Could it be LPR?

I’m 3 months post op after having Laprascopic Nissen Fundoplication surgery. Narcotic pain meds helped a lot during my early recovery, but as I had to stop using them, the horrible esophageal pain returned with a vengeance. It was there all along; just masked by the strong pain meds. My throat gets real sore just from talking and I’m exhausted all the time as I can’t sleep well with unending, burning chest pain.

So, basically, this surgery DID NOT fix my problem; perhaps GERD and my 3cm hiatal hernia wasn’t the cause at all. It was never even suggested to me over the past 8 years by countless doctors that I see an ENT! I believe I would have to see an ENT to diagnose Laryngopharyngeal Reflux (LPR).

I don’t have swallowing problems, but the pain in my esophagus is excruciating 24/7! I’m wondering if I’m wasting my time with Gastroenterologists. I’m still in recovery from my surgery but I’ve been to ER twice to rule out Pulmonary Embolism and had a barium swallow and x-rays to check my wrap which is fine. The barium swallow didn't show any reflux at all.

I’m even wondering why my surgeon didn’t ask me if I had ever been seen by an ENT. Or even my primary physician, years ago when this nightmare started.

Your input would be welcome. I’m at the end of my rope. Thought I had this fixed and now I’m in worse shape than before!

Unfortunately GP's will usually point you in the direction of whichever specialist matches the most obvious conclusion of your symptoms, though I would have thought your gastro would have done an endoscopy prior to your surgery which would have detected something like Barretts or strictures in your esophagus.

Have you talked to your surgeon about the pain you are having? It could be related to the surgery, the formation of scar tissue in some areas of the body can be incredibly painful.

I have LPR, and it was diagnosed by my gastroenterologist not an ENT, I guess their knowledge depends on what their sub-specialty is perhaps. The thing is though LPR is still a form of reflux, the reflux is breaching both the LES and UES, and the standard (and I hear quite successful) surgical treatment for LPR is an LNF. Are you having any symptoms which are specific to LPR? Because esophageal pain could be a number of different things. If it helps my symptoms are chronic liquid regurgitation, aspirating my stomach contents, a barking cough, shortness of breath, lump feeling in the top of my throat, sensitive and irritated sinuses, excessive saliva and thick mucous in my mouth and throat. As well as that my back teeth show signs of acid wear which is apparently common with LPR.

It could very well be worth seeing an ENT then, the only problem is that they will be limited in what kind of testing they can do this soon after your surgery, if memory serves me right I had to be 4 months post-op before they would even consider doing a gastroscopy, and that was just for a gallbladder removal, I imagine it would be longer for the Nissen.

Is your surgeon going to meet with you or have they just fobbed you off to a gastro?

Are you able to tolerate ice blocks? It sounds really stupid but with the throat problems I have with LPR, especially the lump, ice blocks are a god send, just purely because they act like a local anesthetic. Maybe that might give you some temporary relief? I have found even just putting an ice pack on my throat can ease things a bit.

Andy,
Yes, I immediately stopped Nexium 40mg, twice daily. Last dose was the night before surgery.

My surgeon feels that there is something else going on and I shouldn't have this pain, and I haven't seen anyone else on this forum with this unbearable esophageal pain this long after surgery. When I weaned off the narcotics, the pain returned with a vengeance and is worse than before surgery. Surgeon has suggested I go back to my primary care doctor.

A recent Barium Swallow showed NO REFLUX. Right now, I'm just trying to get a doctor to give me something for pain until I can see my PC doctor Oct. 21st - the earliest appointment I could get.

I don't know if I can get co-codamol here; I will check. Thanks, Andy 1986. This is just so frastrating; I can barely function with this pain.

JENAGADE; What is a 'gastroscopy' and how does it differ from an endoscopy?

jenagade,
I am starting over again with a new gastro doctor who has ordered both manometry and esophageal pH. God, I can't believe this. Tests scheduled for Oct. 19th and I couldn't get an appointment with my primary care doctor until Oct. 21st!! I will also be having yet another endoscopy, as well.

Narcotic pain meds is the ONLY thing that takes the edge off the unbearable esophageal pain. I feel so much worse than before surgery.

My new gastro doctor suggested that perhaps my wrap is too loose or I have a hypersensitive esophagus. I don't know which is worse, at this point. No one will prescribe a pain med that WORKS. I've started on Gabapentin 300mg from the pain clinic, but it takes a week to build in your system and I don't know if it will work or not. In the meantime, I have a source to get Hydrocodone and I am managing the pain as well as I can and taking them ONLY when the pain becomes unbearable. What an awful place for me to be! It seems like my LNF surgery failed!

I MUST have pain relief so I can WORK! I also have Tramadol that I can take with Tylenol but that does very little for pain relief. I don't want to be taking these narcotic pain meds and if I wasn't in such horrific pain, I would NOT take them.

Now I must wait, wait, wait!

jenagade,
Thank you for your kind message. I had the best nights' sleep last night in a LONG time. I believe the Gabapentin is starting to work. I used it with Tramadol 50mg plus Tylenol PM last night and watched TV in bed for about an hour; immediately went to sleep at 11pm and didn't wake up until 8:15am when I had to pee! If I hadn't had to pee, I believe I would have slept another hour! Pain did NOT wake me up in the wee hours as it has in the past. Maybe I am getting somewhere and good sleep will help me greatly.

I will try the Tramadol + 2 Tylenol tomorrow for work and see how it works. (The Gabapentin takes about 7 days to get into your system and I am tolerating it just fine. At the 7 day point, I can increase it and will be talking to the pain clinic about when to take a second capsule).

Thanks again, jenagade!

Andy 1986
Yes, I started taking one 300mg at bedtime Wednesday night and I'm able to tolerate it. They told me that after 7 days I could increase it to two. Do you happen to know if that means a second one at bedtime, or a second one 12 hours later?

I was planning to call them and ask about this, but since you've taken it, you probably know. I will be increasing it Thursday night. Thanks.

Linda Sue said...
jenagade,
Thank you for your kind message. I had the best nights' sleep last night in a LONG time. I believe the Gabapentin is starting to work. I used it with Tramadol 50mg plus Tylenol PM last night and watched TV in bed for about an hour; immediately went to sleep at 11pm and didn't wake up until 8:15am when I had to pee! If I hadn't had to pee, I believe I would have slept another hour! Pain did NOT wake me up in the wee hours as it has in the past. Maybe I am getting somewhere and good sleep will help me greatly.

I will try the Tramadol + 2 Tylenol tomorrow for work and see how it works. (The Gabapentin takes about 7 days to get into your system and I am tolerating it just fine. At the 7 day point, I can increase it and will be talking to the pain clinic about when to take a second capsule).

Thanks again, jenagade!

That's brilliant to hear, here hoping it's onwards and upwards from here