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Fundoplication to Treat GERD
GERD (gastroesophageal reflux disease) is a common diagnosis in people with IPF. In some cases, it is thought to be contributing factor to the development of scarring in the lungs. GERD is often a silent disease, with the reflux occurring at night when a person is laying down. Symptoms can be hard to notice, and it can damage structures of the throat and lungs without ever being diagnosed.
Over the past year, my mom, Holly has had some decrease in her PFT scores, and some lung inflammation showing up on her CT scans. This has been really disheartening and scary after everything she went through before her double lung transplant. One of the things that her transplant team investigated was the likelihood of GERD affecting the health of her new lungs. In September, she had an overnight procedure known as Esophageal manometry–a pressure sensor swallow test–and a 24 hour esophageal pH test. The results of these tests suggested that she does suffer from GERD, and her team recommended she have fundoplication surgery to treat it.
She is scheduled for surgery next week, and I am wondering if any of our forum members have had this procedure. Do you have any notes on what to expect in the short and long term after surgery? Any tips and tricks to help the recovery process go smoother? Please let me know! This will be the first time my mom will need to be admitted to the hospital for an extended time since her lung transplant almost three years ago, and I am a little worried about her mental health. She has ICU-related PTSD and this time around, there will be no visitors allowed due to COVID so she will be braving this on her own.
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11 Replies
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I was diagnosed with “silent” reflux shortly after my IPF diagnosis. I raised the possibility of fundoplication with my gastroenterologist and he advised against it. He has been treating the GERD with Prilosec. So far, all of my CT scans have remained stable over the past 6 years. Good luck to your Mom!
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Thanks for sharing Linda! I’m glad to hear that the connection between the two, and treatment of reflux has stabilized your IPF. My mom is already on Prilosec, so the surgery is sort of the last option. Hopefully, it will do the trick and reduce the inflammation in her new lungs.
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Dear Christie,
I have had two fundoplication surgery, a year apart, back in 2017 and 2018. I had them not because of GERD, (I don’t think I had GERD at the time), but rather because I had a giant paraesophageal hernia, an 8cm hole and the first surgery took 8 hours, and the second, nine hours, but the surgeon took three half hour breaks during the nine hour one. I had to eat very soft foods for a short time afterwards, but wasn’t a big deal. Pain after the surgery was bad, but I was given plenty of pain killers. Pain killers constipate you, so you have to take lots of laxatives. I still have the same amount of GERD, which I had before, minimal. So the fundo didn’t help one way or the other. Keeping your stools liquid for a while was the only thing I remember. I don’t know where you live, I live in Philly. Doing a straight fundo should be easier than my operation. But if she is having lots of problems, then perhaps she should get a second opinion on the surgery. Also, most importantly, ask the surgeon how many of this type of surgery has he done in the past year or so. Where I initially was going to go to one place, the surgeon did about 50 of my type of surgery in a year. So I had to go to another city to have the surgery (surgeon did 200 per year).
I probably didn’t help you too much. But please, consider a second opinion.
Kindly,
Marilyn
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Thank you for sharing Marilyn. I think my mother’s procedure will be much more straightforward than yours. We trust the team at UCSF above all and it is their recommendation to move forward with it. Their approach is collaborative across disciplines, so a transplant-savvy gastro doc should be experienced with the particularities of her situation.
Good tips about soft diet and laxatives. The last thing you want/need after surgery is constipation. ugh!!
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Dear Christie,
I think your Mom will do just fine, she is in the hands of very competent doctors. I will pray for her.
Kindly,
Marilyn
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Hi Christie, my pulmonologist was unsure about the type of Fibrosis I had. He wanted to do a lung biopsy but as I also had GERD as determined by Esophageal manometry and a 24 hour esophageal pH test, he also suggested the Fundoplication and the surgeon decided to do both operations, the biopsy and the Fundoplication, simultaneously which I was told was the first time ever. Unfortunately the biopsy showed IPF. After a year the manometry and 24 hour esophageal test was repeated and showed the GERD as unchanged and that part of the operation failed. A second Fundoplication was considered but rejected. Meanwhile my IPF has progressed.
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Dang, I am sorry to hear that the operation failed for you Rene. Thank you for sharing your experience, and I am glad at least that they were able to do a biopsy at the same time to confirm IPF. Hopefully, that has given you a clear treatment plan that you might otherwise have not had at an early stage.
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Hi Christie,
I was diagnosed with Gerd about 25 years back and, obviously, long before my IPF diagnosis. I was prescribed several PPIs, which none worked that well so my gastroenterologist recommended the Fundoplication procedure, which I agreed to. Preparation included the manometry test, which established how tight to make the stricture. Probably the most difficult part of the procedure was the liquid diet both before and following surgery. As for results, my Gerd symptoms immediately abated, but after five years slowly returned. In my case, the surgery eventually failed and Gerd symptoms return. I suspect my failure may have something to do with stretching due to overeating.
Over the years I have had five surgeries, which included my Fundoplication. Of the five, the Fundoplication was the easiest and least traumatic. Unfortunately, I have no tips on how to best prepare for pre and post procedure, but after lung transplant surgery I suspect your Mom will not have any significant issues with Fundoplication.
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Thank you for your story Shaw. I’m glad to hear it was the least traumatic of the surgeries you’ve experienced. Do you feel like it was worth it to have ~5 years without GERD? Could you feel a difference when it started to come back?
Just since these things seem so often to coexist, I wonder, do you think it may have been related to your eventual IPF diagnosis?
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I had a fundoplication in 2015, I had a large hiatus hernia about the same time my IPF was noticed. I had been on Nexium a PPI for some years prior to that to control reflux. I didn’t have any obvious reflux symptoms while on Nexium.
After the fundoplication I was warned against heavy lifting, the recovery was as expected and the fundo is still in place and working well I’m told.
I still take Nexium as it the Esbriet causes reflux like symptoms if I stop.
cheers
Mal
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Thanks for sharing Mal, it sounds like your situation is most similar to my mom’s. I believe she also has a hiatal hernia. I’m sure some of her dozen-odd meds might contribute to ongoing reflux at this point but I suspect she had it before transplant as well. Who knows.
How long were you on restricted lifting, recovery diet, etc?
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