NERD and Nissen

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Roger D.
Regular Member


Date Joined Jul 2011
Total Posts : 41
   Posted 10/28/2011 3:33 PM (GMT -6)   
I have NERD and I'm on Nexium twice per day. The PPI does not work as is the usual case with people with NERD.
I also hear that fundoplication only works about 50% of the time for people with NERD.
Should I have it done anyway? I don't know what else to do as my symptoms are severe and constant.  

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 10/28/2011 8:11 PM (GMT -6)   
Hi timespace,
Welcome to Healing Well!  Glad you've joined us.  While nobody here can tell you whether or not to have the Nissen surgery, I can share my own thoughts and experience with you.  Most GI docs and surgeons love doing Nissens on those patients who have wide-open LES valves and tremendous amounts of acid and food regurging into the esophagus and mouth.  They are certain that those people will be helped enormously by the surgery.
 
Those of us who don't have that type of GERD are looked upon as questionable candidates.  We don't have as much reflux, and surgeons can't guarantee we won't have ANY reflux post surgery...we will have less, certainly, but to do the wrap so tight that absolutely no reflux could occur, would create other problems.  Their fear is that they will do the surgery and it won't be effective, since our reflux wasn't that impressive in the beginning.
 
Here's a link to an abstract studying the effectiveness of the surgery.  It's called Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease. http://www.ncbi.nlm.nih.gov/pubmed/20473997
It concludes that the effectiveness is pretty nearly the same for both.  Check it out. 
 
I had atypical symptoms, and the reason I had the surgery was because it was creating havoc with my lungs.  There were no guarantees taht it would work for me, but I had to try it.  Thankfully, it did work, and my lungs improved tremendously.
 
If your symptoms are severe and constant, then I definitely think the surgery would be worth the effort for you.  I don't recommend it for someone who is helped by PPIs and has no other ill effects.  In my humble opinion it's not worth having if you're just wanting to avoid taking meds.  Those people who are suffering from GERD, will find that the Nissen will improve their quality of life.
 
If you do ever decide to get the surgery done, be sure you come back here for tips on picking a great surgeon.  A highly qualified surgeon who has has a large amount of experience in this particular surgery is extremely important.
 
I'm sure others will be by to weigh in on the subject...
Good luck!
Denise

Roger D.
Regular Member


Date Joined Jul 2011
Total Posts : 41
   Posted 10/28/2011 9:12 PM (GMT -6)   
Thank you so much for your kind and informative words. I already have a surgeon who did a 24 hr ph test and a manometry test. My 24 hr ph test was negative. I could not believe it because of the heartburn and pain. I would like to hear from people with NERD who have had the surgery and their outcome. 
Also a read somewhere that I would probably get relief if I went on anti depressants like SSRIs.  I am not depressed but I would be willing to try anything. My first impression is that an SSRI would make my NERD worse due to introducing a strong chemical to my system. Does anyone have any thoughts on this issue?

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 10/28/2011 9:59 PM (GMT -6)   
Hi timespace,
I went through a very similar experience with my GI doc and PH monitor.  I was having severe lung issues and my asthma and family doctors were both confident that the severity was a reaction to my reflux.  They sent me to a GI doc for testing.  Keep in mind that I was having what I considered significant reflux (I never left the house without TUMS and was keeping Maalox in business.) 
 
On top of that, I was taking 40mg Protonix twice a day and 300mg Ranitidine at bedtime.  My lungs were extremely bad and I was on high doses of steroids to conteract the effects of reflux.  I had also been hospitalized for a week after a bad episode that made my lungs dangerously impaired.
 
So...that said, when I had my first PH test I had a DeMeester score of 4 and my GI doc confidently told me that my lung issues were not being caused by reflux.
 
My family doc wasn't buying it.  Still, I wasn't pushing for the surgery because I'd read so many horrible posts describing terrible side effects from the surgery.  (I hadn't found this wonderful forum yet.)  I went on like that for four years, with my lungs getting worse and worse.
 
Finally, my family doctor said that I was in a life-threatening situation, and he referred me to a surgeon himself.  The surgeon did a barium swallow and an endoscopy and told me that I would be a good candidate for the surgery and should call and schedule one.  As I said, I was very hesitant to just go and have the surgery, so I went back to my GI doc with that information, and asked for a second opinion. 
 
He did another PH test, and my DeMeester score was a fraction over 14, which is the top score for "normal".  Still, after four years, and my doctor referring me himself, my GI doc said that I could either "continue using medication" or he could refer me to a surgeon to discuss the possibility of surgery. 
 
Since I'd already found the medication route ineffective, I opted to see the surgeon.  He was willing to do the surgery based on my doctor's opinions, but did mention that he was a bit concerned over the low DeMeester score.
 
Long story short, I had the surgery three weeks later.  I had horrible lungs before and after surgery, with a lung infection.  I was on very high doses of steroids...unhealthy doses.  Anyway after two and a half months, my lungs cleared. 
 
I only wish I'd insisted on the surgery four years earlier, because I ended up with thin skin that bruises and tears very easily, as a result of all the steroids.
 
I tell my story (sorry it's long) because I want to illustrate the fact that PH tests do not tell the whole story.  Like you, I had extremely painful heartburn during the tests and was shocked to find that my reflux was not registering as high as I was perceiving it to be.
 
If you're suffering, don't give up.
I wish you the very best of luck!
Denise

Post Edited (dencha) : 10/28/2011 9:03:08 PM (GMT-6)

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