How should recurring GERD symptoms be addressed in a male?

Question

Hello doctor,

I am a 50-year-old man who underwent fundoplication surgery three years ago to manage severe GERD (gastroesophageal reflux disease). While the surgery initially provided significant relief, I have recently noticed a recurrence of my symptoms, including heartburn, regurgitation, and occasional chest discomfort. These issues are starting to interfere with my daily life again.

I am concerned that the surgery might have failed or that I could have developed a new issue, such as a hiatal hernia.

What diagnostic tools, such as imaging, esophageal pH monitoring, or manometry, would you suggest to determine the cause of my symptoms?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

It is concerning that your GERD (gastroesophageal reflux disease) symptoms have returned after having fundoplication surgery, especially when it was initially effective. A recurrence could be due to several factors, including surgical failure, a hiatal hernia, or a new underlying issue.

You can do the following tests to confirm your diagnosis:

1. Esophagogastroduodenoscopy can detect hiatal hernia, esophagitis, or esophageal stricture.

2. Esophageal pH Monitoring.

3. Esophageal manometry will give you the status of your lower esophageal sphincter.

4. Barium Swallow X-ray: It can pick up many esophageal structural anomalies including hiatal hernia.

5. Abdominal CT scan.

If a hiatal hernia is present surgical repairing of the hernia will be required. Surgical revision may be necessary if the fundoplication wrap has become undone or too tight. This can involve replacing or tightening the wrap.

If the symptoms are less severe, adjusting medications might help. This could involve increasing the dose of proton pump inhibitors (PPIs) or using H2 blockers, as well as addressing any gastritis or other digestive issues.

I hope this helps.

Thank you.