Roux en y for Gerd failed

[Dawn.s 2]

Hello

Looking for information if anyone can help me. I had three nissen fundoplication operations for Gerd and they all failed. in June 2015 I had my roux en y.... now 15 months later I have another hiatis hernia, severe reflux and severe reflux eosphagitis. This was mean to be my final surgery to fix the Gerd....

Suggestions? Ideas?

I am in Australia..

Thank you

Dawn

[James Marusek 5,244]

I haven't heard of nissen fundoplication operations before so I looked it up.

Laparoscopic Nissen fundoplication is now considered the standard surgical approach for treatment of severe gastroesophageal reflux disease (GERD). GERD is increasingly prevalent and costly, and it may affect as much as 20% of the US population.

The pathophysiology of GERD is not due to acid overproduction but rather mechanical dysfunction centered around the lower esophageal sphincter (LES). Furthermore, the mainstay of GERD treatment, proton pump inhibitors (PPIs), have come under scrutiny because of worrisome side effects. Laparoscopic magnetic sphincter augmentation of the LES has been proposed as an additional surgical option. Like Nissen fundoplication, it relies on 360° buttressing of the LES, but it may cause fewer long-term adverse effects.

http://emedicine.medscape.com/article/1892517-overview

Prior to my RNY gastric bypass surgery 3 years ago I had severe acid reflux (GERD). But after surgery this condition went into remission. Sometimes dumping syndrome feels a little like GERD. My severe acid reflux was caused by the fact that I was obese. That doesn't seem to be the cause of your problem. I am not a medical professional, so take whatever I say with a grain of salt.

One of the most common complications causing nausea and vomiting in gastric bypass patients is anastomotic ulcers, with and without stomal stenosis. Ulceration or stenosis at the gastrojejunostomy of the gastric bypass has a reported incidence of 3% to 20%. Although no unifying explanation for the etiology of anastomotic ulcers exists, most experts agree that the pathogenesis is likely multifactorial. These ulcers are thought to be due to a combination of preserved acid secretion in the pouch, tension from the Roux limb, ischemia from the operation, nonsteroidal anti-inflammatory drug (NSAID) use, and perhaps Helicobacter pylori infection. Evidence suggests that little acid is secreted in the gastric bypass pouch; however, staple line dehiscence may lead to excessive acid bathing of the anastomosis. Treatment for both marginal ulcers and stomal ulcers should include avoidance of NSAIDs, antisecretory therapy with proton-pump inhibitors, and/or sucralfate. In addition, H pylori infection should be identified and treated, if present.

So basically there are 3 recommendations here. Strictly avoid NSAIDs such as aspirin. Use proton-pump inhibitors such as Prilosec (omeprazole). Make sure you are medically tested for Helicobacter pylori infection. My surgeon put me on omeprazole for the first year after surgery, not for GERD but to allow my stomach to heal properly. So you asked for ideas from non-medical professionals, so this is all I can offer.

[Djmohr 6,965]

I am very sorry! Having had severe gerd before RNY, I cannot imagine how disappointing this is. Have they confirmed that it is definately gerd? Or could it be an ulcer?

I just wanted to say that I hope you get answers and solutions soon. It is awful living with this and you are seriously the first person that I heard was not resolved with RNY.

[Dawn.s 2]

I am very sorry! Having had severe gerd before RNY, I cannot imagine how disappointing this is. Have they confirmed that it is definately gerd? Or could it be an ulcer?

I just wanted to say that I hope you get answers and solutions soon. It is awful living with this and you are seriously the first person that I heard was not resolved with RNY.

Yes they have confirmed it is Gerd. I had a gastroscopy on Monday and it says severe reflux esophagitis and a hiatus hernia. Dr says I have quite severe Gerd again. I see him on 5 October for discussion on where to from here. I have been tested for heli blactor and it was negative, no ulcer's or constrictions either

regards

Dawn

[Dawn.s 2]

Thank you for your input, I do not take nsaids, i am on Nexium- proton pump inhibitor, no helicobacter as I was tested for this.

Regards

Dawn

I haven't heard of nissen fundoplication operations before so I looked it up.

Laparoscopic Nissen fundoplication is now considered the standard surgical approach for treatment of severe gastroesophageal reflux disease (GERD). GERD is increasingly prevalent and costly, and it may affect as much as 20% of the US population.

The pathophysiology of GERD is not due to acid overproduction but rather mechanical dysfunction centered around the lower esophageal sphincter (LES). Furthermore, the mainstay of GERD treatment, proton pump inhibitors (PPIs), have come under scrutiny because of worrisome side effects. Laparoscopic magnetic sphincter augmentation of the LES has been proposed as an additional surgical option. Like Nissen fundoplication, it relies on 360° buttressing of the LES, but it may cause fewer long-term adverse effects.

http://emedicine.medscape.com/article/1892517-overview

Prior to my RNY gastric bypass surgery 3 years ago I had severe acid reflux (GERD). But after surgery this condition went into remission. Sometimes dumping syndrome feels a little like GERD. My severe acid reflux was caused by the fact that I was obese. That doesn't seem to be the cause of your problem. I am not a medical professional, so take whatever I say with a grain of salt.

One of the most common complications causing nausea and vomiting in gastric bypass patients is anastomotic ulcers, with and without stomal stenosis. Ulceration or stenosis at the gastrojejunostomy of the gastric bypass has a reported incidence of 3% to 20%. Although no unifying explanation for the etiology of anastomotic ulcers exists, most experts agree that the pathogenesis is likely multifactorial. These ulcers are thought to be due to a combination of preserved acid secretion in the pouch, tension from the Roux limb, ischemia from the operation, nonsteroidal anti-inflammatory drug (NSAID) use, and perhaps Helicobacter pylori infection. Evidence suggests that little acid is secreted in the gastric bypass pouch; however, staple line dehiscence may lead to excessive acid bathing of the anastomosis. Treatment for both marginal ulcers and stomal ulcers should include avoidance of NSAIDs, antisecretory therapy with proton-pump inhibitors, and/or sucralfate. In addition, H pylori infection should be identified and treated, if present.

So basically there are 3 recommendations here. Strictly avoid NSAIDs such as aspirin. Use proton-pump inhibitors such as Prilosec (omeprazole). Make sure you are medically tested for Helicobacter pylori infection. My surgeon put me on omeprazole for the first year after surgery, not for GERD but to allow my stomach to heal properly. So you asked for ideas from non-medical professionals, so this is all I can offer.

[JulieNOLA 44]

Have you been scoped to check for Barrett's Esophagus? My suggestion would be liquid Carafate 1hr before meals or 4x/day. This coats all of those membranes to promote healing. Also, Pantoprazole which decreases acid produced in the stomach.

If surgeries aren't working, medical management seems necessary.

Finally, are you adhering to ounces allowed at meals? If too much consumed, reflux can occur. Best of luck!

Sent from my iPhone using the BariatricPal App