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Nissen for LPR - am I a candiadate or not?

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Posted 6/8/2011 2:05 PM (GMT 0)
Here is my situation:

- I can not take the PPIs (bad side effects)
- My LPR is comparatively mild so far and is sort of manageable with the diet
However, I experience quality of life issues daily - throat ache, slight burn in the tongue etc.

Plus:
- I am not a "volume" refluxer
- My manometry results were normal (LES pressure is normal).
- My dual pH scores were: about 62 times reflux in the throat (highly abnormal) and 51 in the espophagus (not that abnormal)

Now - does it then mean that I am *not* a good candidate for Nissen to fix my LPR? I'd rather just fix this thing and move on .. but don't want to get a new set of problems for myself and then .. not be able to get the underlying reflux fixed either ..
Posted 6/8/2011 2:57 PM (GMT 0)
you and i, are in the same situation,


-LPR
-normal manometry
-abnormal ph test (impedance in my case)
-not a "volume" refluxer" either

that *does* mean that you are not a candidate, no surgeon will perform a nissen on a patient with normal motility, if you see it from the doctor's point of view it's actually quite logical, why operate when there's nothing to fix (normal LES in this case), my pressure was low normal 12.7 but still i can't have surgery because of that result. Im not sure but i think esophageal sphincters relax while you are sleeping, im a night refluxer so maybe that's what's causing the problem. Do you have any anomaly on your GI tract? my manometry was not completely normal, it says a have a "nonspecific esophageal motor disorder" no idea what that is supposed to mean, and i also have a hypotonic stomach (long stomach). It's not uncommon for LPR patients to have normal motility but when GI's are not familiar with LPR they almost dont believe one actually HAS reflux,

what do your doctors say?

what are your symptoms?
Posted 6/8/2011 5:15 PM (GMT 0)
My GI doctor does not think I should get the surgery - my ENT doc says we should not rule it out yet.

My symptoms are:
- throat ache, hoarseness
- voice gets weak by the end of the day
- swallowing grinding sensation in the throat - esp. after the meals
- acidic taste in the mouth at times
- sometimes the tongue feels kind of burned

My LES pressure is 24.4mmHg (normal 10-45 I believe)
Posted 6/8/2011 6:06 PM (GMT 0)
same here, ent docs keep mentioning surgery but gi's say no

my symptoms are

-hoarseness
-throat clearing
-acid taste at times aswell
-sore throat
-i spit yellow saliva in the morning

my pressure is 12.7 mmhg

ppi's didn't solve anything for me, there gotta be something we can do to fix this.
Posted 6/8/2011 7:22 PM (GMT 0)
Neptunian,

Im no expert, but isnt yellow saliva a sign of bile reflux? Have you had your gall bladder checked?

Chuck

Post Edited (Chuck T) : 6/8/2011 1:26:43 PM (GMT-6)

Posted 6/8/2011 7:58 PM (GMT 0)
yeah i did it was all normal, i say this is bile reflux too but since im not a "volume refluxer" i had a negative bilitec, that's the test the measures bile reflux but only in the esophagus, i had a 29 min episode at night but that wasnt enough to be considered pathological
Posted 6/8/2011 9:00 PM (GMT 0)
These darn GI doctors just dont understand how fragile the throat is. Its so annoying. Id be willing to bet that 29 minutes of bile hitting your throat (if its getting up there) does a good bit of damage. ENTs and GIs really need to combine fields.
Posted 6/8/2011 10:39 PM (GMT 0)
Have you guys considered going to UK and getting the LINX procedure done?
Posted 6/9/2011 1:00 AM (GMT 0)
i would travel anywhere to get rid of this darn disease but i dont have the money.
Posted 6/9/2011 1:12 AM (GMT 0)
@Chuck T, i couldn't agree more, the bile is definitely reaching my throat since i see it everyday when i spit, GI's just don't care, i have to see one tomorrow, he'll probably say im imagining things, i dont even know why i bother.

There has to be a solution for ppl with LPR who still have symptoms despite ppi therapy.

there's a new drug called lesogaberan that is being develped by Astrazeneca (the ones who made nexium) that should reduce non acid and weakly acidic reflux events same as Baclofen but i bet it wont be available anytime soon.

so it's surgery or a new drug, but in the meantime it would help if gastroenterologists were a bit more understanding.
Posted 6/9/2011 9:55 AM (GMT 0)
Neptuinian - did you try Baclofen yet?
Posted 6/9/2011 3:46 PM (GMT 0)
no but i really want to, but i can't find a dr who wants to give it to me, here they don't even know the connection Baclofen has with reflux, doctors here (Chile) don't even believe weakly acidic reflux can cause symptoms so when i tell them about all the trouble this is causing me they look at me like im crazy and just prescribe more ppi's.
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