Reflux sufferer; which op?

[wannabeminime]

Since February, i have been suffering with worsening reflux, so much so that these days i have the sensation of a permanent lump in my throat. I am now taking omeprazole daily. My concern is that i am hoping to have a sleeve in August, but i have read that it can worsen reflux.

Does anyone have an opinion as to which op i should have? Also, Lamornamiss's thread about NSAIDS has thrown me, as i had presumed i would be fine taking NSAIDS following a sleeve, but apparently i would only be able to take them for short periods. My arthritic mum takes them permanently, they are the only things that keep her mobile. Although recently she has had stomach problems from them. Sigh. I was all geared up for a sleeve, now i am not so sure. I dont want to get it wrong!


Found this, written by a bariatric surgeon, with supporting evidence;

Sleeve gastrectomy is a relatively new operation. The data on the sleeve, hiatal hernia repair, and reflux is limited and conflicting. Most of the sleeve data is very short term, meaning a few years at most. The only long term (>5 yr) results that address reflux after the sleeve suggest an increase in reflux problems as time goes on. (See the abstract by Himpens below)

On the other hand it has been well established that the GBP is an effective treatment for esophageal reflux. This observation has certainly been true in our practice as well. I think that your surgeon has a real point when he is concerned about a high pressure situation created by the sleeve. Furthermore, you have a hiatal hernia. Hiatal hernias are a set up for reflux. Even if the hernia is repaired, there may still be problems with esophageal motility and reflux. The effectiveness of hiatal hernia repair and sleeve gastrectomy with regard to reflux has not been reported in the medical literature so far. So you would be going into really uncharted territory. Since the gastric bypass has become a very safe and effective procedure, I'd go with it pending long term follow up studies of the sleeve.

 

[wannabeminime]

If i have the sleeve, i guess i will be on PPIs forever. From the same place i found this;

There are some risks of using PPIs for prolonged periods of time. These can include difficulty absorbing magnesium and calcium (risk of fractures), increasing the risk of the development of a toxic colon bacteria, c. difficile, and other bacterial overgrowth conditions. PPIs do not increase the risk of cardiac conditions or cancers. PPIs like any other potent medication should be taken for the shortest period of time necessary. If you are going to use them for more that a few weeks, you should consult with your primary care doctor regarding drug interactions and other health implications. If you have been on higher doses of PPIs it is good to taper the dose since rebound elevated acid levels can occur with abrupt withdrawal. An example of a taper would be from twice daily dosing to daily dosing to every other day dosing taking two weeks for each step. An H2 blocker such as Pepcid can be used after the PPI is stopped for a couple of weeks.

 

[witchingmoon]

I had bad reflux before my op and too was onomeprazole daily. Since my bypass I haven't had any reflux it been so nice. My team said the bypass was best to help with reflux but talk to your team and see what they feel.
I know someone who had a sleeve and the reflux is so bad she having it changed to a bypass but other sleevers don't have it. Good luck with your op hun x

 

[penelope1008]

I had reflux & IBS pre op & took mebeverine & ranitidine to ease that & protect my stomach as I was also on paracetamol & ibuprofen. Post op I still take mebeverine more for wind & occasional stress induced IBS symptoms (not quite the same but not nice when it hits) I take omeprazole instead of ranitadine daily incase I need the paracetamol & ibruprofen for osteoarthritis & fibromyalgia.
But I had a bypass so can't as such comment on the sleeve's affect or not on reflux but I've had none since the op & as I say the mebeverine prevents wind pain on 1a day, painkillers are used sparingly & through it all omeprazole protects the new pouch.

 

[jenny17]

I had really bad reflux pre bypass and had to take 2 x 150mg Ranitidine and 3 x 10mg of Domperidone a day just to make it bearable. Since my bypass I have had no reflux at all. It is fantastic. My surgeon did say to me that a bypass is the best option for people suffering GRD.

 

[newcy]

Oh dear! I'm having my sleeve op one week tomorrow but I used to suffer from reflux - although no symptoms for 6 months since starting to take low dose Lanzaprozol.

My surgeon initially recommended a bypass but I wanted a sleeve so he did an endo which his said showed no signs of anything serious so I could have the sleeve after all.

Have I made the right decision? x

 

[penelope1008]

Only you & your surgeon can decide that if your concerned speak to him now while there's time to swap if he & you agree it's the best thing but he wouldn't have agreed to the sleeve if he felt it was wrong for you after the endo. Take heart in that & give him a call to calm your nerves & help you be sure you've made the right choice.

 

[jenny17]

Talk to the surgeon when you get there Newcy and explain your concerns. I had a sudden last minute panic about whether to go for sleeve or bypass, and I explained that to the surgeon when he came to see me. He told me he was quite happy to do either and I just had to tell him the morning of the surgery. Just see what he advises on your concerns

 

[Mazza]

Hi Becky

Sorry to hear you are suffering.

My friend at work had a variation on the wrap, as detailed on this link:

Fundoplication Surgery for Gastroesophageal Reflux Disease (GERD) - Procedure, Risks, Before & After Surgery

He very quickly lost 8 stone but as with all surgeries it comes with its risks.

 

[wannabeminime]

Oh dear! I'm having my sleeve op one week tomorrow but I used to suffer from reflux - although no symptoms for 6 months since starting to take low dose Lanzaprozol.

My surgeon initially recommended a bypass but I wanted a sleeve so he did an endo which his said showed no signs of anything serious so I could have the sleeve after all.

Have I made the right decision? x

Sounds like the same worries as me Newcy! Sorry i cant help! x

 

[wannabeminime]

Hi Becky

Sorry to hear you are suffering.

My friend at work had a variation on the wrap, as detailed on this link:

Fundoplication Surgery for Gastroesophageal Reflux Disease (GERD) - Procedure, Risks, Before & After Surgery

He very quickly lost 8 stone but as with all surgeries it comes with its risks.

Hi Mazza, this is really interesting, it really does look like a half wrap (plication)! So he had the surgery for GERD, but lost weight as a result? Or had the fundoplication for weight loss and it corrected the GERD?

Here's a pic;
http://www.mayoclinic.com/images/image_popup/mcdc7_fundoplication.jpg

 

[Mazza]

Both really, he had the op mostly for the GERD but also knowing that he would lose lots of weight.

 

[wannabeminime]

Both really, he had the op mostly for the GERD but also knowing that he would lose lots of weight.

Was he referred for GERD or weight loss?? Was it done in this country? If thats the case i am surprised the full wrap isnt done here (well, it is now i think, but only in the early stages).

 

[Mazza]

He had the surgery abroad but it was in Europe and through his medical insurance (working in Europe). It was recommended as a way of curing the GERD but also to lose the weight.

As Im sure you are aware being overweight can make the symptoms worse.

 

[wannabeminime]

He had the surgery abroad but it was in Europe and through his medical insurance (working in Europe). It was recommended as a way of curing the GERD but also to lose the weight.

As Im sure you are aware being overweight can make the symptoms worse.

Yes, i am wondering if i have reflux due to obesity or stress. I have had a very stressful 6 months!

Thanks for the info, i'll look into it!

 

[chrisa]

Newcy don't panic When Mr.Mahawar did my bypass he came round before hand with the consent form and explanation I had to sign up for bypass laproscopically, however if the bypass wasn't possible he would do the sleeve and if it wasn't possible then they would convert to open procedure, so don't think that is a problem, your theatre slot is booked and must take a similar amount of time so there you go discuss it with him when you go in. xx

 

[Mazza]

Yes, i am wondering if i have reflux due to obesity or stress. I have had a very stressful 6 months!

Thanks for the info, i'll look into it!

No probs, stress is bound to make it worse - doesnt it make everything worse xx

 

[stuckinafatsuit]

Yes, i am wondering if i have reflux due to obesity or stress. I have had a very stressful 6 months!

Thanks for the info, i'll look into it!

Hi becky
Have you only been suffering this since Feb or is it on your medical notes that you are a reflux sufferer?
I was asked this and told my surgeon that i got heartburn from time to time and just took rennie for this. He said that if i generally dont suffer from heartburn then a sleeve would be fine.
All you can do is give him your history on this and see what he suggests.
Good luck

Kim

 

[stuckinafatsuit]

Im a sleever and was only told to take lansoprazole for a month, i dont take it any more but how long did you have to take your ppi's for?

Kim

 

[wannabeminime]

Its only since my deceased father got sick (and subsequently died) Kim. Ever since then i havent felt right. So far the doc cant get to the bottom of it. I am sure its gastric , although it isnt a acidy reflux, more phlegmy (sorry tmi). The PPIs are a left over prescription for when i took diclophenac for tennis elbow. Nothing is official yet, although i have had reflux before. I had a barium xray years ago!