Your story is very similar to mine. I had the Nissen fundoplication done in Nov 2015, and things dramatically became worse after that. I am actually waiting to get the Nissen reverted.
For those suffering from LPR is very important to understand one thing: the symptoms you feel in the throat are caused by 2 separate failed mechanisms: reflux of gastric content into the esophagus AND the inability of the esophagus to clear the refluxate. about 90% of patients suffering from LPR have some sort of dysmotility (either in the LES or in the peristaltic movement). Long term GERD can affect the functioning of the esophageal body, leading to poor clearance and longer residence time of reflux content. Tightening up the LES through a Nissen will only make much more difficult for the esophagus to clear the gastric content when reflux happens.
Another thing to consider: having gastric content reflux into the esophagus is normal and no medication or surgery will avoid that. A normal esophagus has the ability to clear the reflux out through secondary peristalsis (the one not triggered by swallowing). Normal people have up to 72 reflux events/day. Once again, any type of the dysmotility of the esophagus may impair the clearance.
Many times, doctor only treat one cause of the problem - they prescribe PPIs, which only decreases the acidity of the stomach. However, in patients with LPR, most of the reflux events are caused by non-acid (pH 4-7) content. That's also the reason that most LPR patients don't feel heartburn or respond well to PPIs. The content in the esophagus can make its way up to the throat and irritate the tissues. This non-acidic refluxate also contains pepsin, which can bind to the throat tissue and lead to chronic inflammation.
I was diagnosed with LPR last year after suffering from GERD for 15 years. I had a Nissen Fundoplication despite a normal DeMeester score (=7, normal is <14.2) because no combination of PPIs or H2 blockers ever worked for me. However, my manometry showed that I had 100% failed peristalsis (>50% swallows with <30mm Hg pressure is considered abnormal). After the surgery, hell broke lose and symptoms increased to unbearable levels. That was a clear evidence that the main problem was a dysmotility issue, rather than an acid-reflux problem. My doctor has now suggested that I should either reverse the Nissen and treat the dysmotility with some medication (Domperidome, Bethanechol or Buspirone) or convert the Nissen to a partial 180 degree wrap. This would still give me some protection against reflux but improve the motility.
Have you done a manometry test? This is the only test that can measure motility issues in the upper GI tract. Also, have you done an impedance test? That's the only way to measure acidic and non-acidic fluids in your esophages and near throat area.
I totally agree with you.
Our cases sound similar. Normal demester score normal phmetry.
According to my manometry results I have 88% peristaltic contractions and 12% simultaneous contractions with mean peak ampiltude 43mmHg.
My % LES relaxations was 90 and normal is above 96%. My LES pressure was low normal but the duration of my LES is very short.
i suppose I have some kind of non specific esophageal disorder but doctors do not pay much attention to that and insist that everything is normal.
And this diosrder leads to have severe non acidic reflux.
My problems came to the forefront last May after taking strong dosage of antibiotics. Coincidence???? who knows...I believe that somehow the huge pills of antibiotic irritated my stomach because I was diagnosed with mild gastrtiis and then start the reflux nightmare.
I am currently taking ibutin a prokinetic agent and it seems to help me somehow...
for how long do you have symptoms and what was the trigger of your reflux???