i had a oesophagectomy 17 years ago for barretts and severe dysplasia. Two years later I had my gall bladder removed. Reflux is a problem.

[grahamapt]

I am 62 and in reasonable health. I have psoriatic arthritis for which I inject methotrexate once a week which has controlled the arthritis well. I seem to be suffering more reflux problems in recent years particularly at night.I take nexium but it doesn't control it fully. My lung function is under investigation at present partly due to my taking methotrexate. I get asthma and take steroid inhaler. I occasionally am woken in the night having inhaled a little gastric acid or could it be bile. I feel perhaps I need some dietary advice. I always start the day with porridge but perhaps have too much cheese! Anyone know where I can get some sound dietary advice as this might provide a solution. I am on the OPA mailing list and have been grateful to them for advice over the years.

[Hidden]

It sounds like you need to speak to an Upper GI specialist dietician - if you contact the hospital where you had the oesophagectomy they will tell you whether there is one there (not all have them). But the effect of diet is generally not so intense as medication, so I think it would be worth asking for a test to establish whether the reflux you have is acid or bile and/or ,ay be affected by the medication you are on. And I think seeing a gastroenterologist might be worthwhile as well. Again, the specialist nurse would advise you as to whether there is a gastroenterologist who has special expertise.

If you look at some of the material on the website about the Dumping Syndrome such as the Food Workshop - opa.org.uk/regional-shop/lo...

you will see that some people do have various foods that gives them trouble. It can be remarkably different for individuals, but if you think you are eating too much cheese, give it up for a while and see what happens. Try a food diary for a while. You might also consider having a test to see whether, for instance, you have some sort of intolerance that might be triggered off by the porridge? You might try giving up all dairy products for a while and seeing whether that has an effect? I wonder whether you might think about whether have been gradually eating a bit too much in the way of fatty food?

[grahamapt in reply to Hidden]

Thank you for your suggestions, it is good of you to take the trouble in replying. Will do a bit of experimenting re diet.

[chris_usa]

I have found that the things that help me minimize nighttime regurgitation and aspiration are three things:

1. No fatty foods with supper, which I eat at about 1800. I can do linguini alfredo with lunch, but not at supper. Same with creamy soups, cheese, yoghurt etc. I still have issues with dumping syndrome, but less problems with bile acid aspiration.

2. Nothing to eat at all after 1930. I used to take a snack after supper to try to get more calories in, but that is out now.

3. Head of the bed raised considerably and avoid sleeping on my back. When I am awoken by major aspirations, I have always been on my back.

These are what works for me. It doesn't eliminate the problems, but sure cuts down on them. If you notice fever or increased shortness of breath after an aspiration episode, call your doctor. These can be possibly emergent events, especially with your use of MTX for psoriatic arthritis.

[grahamapt in reply to chris_usa]

Thanks Chris for sharing your experience, I appreciate it.

[jay2908]

Some things that I do which help me include:

Warm cup of tea an hour or so after eating just help food along its way.

Amitriptalene 25mg in the evening to ensure I get a good nights sleep. Also helps with any muscle spasms, stopping reflux.

I switched from nexium to ranitadine which if found significantly better.

[Spikey]

Dear Graham, I agree to a large extent with Alan. I would try giving up all dairy products for a while and adopting a low fat, low sugar diet - lots of eggs, fish and vegetables. If that doesn't work, ask to be referred to a gastroenterologist. Unfortunately, in my experience, the advice offered by upper GI specialist dieticians too often tends to focus on maintaining weight rather than controlling reflux/bile. After my operation, seven years ago, I got some good dietary advice from Penny Brohn Cancer Care in Bristol. However, their so called "Bristol approach" is based on a vegan diet and meditation, which is not to everyone's liking. Good luck, G