UK member looking for help; Iatus hernia, singing, surgery operation...

Hi again, Paolo --

Thank you for providing the link for the Linx procedure.  I actually know quite a bit about this procedure already, as I am a patient at the Mayo Clinic in Jacksonville, FL, which is one of the centers in the U.S. where the Linx will be made available on a limited basis.  Unfortunately, I am not a candidate for the Linx.  I have had a previous surgical procedure (which disqualifies me), and, as a result, my reflux now technically falls into a "normal" range.  The Linx is only available to those who test above 5% pH<4.0, and also can not be implanted in those with a hiatal hernia.  Even if I was a candidate, it is not currently covered by insurance here in the U.S.

Why did I go with the TIF instead of a Nissen?  Primarily because it is less invasive, and because I didn't believe that my condition was serious enough to warrant such a drastic overhaul of my upper GI tract.  As it turns out, the results I was able to get through the TIF are very close to what is theoretically possible with the Nissen.  My percentage of reflux <pH 4.0 was reduced from about 6% to 2.9%, and the theoretical limit for a Nissen is about 2.0%.  However, the fact that I also apparently have a weakened upper esophageal sphincter, which allows the reflux into my throat, means that even that small amount of reflux produces symptoms.  So, it didn't matter that I chose the TIF instead of the Nissen, nor would tearing down the TIF to get a Nissen now produce any positive results...and would probably end up making my life even more uncomfortable than it is now.

There has been quite a lot of anticipation and hopes built around the new Linx device.  However, it is not the "be-all, end-all" GERD solution.  It is not being promoted as a replacement for the Nissen, and there is simply not enough data presented to demonstrate its overall effectiveness.  You say that you know that the TIF is not as efficient as the Linx...I have not seen anything to this effect.  As far as I know, it's being promoted as a "bridge" procedure, the same as the TIF, as a surgical alternative between PPIs and the Nissen.

In 2008, I was 47.

A sliding hernia is just what it sounds like: depending upon certain conditions, the fundus of the stomach can be in a normal position, or, it can slide upwards through the hiatus...when it becomes a hernia.  What can cause it to slide?  Perhaps bending over, or a full meal, or lifting something heavy.  When an inexperienced GI doctor inflates the stomach during an endoscopy, it will force the fundus upwards through the hiatus, and perhaps make the hernia temporarily worse than it otherwise would be without the inflation.  This is what happened to me, and why a 2.5cm hernia appeared in one endoscopy, and none six months later when the procedure was done correctly by an experienced doctor.

The esophagus passes through an opening in the diaphragm called the hiatus.  The hiatus should fit snugly around the esophagus, but, sometimes will stretch and become large enough to allow the fundus to push upwards.  Measuring a hiatal hernia is not an exact science, but, generally speaking, it's the distance from where the esophageal "z-line" should be positioned, either at or just below the hiatus, and its new position above the hiatus.

There are no medical alternatives for me.  As I mentioned before, I can not take PPIs because of the side-effects, and, since I seem to have a sensitivity to reflux that goes beyond what even a Nissen could realistically offer, there is no point in exploring additional surgery which would likely make me even more miserable.  I've driven thousands of miles to see eight different doctors over the past four years, at one university hospital, and two other large medical centers in addition to the Mayo Clinic.  For me, this is the end.  But you are much younger, and have opportunities and motivation that I no longer do.

Thank you for your well-wishes, and offer to translate Italian.  I'm sorry that I can't offer you anything really useful, but I hope that you find some better answers soon with your next doctor's appointment.

-Bruce

Hi Paolo --

The Linx system is only being made available on a limited basis right now in the U.S., and I simply don't qualify for the reasons I pointed out.  No matter how I might argue with the docs, it doesn't matter.  The doctors at the Mayo Clinic are fully aware of the loss of my voice and the impact on my life, and I remember the look on their faces when they told me there was nothing that could be done. 

There was one forum member who traveled from the U.S. to Italy to have the procedure done.  This is the thread: https://www.healingwell.com/community/default.aspx?f=45&m=2276616  Perhaps my perspective on this disease, and the world, might be different if I had a lot of money to spend.  Unfortunately, I am of modest means, and something like this would be out of the question for me.

I agree that the Linx does sound interesting, however, one of the things that bothers me about it is the narrow pressure point on the esophagus created by the ring, instead of a broader band such as is created by fundoplication.  Also, since I have had the TIF, I don't know how this would complicate the implantation, including how the vagus nerve would be addressed.  I assume that my vagus nerve is somewhat pinched by the TIF.  All this is academic pondering, anyway...

I don't understand why they wrote diameter on the report for your endoscopy.  Is it possible that you could call and ask?  The only way you could measure the diameter of the hiatus is within the chest cavity with a laparoscopic instrument.

I'm concerned about the pain you're describing in your stomach.  If what you are describing is something like gastritis, or even an ulcer, GERD surgery won't do anything for this.  I hope you can get some clarification for this symptom soon.  In the meantime, have you ever tried Pepto Bismol?  Does it help ease the symptoms of stomach pain?  Maybe I'm not understanding what you're describing.

-Bruce