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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Reason For Acid Spewing Out During Night?

Hi, I live in Canada and have severe Gerd. I have also had a gastroplasty 14 years ago. I am on the lastest medications which after awhile become ineffectual, purchased a $9000 electric bed to elevate my upper torso and eat healthy, and try to stay away from food triggers. I will stop eating hours before bed and i still have acid spewing out of my nose and mouth 1 - 4 times per night. Sometimes hours after Ive gone to bed. I have been scoped, do not presently have Barrets esophagus and had esophageal motility tests done. I do have peristalsis in 90% of solicited swallows, but most contractions are of low amplitude. There does not appear to be any surgical options for me available here in Canada due to my bariateric surgery. Please help. Thank you, Claudia
Tue, 8 Nov 2016
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General Surgeon,  's  Response
hello,
1) prolonged GERD, severe GERD (reflux upto mouth) indicate underlying anatomical abnormality (as esophageal motility test had no any abnormal finding in your case)
2) most common anatomical abnormality is hiatus hernia in which diaphragm opening from where esophagus enter into stomach is wide. This causes upper portion of stomach to move upward into chest and due to this valve function of esophago-gastric junction will be lost and symptoms of GERD will be prominent
3) medium to large herniation can be detected in upper GI endoscopy. Otherwise it might require CT scan of abdomen for confirmation
4) another most common cause is laxity of diaphragm opening due to obesity and this is most common cause if GERD in ibese patients
4) having done bariatric surgery previously, it is important to know which procedure was done as after certain procedure (sleeve gastrectomy) hiatus hernia is nearly impossible to develop.
5) in your case, first confirmation of cause which develop GERD is essential and also it decides further treatment plan but till that confirmation you should continue your medications for GERD.
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Reason For Acid Spewing Out During Night?

hello, 1) prolonged GERD, severe GERD (reflux upto mouth) indicate underlying anatomical abnormality (as esophageal motility test had no any abnormal finding in your case) 2) most common anatomical abnormality is hiatus hernia in which diaphragm opening from where esophagus enter into stomach is wide. This causes upper portion of stomach to move upward into chest and due to this valve function of esophago-gastric junction will be lost and symptoms of GERD will be prominent 3) medium to large herniation can be detected in upper GI endoscopy. Otherwise it might require CT scan of abdomen for confirmation 4) another most common cause is laxity of diaphragm opening due to obesity and this is most common cause if GERD in ibese patients 4) having done bariatric surgery previously, it is important to know which procedure was done as after certain procedure (sleeve gastrectomy) hiatus hernia is nearly impossible to develop. 5) in your case, first confirmation of cause which develop GERD is essential and also it decides further treatment plan but till that confirmation you should continue your medications for GERD.