1) Your doctor should be aware that getting objective evidence from a patient describing reflux symptoms from endoscopy, manometry and barium studies alone is unreliable. They have poor sensitivity, relatively. The way to do it is with 24-hour pH or impedance studies.
- Barium swallows just capture an immediate and potentially largely unrepresentative snapshot of you drinking a liquid while standing upright (maybe tilting if you're lucky). As a realistic representation you wouldn't get a less reliable result if they X-rayed you juggling while wearing a clown suit. They work well if you had absolutely no esophageal sphincter tone whatsoever, plus they can capture other disorders like achalasia.
- Manometry just tests esophageal pressure.
- Endoscopy can show hernias and a some other conditions but they certainly aren't a good tool to test the presence of reflux. Having a healthy esophageal surface in no way
proves a lack of reflux. Just that the surface hasn't become meta/dys/neo-plastic. Some people reflux a lot without scarring. Some scar with apparently minimal reflux. Some haven't scarred because whaddaya know the PPI tablets have protected the esophagus.
2) The advice of 'ruling out' surgery due to low esophageal motility is outdated
. Numerous anecdotes but here are a couple of studies both of you may want to read:
Prospective study: http://www.ncbi.nlm.nih.gov/pubmed/16643177
Retrospective study: http://www.ncbi.nlm.nih.gov/pubmed/19172353
3) Sounds like you may
have some delayed gastric emptying (gastroparesis), not uncommon in those with abnormal esphageal motility. Again, there is some small but encouraging evidence that surgery in fact enhances
If you've adopted all lifestyle measures (lifting head of bed, avoiding trigger foods, delaying lying down after oral intake etc) and despite maximal medication therapy you still haven't found relief your solution is straightforward
A) You certainly warrant either Impedance or 24-hour pH study. I imagine this will show what you know already.
B) Assuming the above, you will then have surgery to repair the hernia and have a Nissen's wrap (or a partial one if your surgeon prefers). From my understanding the Linx procedure needs a decent degree of esophageal movement.
Get on the case fast and don't delay the steps you need to get the surgery you sound like you warrant.
Post Edited (Marcello) : 3/13/2012 7:44:31 AM (GMT-6)