Severe Acid Reflux Disease and Gastroparesis

Sandy from Houston sent us this question: “I have a hiatal hernia and have been taking Omeprazole 40mg each morning and 300mg Ranitidine at night. I now have a very bad case of gastroparesis. I don’t see my GP until mid-August but was wondering if my hiatal hernia was fixed and I could get off of these medications, could it reverse the gastroparesis?”

Dear Sandy,

Thank you for your interesting question. Gastroparesis or delayed gastric emptying contributes to acid reflux symptoms especially in the setting of a hiatal hernia. Fortunately, Nissen fundoplication improves gastric emptying. In cases of mild gastroparesis, hiatal hernia repair with Nissen fundoplication are enough to cure both acid reflux and gastroparesis. In cases of acid reflux disease and concomitant severe gastroparesis additional procedures may be added to facilitate or promote gastric emptying. Pyloromyotomy or cutting open the pyloric sphincter is commonly advocated. A pyloromyotomy reduces resistance to gastric outflow and may help improve gastric emptying. Pyloromyotomy can be performed laparoscopically at the same time as the Nissen fundoplication or endoscopically following surgery.

At Houston Heartburn and Reflux Center, I perform a longitudinal gastrectomy along the greater curvature that preserves the gastric antrum and ends just below the fundoplication. I have developed this technique several years ago and found great results in improving gastric emptying in a number of situations. The advantage of this approach over a pyloromyotomy is the actual increase in gastric emptying pressure and not just mechanically drain the stomach.

I recommend you consult with a competent acid reflux specialist to help you control both acid reflux and gastroparesis. I am assuming your symptoms are severe since you are taking high dose PPIs and Ranitidine. Medications do not cure either problem, and some patients develop delayed gastric emptying secondary to heartburn medication intake.

Hope this helps. Dr Darido