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Would A Nissen Fundoplication Improve The LPR Situation With A History Of GERD?

Posted on Thu, 2 Jan 2014

Question: Hi, I believe i have LPR(in the throat with globus feeling) but because i have had GERD for a number of years,my doctor has said i won't refer you to ENT specialist as he will just ask you to take your ppi's.I have been on 1ppiplus 2 xantac per day for 1 month and then now i am on 2 ppi's per day for about 2 weeks.The pills help the esophagus but don't seem to help the LPR very much.The odd morning i have blood streaks in my saliva.When should we get this formally scoped and diagnosed to ensure there is nothing serious such as growths or cancer?Any tips to soothe the throat and/or neutralize the awful metallic taste (is that pepsin?)?Would a nissen fundoplication improve the LPR situation? Thx. XXXXXXX XXXXXXX

Answered by Dr. Prahlad Duggal (4 hours later)

Brief Answer: if symptoms are static and tolerable, u can avoid Detailed Answer: Hi, Thanks for your query. Diagnosis of LPR is usually made when there are symptoms as described by you but endoscopy is showing minimal signs in esophagus. There is endoscopic evidence of mucosal congestion and edema in throat in LPR cases. Most of the times endoscopy is advised when symptoms are progressive or bleeding episodes occur. Streaks which you are saying are not that significant and is a common finding in many patients and if not alarming or associated with other symptoms like fever, weight loss should not be worried about. Also get your dental checkup done as many a times gums are the culprit for this. If your symptoms are static and there is no dysphagia, you can avoid endoscopy but your attending doctor is a better judge to make these decisions. Keeping the volume of fluids in stomach low, keeping a good posture and avoidance of bent posture, avoiding spicy food, avoiding or decreasing tea, coffee or alcohol intake helps so also reducing weight if one is over weight. Call for whether fundoplication will be helpful should be taken after seeing the results of endoscopy. If you think that your symptoms are very disturbing, please discuss with your GP and he/she can refer you to a specialist. Feel free to ask another query. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prahlad Duggal (19 hours later)

Thanks Doctor Duggal.I am having endoscopy next monday.Can the endoscopy report on the state of the throat i thought it was only for esophagus,stomach and entrance to small intestine? I can swallow ok although a bit constrained by the globus.I do have esophagus symptoms from Gerd history does that mean that my throat symptoms cannot be LPR?No fever. I seem to always want to eat or drink to neutralize that awful metallic taste.Keeping low volume of fluids in the stomach is tough when it is almost recommended everywhere to drink 6-8 glasses of water per day... If it is not acid from the stomach coming back up,what can it be?Just inflammation of the throat caused by nasal issues? Look forward to your comments.

Answered by Dr. Prahlad Duggal (2 hours later)

Brief Answer: Low volume at bed time Detailed Answer: Thanks for your query. Please ask your endoscopy doctor to have a look at the laryngeal inlet and cricopharynx. If your esophagus is normal looking and there is no hiatus issue, and there is no finding in the hypopharynx (throat), the nasal causes also need to be ruled out. Keeping low volume of stomach is usually recommended at bed time/lying down. Nibbling is recommended and bigger meals at any given time are to be avoided. Feel free for another query. Regards

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Above answer was peer-reviewed by : Dr. Prasad