Laparoscopic Nissen Fundoplication Be... - Oesophageal & Gas...

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Laparoscopic Nissen Fundoplication Being Suggested...?

Lancaster2017 profile image
11 Replies

Hi,

I'm new to this forum, so apologies if I'm not making anything clear. After almost 2yrs suffering from a chronic cough, my consultant seems certain it is being caused by GERD. Originally, I felt the cough was due to a lung issue, reinforced by the fact that as an ex-serviceman I had been caught up in a couple of sandstorms in the gulf and had breathing difficulties for sometime afterwards on return to UK. At times my symptoms emulate asthma; tight chest, struggling to get a full breath, but the Respiratory team do not believe it is a lung condition? I'm on 40mg Omeprazole a day, which helped with an issue I had with a swallowing condition in 2011.

Lately, any attempt at eating causes a cough reflex and at worst, even breathing-in causes a sensation of needing to cough. Some days are better than others, but the symptoms are always there. My consultant says he's 90% certain that the LNF procedure will be successful, but I do not have confidence that creating a new 'valve' will sort the cough reflex out? Am I just being ignorant? Why am I not able to believe what I am being told?

Is there anyone else who has gone through or is going through the same thing? My apologies if I'm making more of this than I should as there seems to be so many of you in a far worse situation than me...but any advice or support will be welcome.

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Lancaster2017
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11 Replies
Auda profile image
Auda

It sounds like you need a bit more information, before you decide what to do. Sharing my experience in the hopes it might help.

My doctors are putting me forward for fundoplication. But first I had to have a few tests including gastroscopy and 24 hr manometry (measuring acid levels in throat over 24 hrs). I wont decide whether to go ahead with the op until I have the information from these tests.

With the manometry You can actually see the read out of the pH on the monitor in real time. Every time I got symptoms (burning rather than cough) sure enough the numbers dropped from neutral 7 to very acidic 1 or 2. I had no idea just how bad my reflux was until I did this test.

If the gastroscopy shows Barrett's or bad inflammation despite full dose PPI I'll probably go for the surgery even though it's effectiveness isn't guaranteed, but I'm still undecided. I'm still researching all the pros and cons. But the pre op tests have at least confirmed bad reflux. Has your diagnosis been confirmed with tests?

Lancaster2017 profile image
Lancaster2017 in reply to Auda

Hi Auda, Initially, there was a long delay after the swallowing issue (2011) and having the manometry test earlier this year (due to service overseas). On return to UK, I developed the cough in 2015 and after 9months sought help as the cough would not go. I tried Gaviscon. My voice suffered the worst and was referred for speech therapy (for breathing exercises and cough control). I had a gastroscopy to illuminate a stimache food retention issue I had in 2012 as the Consultant felt that if this was still happening, then surgery on the stomach would be preferable to reducing acid reflux. I was not a fan of this and the gastroscopy confirmed no food retention in stomach.

The manometry should severe acid reflux, and the surgeon recommended immediate referral to the Sugical Team for LNF. The impact of the cough is hard to explain to people - I have lost a lot of confidence in groups, eat on my own at lunch, avoid business lunches and sometimes in meetings completely miss making a contribution due to the fact that I am frightened to open my mouth. Even not speaking, at times I am constantly surpressing the urge to cough - breathing in and out is enough to trigger a coughing spasm.

I'm just worried that the recommended surgery will not change what I see as a breathing problem? Everyone medical seems more confident than I am. What if I have the surgery and nothing changes?

Auda profile image
Auda in reply to Lancaster2017

You have had a lot of tests to confirm reflux, but have you had tests to exclude lung/breathing tube disease?

But absolutely in my experience, the acid can cause both cough and problems with speech and vocal cords. That said there are many other causes for a cough hence my question above

Panic123 profile image
Panic123

Hi read your e Mail with interest. I have had a cough for the last five years it occurs only after I have had something to eat , if I don't eat I don't cough but of course I can't continue like that . It's a very productive cough and can be quite embarrassing in company. Does anyone else have this problem I wonder ?

Lancaster2017 profile image
Lancaster2017 in reply to Panic123

Hi, sounds similar, but my cough is less productive and triggers on first swallow; at worst it triggers as I open my mouth before I've even put the fork on my mouth!

Similarly, I avoid eating in company, and feel for my wife who has to put up with such an anti-social palava whenever we sit down to eat. Speech Therapy has helped, but it is only helping with symptoms.

1960finas profile image
1960finas

Acid reflux eosophagitis cure

1960finas1960finas a month ago 4 Replies

Hi my daughter had terrible acid reflux and was taking at least 5 amoprizole a day,she also had stage2 oesophagitis had to sit up in bed because acid would come up into her lungs she would be coughing all night and I mean all night.Was on waiting list to have operation .I told Dr I would get this sorted and I have She is not on any medication sleeps with only one pillow no acid reflux and oesophagitis and took off list for nissense fundoplication Drs are amazed had endoscopy all clear no inflimation , staying on ppi's is dangerous and u will never get better.I think we all know what this can turn into. Cheers 1960finas

Garysreflux profile image
Garysreflux

I've just had LNF, 6th Sept 17. Im recovering. Very early after op but whilst I presently off omprez I still get some reflux. Last night I had a no reflux night; over the moon. Tricks on the go last night were: a digestive enzyme, reduced food volume, constipation now cleared, slept on LHS, slept on sloping bed as opposed to stack of pillows and I will eliminate/add to the above going forward. I read a report yesterday stating that 1 in 6 continue taking PPIs after LNF - I was not happy (touch wood Im off PPIs at the minute)

I was offered the op as I had reflux, oesoph narrowing, oesoph dilated (resulting from food backup at narrowing) and giant hiatus hernia. The originator of this post (the ex serviceman: might add your service is appreciated Sir) appeared to have digestive and respiratory issues. I, like one of the other posters above, suggest you get the underlying reasons pinned down a bit more before proceeding with LNF and if poss isolate your issues more on both digestive and respiratory side (notwithstanding its highly likely you gave us the shortened version on here) e.g.. do you actually get acid/bile coming up in the night, when is it worse etc.

The giant HH meant I had little option other than LNF as I may well of gone for the Lynx treatment (strengthens LES) as this is lesss invasive than LNF; Lynx doesnt address HH. My understanding is that if Lynx didnt work you could have LNF post Lynx but not vice versa (check that, I'm not medical).

Has to be said you will get luckier if you've got your own house in order: weight, fitness, diet, drinking, smoking etc. I know its early days for me but I'm 60 but I've sorted my weight, dont drink much (less than a pint a week on annual basis), dont smoke, dont eat rubbish (well only a little bit & I mean little) + I do fitness circuit training 3 times a week (well I did - be a time before I pick that up again, probably swim instead). Today I'm a week post op - I came off pain killers day after op, walked everyday , did 1.5ml walk (by the way - its not normal walking more a gentle amble; all on/near bus routes, with a phone (cab if no one in) so if I get in trouble en route I can get home), will do a 2ml today. I hope Im not speaking too soon but I feel great, no doubt I'll get some dodgy days. By the way my recovery activities say more about me rather than being prescribed medically - in my younger years I didn't feel well once on holiday and decided I'd improve by taking long walks and running; turns out I was dehydrated, made it worse, wrecked holiday) so check it all out and do what's right for you individually.

Finally, I suggest as a matter of course you double check all info/advice from doctors and make sure theyre current on your situation as sometimes, for example,notes go missing etc and through no fault of their own (those guys are busy) theyre making decisions without all the facts - not good .Cheers. G

Lancaster2017 profile image
Lancaster2017 in reply to Garysreflux

Hi 'Garysreflux', not sure about the relevance, but I was RAF. As an ex-sportsman, I have been fine with weight, but diet could be better as work long hours. Don't smoke either.

Sounds like you've been through it recently, but I live your drive and determination; well done! I'd like to hear how you do over the next few weeks.., did you ever have this issue with reflux related coughing?

Garysreflux profile image
Garysreflux

Me .. Reflux related coughin .. very rarely fortunately. I chew my food really well for what its worth.

But if get reflux related coughing whilst eating then try and pin it down. Heres some food 4 thought (no p intended) simply as an example of type of info i built up myself over time that enabled me to challenge/confirm drs diagnosis

.. get to know how it all works obviously theres a limit but i started with a model that my digestive system was a simple plumbing job and i added to the model as i gained more info

.. what initiates cough. Is it food/acid that has travelled up oesop.

.. does food get to your stom or reside in oesoph pre cough (ie some oesoph obstruction). My food resided in oesoph 1st .. = bad breath. Look for signs .. my HH was initially diagnosed cos my wife noticed i coughed when i laughed deeply .. so i stoppd laughing .. not really went drs and outcome was HH

.. assuming food goes into yur stomach

Xx what causes your LES (stomach cap to open)

.... is cap open already 24/7 (dodgy cap .. alchalasia ?? .. im abt to embark on trying to strengthen my LES naturally .. not sure how yet .. but mine not worked properly for 15yr so gotta b weak or broke

.... is cap open 24/7 due to physical obstruction as per my hHernia

... does cap open due to gas pressure building up in stomach (bacteria issues .. ulcer etc)

I tried intermittent fasting .. shld get back on it soon .. water 1 day .. next day healthy juices only ( i wasnt 100% fasting but not far off) .. hows yur reflux vary in these circs

.. cut down acidic foods .. boost alkali .. and vice versa and assess impact

All these variations will over time enable u to build a picture of what could be or cant be going on. Match that info to doctors advice.

Foodwise discipline is your friend .. but i always blipped once a week just to get me thru it.

My diet wasnt brill but wasnt terrible however the type of foods recommended for condition i just didnt fancy or cldnt contemplate eating. However, slowly but surely i introduced them over time and now i cant eat rubbish; i believe with perseverence your palette changes over time.

Also initially SEP16 they thought my oesop stricture/narrowin was C .. confirmed not C in Mar17 .. believe u me that focussed my mind. You hear people talk abt coughing .. stomach aches .. difficulty eating etc .. all these are bad but bottom line is u cant have reflux (acid or bile) goin up/down yur oesoph .. do whatever u can to get on top of it. Cheers. G

Lancaster2017 profile image
Lancaster2017 in reply to Garysreflux

Thanks for all the advice! You have made me think about diet... Not sure what the opinion was about my stomach valve, but do recall Consultant saying it needed tightening and raising to diaphragm level. I do have a lot of pain from a point mid-chest (v.tender to touch). Is this the same thing?

Garysreflux profile image
Garysreflux

Not sure mate .. no pain from my les. But that sensivity u mention doesnt sound right .. get it explored explored soon.

See if u can take anything from my experience. I was lucky. On my own devices cos of reflux etc i lost 3stone. Still had reflux issues so went GP. GP now looking at a man 3st lighter saying he feels unwell. My GP was a caring chap .. i hardly ever visited him and he obv thought i must b unwell (lose alot of weight they always think C). He put me forward to local hospital on a C related nhs scheme (aug16) whereby nhs got to arrive at a diagnosis or treatment plan within 2-3wks on potential C cases - not sure of details. That meant my local hosp kept me in for 4days but within a fortnight id had .. endosc .. ct and barium. How lucky was i. They diagnosed i had a stricture and referred me to approp dept in central ldn hosp (process slows down a bit there) but wheels were in motion.

Im assuming yuv had these scans. If not .. if u convinced yur dr you were losing weight or feeling tired then may b try get on sim scheme (not suggesting u got C but use scheme to get diff drs (respiratory .. gastric etc) to review yur case in short space of time): u need allocating to appropriate hosp dept quic . As i say scheme was/is a multidisciplinary thing (all types drs meet briefly to discuss yur case). U need all the scan info avail so they can quickly decide next appropriate treatment/departmen otherwise can get bounced around 1 department which may not b correct dept.

Bottom line for me is luckily my GP was on it .. referred me early .. plenty drs dont and instead take u the "try this med" route which is invariably a drawn out process. U kno what .. if i hadnt lost all the weight (promptin GP to think C) im not sure id have been put on that scheme.

All the best. G