I have a topic hovering in my mind about the post op (acid/bile) reflux. Few patients require dilation of the upper oesophagus and would be keen to understand if this condition was helpful in the night to reduce reflux?
There seems to be no medical case study where post IL Op a LINX device was used to control reflux in the night. ( LINX is useful GERD patients with lesser of HH).
Can we have a poll or something formally from OPA on this idea please?
I think that the need for dilatation for the upper oesophagus would probably be because of scarring around the surgical joint. As I understand it, some people develop large scars (keloid scarring); others do not.
I do not know whether the presence of such scarring would reduce reflux. In theory, anything that tends to block the oesophagus would help against reflux coming up; ad dilatation is conversely likely to make reflux more likely as the passageway is clearer.
I do not think that Linx is approved for oesophagectomy cases. It was not when I spoke to a representative of the company that makes them a couple of years ago. They were very wary of the device slipping out of place in an oesophagus / stomach pull up which is a very different profile from normal.
If the issue is reflux in the night, which is a common problem, you invariably come down to the usual things like using gravity to help (raising the bed head, adjustable bed, pillow wedges etc); medication like Gaviscon Advance; getting PPIs right (eg Omeperazole but some people do not respond to PPIs well); and clarifying whether it really is acid reflux or bile reflux that you are suffering from.
It is probably quite complex, but the polls can be organised through the OPA (helpline 0121 704 9860)
Yes you are right the LINX band is Not approved for Oesophagectomy case, yet. One of their reps did contact me just before my surgery in Jan.
Yes the wariness of device slipping up is understandable but it's not proven in any case. Many cases of oesophagectomy have stomach shaped as a pouch below the anastomosis.
This needs to be studied and I am pretty sure there will be volunteer patients willing to get this device installed to reduce the reflux and improve quality of life, including myself.
The methods mentioned in your second last paragraph are mainly ongoing management of the issue and not root cause treatment.
There is potential to lobby medical surgical community along with device manufacturers like LINX to come with solution to provide alternate to the lost sphincter after the oesophagectomy Op. And in this case distinguishing the reflux acid or bile does not take away the root cause issue of deteriorated quality of life, especially if the sleep is disturbed on ongoing basis. Sleep deprivation is one of the worst tortures humans can undergo.
This is a really complicated, technical, surgical issue in an operation that in surgery terms is at the top end of difficulty. And each operation varies in relation to what parts of the oesophagus and/or top part of the stomach are taken away. I know that they do not recommend Linx when, say, there is achalasia and lack of peristaltic contractions that would propel food through the system. I think that this is because the device would potentially create another obstruction to the passage of food. I am not sure whether a new 'stomach' after an oesophagectomy works by peristalsis or not, but there are a good many people who have a lot of trouble with their stomach contents clearing through the pyloric sphincter at the lower end of the stomach. That is why people have stretches and sometimes a myotomy (cut) to allow food to progress downwards. So my reaction is that anything extra that might create a potential obstruction would be a problem that we would be better to be without.
Having said all of that, reflux and sleep deprivation are considerable quality of life problems. I think that one approach might be to concentrate on improving the reflux, including having an analysis to clarify whether it is acid or bile, and get any medication adjusted to the optimum level first. I accept that it does not address the root cause, but this operation does necessarily remove parts of the body (including parts of the vagus nerve system) that were there for good reason. So some adverse effects are probably inevitable.
Getting good sleep is a common problem, not only in relation to reflux, but also comfort and relaxation. There are notes on relaxation on the OPA website opa.org.uk/pages/factsheets... but I am not suggesting that it is necessarily very easy to achieve when you have a lot on your mind. Sometimes were feel that we have not slept at all, when in fact we may have been dozing or asleep for part of the night. It can take quite a long time before one is able to sleep through the night. I dare say that we can all remember long nights downstairs unable to get comfortable or sufficiently relaxed and sleepy.
Reactive hypoglycemia
