linx reflux surgery March 2014

Responding to Nc12345

I had esophageal dilatation done about 8 months after my LINX, which was performed 10 months ago. Esophageal dilatation reduced swallowing difficulty (dysphagia) but did not eliminate it. It was a simple procedure from patient perspective--no more difficult than esophagoscopy without dilatation. But it has probably increased my reflux as might be expected since to some extent it nullifies the effect of the LINX. I still have episodes of of esophageal spasm after eating but they are infrequent and not usually severe. Minor discomfort occurs much more commonly. I may need to pause or stand up for a few minutes before chest discomfort due to food getting stuck goes away. Occasionally I experience cough while eating or soon after eating--due, I think to retained food traveling up esophagus to my trachea.

I probably would not do the LINX if I had the decision to make over again. The reduction in reflux symptoms has been modest and not enough to make me feel that the swallowing difficulties are worth the benefits. But I have not reached the point where I am willing to take the risk of having LINX removed. I am about 10 pounds overweight. My hope is that getting closer to my ideal weight will make a meaningful difference. I've read long term studies on LINX, and I think they fail to give a full account of the subjective patient experience. I'm not implying the studies are poor or biased, simply that it is hard to measure the way people feel.

It occurred to me before surgery that I should see if GERD would respond to weight loss before taking the plunge, but I didn't succeed in losing the weight and felt I couldn't delay forever. I was also hopeful that LINX would favorably affect my asthma since there is thought to be a link between asthma and GERD. My asthma is unchanged. I hasten to add that NO doctor or nurse suggested that LINX would help my asthma, but the hope that it would was one factor that motivated me.

By the way, small erosions were present in my esophagus when I had my recent esophagoscopy and dilatation--evidence that LINX did not eliminate reflux. On the other hand, I no longer take PPIs, but I do use ranitidine, Gaviscon, and Tums.

Obviously, no meaningful conclusions on the value of a procedure can be drawn on the basis of the subjective view of a single patient, and I am not trying to discourage anyone who is contemplating LINX, just to point out that it may not be a slam dunk.

Linxcat, I hope you are doing well. Do you have any updates on how you're doing post-LINX?

Thank you SueJay for your reassuring post. Just to set the scene, I am a UK resident 74-year-old retired military and airline pilot with 4 very successful heart artery stents put in about 10 years ago. My other conditions are that I have suspected Hypothyroidism with connected 3rd stage Chronic Kidney Disease which I am treating by careful dietary and lifestyle choices by means of which I have actually restored my kidney GFR to it's 2010 level - but that's another story!

I first noticed odd symptoms over 3 years ago. My throat had a feeling of something there that could not be cleared. I was hoarse and a little breathless, almost like asthma. My inner ears were very itchy and with more wax production than before. Even my normally good eyesight was a little blurry sometimes. Certainly my eyes were irritated.

It wasn't till April 2014 that my GP suggested the possibility of Lower Oesophageal Sphincter (LES) malfunction - I thought about it and revelation dawned! I did a lot of research online and had to agree. I was not actually getting reflux with stuff coming up past the LES but definitely feeling mild heartburn from time to time. However my real problem was that my incompetent LES was allowing fumes from stomach acids to get up and into my trachea, bronchial passages and into my lungs - hence the breathlessness and asthma & therefore I was also tired a lot. The other thing, which I have never seen mentioned before, was that these fumes were finding their way through the Eustachian Tubes into my ears and even affecting my eyes. So it looks as though these stomach acid fumes were irritating the epithelial tissues of my breathing mechanisms, my ears and my eyes. And all because of the incompetent LES.

I saw a highly thought-of professor consultant surgeon in June 2014 in Glasgow under approval from BUPA. Unfortunately due to various delaying interventions, I was not able to get Endoscopy, Bravo Pill and Manometry tests completed till very recently. I don't have Barrett's Oesophagus but feared it was coming. I also have a 2cm hiatus hernia which the surgeon may or may not repair when he does the Linx job. So finally to now!

Tonight from midnight I am "nil by mouth". Tomorrow morning, very early, I have to report to Ross Hall Glasgow for my Linx procedure. I think I heard the consultant surgeon say that I will be his very first Linx case. However I am reassured that he has co-opted another professor gastrointestinal surgeon, who has done Linx and is Scotland's leading gastro-intestinal man, to assist tomorrow. Also I believe that Torax, the American Linx device manufacturers, send a team to monitor the whole thing. All in all, I am very happy with arrangements and keen to get this thing done.
I am well aware of the range of possible post operative problems I should expect such as dysphagia, oesophageal spasms etc. I guess we all have to work through these and not expect a total miracle.
Thanks for all the useful posts. I will try to add to the fund of patient knowledge and keep you posted about my own Linx experience.

Now here is an interesting observation; previously to the Linx procedure I had been on a small weight loss programme trying to get below 11 stone again. I just made it to 10 stone 13.6 lbs. However the day after Linx, I weighed 11 stone 8.2lbs! Quite a weight gain. Looks to be mostly water as my stomach looked quite distended.

On the afternoon and night after Linx, I could not pee at all! I sat on the hospital loo for 45 minutes and - nothing! In great fear of the dreaded catheter, I woke at 4am and made a determined effort to be rewarded but with ......not much. At least it was a start and since then, no problem with peeing - phew!

It is now day 4 after Linx and I have some seepage of blood and lymph from the 2 centre abdominal ports which needed change of dressing. Hopefully they will dry up soon. I now weigh 11stone 4.2lbs with still a slightly distended stomach so, making progress.

So far too absolutely no trouble eating and drinking anything although I was aware last night that I felt the need to stand up to burp after supper. My ears feel much less itchy and I swear that my eyes feel less irritated. That asthmatic feeling I had has definitely reduced. This could be subjective so we will wait to see. As they say: early days but looks promising.

Hi all. I had the Linx procedure done 5 days ago. I am having reflux still. I'm wondering if anyone else has experienced this post op? If so, did it stop over time? It's making me nervous.

Any input would be greatly appreciated!
thanks

Post Edited (fall18) : 11/23/2014 7:44:45 PM (GMT-7)

Hi fall18 post linx my reflux magically disappeared and I was able to sleep in a bed for the first time in a few years (slept in recliner due to reflux at night) I was told to come off PPis straight away and five weeks post op in I got acid rebound and had to go back on them. Not as high a dose though.Took me ages to get off the PPi as reflux returned every time I tried to stop but eventually , within 12 months I was off everything and eating a normal diet but avoiding coffee, fizzy drinks and other classic reelux causers...I drink ginger tea now as I prefer it. I have had 3+months completely reflux free then this relapse so need to get back on track and get this settled as it obviously can be better. I still would have the Linx again as it has improved things so much and this is the first time I have had a set back off PPis so will just have to see how it goes.

I'm still not sure if LINX will work for me. Since you can still burp after the procedure, and burping is the primary cause of my problems, including shortness of breath, PND and bringing up acid, would it be of any benefit to me at all?

I thought I'd post my LINX progress report to see if anyone has suggestions. My LINX was performed 18 months ago. Because of dysphagia (difficulty swallowing) postop, I also had an esophageal dilatation about 11 months ago. The dilatation reduced but did not eliminate the dysphagia, and it may have worsened my reflux a bit. I still take omeprazole and Carafate on a regular basis with some ranitidine and Gavascon when required. I have quite a bit of abdominal distention/bloating, which I experienced to some extent before surgery but which did seem to go away for a few weeks postop during the LINX honeymoon period. Chest pain is present most days. I believe if I could change my life style (eliminate coffee and eat less), my symptoms would diminish. I am not obese but probably 15-20 # overweight, and I drink a couple of cups of coffee each day. Overall, I have to conclude the LINX hasn't improved the quality of my life but acknowledge that I haven't taken the additional steps necessary to create the optimal circumstances for it to work. Maybe it has reduced the risk of getting Barrett's or esophageal cancer, but that data is not available and probably won't be in my lifetime, if ever.

Apparently most LINX recipients are pleased. I don't think I'd make the same decision if a do-over were possible. But I'm hesitant to have the device removed. Would like to hear from LINX recipients who have had the device removed or who have had a CT scan of the abdomen with the LINX in place.

Hello,
I am new to the forum. I just had the linx procedure 2 weeks ago.

First some history.. I never did feel reflux in my chest. I have had issues with acid in my mouth, raw feeling on my tongue, nasal congestion and teeth issues and gum disease. Literally needed 4 new crowns and 3 quadrant gum surgery only 6 months after my last good check up! The Dentist thought something had to be going on medically. I also went to a pulmonologist for bronchitis and the Pulmonary function tests were conclusive for GERD (Getting worse lung function after albuterol treatment, not better - classic GERD). But I continued to live with that for another 2 years and now have to have MORE gum surgery and my sense of taste is really messed up!

So I went to the gastric surgeon that two of my friends went to for their Nissan Wraps. (they have had no problems by the way) The gastric surgeon believes my symptoms could be related to the reflux but could not guarantee it but the tests he did confirmed reflux regardless of the lack of heartburn symptoms. It seemed worth a shot to see if this got better, and I don't want to get Barrett's so I went for it.

Post op I really didn't have any true pain except my left shoulder and shoulder blade. It was EXTREMELY painful but I get knots all the time in this area (military neck), just not this intense. I mean breathing hurt sometimes! I mentioned it on the post op visit and was told it could also be due to the surgery and a stitch that was placed in the diaphragm causing referred pain in my shoulder, especially on breathing/burping. I have since seen another Linx patient post that they had a similar pain and it is now residing quite a bit but still there. My incisions are fine and appear to be healing as expected.

I had the surgery at 7:30am, left the hospital at 11:30am and was sitting at a restaurant with my husband at 12:30. Albeit, dealing with the shoulder pain. I had meatloaf and mash potatoes and got my first bout of dysphagia. Starting with hiccups and so I drank water until it cleared and then SLOWED DOWN! It was fine after the first bite or two

I have since been dealing with the dysphagia at least twice daily (I am eating every three hours as told) I just drink water before during and after and it helps but those first few bites can be quite painful when the food is stuck and you are trying to get it down. Also feels like I'm going to vomit but this has not yet happened thank goodness! Interestingly, when the food gets stuck, or when I burp when it is trying to go down, the shoulder hurts again even though not as bad as the first week.

I am very aware of the Linx constantly. It is not really a pain but a feeling that it is there. I do have some slight nausea at rare times and I believe, like another poster, it is from saliva as it is not heavy enough to cause the linx to expand. I will try to eat a little something when that happens to see if this will resolve the nausea.

Chicken seems to be an issue with me as well! I hate that because I eat a LOT of chicken! Hopefully that will resolve soon. I haven't tried rice yet.....not sure I want to after some of the posts about it being too light to move the Linx. But I love Sushi... Maybe the fish will make a difference and open the Linx. I don't eat much plain rice other that that. Cottage cheese in the morning seems pretty easy. I hope it has enough bulk to make the Linx move? Carbonation is not my friend but I still drink diet coke occasionally. Alcohol does not seem to be an issue.

Anyway, That is where I am at this point. Part of me thinks it is too tight but I will hang in there until the tissue around it forms and see how it goes. I hope the dysphagia doesn't get any worse! I have lost 8 pounds but I am quite tall and this is not much of a fluctuation for me and I weighed the same a couple months before the surgery. I could lose another 10 and I would be quite happy and at my ideal weight. I think I am just losing the weight because it hurts to eat at times and I just don't bother finishing what I have in front of me and I know I am going to eat again in three hours.

Reading the posts are helpful but everyone seems to have had different experiences. I hope posting mine will help others make their decisions as well as perhaps find someone else that has had the Linx and a similar experience.

Hi,
I had pretty similar symptoms to you as far as immediate difficulty in swallowing. The literature says this should happen from 3-8 weeks out. However, my surgeon says that this has not been his experience thus far despite the literature. He indicates that what he typically has seen was immediate difficulty swallowing that gets better in 8 weeks. Well, for me it has been 8 weeks and I can swallow MUCH better now without it getting stuck. I feel it a bit on the first bite but not the pain in the esophagus or the referred shoulder pain any where near what it was before and the food does not get stuck. It almost got better overnight! I do know that about 2 days before it got better, I started feeling pain all day/night in my LES area. I assume something to do with scarring over the Lynx?

Please keep me posted on your progress!

annpharmd,

I can't thank you enough for your reply. This makes me feel a whole lot better! I left out the other contributing factor-repair of a hiatal hernia, so I know that I have a double whammy for my esophagus and diaphragm!

I'll keep forging forward! I've avoided carbonated drinks, but saw that mentioned as something that helps. I tried it last night and I have to say it works!

DROT! I told you wrong! I am just past 5 weeks out! Tough getting old!

Hi. I had the Linx device fitted 4 months ago and now have had 3 separate dilations to stretch the device as 1 in 5 meals resulted in food getting stuck and me being sick.
Unfortunately I am now suffering from acute reflux symptoms again with stabbing centre chest pains and impossible to drink hot fluid, i.e. burnt throat, and all the classic reflux symptoms. I have recontacted my surgeon and had a resent barrion X-ray for the food getting stuck every now and again. This I can live with, however very frustrated that reflux has returned. Can anybody offer any advice if they have experienced the same symptoms after having the Linx device fitted. I am now in month 4 and post op haven't experienced any reflux or heartburn symptoms, which have now started again in the last 2 weeks. Can anybody help?