I'm on Nexium (which is the "last of the PPI drugs before we consider the Fundo" according to my doc) and it seemed to work for about 2 weeks. Previously I'd been on Prevacid for 4 months with good results until about a month ago, when I started waking up at night with a choking sensation and it seemed to just generally lose effectiveness. So Nexium seemed like my last resort before surgery.

So, for the last 2 nights, I woken up. How is this possible that a double dose of Nexium doesn't seem to be enough?? I've changed all the lifestyle stuff and am very frustrated...any ideas appeciated, thanks

How often are you taking the Nexium and at what dose? Are you taking both pills at once? Or are you taking one in AM and one in PM? Often times increasing the frequency and changing the timing of doses works better than upping the dose.

Nexium is not the last of the PPIs before a fundo, and according to my GI doctor, fundos should really never be considered unless there are severe anatomical deformities, which is rarely the case, since it is rarely effective for more than a year in most cases.

Different PPIs work for everyone. I was on Nexium 40mg twice a day and that didn't work at all. Prevacid 30 mg twice a day works well for me- usually.

Other medications can be added too- reglan, antiemetics, miralax, zantac, or carafate. These things should all be tried in different combinations and doses.

If your doctor is recommending a fundo just because Nexium doesn't work, you deperately need a second opinion.

I'm taking 2 Nexium 40 mg per day, one in the morning and one in the evening. The morning pill is 30 minutes before breakfast, but the evening pill is about 1-2 hours after dinner (because I eat dinner so early I don't want to have pill lose effectiveness overnight). Any advice on how to adjust the doses/timing?

And thank you for bringing back reason into the whole Fundo thing. I also don't want to jump into surgery. Granted, I've tried Prevacid, Nexium, Aciphex and Prilosec, but am not ready to resign to an irreversable surgery. When I posed questions to her about complications she just repeated over and over that it still beats getting cancer from untreated GERD.

I saw an ENT today as I have classic LPR symptoms. He saw no inflammation, so I guess that's positive. So hopefully the irritation isn't at the point in my esophagus to require surgery yet.

PPIs work best when taken before meals. I would put the second dose of Nexium before dinner, and possibly move dinner back later if possible.

Right now your best bet is combinations of medications. You have one more PPI you can try- Protonix. Adding Reglan is gnerally highly effective at reducing reflux, but has a huge list of side effects, many which I experienced on it, associated with it, so this too should be avoided.

Adding an H2 blocker like Zantac at a high dose (read, 300mg several times daily) if probably your best bet right now.

Adding Carafate isn't a bad idea either. You can add them both.

Finally, you really need a new doctor. Fundo happy doctors scare me, especially after all my (several) GI doctors have told me about them. What's worse than that is that she is not considering your concerns and discussing them, but instead just forcing you into one option.

Last but not least, what diagnostic tests have you had done and what were the results? Before recommending a fundo, I would expect at least to 24 hour pH studies (on and off meds), more if several PPIs were tried, a motility scan, a barium swallow, and a scope. I have also had allergy testing, a head CT, chest x-rays, and liver blood work done. A lactose tolerance test isn't a bad idea either. Everything that could be affecting your reflux needs to be considered.