Hi I am 15 months post osaphagectomy now I am on omeprazole 40mg a day any suggestions how to slow Dow acid reflux which is really dreadful

[Gerard]

[sensus]

I am now 4 1/2 yrs post Ivor Lewis and well know the horrible acid reflux problems. My problems with this have eased considerably over time but time is what it takes. I am taking 2 x 20mg omeprazole a day and will no doubt for ever and in between take Gaviscon when stomach is feeling iffy. I have found that when you can feel "bad" acid in stomach then no amount of waiting or omeprazole or Gaviscon will have any affect and the only way to relieve this is to vomit ALL stomach contents up to get rid of the acid. It is not pleasant but it really does work, Try it! Good luck for the future and stay the course!

[clachuk]

Hello Gerard. I am 4.5 years post op. I too suffered terrible reflux during the night, causing severe coughing fits and sore throat. I found that not eating or drinking for 2 hours before going to bed helps. Also make sure you are sleeping at an angle of about 15 degrees either by getting adjustable bed or using pillows. I have been lucky as during recent surgery for diaphragm repair, the surgeon also performed roux-en-y bye pass which seems to have cured the oroblem completely.

[Hidden]

The surgery removes the lower oesophageal sphincter which should act as a valve that stops the stomach acid/contents from rising up, so some degree of problems with reflux is common. But it is worth having things investigated when it gets that bad, because having that much reflux is not good for you.

Is it stomach acid, or is it bile that is refluxing up? Bile is an alkali, usually tastes extra foul, and omeprazole will not have any effect against it because omeprazole is a proton pump inhibitor that switches off the stomach acid production (but not bile). So it would be worth getting into contact with your specialist nurse for an appointment so that you can be tested for whether the reflux is acid, or bile. That will determine the medication.

It may be that the PPI needs to be changed to an alternative, or increased, or replaced / supplemented by something (perhaps cholestyramine) that combats bile reflux.

There are some over-the-counter medications that might give some help. If you take additional antacid and it makes things better, it might just indicate that you have an acid problem rather than bile. You have to be careful with these experiments, but over the counter medication is pretty safe, and if there is a dramatic improvement, the doctor would be interested to know.

Gaviscon works as an alginate by creating a barrier which should work for acid or bile, and is a different method of achieving relief. It comes in different strengths.

Is it worse at night? Gravity can make it worse, and sleeping position can be really important (ie propped up).

Stomach acid is in our systems because it is part of the digestive process. So removing some or all of that acid is bound to have some effects one way or another. I can understand the relief that vomiting can bring, but if you have to resort to that too often, that again is not normal, and it would be worth considering having yourself checked over.

Some people believe that controlling the kind of food you eat can have an effect on the amount of reflux that gets generated, and that it is the chemical reaction of fermentation that creates the upward movement of stomach contents / acid. I am not sure that we know nearly enough about this, particularly for people who have had oesophagectomies, but keeping a food diary, and trying a low FODMAP diet (mostly developed for people with irritable bowel syndrome) MIGHT help some people some of the time. The idea is that reducing some elements in the food such as processed sugar, or carbohydrates that turn into sugar, can have an effect.

My guess is that many people reach the point, after a number of months, of coming to terms with the idea of changing their diet; and having to experiment more seriously with the food that they can tolerate, and things that give them problems anyway; and that further experiments with a food diary might result in some good.

ibsgroup.org/brochures/fodm...

Food diary at opa.org.uk/pages/factsheets...

[Hidden in reply to Hidden]

Thanks for this advice, as new to the site I just read it as so much applies to me. It has helped me already

[Spikey]

Gerard, just to add to what Alan said, I have certainly found that controlling what I eat has a significant effect on the amount of both acid and bile reflux that I suffer. Things that help include peppermint and fennel tea, porridge, green vegetables (provided the operation has not left you with a fibre intolerance) and substituting soya milk for dairy. More importantly, things to avoid include anything that is high in animal fats or sugar, such as pastry, sweets, biscuits, full fat cheese and cream deserts. Hope this helps. Good Luck, G.

[strangetimes]

Very interested in mediator Alans post as I've not thought to distinguish bile from acid .

I am 6 weeks post op ( very recent I know ) and having a lot of reflux .

Was taking 3 x 20mg omeprazole which seemed to do the trick but dietician has suggested 2 x omeprazole ( some acid needed for digestive process ,in particular mentioned iron absorption ) and now I'm going to start Metoclopramide .I think based on possibilty that food sitting at bottom of stomach tube and aggravating reflux .

Hard to know isn't it ? This condition and individual responses to it seem a real detective hunt for soloutions/causes etc

I kind of suspect bile as well ,my bowels are all over the place and my feeding tube nearly always overflowing with greeny yellow liquid .

[Hidden in reply to strangetimes]

If food is not clearing from the bottom of your stomach, they can do something about that. Quite often the pyloric sphincter can be stretched. Not sure about the greeny yellow liquid - I think it would be worth checking with the specialist nurse as a first thing to do to get it checked out?

Alan

[strangetimes]

Thanks Alan .

I think the dietician is hoping that the metaclopromide might help with the food clearing .

The surgeon seemed to want to keep an eye on the greeny yellow stuff but I think I've been handed back to the oncologist now and probably wont see the surgeon again .

The nurse who works for Nutricia and showed me how to adminster the feed just said it was "overspill " .

But I'll ask again ,it usually accompanies a rather distended stomach and lack of bowel activity -)

Thanks again for your advice ,much appreciated in these unchartered waters !