do you think I need a nissen?

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pharcyder
Regular Member


Date Joined May 2012
Total Posts : 69
   Posted 12/14/2012 3:49 PM (GMT -6)   
Hello all,
IoIm a 26 year old male. 5'6, 135 pounds. I have suffered from heartburn for 6 years. I have taken zantac, pepcid ac, lanzoprozale (prevacid), dexilant 40mg. And now im on 80mg nexium and 4 grams of carafate every day. I suffer from discomfort 80% of the day, every day. My heartburn isnt horrible like it used to be, but it is definitely unfomfortable. It outs me in a horrible mood and disturbs my sleep. Also, I have quite a bit of anxiety of getting esophageal cancer.

I had an endoscopy last april and I did not have barrets or dyssplasia, however I did have some mucosal breaks. This was before I started nexium.

So, with this said, do you think in likely to get cancer? Would the risk/reward of a nissen be worth it?

Thanks everyone :)

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 12/14/2012 5:36 PM (GMT -6)   
You're on a lot of medicine and it still isn't helping.
I think you need to go forward with the surgery.
Joy
Lupus, Fibromyalgia, Glaucoma, Asthma, Hypothyriodism, Sleep Apnea, Degenerative Disk and Facet Disease, and Allergies

When life throws you lemons....
Pick them up and throw them right back at them! :))

theacidrefluxman
Veteran Member


Date Joined Oct 2009
Total Posts : 739
   Posted 12/15/2012 8:49 AM (GMT -6)   
I'd say it depends. With what you wrote we don't have enough information. I can tell you from personal experience as someone essentially in the same boat as you, the following:

1) Of those that still get symptoms while on 80mg PPI, the vast majority don't have abnormal acid reflux. (It could be non-acid reflux, weakly acid reflux, etc., or not reflux at all). Remember, just because the acid is out of your reflux does not mean that you don't have GERD...you are refluxing all of the time, it is just that the acid is out of it.

2) Barrett's is generally found upon the first endoscopy. I have had GERD for 5 years and was told that "If you are afraid of esophageal cancer, don't be". It seems pretty sure that Barrett's always precedes esophageal cancer, and if you haven't developed Barrett's after 5 years, odds are you will never develop it. I was told that this is likely due to 'genetic factors'.

You would need additional testing, like motility and PH testing, to find out what is causing your pain.

Try reading something like the following. If you can't find it online, give me your email and I can send it to you.


Persistent Reflux Symptoms in the Proton Pump Inhibitor Era: The Changing Face of Gastroesophageal Reflux Disease
Fby Dellon, Evan S and Shaheen, Nicholas J

pharcyder
Regular Member


Date Joined May 2012
Total Posts : 69
   Posted 12/15/2012 11:33 AM (GMT -6)   
Wow, nice article. My endoscopy showed a gaping lower esophageal sphincter and small hiatus hernia.

theacidrefluxman
Veteran Member


Date Joined Oct 2009
Total Posts : 739
   Posted 12/15/2012 11:48 AM (GMT -6)   
Its tough. People give different answers. I am not a Dr. and cannot defend Dr. logic all the time because sometimes I don't understand it myself. But I can tell you that a Dr. should run those tests on you before you get a Nissen. I also have a small hiatus hernia, but no gaping LES. If you have a gaping LES maybe that changes things.

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 12/15/2012 12:53 PM (GMT -6)   
I had a gaping LES. The surgery fixed it for me.
The medicine will not fix the defect in your LES.
The surgery will repair it.

I think of it like this...
a bandaid is not going to help a gunshot wound.
Joy
Lupus, Fibromyalgia, Glaucoma, Asthma, Hypothyriodism, Sleep Apnea, Degenerative Disk and Facet Disease, and Allergies

When life throws you lemons....
Pick them up and throw them right back at them! :))

theacidrefluxman
Veteran Member


Date Joined Oct 2009
Total Posts : 739
   Posted 12/15/2012 1:06 PM (GMT -6)   
What if it is just a grazing wound? :) Just joking

pharcyder
Regular Member


Date Joined May 2012
Total Posts : 69
   Posted 12/15/2012 1:43 PM (GMT -6)   
But theoretically, shouldnt it be ok to have a gaping les because the nexium is making my reflux non acidic? Thats what I understood from my doc. Or do you think my esophagus is still getting damaged?

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 12/15/2012 2:35 PM (GMT -6)   
I believe it is still getting damaged. Anything coming from the stomach is damaging to the esophagus because the esophagus is not made to hold stomach contents. The cells are different.

Long term use of Nexium can cause stomach polyps. I have photographic proof (my stomach) and it is on the nexium drug site.
Also it prevents proper absorbsion of needed minerals and vitamins.
Joy
Lupus, Fibromyalgia, Glaucoma, Asthma, Hypothyriodism, Sleep Apnea, Degenerative Disk and Facet Disease, and Allergies

When life throws you lemons....
Pick them up and throw them right back at them! :))

WJF
Regular Member


Date Joined Sep 2011
Total Posts : 273
   Posted 12/15/2012 8:18 PM (GMT -6)   
hi pharcyder,

If you have a wide-open LES, PPI will not help much. PPI only turns off the acid. There are other offending agent that could hurt your esophagus. Pepsin for example, bile in some cases. Bile can trigger the cell changes to progress to Barrett's.

I assume you take considerable effort in lifestyle modification in these 6 years, and your LES is still wide-open. I think surgery is the way to go. You could consider LINX as an alternative to Nissen, as it is a reversible surgery.

WJF
Regular Member


Date Joined Sep 2011
Total Posts : 273
   Posted 12/15/2012 8:31 PM (GMT -6)   
Hi acidrefluxman,

Could you send me the paper? My email can be found in my profile.

pharcyder
Regular Member


Date Joined May 2012
Total Posts : 69
   Posted 12/18/2012 1:34 PM (GMT -6)   
Thank you for all of your replies.

Sincerley,
Stephen
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