Return of severe GERD symptoms 2 years post Nissen Fundoplication...YOUR THOUGHTS PLEASE

I had Nissen Fundoplication (NF) with hiatal hernia repair in August 2014. In October 2016 my symptoms returned. My story from January 2014 to present...

My symptoms were heartburn, chest pain, chronic cough, feeling like food/drink getting stuck. GI put me on PPI in January 2014. After changes in dosage over 3 months or so, was getting no relief, so saw surgeon to discuss surgery. Had all the tests done to see if I was good for surgery and was. Had NF in August 2014. Development of cough 1 week post surgery, but disappeared in a bout a month. Totally symptom free until October 2016. Went back to surgeon and he ordered Upper GI series (Barium swallow x-rays) and endoscope. Those tests indicated that the wrap was still intact and in place. Follow-up with surgeon was everything was good. Follow-up with GI, was again told according to x-rays and endoscopy, nothing wrong with wrap. GI put me back on PPI, changed medication and dosage several times. Has added medication and I have no relief. The symptoms I am having (and what started in October 2016) are...heartburn, chest pain, chronic cough, pain in chest that wakes me up at night and a burning sensation from back of throat all the way to upper stomach. I avoid chocolate, spicy foods, tomato sauce (and foods containing tomato sauce), alcohol and soda. In the last few months, I am hit with heartburn and chest pain within 30 minutes of eating. I have tried Pepto Bismol, Maalox, Mylanta, Tums and Rolaids when this happens, but no relief.

I have done a lot of research into this and I am positive that my wrap has loosened. I go to my GI on June 28 and am hoping he will now agree that something drastic needs to be done so I can get relief. It wouldn't be a problem if the PPI was giving me relief, but I believe that having my wrap redone will give me the relief that I am seeking.

Any thoughts or comments would be greatly appreciated.

Saw my GI yesterday. He says no more medicines he can put me on. He still maintains that my wrap is fine based on barium swallow (done in November 2016) and endoscopy (done in January 2017). He wants PH test to see if any acid. I am scheduled to have an endoscopy with Bravo implant on September 1. This 96 hour PH test will record 2 days on no meds and 2 days on meds to check acid. If acid, then he will possibly send me for a 2nd opinion to Cleveland Clinic. If no acid, then something else is causing my symptoms. As we were talking about the meds and acid, he did say that the test will show if the meds are working. He said it is possible that the meds are working, but that I may not be noticing since my symptoms are so bad. Will wait until September (which will be 3 years post NF) and see what the results say.

So went to hospital at 9:30 this morning for the Bravo 96 hour pH implant. So far I don't feel that it is in there. Doctor scoped all the the way to check things. He noted in the initial report that the wrap appeared loose. This confirms my thoughts that the wrap was loose since October 2016. Follow up with doctor on September 14th. Will see what they will decide to do then.

Had my follow-up with GI on 9/14. The pH testing showed no acid in stomach when off the PPI and when on the PPI. When I was originally tested prior to NF, the mobility testing showed I have Hypercontractile Esophagus (HE) also referred to as Nutcracker or Jackhammer Esophagus and that the GERD symptoms could be from that. Although the wrap appeared to be loose when I had the Bravo implant, it is not an issue with my symptoms since there is no acid. I can't take calcium channel blockers which are used to treat HE so my GI has put me on 25 mg Amitriptyline which he says will take about 3 months to see if it will help. I go back in 4 months for a follow-up.