Bravo PH testing and oesophageal manometry prior to nissen surgery

Hi guys,

I am new to this forum. I was hoping I could get some advice from some helpful souls who have been trough the process I am about to go through now.

So basically I am a 35 year old female and I have had constant heartburn and indigestion for more than 12 months now. (And on and off before since I was a child). Tried all the recommended stuff, loosing weight- done- 60 pounds in fact so my BMI is now normal, bricks under the head of the bed, reflux pillow, vegan diet, staying away from trigger foods, don't smoke, don't drink alcohol. I eat smal portions frequently, I don't eat late. You name it, I'm doing it. The doctors tried me on various PPI's, Omeprazole, Lansoprazole, Esomeprazole, Raniditine but no relief.

I had endoscopy last September and it showed small hiatus hernia, incompetent LES, mild duodenditis and gastritis. 5 weeks ago on top of my usual symptoms I got excruciating chest pain, couldn't swallow even water, felt like something was stuck in my chest, had sore throat, post nasal drip. My boss at work put me into a taxi and sent me to A&E- they said they suspected my esophagus got inflamed and bumped Esomeprazole up to 80mg a day which helped to calm the chest pain down but I still can't eat solid foods 5 weeks later cause it hurst my chest.

I saw a very pleasant gastroenterologist end of last month who said that I need nissen fundoplication as I have tried everything else without success. He's going to do the 48 hr Bravo PH testing and oesophageal manometry in a day's time, luckily I have been told I can stay on my PPI for these tests due to my chest pain although I might drop down to 40mg for those two days and eat some trigger foods if I can bear it. I am a bit worried that the bravo test will make my chest hurt even more but I guess I will just have to take some stronger painkillers cause I was told that this is a requirement before the surgery.

So my question is, anyone out there that has been trough the tests and surgery and can give me some advice on what to expect?

Your input would be very much appreciated.

By the way, I am not scared of having surgery, I had spinal surgery- lumbar fusion 2.5 years ago and have 2 titanium screws in my back. I just can't believe I have to have another big surgery again! 😞

I really hope this will help as my quality of life has been really low for the past year, I would really like to live a normal life, eat out with friends, be able to have a drink, be able to exercise without suffering and also have a baby in the near future.

Thanks a million in advance guys

Hi Linda,

Thanks for your input, it is very much appreciated. My manometry test was fine, the gastro man said everything looked normal. The bravo test was not a success however, it started beeping a lot during the night, it kept loosing the signal even though I was holding the receiver to my chest. Then the next day it kept going off on the train on my way to work, I kept getting suspicious looks from people, they must have been wondering if I was about to blow myself up any minute. And then it still kept loosing signal and beeping when I got to work so I rang the hospital and they said it sounded like the transmitter came off too early so I had to switch it off. I have to now have it redone Monday night, on my birthday! Joy oh joy :-(

My chest pain actually got a lot better since I got bumped up to 80mg Esomeprazole so I think my esophagus must have just gotten inflamed from all the acid splashing. But still, who wants to be on such a mega dose long term? And it still doesn't quite control the heartburn so yeah, can't wait to have the surgery done.

I hope your chest keeps improving, you must have been gutted after surgery that it was still hurting, I know I would be.

I hope my issues will resolve after surgery, I tell you, this better be the last surgery, I've had enough to last me the rest of my life! Lol

Anna

Hi Linda,

I am having the second "probe" fitted tomorrow night as the first one came off too soon. I am having the 48 hr bravo ph testing. The reason my gastro man is keeping me on the PPI's is because my esophagus got quite inflamed and he doesn't want to risk it getting inflamed again. My esophagus seems to be doing a bit better on the higher dose of Esomeprazole. When he gets the results from the test he will take it into consideration that I am on PPI's.

What he wrote to my GP about this was: "I think I am in no doubt that a fundoplication is what she needs but before that she will need oesophageal manometry and PH testing. This is a requirement from a surgical point of view although in her case I don't think it is a requirement for considering an operation as her symptoms alone dictate the need for fundoplication. What I think PH studies would be helpful for is to give a predictive value as to how successful a fundoplication would be in the medium to longterm. If she has pathological reflux on Bravo testing then the likelihood of success is very high. If her PH levels are normal with very little associated episodes of reflux whether on Bravo or on manometry then her likelihood of success does fall but, in spite of that, I still think it is probably the only option available to her."

They way I understand it is that pathological reflux is when you still get reflux even though you are on PPI's. This is why I thought I drop it down to 40mg of the PPI for those two
days (cause that is the normal dose usually for GERD) and eat a few trigger foods to try and get a more accurate reading. I cannot drop to any lower dose than that cause i don't want to risk my esophagus getting worse.

Once he gets the results and has a follow on consultation with me he will then refer me to the surgeon who will then get the ball rolling on getting the surgery scheduled.

I am really pleased to hear that your symptoms are being resolved although it must suck that you still need to take pills after having been through surgery but the main thing is that you finally got your life back and that you are feeling well. Hopefully I don't have Jackhammer Esophagus, the manometry didn't show any abnormalities and to be honest the chest pain is almost but gone since being on the higher dose of the PPI after these last six weeks which is how long it usually takes for an inflamed esophagus to heal so to me that tells me that it was painful from all that acid splashing.

But anyway, I am looking forward to not having to take PPI's soon as my hair has started to fall out quite a lot since bumping up the dose, my pony tail is a lot thinner than it used to be. I am not sure if it's related but I reckon it is.

I will let you know what the results are once I've had my chat with him if you are interested. I would be amazingly appreciative if you could give me some tips for post op nearer the time.


Take care Linda

Hi Linda,

Thanks for your message. I already know who my surgeon will be as the gastro man mentioned him in his letter to my GP. I looked up his profile and this is what it says about him: "Stephen Brennan is a fully trained Consultant Surgeon with special interests in Upper GI and Laparoscopic (Key-hole) surgery. He is originally from Dublin, and has trained in Scotland. He completed his higher surgical training in the Northeast of Scotland and was trained by some of the leading experts in the country.
After this, he spent a period of furthur training at the internationally recognised centre of excellence for upper GI and laparoscopic surgery in the MATTU centre in Guildford. He has also completed further brief fellowship periods in Melbourne and South Africa for additional training. He recently has completed ‘operation hernia’ missions to rural Africa. He currently works as consultant surgeon at Croydon University Hospital and St Georges in London.
His main areas of expertise are gallbladder surgery and laparoscopic hernia repairs. He is also proficient in both upper and lower GI endoscopy."

What do you think? He sounds like the right man for the job. Here in the UK if you don't have private healthcare and are a National Health Service patient then you don't really get to choose, you get what you are given. But I think he sounds pretty decent, hopefully! He seems to specialise in things which are relevant to my surgery so fingers crossed.

Anna

Anna:

I have to agree with Linda Sue, that you need to find out how many Nissen with hernia surgeries that your surgeon has done. I'd be concerned that he does not have Nissen Fundoplication surgeries listed on his bio, and I would ease my mind and call his office to inquire about this particular form of surgery. It would be in your best interest to have a surgeon that has done many of these surgeries in the past.

Good Luck, Sharon

Hi guys,

I thought I give you an update. So I had a follow up today with the gastro man after my tests. He said that the manometry was absolutely fine and that there was no significant reflux showing on the bravo test whilst staying on PPI.

He said that in this case the Nissen might not be the best thing for me as the calculated success rate was not as high and there is a small chance that it might not work for me. What he did suggest however is to have the Linx surgery done which is less invasive and reversible. I did a bit of reading about the Linx and I really like the sound of it, it's less invasive as it doesn't actually change the anatomy of the stomach, reversible, no hospital stay required as it's done as a day case. I will be able to burp and be sick, no need to be on liquid diet and only one week off work. The only thing is that I won't be able to have MRI which I'm not too bothered about.

He said it's quite a new procedure and only 5 hospitals in the whole of UK currently do it on the national health service. The selection process is quite rigorous and only a few people are referred for it at the moment. It's only finishing it's trial period and the results and very promising with a success rate of over 90%. He said that I could still have the Nissen done if the Linx doesn't work but if I have the Nissen done and it doesn't work then I'm stuck with it as they can't undo it.

It's free here on NHS. So he's going to write back to my GP who is going to refer me to the surgeon. Luckily there is a hospital nearby that does this surgery. He also said that only a handful of surgeons do these surgeries over here and so they are all top notch and that I will be in very good hands. Hopefully I won't have to wait too long as he has already done the necessary tests and he said the surgeons usually accept the results from him and do not require retesting.

So that's it for now, I must say I'm really pleased with the outcome and am looking forward to getting off PPI's and to getting my life back!

Ttfn xx