"Minimal Reflux" Seen on Barium Swallow, with Intact Wrap, 11 Months Post-Nissen..........

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Dave234
Regular Member


Date Joined Oct 2011
Total Posts : 338
   Posted 10/10/2012 10:59 AM (GMT -6)   
I just got back from a barium swallow esophogram (kind of like the upper g.i. series).
 
The doctor was very good at explaining everything he was going to do, and what he was looking for, while he was doing it.
 
He said that the surgery looks good, esophagus appears smooth (does not look like esophagitis), and barium went into the stomach well.
 
When I laid down, however, a little bit of the barium came back into the lower part of the esophagus. This happened again when he had me raise my legs to flex my stomach. It also happened again when I turned around onto my stomach.
 
My surgeon had said in the past that, if there is any amount of reflux remaining, that it just means I am functioning as a normal person. He also said that, if it bothered me, he could do the TIF.
 
That seems strange to me as I have never heard of anyone doing the TIF on top of the Nissen.
 
I'm feeling a bit down about there being reflux. I'm feeling a bit down indeed. I suffered a lot through this surgery, and while the amount that I am refluxing is significantly diminished (it used to go immediately up to my throat after laying down), I was really hoping that this surgery would have eliminated all reflux....maybe just a little reflux every once in a while, but not just from laying down... I absolutely hate the feeling of reflux.

Post Edited (Dave234) : 10/10/2012 10:39:22 AM (GMT-6)


dencha
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Date Joined Feb 2009
Total Posts : 7188
   Posted 10/10/2012 2:59 PM (GMT -6)   
Hi Dave,
I definitely understand your frustration about the fact that you're getting a little reflux upon lying down.  From what I've heard, though, surgeons do not attempt to achieve zero reflux.  Rather, their goal is "normal" reflux levels (<14 DeMeester).  The problem is that if zero reflux were achieved, the wrap would be so tight that you wouldn't be able to eat, which is unacceptable.  You wouldn't want that situation, believe me.  Several have posted here with wraps that are too tight, and are requiring dilation.  A tight wrap creates other difficult problems as well, such as inability to swallow and the discomfort of bloating.
 
Pretty much anything you read about Nissen surgery makes note that it is not a guarantee that you won't need PPIs afterward.  Here is a case in point:
Here is some copied info from this website:
Surgery
For some people, surgery can improve GERD symptoms and lower the amount of medicine they need.
What does the research say about surgery?
  • Fundoplication surgery works as well as only taking medicine to keep you from getting acid reflux and heartburn. However, you may still need medicine after surgery to control your symptoms.

While we'd always love to never have reflux again after our surgery, it is really only meant to reduce reflux to a "normal" level.  That's the reason my PCP and asthma doc want me to continue taking a PPI at dinnertime (I used to take 40mg AM and PM and 300mg Ranitidine at bedtime, so this was a big reduction for me).  I also continued to sleep with the head of my bed elevated.  In my case it's important to keep even a tiny amount of reflux out of my very reactive lungs.  I rarely get reflux, but in happens every once in a while.

The reason that my GI doc dragged his feet for so long when my PCP and asthma docs were certain that my reflux was making my asthma uncontrollable, was just this situation.  My DeMeester score was very low each time I had my 24hr PH monitor...at one time it was only 4.  During that time, my lungs were terrible, but my GI doc assured me that the reflux wasn't creating the problem. 

After 5 years of struggling, my PCP finally referred me to a surgeon himself, who did testing and on the recommendation of my PCP told me I'd be a good candidate for surgery.  At that point I went back to my GI doc and had another 24hr PH monitor.  My DeMeester score at that time was something like 14.8...very borderline.  But because my PCP had taken that extreme step of referring me to a surgeon, my GI doc finally relented and sent me to a surgeon.  The rest is history.

You see, since reflux can not be eliminated, my GI doc was concerned that my low DeMeester score wouldn't be improved, and my lungs would not respond.  Apparently the few reflux episodes I was getting were bad enough that they reached my lungs, because since my surgery, they've been 100% better.

I share this to emphasize the expectation that a Nissen will not eliminate all reflux.  No GI doc or surgeon has that expectation.

Since you're getting some reflux upon laying down, it certainly makes sense to elevate the head of your bed to ensure that it stays in your stomach and doesn't sneak out while you're sleeping.  I don't know if you're getting any symptoms, but it makes sense that if you end up wanting to take a PPI for symptoms, before dinner would be the time to do it, since your reflux is limited to lying down.

Try not to let this get you down.  If you can look at it realistically, and understand that it does not indicate a failure of your wrap.  It's a normal situation, and nothing to be concerned about.

It's okay...

Denise                                                                                                                                

 


Words of wisdom by Eckhart Tolle:
"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”

Dave234
Regular Member


Date Joined Oct 2011
Total Posts : 338
   Posted 10/12/2012 3:58 PM (GMT -6)   
Do you know what I would do if the minimal reflux bothered me while I was standing up or sitting down?

Have you ever heard of anyone getting the TIF on top of the nissen?

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 10/12/2012 7:00 PM (GMT -6)   
Dave-

I have never heard of getting the TIF after a Nissen, but they may be trying something new.

As Denise said, the goal of the Nissen is to put us in the "normal" range of reflux as most people have. It's not feasible to totally stop reflux. I have a feeling your esophagus may be still hyper sensitive to normal reflux. I was with my first Nissen. After having mine so long I have accepted a small amount of reflux is way better than the severe every day, 90% of the day reflux I had before.
I do still take a zantac once in a while if I over eat, as that causes me a bit of reflux. I think my torn up esophagus has so much nerve damage it doesn't feel much any more after the tear and such.

Hang in there my friend,
Bill
opnwhl4
Moderator: GERD/Heartburn
Nissen 6/06 and 5/09
#3 on 8/24/11

Dave234
Regular Member


Date Joined Oct 2011
Total Posts : 338
   Posted 10/15/2012 12:41 PM (GMT -6)   
I actually notice I feel basically no reflux at all after taking a zantac 150. I have no qualms about taking one Zantac 150 in the morning and one at night. I just don't like the prescription medication.

Is there anything wrong with taking two Zantacs a day?

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 10/15/2012 2:59 PM (GMT -6)   
Hi Dave,
Absolutely not.  If it makes you feel better, go for it! yeah
Denise
Words of wisdom by Eckhart Tolle:
"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”

Dave234
Regular Member


Date Joined Oct 2011
Total Posts : 338
   Posted 10/15/2012 7:19 PM (GMT -6)   
In that case, you know what? I'm feeling utterly fantastic. I hate to say I'm feeling great because every time I say that, a day later I feel bad, but I am feeling great.

I think I'm starting to get into the swing of things with this surgery.

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 10/15/2012 7:30 PM (GMT -6)   
Hi Dave,
As I told you before, I'm still taking a 40mg Protonix before dinner on the request of my asthma doc, because it is assumed that there is going to be some (reduced/normal) level.  I also still sleep with the head of my bed elevated.  Do I consider my surgery a success?  Absolutely! 
 
Prior to surgery my lungs were so sick that I was even hospitalized for a week because of reflux-induced asthma.  I was on 40mg Protonix twice daily, as well as 300mg Ranitidine at bedtime.  I was also on 4 puffs of 230/21 Advair (steroid inhaler) twice a day, was doing nebulizer treatments 3-4 times a day, and was having regular lung infections.  My lungs were extremely unhealthy, and my asthma was uncontrollable. 
 
Now I'm on 2 puffs 115/21 Advair twice a day, and haven't had a nebulizer treatment since my surgery.  Yes, my surgery was a huge success.
 
Because you need a little Zantac to be comfortable doesn't mean the surgery was not successful.  Some who have the surgery will not need meds again, but there are others like us who have found great improvement, but still find a need for a lower level of medication.
 
Be happy, and enjoy your life!
Denise
Words of wisdom by Eckhart Tolle:
"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”

Dave234
Regular Member


Date Joined Oct 2011
Total Posts : 338
   Posted 10/16/2012 12:59 PM (GMT -6)   
Ok, I knew that the day after I said I was feeling great, I would feel the weird reflux like feeling again.

I have taken 3 zantac 150's so far today, and some of the UK Gaviscon.

I still feel that feeling. I am very sure that it has to do with eating late at night for the past couple nights (and chocolate), and a beer, and pasta.

Does this sound more like wrap irritation (since the zantac and gaviscon aren't really helping)?

I've stopped drinking coffee, and I will really try to not eat chocolate today. Even though that will be VERY difficult.

Dave234
Regular Member


Date Joined Oct 2011
Total Posts : 338
   Posted 10/17/2012 8:45 AM (GMT -6)   
I feel better today. Yep, I think it was wrap irritation. I haven't needed to take zantac yet today.

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 10/17/2012 1:39 PM (GMT -6)   
Good to hear...relax and enjoy! turn
Words of wisdom by Eckhart Tolle:
"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”
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