Does fundoplication help in treating acid reflux?

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Posted on Tue, 27 Oct 2015 in General Health
Question: Hello Dr. Rynne,
I have been diagnosed with GERD, have a hiatal hernia and acid reflux issues. I had a test that measured the acid content in my stomach and it was found to be quite high (score of 47 when the dr would have liked to see a 14). I have been taking a proton pump inhibitor for a couple of months now and it helps some. I am having a lot of lower abdominal discomfort after eating almost anything. Are these all related? I am 63 and 40 pounds overweight. Other than that I am in good health. My Dr is suggesting surgery to repair the hernia and stop the acid from doing damage to my throat - fundoplication I think. It sounds like a good idea, but I don't see how that will help with the amount of acid my stomach produces. Would really appreciate your input. Thank you very much, XXXX XXXXXXX
doctor
Answered by Dr. Shoaib Khan 25 minutes later
Brief Answer:
There are other options, but fundoplication can also help

Detailed Answer:
Hello XXXX and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. i would like to start off by saying that fundoplication itself helps in reduction of acid reflux, especially into the oesophagus. But there are many options (surgical) that can help to reduce acid production and may be your doctor can help explain more of this to you in person.

But it entails removal of a part of the stomach (the lower part) which provides the reflux for production of acid, thus resulting in lowering of acid production and not just prevention of acid reflux into the oesophagus.

So while fundoplication can help only to prevent or reduce acid reflux into the esophagus, there do exist procedures to cut down on acid production as well. They have their pros and cons, but it is a long topic and best discussed or considered after a long discussion with a surgeon.

I hope you find my response helpful. Please feel free to write back to me for any further clarifications, I would be more than happy to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shoaib Khan 2 days later
Thank you for your response, Dr. XXXXXXX Your reply went to my SPAM and I just found it.

Could the acid production in my stomach the reason for the severe - intermittent abdominal pain I experience? I can go days without lower abdominal pain and then have several days in a row where literally everything I eat causes extreme cramping and discomfort. Usually constipation is not an issue.

In addition to the reflux issues I have a large hiatal hernia. Would the surgery you mentioned make repairing the hernia unnecessary?

Thanks you,
XXXX
doctor
Answered by Dr. Shoaib Khan 6 hours later
Brief Answer:
Possible, but more common due to acid manifestations

Detailed Answer:
Hello once again Ma'am.

Yes, hyperacidity can cause severe intermittent abdominal pain but in more cases than not, the pain is usually due to the manifestations of hyperacidity (e.g. ulcers). So as I recommended, an upper GI endoscopy would greatly help.

I was talking about two possibilities:

1. Fundoplication: Which your doctor recommended that can help the hernia as well as prevent acid reflux

2. The surgeries I mentioned, were to aid cutting down the production of acid which in itself should help with suppressing a few or most of the hernia symptoms as well

I hope my response helps. Please feel free to write back to me for any further clarifications, I am always here to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shoaib Khan 7 hours later
Hi Doctor,

Just to be clear - I have had 2 upper GI endoscopy tests in the past 6 months - neither showed any sign of ulcers - a "Bravo" was left behind on the second test to measure the activity and level of acid in my stomach. I kept a diary of my activities, diet and discomfort for two days. the results of that test showed over 100 acid episodes in 48 hours as well as the acid measure (whatever that is) was 47 when the doctor would have liked to see it at 14.

I also had a swallowing test (x-rays and swallowing barium) to help determine the nature of my hernia and narrowing of the esophagus.

During each upper GI, my doctor, Dr Parra expanded the narrowing in my esophagus with a procedure using a balloon.

My concern is that, while I agree that it makes sense to repair the hernia, I am concerned that the fundoplication itself will not do anything about the amount of acid my stomach produces.
1 - What is the procedure called that removes or reduces the proton pumps in the bottom of the stomach?
2 -Can that surgery be done with a scope at the same time as the hernia repair
and the fundoplication?
3 - Would all three be necessary?

Thank you very much for your responses - you are helping me to better understand my options before I meet with my specialist again.

Sincerely,
XXXXX
doctor
Answered by Dr. Shoaib Khan 5 hours later
Brief Answer:
All options and queries addressed in detail

Detailed Answer:
Hello XXXXX

1. First you should know that there are 2 stimuli to the production of acid in the stomach. The first and main one comes from the parietal cells that are lined in the body and the fundus of the stomach. The second one comes from the antrum of the stomach (lower region), which produces gastrin. This gastrin provides a stimulus to the parietal cells to produce acid.

The surgery of choice in my opinion would be a highly selective trunkal vagotomy + drainage. In this surgery we cut selective branches of the vagus nerve that causes cut in supply to the parietal cells that produce the stomach acid.

2. Usually it is not done by a scope, but it can be (but only by trained surgeons); and yes it can be done at the same time

3. If you plan on going ahead with the suggested surgery, then a fundoplication may not be required at all. But the surgery I have suggested does have its pros and cons, and is much more serious than a simple fundoplication.

A fundoplication, as you suspected will only moderately prevent the reflux of acid into the oesophagus, but the acid in the stomach will remain the same. As for the surgery I suggested, will solve the acid production problem in the stomach altogether, but has its side effects.

I hope I have explained things in a manner best understood by you. Please feel free to write back to me for any further clarifications, I am always here to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shoaib Khan

General & Family Physician

Practicing since :2009

Answered : 9409 Questions

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