) I think that is
why I get head aches cause I drink very little liquid.
I am also constipated most of the time. My doctor sent me to a
psychologist and I also went to a eating disorder clinic was
told they could not find anything wrong. what puzzles me
the most if I lie down for hours after meals I am fine.
Any movement I make like walking around, walking out of
a restaurant I will start vomiting my food after i get up.
If I sit in a restaurant 45 minutes after meals I have no problems tell I get up. I am never hungry. I eat cause
i know I should. (for Eric)

[Erik (in response to Sue)]

First of all, have you had all the usual tests such as upper GI, PH test, Motility test, Upper Endoscopy? The fact that you regurgitate food 14 hours after your last meal suggest that you may be suffering from Gastroperesis, a condition in which the food in your stomach takes alot longer than normal to digest which allows you to have regurgitation so long after eating. I would suggest having a "Gastric Emptying" test. If this is the problem, there are medications to help. If you have already had all these tests and they were normal, then you might want to look at stress, nerves or anxiety as the culprit. Even if you don't feel anxious, you could be having stress-related complications. Then you should try talking to a Psychologist or Psychiatrist. Medications can help you. They have helped me.  Good luck.

   -Erik

[sue]

I have been suffering from vomiting/regurgitation since 1988.
my doctor has done alot of tests and can not find anything
wrong. I have been in and out of hospitals with no help.
I have been to the mayo clinic the doctor there said
nothing can be done. I am having a hard time dealing
with that for a answer. I  vomit after every meal.
Many times I still regurgitate 14 hours after my last meal.
(Its undigested food) Seems like its better if i lie down after
meals. does any one know of a doctor that could help me.

[HFHSm.D.-Gastro-rf]

Dear Erik,
It is difficult to answer your question.  We now see that cardiac arrythmias can be associated with esophageal reflux.  Whether another surgery will prevent the cardiac arrythmias is difficult to predict.  You should ask this question to the surgeon that you are considering for the operation.

[Ward Gowland]

I have a hiatal hernia and suffer from heartburn which seems to be connected with the esophagus not emptying quickly. I was tested for h.pylori annd found positive, this as alleviated by the usual treatment. For your information I find that a 0.3 mg tablet of nitro-glycerine under the tongue relaxes the smooth muscle of the esophagus and eases the pain.