Caleb sent us this question from Toronto, Canada: “I had Nissen Fundoplication surgery in September, and I have chest pain before and since then. I questioned my surgeon about this, and he said to restart my Protonix two times a day. GERD has reappeared in my throat also. Possibly unrelated I have black stools. Any help is appreciated.”
Dear Caleb,
Nissen fundoplication surgery is the most reliable treatment for GERD. Success rate is very high reaching 100% in centers of excellence like Houston Heartburn and reflux Center. Heartburn, chest pain, and sore throat are excepted to completely resolve following a properly performed hiatal hernia repair and Nissen fundoplication surgery. Surgery restores the anti-reflux barrier allowing patients to stop proton pump inhibitors or PPIs like Protonix.
If any acid reflux related symptom persists or recurs after Nissen fundoplication evaluation is warranted. The gold standard diagnostic test for acid reflux is upper endoscopy with ambulatory pH testing off PPIs. Upper endoscopy allows your acid reflux specialist to evaluate anatomy of gastroesophageal junction, check for hiatal hernia and integrity of wrap. Ambulatory pH testing measures acid reflux into esophagus. An intact Nissen fundoplication is invariably associated with negative ambulatory pH testing.
If there is evidence of recurrent hiatal hernia, slipped Nissen fundoplication or undone wrap, revision surgery is indicated. At Houston Heartburn and Reflux Center, we do not recommend blindly resuming Protonix after Nissen fundoplication for chest pain, sore throat or any other GERD related symptom.