Juan from San Antonio, TX sent us this question: “I have had a long history of acid reflux, including Barrett’s esophagus.
However, each year my symptoms have gotten a little worse. Finally, I had a pH Bravo test while off PPIs that demonstrated clear reflux. All my prior EGD’s have been unremarkable.
I do have mild gastroparesis and occasionally get nausea and feel sick after eating solid foods.
Is fundoplication surgery helpful to me? What are my best options to get rid of reflux symptoms?”
Dear Juan,
Properly performed Nissen fundoplication and hiatal hernia repair is the most reliable treatment for stage 4 acid reflux. You have stage 4 acid reflux because you have developed Barrett’s esophagus. Barrett’s esophagus is the result of longstanding severe acid reflux disease. PPIs do not cure acid reflux. PPIs only mask symptoms while acid reflux continues to progress over time.
Concomitant gastroparesis or delayed gastric emptying exacerbates acid and bile reflux. Interestingly, Nissen fundoplication promotes gastric emptying and in cases of mild gastroparesis, Nissen fundoplication cures both acid reflux and gastroparesis. For moderate or severe gastroparesis, I add an antrum preserving longitudinal gastrectomy that stops below the level of the wrap to promote gastric emptying.