Fundoplication - Go for it?

Hi everyone,

I'm new (okay, maybe a tiny bit of a lurker), and would greatly appreciate any advice from fellow reflux sufferers. Sorry in advance for the wall o'text. :)

In my early 20s, I was struck with really bad abdominal pain and nausea. I had loads of tests (scans, bloodwork, stool analyses, etc). They ruled out food allergies, intolerances, Celiac, inflammatory bowel disease, Crohn's, H. pylori infection, and diverticulitis. [and probably some more stuff too; I can't remember... but those were the big hitters]

Eventually, I was diagnosed with gastroesophageal reflux disease, irritable bowel syndrome, and Barrett's esophagus. A gastric emptying study showed I had a slightly abnormal emptying time (potentially mild gastroparesis), but apparently it was hard to determine if that was natural variability or a true abnormal result since it was just slightly out of the reference range.

Since then, I've had about 5-6 endoscopies to monitor and biopsy the Barrett's esophagus. Some biopsies have been negative, and some have been positive (about half and half). The most recent endoscopy reports note: esophageal stricture, esophagitis LA grade 3, cameron ulcers, and large hiatal hernia. I'm still awaiting the biopsy results. One report a few years back noted that there was still some residual food in the stomach from the night before, supporting delayed stomach emptying. Another older one noted gastritis. Bloodwork shows consistently raised inflammatory markers (CRP, ESR).

My symptoms are, thankfully, well controlled with high doses of PPIs and domperidone. Would it be worth it to try and go for a fundoplication as well, or is there no point since my symptoms aren't really bothersome? Would it be worth it to correct the large hiatal hernia? (I don't know what qualifies a hernia as "large" but apparently, mine is large) Or to theoretically stop taking the medications for the rest of my life?

I'm in my late 20s now, am not obese, have never smoked, and at most, have about 3-5 alcoholic drinks in a year.

I'm seeing my specialist again in September. We had previously discussed a fundoplication briefly, but he didn't seem too keen on it because I wasn't in discomfort. (if it's not broken, don't fix it) I'm wondering though if it would be worth it to push for one anyways because even though my symptoms are well controlled, my endoscopy reports continue to note abnormalities (like Barrett's esophagus and esophagitis) seemingly caused by reflux.

Any thoughts? Anyone been in a similar situation?

Altair-- I would think that decision to have surgery will largely be dependant your quality of life. If your reflux significantly interferes with your daily functions or creates significant distress, then surgery is probably indicated. My surgery is on the 28th of this month. My reflux began in my early 20s, but initially was well managed with PPIs. As I developed a hiatal hernia my symptoms worsened and PPIs were useless against night-time regurgitation.

Altair,

I'd definitely consider a second opinion. I'd been on PPI's for many years and it was to the point where I wasn't getting any relief any longer so surgery was my only option. For you, it doesn't appear that you're in an incredible amount of discomfort so from a pain and comfort perspective you may not be a candidate for the surgery. That said, with the number of esophageal ulcers and the presence of Barretts, I'd certainly consider the procedure only as a preventative measure to avoid the Barretts being a cancer risk. The risk is low that Barretts cells lead to carcinoma of the esophagus however if untreated that low risk could turn into something high risk. Just because you aren't experiencing any significant pain or discomfort doesn't mean there isn't damage being done.

Take care and be careful!
-TonyG-