Posted 12/29/2012 5:31 PM (GMT -6)
Surgery does help with LPR. I'm a perfect example of that. It's not that surgery doesn't work for LPR...it's just that there haven't been enough studies to prove it. Here's one that supposes it works for the simple reason (as you've pointed out) both GERD and LPR arise from the same problem: acid reflux.
Here's another summary of studies:
A retrospective review of all antireflux surgeries between 1998 and 2008 provided a patient base for a survey in which patients ranked pre- and postoperative LPR symptoms in addition to patient satisfaction with the outcome. Of the 611 patients identified and sent the evaluation forms, 244 responses (40%) were obtained. The percentage of patients with symptom improvement after surgery were: heartburn (90.1%), regurgitation (92.6%), voice fatigue (75.2%), chronic cough (76.3%), choking episodes (83.1%), sore throat (82.9%), lump in throat (77.4%), repetitive throat clearing (72.8%), and adult-onset asthma (59.6%). Twenty per cent with repetitive throat clearing and 30 per cent with adult-onset asthma had no improvement in symptoms. Eighty-one per cent considered surgery to be a success.
In my view, these percentages point to a lot of improvement...for me it's enough to get the surgery and take my chances. That's what I did, and I got great improvement with my asthma symptoms, in contrast to the study. However, it was not adult-onset asthma.
From what I've read and learned in my search for answers, the reason that GI docs aren't more positive about the surgical option is:
1. They are concerned that reflux is not what is causing the symptoms.
2. Since surgery doesn't stop all reflux, but rather brings it back to normal, GI docs fear that the reflux that may continue could be enough to cause the same problems post-Nissen as they did pre-Nissen.
3. Some LPR symptoms can be caused by other non-GERD related issues like allergy/sinus related postnasal drip, sore throat, asthma, etc.
4. GI docs prefer to use medication rather than surgery. They are most concerned with the physical condition and safety of the esophagus and stomach. They really aren't all that concerned about symptoms that don't harm the esophagus.
That list, I'm sure, is not complete, but there are a few of the issues that keep us from being recommended for surgery.
At times LPR sufferers find relief from the majority of their symptoms, but a few may remain. Even those people prefer their post-op quality of life to their pre-op suffering.
You've got some work on ruling out other options, since this a relatively new situation for you. That's an unfortunate reality. Nobody is going to send you to surgery without trying to help you in some other way.
If the level 10 reflux reading you received in testing is a DeMeester score, then it's within the "normal range" which is less than 14. I never tested higher than 14.8 or so, but still suffered lots of problems. One time, during which I'd even been hospitalized for reflux-induced asthma, my DeMeester score was 4. When my GI doc finally gave in and gave me the option of seeing a surgeon, he said that "probably a couple good reflux episodes in a day could be enough to get your lungs going". Really? Finally...I had surgery within 3 weeks of seeing the surgeon, after suffering for 6 years.
If you can choose surgery with an understanding that it's not a perfect fix, but rather a huge improvement, it can be a great option for you. I can eat pretty much anything I want...I have a sensitive stomach, and my wrap has been created out of that sensitive tissue, so it limits me a little. I'm very happy that I had the surgery. I had to take the chance that it would help...I didn't know if it would work, but I had to rule it out and go from there. Thankfully, it was the right thing to do.
There is definitely a very good chance that the surgery would help you. Keep it in the back of your mind. It can be a great option for those with LPR.
Hang in there,
Nissen Fundoplication 2/09
"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.”