What is this fizzy gas I get with burping

[Garysreflux]

Hi, wouldnt mind pinning this down if anyone can help. I've just had laporoscopic nissen fundoplication LNF to address giant hiatus hernia and reflux (in recovery, doing ok).

Post op I seem to burp more often but the burp often (particularly after fruit) sends up a gas that makes a fizzy feeling in mouth & back of throat.

I sometimes got this same gas pre LNF. I was told then that this is likely to be due to food backup in my oesoph (got dilated oesoph - 10x normal width as a result food backup due to oesoph stricture and eating lots) where the food was fermenting in my oesoph rather than my stomach. That didn't sound good as that means your oesoph is acting like your stomach which as I understand it could lead to cellular changes in the oesoph and down the merry road to Barretts we go.

Post op the surgeon told me that he had straightened the kink in my oesoph (became interwined with stomach - hiatus hernia - and I never had any pain!!) and that food should now go straight into stomach. He felt that the oesoph stricture may have in fact been the crease of the kink as opposed to an actual stricture. By the way his assessment was made totally externally at op time, they never actually went inside my oesoph.

So now post op I get the fizzy burps regularly whereas pre-op they were intermittent. Im in two minds: 1) actually my dilated oesoph (which we are hoping will shrink back somewhat in time) is still holding food and im getting the same gas as before (but why more often) or 2) the food is actually going into my stomach but my stomach lid (LES) which has not functioned correctly for 15yrs is weak and the slightest burp lifts the lid and up comes stomach acid gas. Any ideas.

Given the LES has been ajar with HH for 15yr its inherently going to be weak and I'd like to strengthen it naturally. So far I've heard you can strenghten LES with a combination of carbonated water and burping and I'm looking into this. Any other ideas to strenghthen LES.

Good health to all. G

[Hidden]

It is quite possible for food to ferment in the oesophagus if there is not a clear run through down into the stomach and the lower oesophageal sphincter (LOS) is not at the lowest drain point, as it were. This can indeed happen if your oesophagus gets baggy, or distorted, and it sounds like this was happening before your operation.

The increased frequency of the burps feasibly may not necessarily mean that the problem is any worse. I can imagine that your stomach will take some time to settle down now that it has been put back into its proper position.

It is possible that your LOS is still weak. After all that was the basis of your hiatus hernia in the first place. I have not heard about strengthening the LOS in the way you mention. You will need to ask your surgeon about all of this, and to take your time before committing to anything after seeking their advice.

Repairs to hiatus hernias are sometimes very necessary, as it appears that your was, but there is one school of thought that there is always a risk that they may revert back, so you do need to be careful. In some cases there is a Linx device (a magnetic bracelet) that can be used to recreate the valve-like effect for the LOS but this is not always appropriate, and is pretty new in any event.

The LOS is associated with the belt of muscles of the diaphragm. Whether there is some form of exercise that might be able to help with strengthening it is definitely something that you need to take specialist advice on.

[Player3393]

Has your doctor mentioned possible achalasia. I have it. It's a disease that prevents your esophagus from working properly. The signs are vomiting, weight loss, feeling of food stuck in chest. I mention this because; while there are some variations, generally and at least in my case the LES is stuck closed making it difficult for food to pass as well as a weak muscle pulsations in the esophagus lining making it hard to push food down anyhow. One of the types of surgery is called a heller myotomy where they cut slit in the LES allowing it to relax. I didn't have it done but often times they do a fundolplication. If his assessment is external only; that's a little concerning that maybe he didn't rule out everything. You are having food sit in the esophagus it's important to know. As Achalasia gets worse with time. The sooner you have it taken care of the more successful surgery is. There's three tests they do. An esophageal manometry, an endoscopy, and a barium swallow. I would at least bring it up if it hasn't already.

[Garysreflux in reply to Player3393]

Hiya .. my hh/nissen experience. i had hh and i had nissen 360 at st thoms in london in sep17. My reflux stopped immed and ppis were stopped too. Years of reflux caused a narrowing in my oesoph (due to scarring from acid burn) so i had swallowing issues too, to the extent my oesoph is funnel shaped due to food backup: 10x width of normal oesoph.

Post n360 my doctor was hoping my oesoph would shrink back. A year on I still have swallowin issues .. have to chew food to a pulp .. oesoph still funnel shaped and this leads to food residue in oesoph to the extent that 2 recent endoscopies have failed. I take sparkling water with every meal as the related burping helps food go down. Over the year ive had a couple of stretches but, touch wood, still no reflux.

My doctor thinks there may be some alchalasia involved and/or he may have done the wrap too tight (yours too loose??). Im being lined up for a procedure .. theyve suggested poem rather than heller myotomy .. where via throat he will snip the wrap to loosen. Im not sure cos despite swallowing issues which are manageable .. im 61 .. fit and lifes good. I dont fancy the risk of reflux again. Amazing how individually with hh the probs are similar but our outcomes all vary.

They need info to determine the size of cut to be made and getting this info is problematic due to:

.. barium .. this was successful

.. a mammometry test failed, they were unable to thread the end thru to my stomach

.. endoscopy failed .. due to food residue in oesoph. As oesoph is dilated this hinders the peristalsis process.

.. ct scan .. this was successful and they are deliberating.

The issue is that whilst i have swallowing issues overall im fit and well without reflux. They are reluctant to proceed with a cut until they have all the info as there is a risk, if the cuts too big, my reflux will recur, an.outcome we dont want.

Thanks for your info. Its likely i do have some degree of alchalasia but as ive said its yet to be proven.

Best wishes.

Gary

[Player3393 in reply to Garysreflux]

I'm young; 25, to be exact. So I see why they didn't hesitate a surgery with me. Pre-op they told me I could hold a four-course meal in my esophagus. I never had a wrap but my esophagus too was funnel shaped like an american football. The backup of food caused it. Pre-op it slowly got worse over the course of a couple years leading to unable to swallow liquids. After my surgery my swallowing too was manageable. That was 4 years ago and I'm swallowing with decent ease. Every day still has it's difficulty but again, manageable. I'm glad to hear your without reflux. However; but your description sounds so familiar. At my first appointment I went in thinking maybe I had reflux. They even gave me a prescription. After my first test they suspected achalasia. I'm obviously no doctor; so take what I say with a grain of salt, I'm sure reflux can do a lot of damage but I'm don't see it causing the food backup. Maybe I'm all wrong though.

[Garysreflux in reply to Player3393]

My food backup relates to the severe narrowing of my oesop at the junction with my stomach near to the LES valve. The narrowing was caused by scar tissue. This scarring arose through years of unattended reflux acid burning the area away. The n360 op cured the reflux but the narrowing remains, the wrap may have made the narrowing slightly narrower and my oesoph is still funnel shaped.

The funnel shape means i get limited peristalsis. Peristalsis .. im not brill on this .. is oesoph function which has the effect of squeezing the oesoph to assist gravity moving food down the oesoph. My oesoph is too wide which means nothing gets squeezed thus peristalsis has a limited effect in.my case and food can remain in the upper oesoph by effectively sticking to the side; ive had several failed endoscs as a result.

I find drinking sparkling water with my meals helps. It washes food thru but also triggers burping which loosens any foods lodged in my narrowing.

Ive got to be more careful with my food choices. Just recently ive have a bit of steak caught near LES also a hotdog off a stall (onions .. mustard .. sauce ) literally had the effect of cementing my oesoph near my LES so did hummous, bread and roasted vegetables. All the above caused me to be violently sick to dislodge the stuck food.. Worth talking about being sick in these instances. In the past being sick meant i had a stomach upset so it got rid of the crap and i got back to normal quick with no ill effects. Post n360 severe vomiting as a result of food being stuck is different. U strain the stomach/oesoph region and next day i get soreness in that area but also i feel tired and it takes me a day or two to recover. I also find swallowing even more difficult after being violently sick .. this imo is due to inflammation caused by the stress of vomiting. Again it takes a few days to settle down. Got to be careful what i eat and speed i eat it.

Another thing that i think is affecting my swallowing is that i recently lost a huge tooth (molar). From a child ive always been a bad chewer of food and swallowed food before it was chewed; parents always berating me about chewing. The loss of that molar represents the loss of significant chewing surface area and as much as i try to switch food to the other side of my mouth i get the impression some food slips down less chewed than is necessary. In support of my assertions here is that ive had more failed endoscs down to food residue since losing my molar than pre/post n360 op. The dentist is adding a molar to a plate which hopefully will assist crushing food on thr lhs of my mouth. Lesson here is look after your teeth.

My next appointment at st Thoms is late december.

Cheers. G