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Old 02-06-2005, 10:48 PM   #1
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Nissen, anyone?

Hello,

I've had GERD (known) since 1998. I'm currently taking 30 mg Prevacid twice daily, and 300mg Zantac twice daily. I use assorted antacids (mostly TUMS and Pepto) during the day. I would say that 80-90% of the time I have chest pain and almost constantly taste acid. I'm only 28, but I'm starting to think about having a Nissen done. Has anyone had success with a Nissen? Any suggestions for or against?
Thanks a bunch!!
JVoss

 
Old 02-07-2005, 12:28 PM   #2
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Re: Nissen, anyone?

I'm 19 and thinking about a Nissen as well. Whenever I talk to doctors about it I'm told, "It's almost never done in 19 year olds.....but you should seriously consider it." I was diagnosed when I was 16 after almost a year of near constant vomiting. I never had the heartburn type symptoms. I was put on Zantac first, then Prevacid 30 mg twice a day. I was free of symptoms for awhile, then they returned and Carafate was added. Free for awhile, then they returned. I was switched to Nexium. A pH probe done then was as bad as one on somebody who wasn't being medicated at all. I was switched back to Prevacid, and Reglan was added. I couldn't tolerate the Reglan, so now I am running out of med options, thus the fundo. I'm getting a second opinion soon, and having another pH study next week.

I have had some not too fun complications of GERD as well. I have torn a hole in my esophogus, given myself 14 cavities from all the vomiting, have had electrolyte problems, and have asthma now.

My main GI doctor is still a ped GI doctor, and I was told by the people there that they have never had a fundo patient that wasn't back on meds after 1 year. There's a pretty grim stat. Also to consider is the fact that it's major surgery that changes your digestive system.

I've heard that all those over the counter antacids you're taking can stop the proton pump inhibitors from working. Have you talked to your doctor about that? Have you had pH studies to see if your chest pain is really acid related?

 
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Old 02-07-2005, 01:24 PM   #3
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Re: Nissen, anyone?

Hi Blondy,
Thanks for the reply. I have never had pH studies done. My GI doc said the chest pain was from GERD. I had an edoscopy (upper) with esoph. dilation done in 2001, but haven't been scoped since then. I went to my primary doctor in January of this year, who increased my prevacid to twice daily. I haven't seen my GI doc since 2003, who then suggested that I think about a Nissen due to the severity of my GERD and high medication requirements. He had prescribed levsinex in the past for esoph. spasm/pain, which seemed to help. He really favored the Nissen though, which is why I haven't gone back. Now, I'm thinking that may be a good option, since I can't eat any of the food I enjoy, even with all of this medicine. Let me know what you end up deciding. I'd be interested in seeing what an adult GI says. Also, do you think I should ask for pH testing??

 
Old 02-07-2005, 07:17 PM   #4
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Re: Nissen, anyone?

pH testing is helpful because it can be done on and off meds to see how the meds work, and just how severe your GERD is. When I had mine I was on 40 mg Nexium twice a day. I felt like I was refluxing, but I didn't feel it hurt, so I didn't think it was acidic reflux. Turns out it definitely was acidic.

There's no way anyone is going to recommend a Nissen if you aren't seeing a GI doctor. The one I see March 1st is my 3rd GI doctor.

I also doubt anyone will even think about a fundo until you have another scope, gastric empty time series tests (laying in a CT machine after eating basically), and probably more than one pH probe.

Nissens are usually a very last resort. They have a high failure rate, and often take a long time to recover from. They also make it impossible to vomit, and sometimes even to burp. This has obvious disadvantages.

You have hardly exhausted your medication options. Prevacid is not the only proton pump inhibitor, and by many isn't even considered the most effective. There's also Nexium, Protonix, and Prilosec. From what you wrote you also haven't tried any pro-kinetics (Reglan, and Motilium [not sure where you live, but that isn't availible in the US except in odd circumstances]).

I suspect you haven't had these tests or tried these meds because you haven't seen GI on a regular basis. You don't have to go back to the same one, but you should be seeing someone.

2003 wasn't that long ago, but fundos become less common every year. Also, some doctors favor them more than others (my doctor doesn't, but that's part because he's peds). There are also newer techniques I've been waiting for to become more widely availible. The endocinch is one to look into, along with various other techniques, one using lasers to strengthen the LES, and another putting small implants in the area to make it narrower. I'm not a candidate for any of these because of my age primarily, and they are not that widely availible anyways, but it may be something to look into since you have a few years on me.

I really hope this is helpful. There are a lot of great people on this board.

 
Old 02-08-2005, 01:50 PM   #5
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Cool Re: Nissen, anyone?

I had a Nissen on December 23rd at Georgetown University Hospital in Washington, DC. I have no regrets and cannot explain how wonderful I feel now. I still have problems eating bread and sticky stuff and I cannot drink sodas because I have problems with gas and burping but this is a SMALL price to pay for a good nights sleep. I had a problem with acid reflux but my main complaint is that I was regurgitating (s/p) my food daily. It would be so bad sometimes, I would wake up choking on food and acid and it would be in my nose!

My nissen has made me feel wonderful and I can brush my teeth, drink some OJ and eat Taco Bell without feeling like I was dying! I would encourage anyone to look into but get someone that knows what they are doing. I did plenty of research on message boards and even got a second opinion. Yes, I had to endure the PH test, 3 colonoscopies, 2 endoscopies and a test where they stuck a tube up my nose and down my throat to callobrate my esophogus. IT WAS WORTH IT!

Feel free to ask me questions as I can tell you truthfully how good I feel. I will not sugar coat anything for you. I have 6 small incisions on my stomach and spend three days in the hospital. I was back to work less than 2 weeks later. I have lost some weight and feel great!

W.

 
Old 02-08-2005, 02:55 PM   #6
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Re: Nissen, anyone?

How long do you expect to stay off meds for GERD? My doctor said most patients are back on meds within a year. If you are back on meds within the year will it still have been worth it? How bad was the pain afterwards? What did you have to do to prepare for the surgery? I am seriously considering a fundo and would love to hear anything you have to say about it. What meds were you on before it?

 
Old 02-08-2005, 08:30 PM   #7
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Re: Nissen, anyone?

Thanks for sharing your Nissen experience, Krazyboy. I'm so happy to hear that things went well for you. My main issue is with my insurance. I'm a nurse, and work at a large teaching hospital, but our insurance is very selective, and I can only take Prevacid and Zantac per the formulary and have the meds be covered. I've tried prilosec in the past, and axid, when they were covered on my plan, but really haven't seen a lot of difference in the meds. I was told that my LES just plain doesn't work, and so when I bend over, food/acid/etc. comes up. As for taking meds after a Nissen... I wouldn't mind taking a ppi or h2 blocker, if I could have complete relief of my symptoms, and know that I wasn't headed for Barretts esoph. in a few years. It's the taking all of the meds, sleeping elevated, not eating all of the food I love, etc, and still having bad symptoms that is so irritating to me. WOW... you can eat Taco bell now?!

 
Old 02-11-2005, 06:09 PM   #8
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Re: Nissen, anyone?

I had a Nissen Fundoplication done in February 2001. I am 27 years old. I have gone medication free ever since. It was the best thing I could have ever done. Yes, I had problems the first year not being able to burp. But, after awhile I was able to burp again and there were no problems. I still cannot vomit, however that has not been a big problem for me. I try to avoid things that I think will make me sick. I have not had heartburn once since the surgery. I can't express to you how much of a difference it made in my life. The fact of not taking medication daily or taking tums is a great thing. I would suggest doing research before thinking about surgery lightly. It worked great for me and I don't regret it.

 
Old 02-11-2005, 08:28 PM   #9
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Re: Nissen, anyone?

If a person can't vomit, what happens if they get the flu and have to vomit, do they just go through the motions with not being able to get rid of the vomit? I'm at my wits end with this GERD, I have Barrett's mild with no cell changes but I'm still getting gerd symptoms just more mild or if I eat soemthing wrong. But it bothers me if or should one need to vomit and can't what happens? Granted I haven't had a flu bug since the early 70's but it would just be my luck that I'd get it and couldn't vomit. I'd sure like to know step by step what I'd be going through with this surgery, do they go through the mouth or stomach?

 
Old 02-11-2005, 10:39 PM   #10
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blondy2061h HB User
Re: Nissen, anyone?

As my doctor said, "There are other ways it can come out."

 
Old 02-11-2005, 11:44 PM   #11
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Re: Nissen, anyone?

Thanks to everyone for their personal accounts regarding Nissen. Nancy, as for surgical approach, my GI said that they like to do laparascopic Nissens now (with several small incisions and using scopes through the abdominal wall), or they can do an "open" incision (a larger incision on the abdomen). In my case, he mentioned that it would be open. I was in a car accident in 98 (after which my severe GERD developed) and had extensive internal injuries. I already have a large incision scar, and so he thought it would be safest to do an open incision in case there were adhesions in the abdomen. It's certainly not something to take lightly, but as a surgical ICU nurse, seeing patients having to face an esophagectomy for esophageal cancer pretty much seems to eliminate having a good quality of life again. It just worries me that I am only 28, have had GERD for 7 years, and haven't experienced good relief from my symptoms. I'm trying to weigh the benefits and risks of the Nissen with that.

 
Old 02-12-2005, 10:29 AM   #12
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Re: Nissen, anyone?

As far as what happens when you have to vomit and you can't? You basically go through the motions (dry heave). It can be a pretty bad feeling. However, like I posted earlier I avoid things (alcohol, old food) that I know will make my stomach unsettled. And also as someone else posted, it will come out another way. (sorry trying not be so graphic, but trying to be realistic). But even with this, I am still glad I had my surgery. This has only happened to me maybe twice in 4 years. The few times when I was sick and started feeling nausea, I would usually take some Phengran and that helps alot. I do eat some spicy foods now, even taco bell as someone else had posted. I don't have to avoid certain foods anymore. This has helped me to be able to eat things I had to avoid before, especially orange juice. The surgery far outweighs this side effect. My surgery was done laproscopicly. I did lose some weight initially with my surgery. However, once I was able to burp again I was able to eat more because there was no more trapped air in my stomach. In the first few months, it was hard to eat because things did feel like they were getting stuck, but you just have to be careful what type of foods you eat. Also, if I ate too much I would have alot of pressure from my stomach onto my esophagus and it was uncomforable. But even with these few side effects, it has still been worth it and those side effects were not unbearable. The only side effects I have today (4 years later) is that I can't vomit. But this is something I can live with and is not unbearable. To this day I don't have any other problems or side effects and I can eat normally without having to think about heartburn. I hope this helps some of you!

 
Old 02-12-2005, 03:31 PM   #13
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Re: Nissen, anyone?

Well that definately is something to look at seriously. My Gastro Dr said he will try all avenues before the surgery, I'm a poor candidate as I have what they call "exhausted immune system" Pernicous anemia, Mitral valve prolapse, neuropathy and a host of spine and neck problems from past car accident. I still have a couple more options to try before it I make that decision, tho I would like to as I'm sick of this, it has been going on since July and I think I've had about 3 weeks reprieve in January but now the Nexium seems to have stopped working as good as in Jan, or maybe since it felt so good I ate like I use to thinking it was all taken care of, duh, I'm was in the nursing field years ago, you'd think I would know better. Graphic is fine with me, I get a clearer picture of what will take place, I've not been working in the nursing arena for 20 yrs.

 
Old 02-15-2005, 06:59 PM   #14
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Re: Nissen, anyone?

I wanted to share my experience with the Fundo. I had the Nissen in April of 2003 and I have had nothing but problems since then. I know there is a 85-90% success rate, and I have no reflux, but the full wrap seems to come with more chances of problems than a partial. I would encourage you to try all alternatives to correct your problem; i.e. meds, elevated bed, diet changes etc. If that doesn't work, then try the less invasive procedures that are now being performed; the Nissen can always be performed if these fail. With a Nissen, there is a lot of slicing and dicing that goes on, something the surgeon's tend to gloss over when they tell you about the surgery. When I was being sold on the surgery, I was handed a little booklet explaining the surgery which showed the stomach being wrapped around the esophagus like a shirt collar being buttoned. I always figured it could be snipped and everything would go back into place in the worst case scenario. In case you don't have an idea what happens, they cut your stomach loose from the spleen, severe the tendons and nerves that restrict its movement to its new home and stitch it to your diaphram for support. Then the top part of the stomach is wrapped around the esophagus and stitched. The reason I am relating this to you, is the fact I wish someone had told me the truth, not a glossed over comic version. Bottom line, your stomach isn't going to be able to ever go back to where it once lived.

Don't misunderstand me here, LOTS of people have been really pleased with the Nissen Fundoplication, some others have had problems and those are the ones you normally hear from. The decision is yours to make, be as informed as you can be, and if it seems right for you, go for it. Make sure your surgeon is very experienced with the Nissen and you should greatly improve your success rate.

As with all medical surgeries, there is no guarantees, but you can minimize your risks by doing your research like you are here. Ask questions of the surgeon, if you don't like what you hear or are apprehensive, look for another surgeon. Ask to possibly speak to some fundo patients he has worked on and get their opinion of the surgeon. Good luck and let us know how it goes.

 
Old 02-17-2005, 07:58 AM   #15
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Re: Nissen, anyone?

Hi, where did you get the "they cut your stomach loose from the spleen, severe the tendons and nerves that restrict its movement to its new home and stitch it to your diaphram for support" info from ?

 
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