Help Awful acid reflux

[Tilly1000]

Hi, my husband had his 1st dilation a few weeks back which means he can eat better but now has awful acid reflux, the nurse said before the dilation the acid was kept down by the narrowing but not anymore, he is awful at night with coughing, you can actually hear the acid gurgling up, he takes lansprole, gaviscon, doesn’t eat 4 hours before he goes to bed, eats correct foods, he has a wedge pillow and 100 other pillows to keep him upright, but nothing is working, is there anything else we can try?

[Mauser1905]

From your write up, I would be wary of trying any more management ideas. Please get the root cause treated immediately and not anything else.

Ask GP for Helicobacter test, which is done orally and test results available within a week or two.

After the test comes negative ask GP for referral at hospital who will undertake variety of diagnostics such as upper GI endoscopy, 24hr pH test, manometry. Assuming that GP have exhausted all day to day management ideas such as variety of prezole family brands/dosage strengths/increased intakes, endless diet experiments at al.

Essentially if the card is is lax due to Hiatus Hernia then Nissan Fundoplication360 (where HH is greater) otherwise LINX magnetic band (where HH is lesser). Perhaps the sphincter is not working at all and this is mechanical issue and not curable by medicines.

If the diagnosis and obviously treatment is delayed, high chances of developing high grade dysplasia near the LES. Not scaring you but this was how I got my adenocarcinoma.

[Tilly1000 in reply to Mauser1905]

Thank you, I.ll do what you say

[liz_crisp]

Talk to the CNS and see if they Can help, I had this after one of my stretches and was up at night crying in pain,. I found spoonfuls of yoghurt or actimel at night inbetween my slugs of gaviscon helped, I slept in a reclining chair for a while, and ate very small meals! basically just grazing all day, I only drank milky drinks half a mug at a time, and ate creamy sauces with all meals I also use zolton fastab which is orally dispersible as my anti acid which worked so much better than any other for me. I take 30mg twice a day. I also found that it was often bile that was coming up which PPIs do not help with but it is just as painful

[Tilly1000 in reply to liz_crisp]

Thank you

[Judley in reply to liz_crisp]

Going through something similar and noticed your reply about bile coming up and also being painful. Do you mean the bile can be refluxing and could it also burn like acid reflux? Do you know why bile would be coming up because surely it supposed to go elsewhere? Thanks

[liz_crisp in reply to Judley]

Hi Judley, Probably because i don't have a valve or a stomach really as they were removed with the cancer. This happens fairly often with an IL op. Hence lying flat is fatal and anything in the stomach will flow backwards.

[Judley in reply to liz_crisp]

Oh no 😢 I'm so sorry about that. Just wondered if bile can also be a burning feeling like acid? I had never had reflux but last few years back & to GI but every time a Gastroscopy cannot find anything except I have a loose valve, hietus hernia and other year had two bouts of chronic yeast/fungal infection. I feel really bad stinging & hear a gurgling in my chest, feels painful. Drs won't do anything cos said last Gastro was clear - trouble was it had cleared weeks prior then started again couple of weeks after Gastroscopy. Worried if left it could do damage but no idea if it is acid or bile because it doesn't feel like heartburn I had when I was pregnant, it's different and no Gaviscon shifts it yet it did when I had classic heartburn while pregnant. I'm in so much pain cannot stand it but Drs won't do anything

[liz_crisp in reply to Judley]

Bile is a burning sensation too its often darker in color or green , its alkaline other end of the litmus scale. I found thick youghurt,, cream or icecream helpful.

Take care Lizzy

[Judley in reply to liz_crisp]

Thank you. It could be that seeing as I take high dose PPIs. GP thought they might have stopped working and wanted me on a stronger one but I need to know what it is instead of him guessing because it could make it worse. Also had a few bouts of fungal infection down there and a different GI said normally your stomach acid takes care of that before it travels up but if on PPI this often doesn't happen. I just feel miserable though I know that there are people suffering much worse things than me. It's been a couple of years I think now with odd bouts of it calming down and then coming back. I've tried Actimel to re introduce the bacteria and yogurts but nothing has helped yet. Thank you so much for replying

[Alan_M]

Can I just check? Has your husband had an oesophagectomy, and the dilatation for the pyloric sphincter ie at the bottom end of the stomach? (the alternative would be the lower oesophageal sphincter getting stretched, between the oesophagus and the stomach in the diaphragm area, but with an oesophagectomy this will have been removed).

Depending on how much of his stomach he has left after the surgery, there is a good chance that it might be bile reflux rather than acid, but this does need to get checked out, and different medication considered. Bile is alkali;

Try Gaviscon Advance, which should work against either because it creates a protective raft against reflux (it is an alginate). But do contact the specialist nurse.

Position / posture when sleeping (or trying to sleep!) can be really tricky. Sometimes he might be better off in a chair, because gravity does help to keep the reflux down. Sleeping on one's left side rather than right can make a difference to a normal stomach because the entry of the oesophagus is to the side of the stomach, but the surgery may have changed that. The reflux at night is combatted by posture, medication and avoiding eating for a few hours before lying down. I am not sure that there is any other alternative.

I am interpreting Mauser1905's comments as helpful but only if he has not had the oesophagectomy already. The Linx bracelet needs to be applied to a normal oesophagus and lower oesophageal sphincter, and is not used after an oesophagectomy.

Hope this helps

[Tilly1000 in reply to Alan_M]

Thank you, doctor has given metolopramide? She said it will empty his Stomach quicker? Said it was unfortunate that his stomach digests at night so speed up emptying might mean reflux during the day which he could manage easier rather then at night, he had the dilation not sure where? we wish he hadn’t had it done now, he’s had a oesphagectomy, I’ve got some gavisvon double action so going to try that tonight when he wakes up with the reflux, I’m really hoping this metolopramide works, I don’t think he can take much more

[Alan_M in reply to Tilly1000]

It might be metoclopramide? It is very natural to start to regret having these procedures done when you get these after-effects. It can be very debilitating, especially when one is weak after all the effects of the surgery. It is very hard on the spouse as well. All I can say is that sometimes you do have really hard periods when nothing seems to go right - and then things start improving. But when you are in the middle of it you cannot see the light at the end of the tunnel. Sometimes the doctors do have to find the right solution with what seems like a bit of trial and error, so do go back if things are not improving.

Normally getting a bit more sleep does help.

And often changing the diet a bit and avoiding some food (usually the one that he is most fond of!) can help as well.

For some people, and this may not be so in your case, people do try and get back to eating 'normally' ie as they did before the surgery. I am sorry to say that this is very unlikely, if not impossible, and it does take a big mental leap to transfer into eating 'little and often' ie grazing on food during the day rather than having set meals, for a while.

[Tilly1000 in reply to Alan_M]

Thank you, what u.ve said really helps, hopefully a better night tonight!

[liz_crisp]

Just a question Tilly, when you say doctor do you mean GP or your surgeon?

Cheers Lizzy

[Tilly1000]

Hi, spoke to gp today and also upper gi nurses, we now have a drug to speed up the digestion which he.s started tonight and I’ve bought some gavisvon advance so fingers crossed!