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Dealing with GERD symptoms after Nissen Fundoplication


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Old 07-05-2017, 10:28 AM   #1
Queenie99
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Dealing with GERD symptoms after Nissen Fundoplication

I had Nissen Fundolplication almost 3 years ago. I was totally symptom free from August 2014 until October 2016. I have been seeing my GI since then. Long story short...my GI now tells me there is no more medicine for me to try. We again talked about my wrap being the problem. All tests show the wrap is intact and has not slipped. GI also says that it doesn't appear that the wrap is loose. I told him I think it has either loosened and just doesn't show in tests or that maybe there is a small pin ***** sized hole in it. I am scheduled for an endoscopy with BRAVO placement to do a 96 hour PH test (unfortunately the procedure won't be until September 1 as that is the soonest available opening). GI says this test will show if acid and whether Pantoprazole is working. I have to stop my Pantoprazole 7 days prior to the procedure and then start taking it on day 3 of the test, so the testing period will be 2 days no meds and 2 days with meds. If acid, then GI is talking about possibly sending me to Cleveland Clinic for a second opinion consultation. If no acid, then I have to start over trying to find out what is causing the symptoms. GI did say that the Pantoprazole could be working, but that I am not noticing because the symptoms are not improving. As of my visit last week with my GI, symptom-wise I am exactly where I was before my Nissen.
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Old 07-06-2017, 01:14 AM   #2
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Re: Dealing with GERD symptoms after Nissen Fundoplication

I have no experience of the surgery you have had, but wanted to commiserate

Do you still have your gallbladder?

I don't and I think my reflux may be acid AND bile. PPI'S don't really work well on bile

Hope your forthcoming procedure solves your problems

 
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Old 07-06-2017, 09:53 AM   #3
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Re: Dealing with GERD symptoms after Nissen Fundoplication

Had my gallbladder removed in 2010 but had very mild symptoms of reflux several years before that.
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Old 07-06-2017, 12:41 PM   #4
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Re: Dealing with GERD symptoms after Nissen Fundoplication

You may have part bile part acid like me which would explain the PPI'S not working as well

When I had my first endoscopy my stomach was full of bile

 
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Old 07-08-2017, 07:08 AM   #5
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Re: Dealing with GERD symptoms after Nissen Fundoplication

I had an endoscopy in January 2017 and my GI checked my wrap and my stomach...wrap looked good, nothing in stomach, but some erosion in esophagus. I am going to have him check everything out again when he places the BRAVO.
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Old 08-09-2017, 10:05 AM   #6
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Re: Dealing with GERD symptoms after Nissen Fundoplication

Still no relief in symptoms, some actually seem to be getting worse. Counting down the days until BRAVO implant.
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Old 08-09-2017, 01:00 PM   #7
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Re: Dealing with GERD symptoms after Nissen Fundoplication

My wrap is intact, yet I suffer. I take 60mg Lansoprazole daily plus Ranitidine when it's really bad. I'm sorry you are the same, it's horrible.

 
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Old 09-01-2017, 01:42 PM   #8
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Re: Dealing with GERD symptoms after Nissen Fundoplication

Had my 96 hr Bravo implant put in this morning. Doctor took scope as far down as it would go to check things. In the preliminary report, he did note that the wrap appeared loose. I have been telling him this since October 2016. In the 4 hours it has been in place, I have eaten, had chest pain, took a nap and have been having some weird pain in my upper throat to just above the stomach. I don't even know how to describe it, but on a pain scale of 1-10, I would have to give it an 8. It is even radiating into my right ear. I have been off my PPI since August 25 and won't restart taking them until September 3 in the morning. Hopefully, some of this pain will diminish when I can restart PPI (even though they don't give much relief). Go back for results and next step in treatment on September 14.

As far as the Bravo implant, I don't even notice that I have it, unless this weird pain is from it. We shall see if the pain subsides or changes.
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Old 09-24-2017, 06:41 AM   #9
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Re: Dealing with GERD symptoms after Nissen Fundoplication

Had my follow-up with GI on 9/14. The pH testing showed no acid in stomach when off the PPI and when on the PPI. When I was originally tested prior to NF, the mobility testing showed I have Hypercontractile Esophagus (Nutcracker/Jackhammer Esophagus) and that the GERD symptoms could be from that. Since I can't take calcium channel blockers, my GI has put me on 25 mg Amitriptyline which he says will take about 3 months to see if it will help. I go back in 4 months for a follow-up.
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Old 09-24-2017, 04:11 PM   #10
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Re: Dealing with GERD symptoms after Nissen Fundoplication

Sorry to hear about your troubles. I wouldn't completely rule out that you don't have reflux. Maybe you just didn't have it during your test? Something to note, I was also a bit troubled and was wondering whether the pain that I was having was coming from Acid/GERD, or from some esophageal problem.

If you take water and mix in some baking soda, you will get something that can neutralize much of the acid in your stomach. Further, if you take the water and put in a lot of baking soda (to the point where it gets salty), you will have something very strong.

In a couple occasions where I was wondering whether my pain was reflux or esophageal, I took a solution like this that I made with a lot of baking soda, and drank it. In both times, I felt better afterwards...Indicating that I definitely had a reflux problem that was causing the pain, and not some esophageal problem. In general, I advise against too much baking soda, but if you're having extreme problems, or just really want to find out that acid reflux is your problem, then this is a solution that will work.

 
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Old 10-09-2017, 06:34 AM   #11
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Re: Dealing with GERD symptoms after Nissen Fundoplication

I use Alka-Seltzer and Mylanta when it feels like I am having a reflux episode. The Mylanta only works for a short time, but the Alka-Seltzer seems to work for a longer period of time. My GI had put me on Pantoprazole (couldn't take generic Prilosec) shortly after this all started. When I went for my follow-up after 96 hr pH test, he put me on Amitriptyline and told me to continue the Pantoprazole. I am still having reflux episodes but will continue on the meds and see if I have any improvement by the time I go back in January.
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Old 10-14-2017, 10:19 PM   #12
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Re: Dealing with GERD symptoms after Nissen Fundoplication

What type of reflux symptoms are you actually having?
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Old 11-05-2017, 05:05 AM   #13
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Re: Dealing with GERD symptoms after Nissen Fundoplication

MountainReader - heartburn, chronic cough, hoarseness, chest pains that radiate up my neck into my ear, pain/pressure at the top of my stomach/base of esophagus.
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Old 11-05-2017, 07:55 PM   #14
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Re: Dealing with GERD symptoms after Nissen Fundoplication

Have they looked into doing an Esophagram or Barium Swallow for you? It is my understanding from my specialists that the wrap can appear intact during an EGD, but the EGD won't necessarily show if the wrap has slipped and may miss if it is too tight. My Pulmonologist said if the wrap is too tight it can result in some of the same symptoms.

You may look into low stomach acid at this point as well.

With the severity of my issues, I am high dose PPI's for life. I take Gaviscon for breakthrough and Zantac if needed. I developed IBS as a result of my acid reflux issues. If my IBS is off, I find my acid reflux symptoms get worse so I have to stay on top of that. Since we not have less stomach surface, we absorb nutrients less than normal. That can throw off the the GI system for me as well. It is a tough balance. I am just thankful my symptoms have not been life threatening as they were pre-surgery.

The Amitiptyline is interesting. Once I got my reflux and asthma under control, I continued with the chronic cough. My ENT ended up putting me on the Amitriptyline for a neurogenic cough. Basically, my vagus nerve had become irritated with everything I had gone through. The low-dose Amitriptyline did help 'calm' the vagus nerve to get the coughing under control. For me, less coughing meant less squeezing of the stomach which was pushing acid up into my esophagus. The Amitriptyline also helped me sleep, which I needed after so long with poor sleep due to pain and discomfort.
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Old 11-07-2017, 06:42 AM   #15
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Re: Dealing with GERD symptoms after Nissen Fundoplication

I've had the barium back in October 2016 and it showed everything was fine. I don't see in any of my previous posts that when my GI placed the Bravo, he scoped as far down as he could go. In his report, he did note that the wrap appeared loose, but at follow-up he didn't mention anything about the wrap being loose. He indicated that it was functioning properly. As of today, the only relief being on the Amitriptyline is giving is that the heartburn isn't as bad, but still have all other symptoms.
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