LPR after fundoplication

Having been to the doctors and received a battery of tests, I'm now hoping that someone with similar experiences may be able to help me solve a mystery.

I had a fundoplication about 12 years ago after a few years of severe reflux. For 5 years everything was fine then I had symptoms of dyspepsia and after an endoscopy was told I should resume PPIs.
Fast forward 6 years and I began to have LPR, though only one side of my nose/throat is ever affected. The suggestion was to double the PPI dose and take Gaviscon Advance. Doubling PPI was simply not an option so I tried ranitidine at night in conjunction with Gaviscon. All was fine again until I started running, which seemed to exacerbate the problems.

I was referred back to the GI team who then referred me to the surgical team.

So far I've had:
a barium swallow with provocation - all normal, no reflux;
an endoscopy - stomach and oesophagus normal, wrap still in place, perhaps a small hernia, benign polyps;
manometry - very poor swallowing (probably as a consequence of the wrap) but this is asymptomatic;
24 hr ph testing - Demeester score of less than 1: anything up to 15 is normal!

Further surgery is therefore excluded.

After the ph test results I was advised to trial dropping PPIs. I have done so and I'm fine during the day.
If I take nothing at night I wake up in the morning with a sore nose and throat often accompanied by slight nasal bleeding. If I take Gavison I regularly, but not consistently, reflux it into my throat and sinuses. This hurts, a lot.

I've suggested to the consultants that I'm going to trial various approaches to manage my symptoms. They seem to approve of this and, to be honest, I suspect that they have little idea about why I'm having these symptoms. If anyone else has had any luck with a similar set of circumstances I'd be delighted to hear from you.

Thanks for the response, Trotters. It's a conundrum: given that a certain level of reflux is normal one would imagine that much of the population ought to be having symptoms of LPR. I am determined not to return to PPIs as, during the day, I seem to manage perfectly well. In my case, I am sure that there are factors that must trigger reflux at night. I still can't fathom how I can reflux Gaviscon with a successful fundoplication unless, perhaps, the wrap is so tight that the Gaviscon never reaches its destination! Certainly, at the moment, Gaviscon is not my friend unless it's combined with an acid suppressant. This in itself seems illogical.

Hi Pat

Thanks for your reply. Yes, the head of the bed is raised, and has been for many years.

What effect does the ph water have? I'm cautious about substantially reducing levels of stomach acid as there are so many sinister effects.

Thank you Pat. I'll take a look.

I still need to investigate Pat's suggestion of ph water. However, having had a cold for the past few days, the LPR symptoms have decreased: logical when you think about it.

A couple of other factors may be helping although I'm aware that these may be both idiosyncratic and psychosomatic. The first is that, unlikely as it seems, radishes seem to help to quell reflux, the second is a cheap find in a local shop. I saw some milk thistle tablets with various claims on the packaging and decided to research their benefits prior to purchase. It is purported that they help to cleanse the liver but they may also help to relieve indigestion. Researching other sites reveals that some people have found them beneficial for reflux. I shall continue to take them and report back my findings.

Okay, so I've continued taking Milk Thistle in the mornings and then 75mg of Ranitidine of an evening, and a glug of Gaviscon Advance before bed. Absolutely fine on this regimen. I daren't alter it for the moment but when I don't have to be available for work I'll try replacing the Ranitidine with Milk Thistle of an evening.

From what I've read (which is limited), Milk Thistle serves to acidify the stomach - therefore aiding quick digestion, which of course is the opposite of Ranitidine. I have to say that I'd prefer to be on the herbal supplements rather than H2A but I am immeasurably pleased in any situation to have moved away from PPIs.

Your liver disease you mean, you might have had a lot of fatty foods or alcohol, you need to stop both of them, especially alcohol. Change as Diet and nutrition.