Criteria for Nissen fundoplication?

Can anyone tell me what the criteria are for considering a nissen fundoplication?  I have had heartburn/acid reflux for most of my life.  Recently, they've found erosive gastritis/erosive esophagitis caused by breakthrough acid (I take a double dose PPI), yet no one has even mentioned the surgery.

Elcamino

Dear elcamino and friendlygal,

I am wondering about the criteria for surgery also.  Like you, I take double PPIs (plus Zantac and Gaviscon) and am suffering more than ever.  My current symptoms include: incredibly painful burning sore throat, painful and difficult swallowing, acid stomach, regurgitation, stomach pain, headache, exhaustion.  I have had recent endoscopy and barium-swallow x-ray exams and was diagnosed with Barrett's at the lower end of the esophagus (near the LES) but apparently no hiatal hernia. 

I am also frustrated with the doctors.  I was told by the GI specialist that I was not a candidate for surgery because they do not see a hiatal hernia.  Yet, the stuff that I  have read on line and in books does not mention that you have to have a hiatal hernia in order to be a surgery candidate. 

I have also been recently told by the GI specialist at the large medical foundation where I get my medical care that:  - I have failed drug therapy - There is nothing more they can do for me - I will just have to manage this. 

LIke you, I am in constant pain.  I am doing all I know to try to get better including regular taking care with my medication, eating an extremely restricted diet under the guidance of a certified clinical nutritionist; taking homeopathic herbal remedies, probiotics, fish oil, calcium and vitamin B; going to an experienced, licensed acupuncturist for weekly treatments; meditation; not working (I left my stressful career job).  Nothing seems to work.  I was better for about 2 weeks after starting the brown rice/ veggies & fish diet then I seemed to crash and burn again this week for no apparent reason.  I almost cant think straight because of the pain in my throat and esophagus.  I used to just have gut pain and acid.  I still have those problems but now, my throat and esophagus are the most painful areas.

Can you let me know if you have experienced the same symptoms?  What have you learned? 

Are you considering surgery?  What have you been told about risks, success rates, types of surgery, etc? 

Do you think menopause plays into this?  I seemed to slam into menopause when I stopped taking the pill in April -- no period since then and the acid problem and reflux has been worse then I could ever imagine since. 

                       

Interesting. I have never heard that you have to have a hiatal hernia to be considered for the nissen fundoplication.  Maybe for insurance reasons?  I do have a hiatal hernia, but it is very very small and insignificant--not a source for my acid problems.  I will ask my GI doctor when I see him in September, and let everyone know what he says.

el

ElCamino and Margdell,

Has your doctor given you a motility test to see whether your stomach is emptying normally or does food stay in your stomach along time. If it does, this can cause non-acid reflux which can burn just as much as acid. Our stomachs have other gastric juices and sometimes bile can reflux also and if your stomach is not emptying quickly enough these juices tend to reflux up as your food is just lying there trying to digest. One natural product that helps hurry up the process of emptying is orange peel extract. If this doesn't help enough, then your doctor will prescribe a drug to help the stomach empty faster.

This really helped me because I thought the PPI's weren't working. I also suggest you try another GI doctor because plenty of people have the surgery who do not have a hiatal hernia. Go to Heartburn-help.com and under the Nissen Fundoplication catagory, you can talk to several people who have had the surgery. I know what you're going through and I pray you get some relief soon.

thanks for the responses everyone.  I have had the esophgael motility testing done, and I do have a hypomotility disorder.  I have not had a gastric emptying scan or anything like that.  Although I did recently have a HIDA scan done to test for bile reflux.  Everything was normal there (no surprise to me).  My GI did not say I had to have a hiatal hernia to be considered for the surgery; actually, he hasn't said anything about the surgery at all.  I will ask him when I see him again, because I also worry about the long term effects of taking PPIs.  I can tell you, though, that since I've been on 80 mg of zegerid I've had no problems with  acid indigestion/reflux at all.  It works so much better for me than the aciphex. 

El