I also had many times when a reactive stomach and "small amount" of reflux caused me lots and lots of trouble. I had times when my lower esophagus was so burned that I couldn't eat...it felt like a lump, and my stomach could only tolerate a tablespoon of food at a time...sometimes not even that. It took months for that to heal and get back to normal.
Don't be nervous about any of the tests that have a chance of moving you towards recovery. They will be uncomfortable, but you'll manage just fine.
I have a new asthma/allergy doctor because we've moved to a new area. He isn't a fan of GI docs and their testing in regards to reflux and its effect on the lungs. In his experience, a small amount of reflux can do a lot of damage.
Keep in mind that many who are referred to surgery have numbers like 46 and 67 on their Ph monitor tests. If you had any damage at all to your esophagus, even a little, it's an indication of reflux. A score of 4 isn't telling you that you don't have reflux...just that it isn't a large amount/often enough for them to be overly concerned. The other issue is the reliability of the Ph monitor...I'm sure you, like me, was surprised at the low level, considering the pain you experienced off PPI's while you were being monitored.
The thing is this...
The Nissen fundoplication surgery is nothing to go into lightly. I believe that's why they're so careful with referring and doing the surgery. While it has been around for over 50 years (the laproscopic version for just over 10 years), it is a tricky surgery and it takes a highly experienced and skilled surgeon to get it right. Many people get the surgery and go on with their lives without a hitch. Others, though can have new difficulties brought on by the surgery. Therefore, the risk/benefit ratio is very important to consider, and they don't want to operate on marginal people like us, lest they do the surgery for (what they find out later) nothing...that the reflux wasn't the real cause of the problem.
That said, for people like us, often the surgery can be the only option. People with high levels of reflux are a no-brainer. They'll do the surgery to keep the food and acid from refluxing, and they know the patient will experience relief. People with more non-traditional, less specific and obvious symptoms are a tougher call, so we have to be more persistent. Surgeons are worried that they'll do the surgery, make the changes in the upper GI, and the symptoms the patient is trying address are still there afterward. I was told by my surgery that, "If your asthma is being caused by the reflux, it will improve after the surgery". No guarantees, because it could be caused by something else. I'd tried everything else, so I did opt for the surgery. At that point I had to at least rule out reflux (which my doctors were sure were causing my problems)...if the surgery worked, great, if it didn't at least I'd have more information. The surgery worked. (Although my incessant coughing during recovery (lung infection that hadn't resolved) most likely caused some damage that is creating problems for me now. Even so, I am very happy I had the surgery. Things are far better than they were.
My low level of reflux was doing number on my lungs, and if my GI doc was more knowledgeable about lung tissue, he would have known that it doesn't take much. Finally after years of struggle, he admitted that it wouldn't take more than one or two reflux episodes to get my lungs going.
Good luck with your testing. Hopefully it will give you some useful information.
We'll be waiting to hear how things went!