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GERD & Acid Reflux
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Posted 10/23/2003 4:56 PM (GMT 0)
So you found our forum, but do you know about all the wonderful resources HealingWell.com has to offer? Visit the GERD - Heartburn Resource Center located at https://www.healingwell.com/GERD/.
Take a moment to explore, we hope that you will stay awhile and visit HealingWell.com often.
Posted 8/14/2011 3:07 PM (GMT 0)
Post-Nissen Fundoplication Diets

We never offer medical advice here at HW, but do offer support and information. We hope these resources will help inform your decisions and help you in your recoveries.

Denise's Nissen Recovery Journal
My Forum Journal
https://www.healingwell.com/community/default.aspx?f=45&m=2183443

Bill's Nissen Recovery Journal
https://www.healingwell.com/community/default.aspx?f=45&m=2337138

JPT's LINX Recovery Journal
https://www.healingwell.com/community/default.aspx?f=45&m=2639859

Nissen Surgery Information:
http://www.webmd.com/heartburn-gerd/fundoplication-surgery-for-gastroesophageal-reflux-disease-gerd


Post-Nissen Fundoplication Diets

We never offer medical advice here at HW, but do provide as many resources as possible.

Please consult your physician regarding the diet you are expected to follow after your surgery. At times surgeons provide little detail, and these resources will help fill in the blanks.

Also you will find as you read the many posts on the HW GERD forum, that some surgeons are very strict—requiring a liquid diet for quite some time, while others give much more control to their patients judgement and allow a soft diet from the start as tolerated.

One important rule is to never eat something that can’t be chewed to a liquid consistency in the early weeks. Keep a paper napkin handy and don’t swallow anything that can’t be chewed completely. Also take small bites.

If you discover an additional dietary resource, please share it!

Remember these basics to be followed during recovery—

No straws (they introduce air into your stomach which can add to uncomfortable bloating.)
Avoid carbonated beverages

No iced drinks (They can cause painful spasms)

When you start solid/soft foods, be sure to only eat foods that can be chewed thoroughly into a creamy consistency. (You will always want to eat more slowly and chew your food thoroughly—even after full recovery. It’s a good eating habit to develop!)

Don’t panic if something gets stuck at the wrap site. If you keep a warm drink handy it will help you calm the resultant spasms.

Little swallows will help move it through. You don’t have to try to cough it up. That said, stay away from big no-no’s like steak! ONLY things that can be chewed thoroughly.

I remember a time in the early days when I thoughtlessly chewed and swallowed a cherry tomato at a restaurant. I learned that day to be more mindful when eating!

You will only be able to eat small amounts of food in the beginning. The top of the stomach sends the message of fullness to the brain. The post-op swelling is interpreted as fullness.

Your wrap will become increasingly more swollen during the first couple of weeks, peaking on or about the end of the second week. This usually causes additional difficulty and discomfort swallowing, so you’ll likely experience ie as a setback—but don’t worry. This too will pass!

Often people experience worrying pain/swallowing issues at around the 3 month mark. This is generally a result of more adventurous eating choices and forgetting the slow/chew food to a creamy/liquid consistency.

It takes six months for most of the healing and a year for the rest. Many find improvements into the second year—I did.

We can add more to this list as time goes on...

UPMC Diet
https://share.upmc.com/2016/01/diet-after-nissen-fundoplication-surgery-for-gerd/

National Jewish Health Diet
https://www.nationaljewish.org/treatment-programs/tests-procedures/adult-surgery-procedures/esophageal-surgery-postoperative-care/advancing-your-diet-the-post-fundoplication-levels

University of Michigan Diet
https://www.med.umich.edu/1libr/surgery/thoracicsurgery/mushydietafternissenfundoplication.pdf

Ohio State University Medical Center Diet
https://patienteducation.osumc.edu/documents/dietnissenfundoplication.pdf

UW Health Diet
https://www.uwhealth.org/healthfacts/nutrition/397.pdf

Oregon Surgical Diet
https://www.oregonsurgical.com/wp-content/uploads/nissen_fundoplication_diet.pdf

http://www.upmc.com/patients-visitors/education/nutrition/pages/diet-after-nissen-fundoplication-surgery.aspx

Anti-Dumping Diet Information
http://gicare.com/diets/anti-dumping-post-gastrectomy-diet/

https://uvahealth.com/services/digestive-health/images-and-docs/dumping-syndrome.pdf

Postoperative Gastrointestinal Complaints After Laparoscopic Nissen Fundoplication
A study from the Journal of the Society of Laproscopic Surgeons
It's a little technical, but generally easy to follow.
http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3015672/

Caution: These links are for your information only and should never take the place of instructions given to you per your surgeon.

Post Edited By Moderator (dencha) : 1/9/2019 6:51:48 PM (GMT-7)

Posted 4/20/2012 10:06 PM (GMT 0)
A doctor said that you have gastroesophageal reflux disease (GERD), a chronic disease that causes ongoing pain and burning in the chest and throat (heartburn). GERD is also called “acid reflux disease.”
You want to know what research says about your options.
* Check out this link provided by one of our wise members.


http://www.enetmd.com/content/gerd-diet-plan-and-table

http://news.healingwell.com/index.php?p=news1&id=623131

http://my.clevelandclinic.org/disorders/laryngopharyngeal-reflux-lpr/hic_laryngopharyngeal_reflux_lpr.aspx

Post Edited By Moderator (dencha) : 1/9/2019 6:54:12 PM (GMT-7)

Posted 4/25/2013 3:52 PM (GMT 0)
When GERD and IBS Symptoms Overlap

www.everydayhealth.com/gerd/gerd-ibs-connection.aspx


Caution: This link is for your information only and should never take the place of instructions given to you per your Physician

Post Edited By Moderator (dencha) : 7/7/2014 8:11:27 PM (GMT-6)

Posted 6/24/2013 3:03 PM (GMT 0)
Medications and Side Effects:

http://www.drugs.com/

Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.

Data sources include Micromedex™ (updated May 17th, 2013), Cerner Multum™ (updated June 18th, 2013),

Posted 8/19/2014 2:35 AM (GMT 0)
Information on ACV aka Apple Cider Vinegar

www.healingwell.com/community/default.aspx?f=45&m=3157034

This link is for an on going thread about one person's experience, and the possible side effects of Apple Cider Vinegar.
www.healingwell.com/community/default.aspx?f=45&m=3147061


Please consult with your doctor before starting any new treatments for GERD/LPR.

Take care,
Bill

Post Edited By Moderator (dencha) : 8/19/2014 7:44:11 AM (GMT-6)

Posted 8/18/2015 8:08 PM (GMT 0)
The document above describing a PDF that explains how to take your PPI properly is no longer available online. The pertinent information has been copied below. It is written for medical professionals, so there is some technical information included. Just take what is useful to you and disregard the rest!

"You want to assure patients that PPIs are very effective drugs; however, it is important that they be equally aware that it may take some time before they have symptomatic relief. Then, whether or not they experience immediate relief, this medication must be taken everyday continuously and on a long-term basis in order for it to be effective.

Taking PPIs on an as needed basis will not provide adequate acid inhibition in patients with more complex reflux, as PPIs do not permanently bind to proton pumps. Without routine use of the drugs, actions can be reversed by regulatory body mechanisms. Principally, glutathione reductase is responsible for reversal of acid inhibition by breaking the covalent bonds between the drug and the proton pumps.

Additionally, PPIs only work on activated proton pumps. Because of the body’s natural regulation process, inactivated ones will ultimately be activated, resuming acid secretion. Eventually, with continual and consistent use, maximal suppression of acid secretion can be achieved. Conversly, once PPIs have been discontinued, symptoms can return quickly, reinforcing that PPIs are not a cure for acid reflux.

All these points cannot be emphasized enough to patients.
Next, it is prudent that patients understand the importance of taking PPIs properly. Patients should be instructed to take PPIs in the morning, as this is when the amount of proton pumps located on the parietal cells is the greatest. PPIs should also be taken at least an hour before breakfast because they are absorbed in the small intestine, and it takes at least 30–40 minutes for the drug to empty out of the stomach and into the small intestine. Maximizing the absorption of the medication is the first step to ensuring optimal drug benefits.
If a PPI is taken with food, complete absorption and subsequently, full drug effects, will be lost. After the hour has passed, the type of meal eaten
after taking a PPI is very important for maximizing the effectiveness of the medication. Patients should be informed that their first meal after a PPI should be a protein-rich meal (e.g., milk, cheese, yogurt). Protein stimulates the release of gastrin, the major hormone responsible for regulating acid secretion. Gastrin is located in the antrum and stimulates acid secretion through various mechanisms including direct stimulation of proton pumps on the parietal cells and enhancing histamine release.

Without sufficient protein in the meal following PPI intake, only about 10% of the proton pumps will be stimulated by the meal, and the other 90% of the pumps will remain inactive or “asleep.” A protein-rich meal will better activate the release of gastrin to stimulate all available proton pumps, this ensures therapy is most effective, as PPIs can inhibit meal-stimulated acid secretion.

I find that one of the best ways for patients to understand the repercussions is to talk in dollars and cents. They will only get 10 cents on every dollar if they do not eat enough protein after PPI intake.

Dose escalation may be necessary, so it is important patients try not to get discouraged with their therapy. Dosing is highly individualized, based on the level of inhibition required for each patient. Some patients will require twice a day dosing with PPIs due to severe reflux. For such patients, their first dose should be taken in the morning, an hour before breakfast, and their second dose should be taken in the evening, an hour before dinner. Patients should also be instructed to avoid taking their evening dose at bedtime.

An even smaller subset of patients will have nocturnal acid breakthrough (NAB), requiring an H2-blocker at bedtime. Patients should be directed not to take H2-blockers simultaneously with their PPI doses, or it may result in reduced efficacy on acid inhibition overall.

Separating the evening PPI dose and bedtime H2-blocker dose as much as possible will ensure optimal acid inhibition. Unfortunately, resistance to H2- blockers may occur quickly. A 2002 study evaluated the combination of twice a day PPI therapy with bedtime H2-blockers for patients with complicated gastroesophageal reflux disease.

While results showed an 18% initial response rate, NAB resumed in 50% of those patients after one week and in 62% after one month. Hence, emphasizing the importance of continued use despite the lack of symptomatic relief becomes
critical."
SOURCE:
14 PRACTICAL GASTROENTEROLOGY • JANUARY 2007
Digesting the Complexity of
PPI Management and Care
Stuart A. Frank, M.D., FACG, Clinical Associate Professor
of Internal Medicine, South Western Medical
School, Dallas, Texas.
by Stuart A. Frank
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