What are other treatment options before esophagitis surgery?

Question

Hello doctor,

My acid reflux is so severe that I wake up choking on acid almost every night. been on Omeprazole 40 milligrams (mg) daily for six months, but still having constant heartburn and regurgitation. Burning sensation in my chest and throat all day long.

Endoscopy showed severe esophagitis and a small hiatal hernia. Now I have developed a chronic cough and hoarseness from acid damaging my vocal cords. I have tried every lifestyle change, elevated bed, no eating before bed, and avoiding trigger foods, but nothing is helping, and also having trouble swallowing solid foods sometimes, which is scary. The gastroenterologist mentioned Nissen fundoplication surgery, but I am worried about complications. Please tell me, are there stronger medications or other options before surgery?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your symptoms, such as,

Waking up with severe esophagitis.
Hiatal hernia.
Cough, hoarseness.
Dysphagia.

These symptoms, despite 40 milligrams (mg ) of Omeprazole (a proton pump inhibitor) suggests refractory gastroesophageal reflux disease (GERD). This can also occur due to complications

Stricture.
Persistent erosive reflux.
Eosinophilic esophagitis.

You should first optimize and reassess your medicine intake. You should take the proton pump inhibitor (PPI) 30 to 60 minutes before breakfast. There are chances that you might need it twice-daily. In that case, you can take PPI (before breakfast and dinner) for eight to 12 weeks.

You can consider switching to another PPI or adding a bedtime H2 blocker (Famotidine) short-term, plus alginate after meals or bedtime.

If dysphagia persists, repeat endoscopy to look for peptic stricture (may need dilation) and biopsies for eosinophilic esophagitis (EoE).

Your next tests before surgery will be

Esophageal manometry (rule out motility disorder).
24-hour pH (power of hydrogen)-impedance on/ off PPI to confirm ongoing reflux, and assess hernia size.

If objective reflux is confirmed and symptoms persist, anti-reflux procedures are needed: A laparoscopic fundoplication (often with hernia repair) or LINX can be done in your case.

I hope this information helps you.

Feel free to ask further queries.

Thank you.