I am a little more than a year post-op (Ivor-Lewis oesophagectomy/partial gastrectomy). Of course, I had had reflux for years but the symptoms were quelled by PPI's until after the operation. Despite assurances that the cutting of the vagus nerve in the operative process would likely lessen the reflux, I found that it was worse and that PPI's did not quell the reflux as well as they had pre-op. What did work (incredibly to me and my doctors) was chewing sugarless gum immediately after eating and much of the day as well. I now take a 20mg PPI per day, a couple of ranitimide before bed, and chew gum as mentioned above and I have no problem whatsoever with reflux.
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I second the chewing gum benefits .. i too use a non aspartame/sugar gum, although i do wonder if these "healthy" chewing gums contain toxins. I have a serious narrowing of my oesoph and food backs up. The gum generates a steady stream of saliva which helps the food pass. The key for me is saliva generation .. when i have no gum i chew a small piece of cloth (sounds basic .. it is .. any other saliva generation ideas). Cheers. G
If the vagus nerve was cut during surgery, which is normally done during Ivor Lewis, PPIs Do NOT work. The vagus nerve controls stomach acid reflux so I'd it's cut, those meds cannot help you. You are experiencing bile Reflux, not acid reflux. Unfortunately most surgeons do not know the difference and continue to prescribe meds for acid reflux. Ask your gastro doctor about it. Ask your surgeon, gastro doc or your internist to Rx Sucraflate 1 GM 2X daily. Crush it - if you cannot swallow it, and mix in 2 ounces of full fat Greek yogurt like Fage. Take first thing in morning and eat or drink nothing for only one hour. Take the 2nd dose two hours after your last meal. Works like a charm - my husband has had no bile episodes since starting this med. and Sucraflate has none of the potentially harmful side effects like PPIs do. And, it is inexpensive - his insurance copay is $10 a month. I hope this works for you!
You are right that the vagus nerve is cut during the oesophagectomy surgery. This can have an effect through the digestive system on how it works, and for most people their system gradually gets trained to coping better as time progresses. But that is not the reason for the reflux - which is caused by the removal of the lower oesophageal sphincter that should normally act as a valve to keep the stomach acid in its place. Hence the need for medication.
But the more of the stomach that is removed, the less likely it is that any acid will be generated by the remains of the stomach. The more the surgery has involved reconstruction of the system nearer to the bile duct, the more likely it is that the reflux will be bile (alkali) rather than acid. PPI medication (and antacids) do not work against bile because of its alkali nature.
I cannot challenge your experience of surgeons where you are, but in the UK, these operations are done in specialist centres and the surgeons will know all about this. They will not necessarily be able to tell the difference between a patient's acid and alkali reflux without having a test done, though.
It is important to distinguish exactly what the reflux is so that the right medication can be achieved, and you are right that if continuing reflux problems are being experienced, and PPIs do not seem to get on top of it, the possibility of it being bile reflux is a sensible thing to consider.
Many people have problems with their taste buds after chemo and surgery, and chewing gum must help because of its generation of saliva, so that is a really helpful tip, thank you.
Hi .. nhs gastro consultant has referred me for the Ivor Lewis op. I have a serious oesophagus narrowing resulting from acid reflux / hiatus hernia. Your post was useful thanks
I find this works for me too.chewing causes flem which when swallowed neutralises the acid.I have been doing this for 12 months and have gone from 20mgs omeprozloe per day to one 20mgs every 4th day and now no side effects.
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