How can bile reflux be effectively managed?
Unfortunately surgical treatment is not effective in some patients- further explanation below.
Thanks for posting your query.
I carefully read your question and understand your concern.
Reflux can be very difficult to be treated and it might still be a problem even though patients take twice a day a PPI (Nexium) which is the first line treatment and the best one to control it. So your symptoms might still be due to reflux that might be refractory to the treatment.
You seem to be doing the right things eating light meals, not eating late at night, having your bed head lifted, these are things that can help a lot reduce the reflux but still some patients still have symptoms. Smoking and alcohol also are not good for the stomach and make the reflux worse.
Having the endoscopy is very recommended to see if there is damage of the esophagus due to the reflux and also if there is any changes in the stomach mucosa. It will help confirm that there is reflux and also rule out other local conditions. Endoscopy is recommended to be done regularly in patients with reflux.
If the combination of Nexium and other measures you are already trying are not helping enough sometimes there is surgical treatments that can be tried but this is a decision that is taken with the surgeon as many times these are not very effective and the patients need to weigh well benefits, side effects and the risk of recurrence of the problem.
Loosing weight is very important also. If you have gained weight recently or your weight is not as it should be for your height, loosing some kg might be very helpful to reduce symptoms.
Hiatal hernia is a very important cause of resistant reflux disease as it is an anatomical blockage that might prevent the normal function of the gastroesophageal valve locally.
Fundoplication is a procedure that is sometimes tried but some patients do not find it very helpful and literature still is not strong on its use and effect. There are a few kinds of surgical treatments and fundoplication and consulting a surgeon would be a help to know if you would benefit from it and if so which type of surgery would be more of a help.
I hope this gives some helpful information for you.
Dr. Zotaj Antoneta, General & Family Physician
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