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Old 09-20-2012, 09:57 PM   #1
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New dysphagia?

I'm 25 and had a Nissen Fundoplication surgery for my GERD 5 and a half years ago. It drastically improved my reflux and I didn't have any problems for several years. In 2011, I got a large paraesophageal hernia that caused a lot of dysphagia but after surgery, it was fine. In January of this year, I got another paraesophageal hernia with severe dysphagia (I was unable to swallow any food or liquids and had to be hospitalized then have surgery). One again, after surgery, everything was fine.

Starting a few months ago, however, I began to feel like things were getting "stuck" in my lower esophagus again. I initially thought it was my reflux getting worse because it felt a lot like reflux. My doctor upped all of my reflux meds, but it didn't help. I had a barium swallow about a month ago because they thought I might have another hernia, but I didn't. But the pill got stuck in my esophagus and even the water they gave me after the barium just kind of sat in my esophagus and wouldn't go all of the way down. They did an EGD and stretched my esophagus, but it hasn't helped my symptoms at all. Next up is a manometry. They said that it is possible that my Nissen fundoplication has allowed my esophageal muscles to weaken, causing dysphagia. If that is the case, they'll have to do surgery and convert my Nissen wrap to a partial wrap (in hopes of still controlling my severe GERD but also helping the dysphagia). Has anyone ever had this happen? Are there any other possible causes for dysphagia like this?

 
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Old 12-20-2012, 11:40 AM   #2
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Re: New dysphagia?

its not surprising that the nissen surgery could have affected your esophagus to get worse. seems how that surgery messes with the esophagus as it is and also the vagus nerve that is responsible for many body processes, to include swallowing and esophagus function. i hope the correction surgery will help and not make things even worse. i just wanted to reply because I know what it feels like to have esophagus problems. I also have dealt with reflux. my esophagus problems are to the point that I can not eat solid food and I have been on a liquid diet for over a year. i hope you can get back to eating better.

 
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Old 12-20-2012, 01:13 PM   #3
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Re: New dysphagia?

Thanks, Jennuine84.

I'm so sorry to hear about all of your dysphagia problems as well. Have doctors been able to figure out what is causing yours or any possible solutions? Have you had previous surgeries for reflux or diaphragmatic hernias, etc? I know how frustrating and limiting being on a liquid diet is. I've been on and off of one for the past couple of years with my various hernias, surgeries, etc, and was on a liquid/soft smushed food diet since this summer. I had surgery a couple of weeks ago and they took down my Nissen fundoplication and converted it to a Toupet fundoplication, slightly widened the hiatus, and cut out some scar tissue from previous surgeries. It already seems to have helped a lot. I'm still on a soft-food diet, but I can already eat a lot more than I could before surgery, so that's at least promising. I would really encourage you to keep getting it checked out and if you let me know what tests/surgeries you've had, I can offer my thoughts on what they've done for me in regard to those areas. Being stuck at home and tied to your blender where you can't eat what everyone else is or go out is really frustrating, I know. I hope that doctors find out something to improve your eating soon!

 
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Old 01-08-2013, 12:42 PM   #4
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Re: New dysphagia?

How are you doing now? I'm sorry you had to deal with hernias on top of the GERD and dysphagia. I had a Nissen in 2006, and now I'm dealing with dysphagia and I'm wondering if the Nissen did something to my esophageal muscles. I hope you're feeling better than you were, and that your doctors were able to discern the cause of your dysphagia.

 
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Old 01-08-2013, 03:06 PM   #5
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Re: New dysphagia?

Quote:
Originally Posted by glitterbot View Post
How are you doing now? I'm sorry you had to deal with hernias on top of the GERD and dysphagia. I had a Nissen in 2006, and now I'm dealing with dysphagia and I'm wondering if the Nissen did something to my esophageal muscles. I hope you're feeling better than you were, and that your doctors were able to discern the cause of your dysphagia.
I'm doing some better. The surgery helped, although now that I've gone back to a full diet, I'm not entirely sure if the problem has fully gone away - it seems like things are sometimes still getting stuck. But it's only been a month since surgery, so it may be due to swelling still. My surgeon said to be patient since I have such a long history with swallowing problems, numerous surgeries, etc.

They DID tell me that Nissens can cause achalasia, where the esophageal muscles atrophy, so it is possible. They were actually really surprised when my manometry came back normal because they expected that to be the problem. They did convert my Nissen to a Toupet fundoplication (it's a 270 degree wrap - it is generally used for people with dysphagia and lowers the risk of achalasia). In my case, when they got in to do surgery, my Nissen had somewhat twisted and was lower down on my stomach than it was suppose to be (which it wasn't when I had my last surgery in January 2012), which is what they believed was causing my problems. They said that it is unusual for your wrap to shift (it could be the result of something from surgery last January, or I think it could be the result of some severe vomiting I had in June [I hadn't been able to vomit since getting my Nissen, so I was obviously really sick to have that happen]). So it's probably more likely that you have a stricture in your esophagus or some narrowing of the esophagus as a result of your Nissen (I didn't have a stricture and I had my esophagus stretched twice prior to this surgery, which didn't help at all), or that your esophageal muscles have weakened, but more rare things (like your Nissen shifting) can cause dysphagia too.

How long have you had your dysphagia? Is it with everything you eat?

 
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Old 01-08-2013, 03:14 PM   #6
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Re: New dysphagia?

I'm glad things are getting better for you! I had an endoscopy and they didn't see any strictures, although they had a bit of trouble pushing the scope through my LES. I'm guessing my muscles have weakened?

I've had dysphagia since the beginning of December, after a bad flare of my GERD started in October. I managed to still have GERD even with the Nissen. The dysphagia is a problem with everything I eat, and sometimes when I drink. I am completely miserable.

 
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Old 01-08-2013, 03:38 PM   #7
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Re: New dysphagia?

Quote:
Originally Posted by glitterbot View Post
I'm glad things are getting better for you! I had an endoscopy and they didn't see any strictures, although they had a bit of trouble pushing the scope through my LES. I'm guessing my muscles have weakened?

I've had dysphagia since the beginning of December, after a bad flare of my GERD started in October. I managed to still have GERD even with the Nissen. The dysphagia is a problem with everything I eat, and sometimes when I drink. I am completely miserable.
The difficulty pushing the scope through your LES can also be related to things like a build up of scar tissue in that area. If that was the case, though, hopefully the dilatation should have offered at least some relief. If it was close to the time of your Nissen, they could have made your hiatus too tight, but 7 years out, I don't think that could be the case.

I've had GERD off and on since maybe 3 years after my Nissen. It's never been nearly as bad, though, so that's okay with me (I used to wake up and throw up in the morning from it, even on high doses of as many GERD medicines as they could give me, a very restricted diet, and all of the lifestyle changes). Are you positive that the symptoms you are having are refulx (see my explanation of what happened to me on your other post). Typically reflux will show up on a barium swallow.

 
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Old 01-09-2013, 11:42 AM   #8
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Re: New dysphagia?

When they did the first endoscopy and dilated my LES with the scope, I did have some (short-lived) relief. They did the dilation on a Tuesday, but by that Sunday I was having trouble again. They didn't see any scar tissue or adhesions or anything like that.

Before I had the Nissen, like you, I was on very high doses of heartburn meds, and while they fixed the acid part, I was still refluxing like crazy. Then I had the Nissen and all was well until now.

There was no evidence of the reflux on the barium swallow, but I did have signs of erosive esophagitis in my esophagus when they did the endoscopy (it seemed to be worse at the bottom of my esophagus).

 
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