Brief Answer: low recurrence if proper case selection done Detailed Answer: Namaste Welcome to Healthcare-Magic Greetings of the day Dear XXXXXXX Before I reply to your query I would like to stress few important points about Fundoplication The success of Fundoplication surgery and post operative outcome are good if following things are followed 1. Right indication- Failure to respond to full conservative medical management and other oesophageal motility disorder ruled out. 2. Right patient selection- high incidence off recurrence in obese and patients with poor compliance 3. Right and technically correct surgery- the wrap should not be too loosening 4. Right experienced surgeon A technically right procedure done by experienced surgeon with Good patient selection with right indication, the success rate and post operative outcome and improvement are good. Coming to your query 1. The outcome of Fundoplication surgery is assessed by improvement in clinical symptoms and improvement in pathology of oesophagus in form of resolution of ulcer or inflammation. Rightly done wrap will not slip and will last longer, also clinical evidence does not suggest if if last only five years. in case recurrence does occur due to loose wrap, redo surgery can be safely be performed if the cause of symptoms are documented to be due to recurrence. 2. Properly done Fundoplication for right indication in rightly selected patient the success rate is more than 90% 3. Success rate all depends on good patient selection 4. It is important to remember that Fundoplication is basically done to strengthen the natural mechanism of preventing reflux of gastric contents into oesophagus. Lifestyle modification in form of change in eating habits, frequent and small meals, avoiding spicy/oily/carbonated beverages etc form integral part of pre and post operative management of gerd. So it would not be wrong to say that it is lifelong. 5. It is important to treat gastritis before embarking on Fundoplication. As.Presence of gastric implies inadequate tried medical management and also the symptoms of gastritis may worsen after surgery. I hope it helped Wishing you a healthy life Take care Regards Dr Deepak XXXXXXX Consultant Surgeon

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Brief Answer: ppi do not cause significant weight loss Detailed Answer: Greetings of the day I hope you have already been worked thoroughly and have undergone upper Gastrointestinal endoscopy to document the severity of gastritis and to rule out active ulceration. Presence of gastric ulceration which sometime occurs due Helicobacter pylori may sometime be the cause of weight loss. Long term intake of ppi does not affect absorption of protein or fat significantly and is not known to cause significant weight loss. Avoid food which are ulcerogenic, and may cause flatulence. Increase intake of water to about 2liter a day and empirical treatment with anti H Pylori kit may be worth a try. Going by your symptomatology you are not a good candidate for surgery. Lactose intolerance, hyperthyroidism which could have gastrointestinal symptoms could be other possible cause of weight loss. Semithicone containing antacid will provide the much needed relief for gas trouble. I hope it helped Do get back to me if you have any other query. Take care Regards Dr Deepak XXXXXXX Consultant Surgeon

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Brief Answer: Reassessment and reevaluating of symptoms Detailed Answer: Hi, Ulcerogenic food are oily food, fried food, frozen foods. Caffeinated beverages, alcohol, carbonated drinks are all ulcerogenic. Also commonly used analgesic are Ulcerogenic. I meant empirical treatment with anti helicobacter pylori kit, it has definitely helped in many of my patients whom I put on the regimen and has helped them even though they were negative for Helicobacter pylori infection. May be the antibiotics in the kit would have treated the bacterial colonization which occurs because of long term use of PPI. Ppi may cause malabsorption because of bacterial colonization but the amount of weight loss is not significant. You mentioned having lost 20 pounds if weight, the time in which you have lost is more important. Significant weight loss is loss of more than ten percent of body weight in a period of six months. You have gastritis and complaints which may be unrelated to gerd like gas problem, which is unlikely to improve after Fundoplication. Keeping that realistic expectation in note is important before you embark on surgery. I suggest it is time for reassessment of your symptoms with your surgeon and definitely calls for repeat Gastroscopy , 24 hour ph monitoring of oesophagus along with manometry to decide for further management. I hope it helped Do get back to me if you have any other query Take care Regards Dr Deepak

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Brief Answer: Fat predisposes to reflux Detailed Answer: Greetings Fat causes increased relaxation of lower oesophageal sphincter which causes increased reflux of gastric contents into the oesophagus. All that's the rationale for avoiding fat in diet. It's quite natural and a expected sequelae of losing weight if one is on reduced or law fat diet. Ppi may slightly contribute to it by causing malabsortption due to bacterial colonization. It is just your belief and assumption that ppi are the root cause of your symptoms without any clinical basis and evidence . Fat malabsorption can be easily be tested by testing quantity of fat in stools. Getting MRI done won't provide any additional information, just adding to cost of investigation. Mri is definitely not advocated, CT scan has not picked up any abnormality. Unlikely that based on your symptoms,mri will provide any further useful information. Coincidentally diagnosed diverticula are quite a common finding in patients aged greater than 50 years especially if they consume a diet low in fiber. Diverticula may also slightly contribute to your complaints but may not be solely responsible for your complaints. They don't require further intervention apart from advising diet high in fiber. After the further work up, if your local surgeon consider surgery indicated you can go ahead with it . From the description they seem to be quite experienced. Wishing you a healthy life Take care Regards Dr Deepak

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