stomach acid control

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sunbeam48
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Date Joined Jun 2011
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   Posted 12/18/2011 8:44 AM (GMT -6)   
When people have surgery for GERD, how does that reduce stomach acid?  I believe the procedures tighten the LES, but I don't understand how that could impact the acid, and enable people to get off PPI's.

Jesper A
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Date Joined Nov 2011
Total Posts : 131
   Posted 12/18/2011 10:19 AM (GMT -6)   
Surgery does not reduce stomach acid. It fixes the actual problem with the LES not closing off properly to make sure the acid stays in stomach.

dencha
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Date Joined Feb 2009
Total Posts : 7188
   Posted 12/18/2011 10:28 AM (GMT -6)   
Hi Sunbeam,
No, the surgery doesn't do a thing for the acid.  All it does is keep it in the stomach where it belongs.  People with typical reflux issues (a little heartburn here and there...within "normal" limits) have that same acid in their stomachs.  It's normal (aside from things like Zollinger-Ellison Syndrome that increase the amount of acid) to have acid.  It just doesn't cause them problems like it does us.
 
That's why people like me, who've had the surgery but have reactive stomachs with frequent gastritis issues, continue to take PPIs after surgery.  With gastritis it's important to keep the acid down so the stomach lining can heal.  Stress also continues to increase acid production.  The surgery only helps keep the acid in the stomach, rather than refluxing up the esophagus, which is not equipped to handle acid.
 
The reason people don't use PPIs after surgery is because the acid is kept in the stomach, where it belongs. The stomach lining is generally well-equipped to handle that acid.  It's the tissue of the esophagus that can't handle the acid.
 
There is no guarantee that after the surgery you'll never need PPIs again.  It's pretty common for post-Nissen patients to need some PPIs--usually at a lower level.  I think those with LPR symptoms might be more likely to need some level of PPI even after the surgery.  That's because they are much more reactive to even small (normal) amounts of acid. 
 
People who have typical GERD aren't as likely to need PPIs post-surgery because their reflux issues are different.  They're generally refluxing large amounts of acid and even food into their esophagus and mouth.  They're not generally reactive to a little reflux that might occur after surgery.  They can have the surgery and go off PPIs pretty much immediately.
 
LPR patients, though, could get some symptoms with tiny amounts of reflux.  The thing is, the surgery can't be made tight enough to guarantee that every bit of acid stays in the stomach.  That would make it impossible to swallow food.  Surgeons are going for "normal" amounts of reflux--the type that doesn't cause damage or create pain and suffering. 
 
Everybody out there who is eating GERD triggers at will with no problems have some reflux.  They may pop a Tum here and there, or even take Maalox after a party.  Still, their small amount of reflux is not causing them any trouble.
 
I had the surgery for LPR symptoms...especially severe asthma.  The surgery has improved my lungs 100% (I still have allergy induced asthma, so they're up and down during the pollen season).  I still take PPIs to keep my gastritis symptoms in control.  That said, my asthma doc and PCP both like me on one dose of 40mg Protonix before dinner because my lungs are so reactive they don't want to risk even a touch of acid getting to them.  I also continue to sleep with the head of my bed elevated.  Better to be safe than sorry!
 
I'm not all that disappointed that I'm still on PPIs for my condition. Before surgery I was on 80mg Protonix a day, as well as 300mg Zantac at bedtime, and STILL my lungs were dangerously inflamed.  My doctor really pushed me toward surgery because, as he said, it was a life-threatening condition.  I'm just happy to have healthy lungs again.  That's why I had the surgery in the first place.  Would I like to be PPI free? Sure!  But the surgery has allowed me to reduce my steroid dosage tremendously.  I just take a small maintainance dose, rather than the unhealthy dose I had to take prior to surgery.   
 
So that's my take on your simple question!
Have a great day.
Denise

sunbeam48
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Date Joined Jun 2011
Total Posts : 795
   Posted 12/18/2011 12:10 PM (GMT -6)   
Thanks, Dencha, for clarifying that. So for those of us with gastrititis, GERD surgery of any kind would not help. I haven't seen that point mentioned here. I have heard comments that anything but surgery is just a band-aid, and that one surgical criteria would be not wanting or being able to take PPI's. But really these are separate issues.

dencha
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Date Joined Feb 2009
Total Posts : 7188
   Posted 12/18/2011 12:45 PM (GMT -6)   
Sunbeam,
The only help that the surgery would be is to keep the acid in your stomach.  If your gastritis is flaring up your esophagus and creating pain, the surgery would provide a protective barrier.
 
You're right.  Gastritis can only be controlled by being careful to avoid known triggers (in my case the biggest offender is antibiotics.) and taking PPIs.
 
There is one improvement I've had post-Nissen relating to my gastritis issues.  In the past, if I took an antibiotic I'd be in for a burned esophagus and big increase in asthma.  It seems that in my case gastritis increased my reflux.  Once my esophagus was burned it took 2-3 months of very careful eating--small amounts of smooth and non-irritating foods--to heal it.  Since my surgery when I get gastritis the problems stay in my stomach, which is a huge improvement.  On one occasion a post-antibiotic gastritis put me in the hospital for over a week.  On top of the painful esophagus I had dangerously bad asthma.
 
Good luck with your gastritis issues.  I know they're not fun.  I'm just about over a bout--it would seem better, and I'd eat or drink something that irritated it and I'd be right back into full-out gastritis.  My GI doc said to wait until my stomach feels perfect for two weeks, then try eating other things.  That's easier said than done!
 
Best wishes,
Denise

sunbeam48
Veteran Member


Date Joined Jun 2011
Total Posts : 795
   Posted 12/18/2011 12:54 PM (GMT -6)   
I don,t seem to have specific triggers, but following the Koufman diet has helped. I,m on Nexium, and I just started taking pepto bismol tablets before eating.

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 12/18/2011 12:56 PM (GMT -6)   
Hi Jamaica,
Although I'd get some breakthrough heartburn at times, my PCP is certain most of my reflux was "silent", and I was unaware of it.  After a number of years of experience with me, he realized that my asthma was being triggered by GERD. 
 
The big "aha" moment came after I took Augmentin and it gave me terrible gastritis and reflux, burning my esophagus and kicking me into very severe asthma.  I was already being treated for asthma and allergies, so the diagnosis wasn't all that clear-cut.
 
I could tell the reflux was causing the problem because whenever my stomach was acting up and my reflux increased, my asthma would get much worse.
 
Even my asthma doctor had me go post-Nissen to have my wrap evaluated to ensure that the presumably allergy-related asthma wasn't being caused by a failed wrap. Thankfully my wrap was intact and doing fine.
 
As I said to Sunbeam, though, surgeons don't expect to get reflux to zero.  That's where the problem exists for those of us with LPR.  Every time I had a 24 hr PH monitor result it was "within the normal range".  It took a lot of pressure from my asthma and PCP docs to convince my GI doc to even consider offering surgery as a possible option.
 
I never had fumes that I was aware of.  Because of my existing asthma, I was set up to have problems with even small amounts of reflux.
 
There are people with traditional GERD symptoms who actually have acid refluxing into their lungs.  This is very dangerous, as it can do permanent damage, and create a life of COPD.  That's one of the reasons to have reflux taken care of proactively.  If that is the case, it's obvious--especially with people who don't have a history of asthma.
 
Good luck with whatever your issues are!
Denise
 
 

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 12/18/2011 12:59 PM (GMT -6)   
Hi Sunbeam,
I hope those measure continue to help.  It's a bummer that our stomachs are so reactive, but it is as it is.  We just have to suck it up and deal with it, I guess!  That's life.
Here's hoping that you're feeling consistently better soon.
Denise
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