Introduction and questions about Nissen fundoplication

Greetings,

I'm glad I found this forum as it seems like a lively community with many people who've been through what I'm going through now.

I'm 29 and have suffered from reflux since I was about 18. Mostly I controlled it using over the counter antacids (rennies) which has mostly worked but recently I've found that I'm burping constantly and it's really annoying. Sometimes it's a full stomach belch but mostly it seems like I get air trapped in my throat and I have to push to expel it, it's a strange feeling, as if there's some kind of pocket of air in my lower esophagus. I strongly suspect I have a hiatus hernia, and was advised a year ago by a doctor that I probably do.

Recently the burping got to me and I started reading online and become very scared and paranoid that I had stomach cancer (my own fault for googling symptoms, you should never do this when there are 50 possible diagnoses for your symptoms :) so I went to my doctor, had a full blood panel run and they said it's definitely not cancer and is likely just functional dyspepsia and/or a hiatus hernia. They gave me 20mg omeprazole to take daily and said it'll probably calm it down but to be honest, I don't really like the idea of taking meds like this long-term. The reflux I was getting isn't really very severe, but the constant burping is very irritating and I have a constant sense of pressure and aches in my chest which feel like they're at the lower end of the esophagus (I can feel them twinging up into my tongue and jaw sometimes). At the moment I'm feeling a bit down, this problem is constantly on my mind and every 5 minutes I burp and I'm reminded that I'm not well. I'm working on getting fit and healthy but I strongly suspect that this is a physical herniation in the stomach/diaphragm and so isn't going to be fixed with lifestyle changes.

What I would like to know is, would it be worth considering a nissen fundoplication in my case, or are my symptoms too mild to warrant the risk? From what I've read it has a very high success rate and might completely relieve my symptoms. My main concern is that if I go on like I am now the problem is only going to get worse and I'm liable to be prone to Barretts esophagus (if I don't have it already) and ultimately potentially esophageal cancer. I've never smoked tobacco, I used to drink fairly frequently and smoked weed for years which I'm sure hasn't helped but I've quit everything now, I don't even drink coffee or eat spicy food but still the burping persists. The omeprazole has helped a little with the belching, but I still have this constant feeling of pressure and air pushing up into my throat which I can only assume is caused by the hiatus hernia.

I have an appointment with my doctor on monday and I'm pondering asking for an endoscopy to find out what's going on, see whether I really do have a hiatus hernia (although I'm not sure what else could be causing this) and perhaps consider surgery. I live in the UK and suspect my symptoms are probably too mild for the procedure to be done on the NHS but I can afford to go private if I wanted.

The thing that gets me down the most is the realisation that I've probably done this to myself with my unhealthy lifestyle, but hindsight is 20:20 as we all know. It's important to be grateful for what you do have though, at least I have all my limbs and can walk around and see, taste, smell etc. There are much worse things I could be suffering from.

Any advice would be greatly appreciated.

Many thanks,
Mark

Hi mark

I am in uk and have had 2nissen fundoplications, based on what you say your dosage of ppi is very low. I had reflux symptoms including burning, regurgitation after meals and sudden regurgitation in my sleep, also the burping that you detail. My burping was due to my les not correctly closing and to be honest it was not improving even on 60-90mg per day.

I am not sure what your gp has told you but ppi medication controls the acid in your stomach, effectively you produce less. I found that although I produced less all other symptoms were not improved as the medication cannot resolve a weak les or repair a hernia.

Before any surgery will be considered the following has to be done (these are N.I.C.E - national institute of clinical excellence guidelines).
1. Gastroscopy to see damage and diagnose herniation
2. Manometry testing to measure les function
3. 24hr ph monitoring

The surgeon will review the results and determine if your condition is severe enough to warrant surgery, if surgery will resolve the issue and if the outcome of not performing surgery will result in long term problems. I must also point out that my surgeon stated that he would not consider surgery on people where lifestyle changes could resolve the issue unless they tried first.

The above conditions are also the same for private surgery, please bear in mind this is not cosmetic surgery and so conditions must be met. I enquired about private but saw no benefit as the same surgeons that work in the private sector are also the same surgeons that work in the NHS.

I would not worry about barrets as it is rare, this would be diagnosed on the gastroscopy. You can have a hiatus hernia repaired without fundoplication and should ask about this. I too expressed a dislike to taking tablets my entire life and you should also strongly make this point. I can wholly recommend getting fit, I lost 15kg and converted a lot more into muscle and found that I felt considerably better, this took time but helped.

Good luck