Nissen Fundoplication:

[JoHn900824]

I had a Nissen Fundoplication in 2017 and I have been relatively good since surgery and have no reflux sensations, swallowing as been good 90% of the time but occassionally like the past few weeks, I'm eating and I can feel my food go past my wrap and sometimes hold up at the site with certain foods. What could this be?

[Mauser1905]

would the same certain foods caused any issues earlier?Whats changed in past few weeks for you stresswise?

[JoHn900824 in reply to Mauser1905]

It depends it tends to be food that are thicker in texture if that makes sense but again it doesn't happen all the time and I hardly had issues for the first three years but I've had this occassionally( once in 2018, once in 2019 and once at the beginning of the year) but I've got an habbit of eating to fast at times and not chewing enough I've always been the same but my food goes down fine 90% of the time. Since my Fundoplication, I haven't feel reflux or other symptoms that came with acid reflux, The only time I've ached in the past is if I've over eaten.

[Mauser1905 in reply to JoHn900824]

if you dont have blood stain in your stools, no high temperature, no unexplained weight loss, no blood in vomitting/cough, then probably its affected by mental state/type of food/eating habbit. Having said that if you have any cause of concern please contact your local primary care immediately.

as you mentioned you ahve developed a habbit of eating too fast, rushing and not chewing sufficiently, and also with denser food. The surgery you had had provided advisory to exactly avoid doing that for avoiding issues you mentioned.

For finding out for yourself if anything else causing the issue, first of all please avoid denser food cauing issues for few weeks and notice if the problem persists?

After this elimination, secondly attempt to eat the denser foods which was causing issues, but this time slowly, chew it more than sufficiently and swallow without rushing and with very smaller sips of lukewarm water.(small enough only to ease the swallowing)

if both these attempts work out satisfactorily then chances are there is no underlying clinical condition associated for the wrap but the unconsciously developed habbit.

[JoHn900824 in reply to Mauser1905]

I will take that advice thank you for your help. I don't have blood in stool or when I cough, I don't get pains or anything, no high temperature or unexplained weight loss. When i relax and take my time, I don't have issues but it's just rather annoying that I feel food slide past my nissen wrap and sometimes hold up.

[Mauser1905 in reply to JoHn900824]

glad to know no clinical issue per say but only adaption fatigue. Suggest also join local patient network group etc, and see if talking to relatable people with similar outcomes may help to ease the fatigue of continuing the right things.

Its collateral give in for the root cause fix, by adapting to the new normal in your case. It may be bit tight if all food getting stuck, but looks like you already know what works perfectly and what requires more adaptation.

the tightness at the wrap is what offering you protection against the reflux which can be more long term frustrating pain. Its assuring that you yourself have managed and have better control of food intake. thats very good work on you. it is also very normal to feel tired following the new normal advice.

[JoHn900824 in reply to Mauser1905]

I wasn't always getting food slowing down. It has happened a few times over four years but it did improve over Christmas and January but last two or three days the tightness and slowing down of food has came back. I had Steak, Jacket Potato and beans went down fine, then had sausage and Tomato sandwiches and it slowed down but last week I had the same breakfast and it went down fine. Its very frustrating. The last month ive had all meats, breads, another other things and fine but something triggers it.

[Mauser1905 in reply to JoHn900824]

suggest write a diary for the food and drinks date times quantity etc. eventually you will be able to pin point to certain items with some diligence.

Also how about physical activities in those episodes as well stress anxiety issues?

[JoHn900824 in reply to Mauser1905]

I will do but swallowing is still up and down with certain things but fine with others. I did read that people even at three and four years can have set backs and as its a long recovery even at a late stage but I been told to chew well and enough. I might take a few steps back on certain foods.

[Mauser1905 in reply to JoHn900824]

Glad to see you back. Yes some foods need more chewing and care for passing these through your "tightened" "stomach valve".

You are best judge for your own body. hence the suggestion to write a diary which can give you a clear picture once you see correlation between th certain items and the difficulties swallowing.

its day to day management for all of us and we all do success varyingly and at different times. take your time to heal.

[JoHn900824 in reply to Mauser1905]

It's frustrating because I was fine for three and half years with one or two set backs but this has been the longest on and off since October of food slowing down.

[JoHn900824 in reply to Mauser1905]

All this started at the beginning of October has I've mentioned before, I had a bad retching and being sick experience. Since then, its been up and down and slowing, stopping.

[Mauser1905 in reply to JoHn900824]

I am sorry to know of your struggle.Suggest ask your GP for community or hospital dietician urgent referral as you are sustaining the difficulties since october.

I hope your weight is stable and is not a concern right now?

Also suggest asking GP to refer you back to the surgeon's team to investigate current issues.

[JoHn900824 in reply to Mauser1905]

I do need to lose weight, that's my focus to trim about 10 pound. As, I'm currently 13 stone 9 and only five, feet seven. Do you think its possible the retching and heaving, being sick aa disturbed the wrap and moved it.

[Mauser1905 in reply to JoHn900824]

My concern on weight maintenance was in regards to unusual loss of weigth due to symptoms you mentioned since october, leading to malnutrition etc.

If the wrap becomes loose you wont be retching etc. the symptoms kind of show more indigestion or possible delayed stomach emptying. With normal stomach emptying with wrap becoming loose you will get more GERD "heartburn" symptoms.

If the bottom of the stomach not emptying stomach nrmally then you will get sick, lots of gases build etc, apparently wrap working fine then you will be having more difficulty releasing these gases through oesophagus route hence sick etc.

There are many things you could try naturally to induce more normal stomach emptying:

"small, frequent meals.

avoiding raw or uncooked fruits and vegetables.

avoiding fibrous fruits and vegetables.

eating liquid foods such as soups or pureed foods.

eating foods low in fat.

drinking water during meals.

gentle exercise following meals, such as walking.

avoiding fizzy drinks, smoking, and alcohol."

In addition you can request the GP for medicines used in Gastroparesis treatmnent such as Domperidone, metoclopromide to begn with anti nausea medicines to begin with.

There are further diagonoses required to confirm the root cause and furtehr treatment.

Its good to know you are looking to reduce the excess weight and its a good start, slow and steady please do go about it.

[JoHn900824 in reply to Mauser1905]

Everything I eat seems to be sticking. Im really scared.

[Mauser1905 in reply to JoHn900824]

Suggest asking for a Barium swallow or endoscopy at least to see what is going on. What doe GP say?

Most importantly the anxiety/stress effects muscle response in unwanted manner, especially oesophageal muscles. Meaning if you have smaller issue on swallowing, with the additional anxiety this may exaggerate further causing more adverse reaction when you are trying to swallow.

[JoHn900824 in reply to Mauser1905]

My swallowing has improved over the past week with me relaxing and less stressed. It's still not 100% but it is much better than it was 10/14 days back.

[Mauser1905 in reply to JoHn900824]

You may have found your own trigger/s and/or solutions to greater extent. Only you can exploit its potential to fullest. Very happy for you. Well done.

[JoHn900824 in reply to Mauser1905]

Thank you, The thing is, I just don't know what triggered the sticking sensations to begin with. It felt like pre-op where everything was getting stuck but like I said it seems better than it was (touchwood) i'll gradually get back to normal.

[JoHn900824 in reply to Mauser1905]

It has improved in the last two weeks. I still feel food slide past at times and I have to ignore it because it triggers my anxiety and I go all tense in side.

At various stages over the past two weeks I've ate meat and its gone done pretty ok. I've steered clear of all unhealthy food.

Scrambled Eggs, Beans, veg, fruit (I've avoided apples) potatoes, certain meats (chicken I couldn't) I had noodles for the first time in a while it went down quite well, Crackers and stuff. I have to take my time though but I would probably give a rating of 7/10 in terms of my quality of swallowing.

[Mauser1905 in reply to JoHn900824]

Good on you. Especially the first paragraph. Well done.

There will be days great and then some days otherwise. Try and focus on the sustained good days on average. once mastered the scale can be improved towards more good.

[JoHn900824 in reply to Mauser1905]

I will do thank you. 😊

I just hope it continues to improve but I've relatively enjoyed my meals what I've ate.

[focused1 in reply to JoHn900824]

I had same op via day surgery in Jan 2018 . Thick meat makes me feel bloated and as though it is taking its time to get downwards . However for me this has been up to now a miracle cure . I lost 17kg after surgery , eat better and exercise . A whole lifestyle change .

[JoHn900824 in reply to focused1]

That is great news.

I was like that for 3.5 years. I feel well noa but certain fooda seem to slow down past my wrap, linger then continue.

[focused1 in reply to JoHn900824]

I don't eat much solid meat or white bread but when I do I know about it . I still have slight swelling . I managed to get a reasonable flat stomach but still an annoying bump from the bottom of my ribcage to the top of it .

[JoHn900824 in reply to focused1]

What happens when you eat meat or bread? how long long does the swelling last after its come?

[focused1 in reply to JoHn900824]

Bread , meat I feel very full with that blocked feeling for about a hour . Sipping water helps . The swelling from top to bottom of ribcage is there all the time .

[JoHn900824 in reply to focused1]

Try and stay off bread if it's causing discomfort, it might be because bread doesn't break down, it swells in the stomach.

I was fine for 3.5 years. I had little set backs where food was slowing down by the site but last few months since October, its more frequent.

[focused1 in reply to JoHn900824]

I do stay away from the bread . I was given it at someones home . I don't buy it .