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How to tell reflux from esophageal hypersensitivity 4 months after Nissen fundoplication?

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Posted 12/8/2016 3:57 PM (GMT -7)
I'm just tapering off meds 4.5 months after nissen fundoplication and find I've had heartburn all day. What a surprise! I bet some of you have experienced this. Is there a way of telling if it's true reflux or just esophageal hypersensitivity (also known as irritated esophagus)?

I was on an H2 blocker and a low dose of amitriptyline (to deaden pain) because of a burning stomach lining. I can feel my stomach has improved so I stopped the H2 blocker two weeks ago and tapered down the amitriptyline so I could tell what symptoms I actually have left.

Turns out my stomach no longer burns but I've had heartburn coming and going all day, especially after meals (when gastric acid would be strongest). Another clue is that even on the amitriptyline I was getting a cramp in my lower esophagus in the afternoons. That appears to be part of the heartburn process...I get heartburn starting around midday and then around mid afternoon it begins to cramp as well. Apparently the amitriptyline was stopping the heartburn sensation but not the cramp.

So I'm trying to sort out whether I'm actually refluxing or if it's just esophageal hypersensitivity. If I treat it like hypersensitivity but it turns out later to actually be reflux, that could end badly because killing the pain won't stop damage. I don't see why I would get a cramp still on amitriptyline if it was just hypersensitivity.

However it seems to be common for people to think they are still having reflux after this surgery when they really are not.

Tips? Wild speculation?

Your pal in GERD,
Dennis
Posted 12/8/2016 4:36 PM (GMT -7)
I found a 2003 paper the concludes that most people who feel they have reflux after fundo actually have normal acid exposure and their symptoms are due to something else. Therefore acid reducing medications are inappropriate for most.
It also concludes that the only reliable symptom predicting reflux post fundo is regurgitation. I don't have that. Hmm.

"Symptoms Are a Poor Indicator of Reflux Status After Fundoplication for Gastroesophageal Reflux Disease"
http://jamanetwork.com/journals/jamasurgery/fullarticle/394790j

In this study, almost 3/4 of the patients who had an antireflux operation and subsequently presented with complaints of recurrent symptoms were not refluxing. The true surgical failure rate in the selected symptomatic group was 26%.

Still don't know if I'm in the 74% or the 26%.

Post Edited (DennisinNY) : 12/8/2016 4:59:19 PM (GMT-7)

Posted 12/9/2016 3:11 PM (GMT -7)
Anybody know if heartburn is a withdrawal symptom from amitryptoline? That drug has heartburn as a side effect. But I would expect that to happen when the drug is in full force, not when it has been mostly tapered off. It happened to me on 1/2 a 25 mg pill. Not when I was on 50 mg two weeks earlier.
Posted 6/18/2017 5:47 PM (GMT -7)
Update: it's 10 months post surgery and I've been able to taper down on nortriptyline to 10 mg a day. A few months ago when I tried that after three days of 10 mg I had intense burning esophageal pain. But that has not happened this time. I still have discomfort mild compared to the previous burning. But the burning is gone. I think what has happened is I'm slowly becoming less sensitive.
So I think what has done me good is low doses of nortriptyline and several months of time. Plus a very conservative bland diet. Anything that makes my stomach feel bad I don't eat anymore. Like onions and garlic and tomato sauce.
I still have discomfort but that's a great improvement from burning pain. And I'm still working on that with a very low dose of nortriptyline and even more time.
Posted 6/25/2017 3:53 AM (GMT -7)
Thanks for posting your experience.

I had my partial fundoplication wrap >7 weeks ago and am still experiencing reflux pain. On one hand, I feel convinced that it is reflux because it is worse after certain 'trigger foods' and when I'm laying down at night. But on the other hand, I'm also aware of the study you cited about the need for objective pH testing and like you, I am not really experiencing regurgitation. I've had indigestion since I was a child (it got to a point where I could recall food from the stomach to my mouth voluntarily), but after the surgery, I haven't had any indigestion... so it must be working to some extent...

A lot of people say it takes months or up to a year for the reflux pain to fade, but I haven't come across many threads documenting this. I'm fine with having to avoid certain trigger foods, it's just that right now, my reflux seems just as bad as it was pre-op. Just trying to stay hopeful and patient.
Posted 6/25/2017 3:24 PM (GMT -7)
Hi Ejohn. It took me a long time to figure this out after the surgery but my problem was non-erosive reflux. That is, my problem was more hypersensitive esophagus and stomach that it was an excess of acidity. I think most esophagus is better now than it was before the surgery, because the normal reflux is reduced, but it's taken months for that to become apparent. My stomach and esophagus didn't stop burning for around nine or 10 months. In the meantime I could only control it with nortriptyline, which I didn't really want to take because it's a sedative off and made me tired and my eyes a little blurry.
I still have a dramatically modified diet because this whole time acetic or spicy foods would make me burn more intensely.
The reason it takes so long is because it's a neural sensitivity problem. And it takes months and months for nerve issues to settle down.
For months after the surgery I said I wondered whether it was successful because I burned worse than before. But now 11 months later I see it was, but it made me worse for quite a while because my hypersensitivity got much worse from the insult of the surgery and most of all the meds they had me try afterward to try to deal with gas bloat. Which were really hard on my already angry stomach.

That's a long way of saying that it seven weeks you can't really judge very well how you're going to be down the road. You're likely to be a good deal better than you are now.

Post Edited (DennisinNY) : 6/25/2017 4:34:14 PM (GMT-6)

Posted 1/12/2021 1:37 PM (GMT -7)
DennisNY- are you still active on these boards? I’d love to ask you a couple questions.
Posted 1/12/2021 10:40 PM (GMT -7)
Also interested in this thread... - I'm coming up to 5 weeks post op and have just started eating non puree foods and feel a burning sensation like heartburn in my chest.. Woke me up for the first time last night and today it happened again about 2 hours after lunch.. Really making me nervous even though I keep telling myself it can't be heartburn..
Posted 1/13/2021 5:31 AM (GMT -7)
LenDog:

You are still very early in your recovery. Sometimes when you advance your diet you experience a small setback. You might want to try going back to the puree foods for a week or so, then go back to the non-puree foods. Everyone's recovery is unique. For your own piece of mind, contact your surgeon with your concerns.

Sharon
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