Fundoplication - Go for it?

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Altair
Regular Member


Date Joined Aug 2013
Total Posts : 39
   Posted 8/4/2013 3:45 PM (GMT -6)   
Hi everyone,

I'm new (okay, maybe a tiny bit of a lurker), and would greatly appreciate any advice from fellow reflux sufferers. Sorry in advance for the wall o'text. :)

In my early 20s, I was struck with really bad abdominal pain and nausea. I had loads of tests (scans, bloodwork, stool analyses, etc). They ruled out food allergies, intolerances, Celiac, inflammatory bowel disease, Crohn's, H. pylori infection, and diverticulitis. [and probably some more stuff too; I can't remember... but those were the big hitters]

Eventually, I was diagnosed with gastroesophageal reflux disease, irritable bowel syndrome, and Barrett's esophagus. A gastric emptying study showed I had a slightly abnormal emptying time (potentially mild gastroparesis), but apparently it was hard to determine if that was natural variability or a true abnormal result since it was just slightly out of the reference range.

Since then, I've had about 5-6 endoscopies to monitor and biopsy the Barrett's esophagus. Some biopsies have been negative, and some have been positive (about half and half). The most recent endoscopy reports note: esophageal stricture, esophagitis LA grade 3, cameron ulcers, and large hiatal hernia. I'm still awaiting the biopsy results. One report a few years back noted that there was still some residual food in the stomach from the night before, supporting delayed stomach emptying. Another older one noted gastritis. Bloodwork shows consistently raised inflammatory markers (CRP, ESR).

My symptoms are, thankfully, well controlled with high doses of PPIs and domperidone. Would it be worth it to try and go for a fundoplication as well, or is there no point since my symptoms aren't really bothersome? Would it be worth it to correct the large hiatal hernia? (I don't know what qualifies a hernia as "large" but apparently, mine is large) Or to theoretically stop taking the medications for the rest of my life?

I'm in my late 20s now, am not obese, have never smoked, and at most, have about 3-5 alcoholic drinks in a year.

I'm seeing my specialist again in September. We had previously discussed a fundoplication briefly, but he didn't seem too keen on it because I wasn't in discomfort. (if it's not broken, don't fix it) I'm wondering though if it would be worth it to push for one anyways because even though my symptoms are well controlled, my endoscopy reports continue to note abnormalities (like Barrett's esophagus and esophagitis) seemingly caused by reflux.

Any thoughts? Anyone been in a similar situation?

stkitt
Elite Member


Date Joined Apr 2007
Total Posts : 32602
   Posted 8/4/2013 4:52 PM (GMT -6)   
 
Hello and welcome to HealingWell. Thank you for sharing your medical history with all of us and I find it to be very involved with some serious dx note. Would it be worth it to try and go for a fundoplication, I don't know and you may want to wait until you have your final  biopsy report so you will have all of your information?
 
You noted your current physician  didn't seem too keen on preforming a fundoplication because you weren't  in any discomfort.
 
My best advice, make an appointment for a second opinion with a medical health professional. 
 
Please remember all of the members in the forum are peers and not qualified to give out medical advice but they may share personal stories.
 
Kindly,
Kitt 
~~Kitt~~
Moderator: Anxiety, Osteoarthritis,
GERD/Heartburn and Heart/Cardiovascular Disease.



"She Stood in the Storm & When the Wind Did Not Blow Her Away, She Adjusted Her Sails."

Ian Victor
Regular Member


Date Joined May 2013
Total Posts : 214
   Posted 8/4/2013 6:48 PM (GMT -6)   
Altair-- I would think that decision to have surgery will largely be dependant your quality of life. If your reflux significantly interferes with your daily functions or creates significant distress, then surgery is probably indicated. My surgery is on the 28th of this month. My reflux began in my early 20s, but initially was well managed with PPIs. As I developed a hiatal hernia my symptoms worsened and PPIs were useless against night-time regurgitation.

keith k
New Member


Date Joined Jul 2013
Total Posts : 14
   Posted 8/5/2013 5:36 AM (GMT -6)   
A second opinion is definitely in order.
My surgeon was up-front with me. He told me that some of his peers were happy to scope people over and over again, as it's a nice revenue stream. He also was very blunt and told me that advice was coming from a physician (him) who only gets paid for operations, so consider the source. He did give me a few other tidbits to chew on:
1. There has been a rise in the amount of reported tumors on patients that have been on PP2 blockers for a long period of time. It's uncertain as to whether the GERD or the medication is the contributing factor, but there is some correlation.
2. Long term PP2 blocker usage can inhibit the absorption of some minerals, which may contribute to calcium deficiencies and such.
Those items were given by him.
My greatest inspiration is actually provided by the drug companies themselves. (Seems counter-productive). Read the paperwork on your medication. It quotes long term studies of less than a year. LONG TERM?!?
I'd been on these meds for 15 years, and I'm glad to be done with them.

Good luck and post the results.

Keith K

TonyG
Regular Member


Date Joined Apr 2013
Total Posts : 254
   Posted 8/5/2013 4:31 PM (GMT -6)   
Altair,

I'd definitely consider a second opinion. I'd been on PPI's for many years and it was to the point where I wasn't getting any relief any longer so surgery was my only option. For you, it doesn't appear that you're in an incredible amount of discomfort so from a pain and comfort perspective you may not be a candidate for the surgery. That said, with the number of esophageal ulcers and the presence of Barretts, I'd certainly consider the procedure only as a preventative measure to avoid the Barretts being a cancer risk. The risk is low that Barretts cells lead to carcinoma of the esophagus however if untreated that low risk could turn into something high risk. Just because you aren't experiencing any significant pain or discomfort doesn't mean there isn't damage being done.

Take care and be careful!
-TonyG-
-TonyG-
Nissen Fundoplication April 30, 2013
Pain-Free, Reflux-Free, Sleeping on my back!

Altair
Regular Member


Date Joined Aug 2013
Total Posts : 39
   Posted 10/19/2013 5:00 PM (GMT -6)   
Thanks for the suggestions everyone; I've gotten a second opinion and have met with a surgeon. It's been a while, but I have an update. (the wheels can turn slow with the NHS)

End result - I'm getting a fundoplication. (eek)

The consensus was: considering I've been suffering reflux for almost 10 years now, still having breakthrough symptoms (even mild ones) despite being on high dose PPIs and domperidone, having Barrett's, a large hernia, esophageal strictures and ulcers, severe inflammation, and my relatively young age - the surgery was highly recommended.

Apparently, I don't need any additional tests as I've had all kinds of stuff done over the last 7 years. I was expecting a pH test, but I guess the histological evidence of inflammation due to reflux was sufficient.

I'm planning on starting a journal of the experience to add to the collective... maybe my experiences can be of help to someone else. :)

The second opinion was really great (IMO, recommended to anyone contemplating a fundoplication). I was unsure the surgery would be considered since I thought my symptoms were well controlled...but just because you may not *feel* damage, doesn't mean damage isn't being done. Honestly, I would not have thought I had so much stuff going on with my esophagus considering how well I felt.

Anyways, now waiting for a date.

And am more stupidly nervous than I probably should be.
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