Please Help GERD and Hiatal Hernia

Hi theacidrefluxman,

When you say your esophagus looks perfectly healthy, is that because you had an endoscopy done and no erosions were seen? It could be that the Nexium is controlling your acid enough to allow any erosion of the lining to heal, making it look perfectly healthy. But if you stop the Nexium, then the acid level will rise and your lining will be attacked by the acid, leading to pain. Left untreated, the lining can erode and the pain will get even worse.

It doesn't sound like you've come to terms with the fact that you are probably facing a long term problem. It sounds like you have a deficient LES valve, and there is no quick fix for this. Sometimes the valve may start working again on its own over time, but not usually. The currently available surgery, nissen fundoplication, is pretty major surgery, sometimes has bad outcomes, and is irreversible. At your young age, you should not be in a hurry to get surgery. There are other surgical treatments in the pipeline, such as the Torax Linx, which is in clinical trials now. This is a much less invasive procedure than fundoplication, and is reversible if it doesn't work out. That may be available in a year or two and might be a better option than fundoplication, which is kind of the treatment of last resort.

If the medication and lifestyle changes are keeping the symptoms somewhat under control, I think you should stick with that for a few years. Once you start on a strong PPI like Nexium, it is very difficult to wean off of it, since you will always get a strong rebound acid reaction once you stop taking it. If your LES valve is deficient, you will have no protection against the acid.

No one likes to take medication, but I don't see that you have a lot of better options at this time. I too am on long term PPI medication, and wonder about the long term side effects, but worrying about it doesn't really help anything. It's just a risk you have to take since the alternative of not taking it is worse.

speden

yes the endoscopy showed that it looks perfectly healthy, and the dr. thinks its the meds that help it stay that way.

i am going to by DGL and do a food diary and all those things 100 percent to try to get off nexium. Any ideas from others who have been able to get off nexium are more than welcome.

thank you all, i hope to continue posting a be a member of this community.

PS, if the pain is constant, as it is in my case, how long until you develop esophageal cancer? I mean constant pain...I would have thought only a few years...

thanks speden,

i dont get pain when i am on nexium generally...what happens is i will have 2 or 3 weeks of no symptoms, then a few days to a week of hellish symptoms that seem unrelated to anything that i eat or drink. it really comes in cycles. when I am off nexium i am in constant pain no matter what I do.

Well I am absolutely terrified of being on nexium long term so I am going to try my best. but as I said I am puzzled because I have always been a person that does excersize daily, is in shape, and eats healthy. the only thing that really changed is the hours that i eat at and sleeping on literally a 45 degree angle...i slide off my bed at nights...my girlfriend doesnt like that, cause she does too ,)

What is funny was that during my first endoscopy a year ago the doctor found i had level 1 esophagitis, and now a year later the doctor says i am in perfect health there. so is the deal that if you go on pills your esophagus repairs itself continually? I was under the impression that if you are a level 1 esophagitis you have nowhere to go but to level 2...in other words that you couldnt go back to level 1 from the damage done.

For me its seems like a conundrum of getting stomach cancer from nexium or esophageal cancer from not taking it...this has been very hard for me because i have always valued my health and had 0 health problems aside from a broken finger or dislocated something...never any internal issues. And now I am faced with something that I cant just go to the dr. and get fixed easily...and i look around at everyone else my age that is healthy and with no worries. Plus I am getting married soon to a long-time girlfriend that is from another country and will be very dependent on me, and I am afraid that by the time I am in my late 30´s the nexium or something will have caused a cancer that will do me in....I guess we all have our worries, but I just cant get past mine since I got this health problem.

Well I think we all have our ups and downs on symptoms even when on PPI medication. I will have the same thing where I'll be feeling unusually good one week and then out of the blue my symptoms will worsen for no apparent reason. I think a lot of that has to do with random chance where one day you may have bent over or slept on the wrong side or whatever, and acid went up into the esophagus. You won't feel the effect of that until later, so it's hard to connect the pain to the exposure event. Once you do some damage like that, it can take a few days to recover. When the pain gets bad I just tell myself I've been through this before, and it will get better, and try not to dwell on it.

I don't see why you are so paranoid about the long term effects of Nexium. It sounds like you are doing very well on it. Stop worrying and enjoy life. Someday when the Nexium stops working is when you will be in a pickle. I think the main thing with long term PPI is that you take a vitamin supplement, because with low acid in the stomach, some vitamins you normally get from food don't get broken down into a form your body can digest.

I think sleeping at a 45 degree angle is a little overboard. Raising the head of the bed about 8" should be sufficient. Getting enough sleep is important for health, so unless you feel a lot better at a higher angle, I don't think you need it so steep. My bed has a foot board, so if I slide down my feet press on the foot board, and I can push myself back up.

If the esophagus isn't too badly damaged, then yes it is constantly repairing itself. When you have GERD the acid is almost constantly attacking it. If the two things balance out you will basically stay the same. If the Nexium tips the balance in the healing direction, your esophagus will heal over time. If you stop the Nexium, the balance will probably shift back to the damage side and you esophagus will get worse.

Unless you can figure out something in your environment or diet that is causing your LES valve to relax, you probably can't do much to it. For example if you smoked or were around second hand smoke, that would be a very strong trigger on relaxing your LES valve. Eating a lot of red meat, especially late in the day would be another bad thing. Exercising on anything other than an empty stomach could be another. You've probably already eliminated these types of things from your lifestyle already, so you may just have to say to yourself I have this defective valve and it's probably not going to get better. Then you can move on and make the best of things.

speden

thanks Speden. Out of curiosity how old are you? Ive read a bit about nexium potentially causing cancer over decades, and the pill hasnt been out long enough to see cases yet. i hope it is not the case but given that my esophagus is in good health as the endoscopy showed i am going to make an attempt to get off it.

do you know how long i will have to endure the rebound effect of the acid? I have tried going off nexium before but after a few days of feeling horrible i always have gone back on it...but i am thinking if i can get over the rebound period maybe it wont be that different from when i am on nexium, as long as i live dedicated to not aggravating symptoms.

thanks Joy. as you were writing that i was reading about the EsophyX in the various threads you had contributed to. It gives me hope...maybe after a few more years on meds it will be more established and proven. not sure if its done in canada.