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Will nissen fundoplication help in minimising GERD and LPR symptoms?

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Gastroenterologist
Practicing since : 1996
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Hi, I have GERD and likely LPR also.I would expect that a nissen fundoplication would help both the GERD and LPR correct?The LPR symptoms because in the throat and associated chronic fatigue appear more annoying than the Gerd now. Thx. XXXXXXX
Posted Thu, 21 Nov 2013 in Digestion and Bowels
 
 
Answered by Dr. Ratnakar Kini 4 hours later
Brief Answer: Nissen fundoplication will help Detailed Answer: Hi, Thanks for posting your query. I am Dr.Ratnakar Kini and I am pleased to assist you. Nissen fundoplication will help relive symptoms of both GERD and LPR. But surgery ( Nissen fundoplication) should be the last resort while treating GERD and LPR. Medications and lifestyle changes should be tried first. You have mentioned you have been taking nexium and zantac. You need to take nexium twice a day before food or about 8 weeks. Other things you need to do are - 1. Try to reduce weight if you are obese 2. Avoid coffee, citrus, fatty food, tomatoes 3. Avoid alcohol/smoking 4. Eat only smaller but frequent meals 5. Avoid bedtime snacks and go to bed at least 2-3 hours after food. 6. Keep you head elevated while sleeping 7. Avoid tight fitting clothes. If there is no response to medication and lifestyle changes, then you need to get tested with 24 hours pH monitoring test and also get tested for bile reflux. I hope that answers your question. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
Above answer was peer-reviewed by
 
Follow-up: Will nissen fundoplication help in minimising GERD and LPR symptoms? 42 hours later
Thanks for the response.Have done most lifestyle changes for awhile now but can still work on the diet i consider myself at about 80% compliance.I have not done two ppi's a day because a friend of mine has done that and now his body cannot go back to one per day.Is the double dosage of ppi to stop my current bout of esophagitis/lpr or for long term treatment?My stomach spends so much energy now digesting a small meal i can't imagine what this would be on two ppi's per day... I don't think i will be alive very long if i have to take double dose of ppi's for long term.Even on single dose for 15 years my stomach has gastritis in two places. Anyways i am scheduled for mannometry and ph study on November 4 and if no improvement by then i will try the double dose for awhile but i am so concerned about that in the long term.Don't want to go from two pills to none for five days before the test even if i can take xantac for some of that. Where do i get tested for bile reflux and what does the test consist of? Is it normal to be tired easily during a bout of esophagitis/lpr? Thx. XXXXXXX
 
 
Answered by Dr. Ratnakar Kini 7 hours later
Brief Answer: Detailed answer given below Detailed Answer: Hi XXXXXXX Thanks for getting back to me with more questions. Twice daily dose of PPI is to control you symptoms of GERD/LPR. Once the symptoms are controlled, you can either stop PPI or continue low dose PPI if there is recurrence of symptoms. You have mentioned you have chronic gastritis that is not cured with PPI. In this situation, you need to get tested for H.pylori infection as it is a common cause of chronic gastritis and needs different treatment and not just PPI alone. PPI are relatively safe medications and some of the common side effects I see in my patients are diarrhea and head ache. But in elderly individuals who take PPI for months/years can have worsening or osteoporosis. Bile reflux is diagnosed with Bilitec 2000 probe test. Getting tired easily is not a symptom of GERD/LPR. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
Above answer was peer-reviewed by
 
Follow-up: Will nissen fundoplication help in minimising GERD and LPR symptoms? 11 hours later
Thanks again.I have been on ppi's for 15 years and was never able to get off them.Tried this summer over 1.5 months and gave myself esophagitis and lpr that haven;t gone away yet. My symptoms had started going downhill in early 2012 so i was referred to gastroenterologist who did endoscopy in May 2012 and found moderate esophagitis on biopsy plus chronic gastritis in 2 spots of the stomach.Biopsies on stomach,esophagus and small intestine did not reveal h. pylori and later that year i took the blowing test for h. pylori which came out negative. I also have gallstones with no bile duct dilatation noted and small hiatus hernia plus a bit of fatty liver..So what is the test you had in mind for h. pylori so that i can clear my mind of that at least.Where do i go to get the bile reflux test? You say elderly people who take ppi for years have "worsening" can you please elaborate;what do you do if they can't take the pills anymore because it seriously affect their digestive system? Should i take another blowing test for h. pylori? Thx. XXXXXXX
 
 
Answered by Dr. Ratnakar Kini 5 hours later
Brief Answer: Detailed answer given below Detailed Answer: Hi XXXXXXX Since you have been tested for H.pylori twice before, and it came out as negative, I do not think you need to get tested again. I am from a different country and so I may not be able to tell you where bile reflux test is done in your place. You can discuss about that with your doctor. Elderly persons especially above 70 years of age have weak bones due to osteoporosis. If these persons take PPI for a long time, osteoporosis will get worsened and they may develop fractures of the vertebra. If they cannot take PPI, they can go for H2RA like ranitidine, lafutidine etc. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
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Follow-up: Will nissen fundoplication help in minimising GERD and LPR symptoms? 46 hours later
Thank you very much.We will see what comes out of the mannometry and ph studies and go from there.I am hoping there is long term research occurring on the effects of ppi's on the digestive process,i think it is mores serious than osteoporosis. XXXXXXX
 
 
Answered by Dr. Ratnakar Kini 4 hours later
Brief Answer: Will wait for the updates Detailed Answer: Hi, PPI is just 2 decades old. The first PPI omeprazole came to the market only 2 decades ago. Research is still going on to know about the long term effects of PPI and also newer PPI are entering the market which are more effective. I will wait for the updates from you. Regards, Dr.Ratnakar Kini
Above answer was peer-reviewed by
 
Follow-up: Will nissen fundoplication help in minimising GERD and LPR symptoms? 19 hours later
Thank you again.I was diagnosed with small hiatal hernia about 24 years ago and i am pretty sure i was prescribed Pantoloc for 1 month following that episode.Then i had about 7-8 years pill free before i was formally declared with GERD and then took PPI's for about 15 years.My doctor told me that PPI's take away about 90% of our gastric acid secretions.I think our stomach can go by a number of years with that but after a while they have difficulty and we get told to go on the GERD diet because our stomachs no longer can digest fats/complex carbohydrates with 10% acid secretions do you agree.My stomach has been functioning quite differently for about 2 years now and cannot seem to digest the fats very well anymore.I also have way more XXXXXXX gases which i had very few before.I also have LPR and bad esophagitis.I think my body is telling me it cannot take the PPI'S very well anymore. I think 5-10 years without the pills with surgery would help me but have to go thru the mannometry/ph test next week first.It was almost a 1.5 year wait for this it's ridiculous.But i will try your double dose of ppi's after the test for awhile to see but i am afraid this may cause more gastritis or infections.Do you work in the States?
 
 
Answered by Dr. Ratnakar Kini 25 hours later
Brief Answer: Detailed answer given below Detailed Answer: Hi, Thanks for getting back to me again with more questions. I would like to tell you that stomach alone is the not the site of digestion. Early phase of digestion takes place in stomach. But the most important phase of digestion and absorption takes place in the small intestine. I would like to tell you people who undergo total gastrectomy ( complete removal of stomach) still have good nutritional status. The research done so far say it MAY affect the absorption of vitamins and minerals only and there are conflicting reports also. Yes, long term PPI can lead to infection like small intestinal bacterial over growth/c diff infection. No, I do not work in the States. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
Above answer was peer-reviewed by
 
Follow-up: Will nissen fundoplication help in minimising GERD and LPR symptoms? 24 hours later
Today i started my five days without ppi's before mannometry and ph test.So i only took 2 xantacs and my energy levels are much better but esophagitis symptoms not as good.When i take ppi's i am very tired when digesting food even small light meals which form most of my diet now.I also have urinary tract sensitivity for about 1 month now and cipro antibiotic did not get rid of it.My esophagitis symptoms are always worse during the evening,how come? And you are suggesting moving to two ppi's per day versus one nexium and one xantac.I just think generally the body gets used to the new dose and then i am stuck with two pills per day that will make me even more tired at digestion and likley increase the chances of infection in the digestive system.Also my hemorroids are back even on a very good light diet.Don't you think its because the ppi's are negatively affecting the liver function? I think the nissen fundoplication may give me 5-10 years for esophagitis/lpr to recover and hopefully digestive function to slightly improve.If not i think the digestive function will continue to deteriorate same as esophagus.don't you think so?Please tell me why i would not be better with the operation even if 10% have nightmares to go through (esophagal dilatation, etc...)?At 57 years old if i wait too long i'll be too old or my symptoms too advanced for surgery correct? Thx. XXXXXXX
 
 
Answered by Dr. Ratnakar Kini 23 hours later
Brief Answer: Detailed answer given below Detailed Answer: Hi, If you feel PPI makes you tired and also get good relief with Zantac, you can continue taking Zantac twice a day. You have mentioned with Zantac alone, there is no complete relief. You can take Gaviscon for relief of esophagitis symptom. We have been discussing for quite sometime now and I get the feeling that you are very much stressed about your GERD issue. I would advise you to follow some stress relief method which will make a lot of difference. Meditation is one simple thing which is very effective for stress relief. PPI-s do not affect the liver function. As said earlier, when medications and lifestyle/dietary changes do not provide relief, you are left with no other option but to go for surgery. And surgery do provide relief. It is only that you have to keep it as the last option when other measures fail to give relief. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
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