Question about acid reflux treatment options

[mustangsally65]

In a patient with GERD diagnosed 5 years ago who has been on proton-pump inhibitors and an H2 blocker, both 2x daily since then with a lot of symptoms still occuring, what other treatment options remain besides nissen fundoplication or possible hiatial hernia surgery?

First Prevacid 30mg was tried for several years, and now the patient is taking Nexium 40mg twice every day. Caffeine is being avoided, as is carbonation and other triggers. He still has reflux symptoms in the evening about 10 hours after taking first PPI, and 3 after taking second.

No tests like manometry or pH testing have been done. I was just wondering what treatment options are left, and what kind of future lies ahead. There is probably a higher risk of esophageal cancer, but what other complications can come from this? Is it possible to be fed through a stomach tube or IV, or would this cause symptoms too?

I'm a pre-med, so I don't have a lot of GI experience, and I know that any advice on this forum comes from mostly students and residents, but I was still curious to know whether anyone had encountered difficult to treat GERD, and what could be done about it. My best friend's dad is going through a difficult time right now.

Thanks for any help!

[doc05]

first off, after 5 years of aggressive treatment with no relief, your friend needs to be seen by a gastroenterologist for pH testing and EGD.

as far as treatment goes, it is important to first be sure of a diagnosis. Fundoplication is very effective but not everyone is a candidate; nor is everyone willing to undergo surgery.

[retroviridae]

Originally Posted by doc05

first off, after 5 years of aggressive treatment with no relief, your friend needs to be seen by a gastroenterologist for pH testing and EGD.

as far as treatment goes, it is important to first be sure of a diagnosis. Fundoplication is very effective but not everyone is a candidate; nor is everyone willing to undergo surgery.

yep, this is not the place to get medical advice. So in a totally unofficial capacity, tell him to go see a specialist if it is bothering him that much. You don't know it's GERD do you? Let the proffesionals handle it.

[mustangsally65]

Originally Posted by doc05

first off, after 5 years of aggressive treatment with no relief, your friend needs to be seen by a gastroenterologist for pH testing and EGD.

as far as treatment goes, it is important to first be sure of a diagnosis. Fundoplication is very effective but not everyone is a candidate; nor is everyone willing to undergo surgery.

Thanks for your reply. I have read that fundoplication can have severe complications, like inability to vomit or gag. Is this true?

I realize this forum is not the place for medical advice. Since this is my friend's dad's problem, it's really none of my business. But I wanted to know what all the treatment options could be, so that if he gets a certain treatment and I am asked if I know anything about it, then I would be able to explain it to my friend. I also have an interest in this because it's medically related, and I'm hoping to get into medical school this year.

I wasn't trying to solicit diagnoses or any other medical advice. I've done internet searches on GERD treatment, and have found conflicting sources of information. So I thought I would ask those in the GI field here on SDN. Sorry for stepping on anyone's toes, I just wanted to make it clear that I was asking out of personal interest in the condition.

Thanks for the replies so far!

[june015b]

You may want to consider the new endoscopic anti-reflux surgery (fundoplication) by GI docs. It works great with less complication than lap fundoplication.

[droliver]

Originally Posted by june015b

You may want to consider the new endoscopic anti-reflux surgery (fundoplication) by GI docs. It works great with less complication than lap fundoplication.

Those new procedures (Endo-cinch type procedures or the Stretta RFA) are still investigational with very modest track records @ this point. If you have severe reflux, a nissen is the gold-standard & also allows tx. of concominant hiatal hernias, and would prob. be what most experts would suggest in 2005.

5 years of maximal mgt. with multi-modal (H2 + PPI)medical tx. is VERY poor judgement by the treating physician. This is a classic history for occasional patients who eventually present with malignant or premalignant changes @ the GE junction, some esophageal dysmotility problem that could have been effectively treated surgically, or the occasional zebra endocrine type issue.

At the least your friend needs this worked up with upper endoscopy to inspect for reflux signs, hiatal hernia, or occasionally an ulcer. You'd decide on the pH probe & manometry depending on the results of the endoscopy.

[mustangsally65]

Thanks so much, droliver!