My Gastroparesis Is Worse after TIF

My Gastroparesis Is Worse after TIF

Maggie from Cypress, TX sent us this question: “I had the TIF surgery on Jan. 11. I have mild gastroparesis and have not been able to have a bowel movement in almost 2 weeks. I have taken stool softeners and Motegrity the past week. I also fill up very fast and not sure the procedure has made my gastroparesis worse or if it just takes time to recover. Please advise what your thoughts are. Thank you.”

Dear Maggie,

TIF or Transoral Incisionless Fundoplication is a less reliable treatment for GERD than Nissen fundoplication. Indeed, TIF is not even a fundoplication and the name is a misnomer. TIF procedure consists of “bunching” up a small amount of stomach tissue around the lower esophageal sphincter. Gastric fundus is not mobilized during TIF to create an anti-reflux barrier as is the case with a Nissen fundoplication. Furthermore, TIF does not promote gastric emptying like Nissen fundoplication. Consequently, if mild delay in gastric emptying is present in a primary GERD case, Nissen fundoplication will address both the weak anti-reflux barrier and the sluggish gastric emptying. TIF barely improves the anti-reflux barrier, and it does not alter gastric emptying.

Heartburn is a common symptom in gastroparesis patients. Indeed, heartburn may be the first presenting symptom in gastroparesis before nausea and vomiting develop. Careful history taking, and comprehensive testing help the experienced acid reflux specialist differentiate GERD from gastroparesis. GERD is characterized by a weak anti-reflux barrier. A hiatal hernia is typically present. Ambulatory pH testing shows multiple reflux events secondary to transient lower esophageal sphincter relaxation. Distal esophagitis is commonly seen. GERD patients report heartburn, food regurgitation, globus and excessive burping as the main symptoms affecting quality of life. On the other hand, post-prandial (after eating) nausea, vomiting and abdominal pain are the main symptoms reported by gastroparesis patients. Constipation and weight loss are also common. Furthermore, a hiatal hernia is small or absent on upper endoscopy. Solid food residue may or may not be present in stomach. pH Bravo study shows very few acid reflux events in the case of gastroparesis.

My recommendations for you is to get evaluated by an experienced acid reflux specialist. If you have GERD as a primary disease, then TIF to Nissen fundoplication conversion is indicated. If gastroparesis is the primary disease, an antrum preserving longitudinal gastrectomy is our first line of treatment to promote gastric emptying.