Linx procedure

Hi Barretts,

I have read a few of your posts and you seem to be in the know and I wonder if you can advise me?

I have been struggling with reflux for nearly 2 years now had umpteen tests nothing significant found apart from a 3 cm hiatus hernia and some inflammation.  Do you think this hernia could be the cause of all my problems? I am taking esomeprazole and domperidone daily and Stillhave chest/back pain every single day doesn't seem to matter what I eat or drink.

Best wishes,

Lynne

 

Hi, Lynne,

Hiatus hernia is the most common cause of reflux. Sometimes it has formed from being overweight but some people may be born with it.

It is part of the stomach protruding through the hole (the "hiatus") in the diaphragm where the oesophaus passes from the thorax into the abdomen.

Reflux prevention is controlled by two sets of muscles: the sphincter muscles, immediately below the diaphragm surrounding the oesophagus as it meets the stomach, and the diaphragmatic muscles. A hiatus hernia impedes the operation of the latter and the extra mass of the stomach protruding where the musculature needs to exert pressure.

Hiatus hernias are very common in the population and for most people cause no real problems. However, for some, like us, it can exacrebate reflux.

If that reflux is acidic, it can cause permanent damage to the oesophagus (Barrett's Oesophagus which, in a few people, can progress to cancer). PPIs like esomeprazole will reduce the acid but not the reflux and even non-erosive reflux can cause damage and problems.

Unfortunately there is no simple answer to controlling reflux. Some years ago, the drug Cisapride was a useful pro-kinetic agent that helped. Unfortunately it increased risk of heart attack and was withdrawn for European and US use.

Domperidone and metoclopramide are two different anti-emetics which some find slightly helpful in reducing reflux. There is a new pro-kinetic in trial called Acotiamide that looks as if may be helpful.

Meanwhile these are the top tips to reduce reflux:

Lose weight if necessary.

Do not over-fill your stomach: eat little and often.

Avoid exercise after food that will compress the stomach (including bending).

Avoid tight clothing.

Leave at least 3 hours between your last meal and going to bed.

Raise the head of your bed by 6 to 8 inches on blocks.

Sleep on your left side.

If you cannot manage your reflux, you may consider the surgical option of a Nissen fundoplication. (Your hiatus hernia would also be repaired at the same time.)

All the best

Chris

It's most annoying when the auto-emoji decides to give a smiley face when it's supposed to be a closing bracket!

Hi Chris,

Thank you for your explanation and advise.

I am petite and slim build - never been overweight and have tried all the things you have suggested but still my symptoms persist. 

I do suspect the hernia is causing all this and at my last appointment with a gastroenterologist he did suggest this.  I am currently waiting for another endoscopy so hope this helps to diagnose and I can hopefully see a way forward.

Thank you again and best wishes,

Lynne

I have read your post could I please

Ask how you have this knowledge

About the linx procedure ?

I had the linx procedure 2 weeks ago

I did receive information about

Both procedures Nissan and the

Linx procedure and for me I

Decided the best option for me was

The linx procedure.

People need to take time to

Consider any type of surgery.

Hi Lynne,

What tests have you had done?

Seems like most of us get the std barium swallow, 24 hr pH test and endoscopy.

I had the Nissen last year and really regret it (I must be one of the 6% LOL). Cured the heartburn but now I have a load of other problems!

There are so many causes of reflux and I wish I pushed for more testing.

Food intolerances, SIBO, H Pylori (any overgrowth of bad bacteria) and interestingly enough low stomach acid. All can be tested for and all can be treated. Another thing that has been looked at (quite successfully) is using Elavil which is an anti depressant. In some cases it can be irritation of the vagus nerve which causes reflux. The Elavil also acts on these nerves. Do you suffer from bloating/flatulence? If so I would definately look into the causes above. Too little stomach acid is just as much a problem as too much. I would try alternatives first 

I have spent considerable time researching this. I have archives of research material and I have discussed this at length with many gastroneterolgist colleagues both medical and surgical. And I have spoken with the manufacturers, Torax Medical.

I am writing a book "Down With Acid" to be available as a FREE download but am ensuring the contents are factual by cross checking all evidence and having it double checked by my gastro colleagues.

The purpose is to have a resource written in layman's language by a sufferer.

There is an entire chapter devoted to  LINX, Stretta, Esophyx (TIF), MUSE, Endocinch, Endostim, Enteryx, Gatekeeper, Angelchik, Reza Band, MedCline etc as well as one detailing 8 variations of fundoplication.

Hopefully the chapter will be helpful having done the research for them.

Chris did you ever try alkaline water before your procedure? Thanks for all the info.

That alkaline water can help is a myth. It is propagated by those who wish to make money out of it - the bottled water manufacturers and the devices to make it.

I gather it must be well advertised in the States as that's where I get most enquiries from. It's almost unknown in UK.

The stomach becomes a reservoir of highly concentrated hydrochloric acid when any food or drink enters the body. drinking alkaline water is like pouring a kettle of hot water into the ocean. You could physically not drink sufficient quantity of alkaline water to neutralise it.

Furthermore, if you ingest anything with a higher pH, more proton pumps are created so the stomach acidity is increased.

The hoax of alkaline water the water companies play has been exposed on a website which says, "You know a medical product is 'snake oil' when all the salesperson can do is offer outlandish claims based on testimonials and no peer reviewed studies. People are making claims that alkaline water cures cancer, heart disease, eye problems and all sorts of diseases. The manufacturers of the device however do not make these claims."

Another website states, "Alkaline water is claimed to have a range of health benefits, from supporting detoxification to protecting or curing cardiovascular diseases and cancer. Currently, there is some evidence to support the opposite, suggesting alkaline water may have a negative effect upon physical health and well-being, if any effect at all."

The only positive effect it can possibly have is as a placebo.

Quick reply. I've given a longer reply but it's gone to moderation. In copying text from one source, it may have accidentally included a weblink unintentionally.

The short answer (which I supported in the long answer) is alkaline water is a hoax and can be dangerous.

Hi Moonbuggy,

Thank you for your post. I am sorry to hear you do not think Nissan has worked well for you.

I have had numerous tests including barium swallow, PH manometry and endoscopy all showing nothing significant exept 3cm hiatus hernia and some inflammation. Sometimes I feel as though Doctors think I am making it all up!! which I most certainly am not!! Chest/back pain continues everyday and I am sick and tired of it all.

Have to keep on punching!!

Best wishes,

Lynne

Hi Chris,

Would be very interested to read your book when it is available.

It's probably about 75% complete. It occupies 86 pages and finished book will probably have between 100 and 120 pages. It is being compiled as a website here www.DownWithAcid.org.uk

The "Alpha3" version of the book is downloadable from that site but it's a large file (2826K). Click on the Image top left of any page on the site.

Thanks for all the info much appreciated. I think it depends on the type of reflux you have. From full blown mine has come down to minor acid leakage at night ZERO in the day thank heavens. My strategy for dealing with this is without any meds or antacids. Before bed I take a couple of swallows and then tiny amounts if I feel acid coming on in the night. You can train yourself to do this without waking up fully. So I am not trying to alkanise my body but just denaturing my throat to neutralise pepsin. Now it does do this really well and I feel it is better than using baking soda. It is only PH 8.22. 

Sounds very interesting.  What exactly do you swallow?  I have similar symptons to you and if I could get away withoug susrgery that would be preferable.  thanks Chris

When will your book be available?  Sound just what I am looking for.

thanks  Chris

Hoping t have the book completed by October. It'll probably be between 100 and 120 pagesof A4. The present "state of play" is 86 pages and it is downloadable from the site where it's being compiled. I posted that as a link but it's still being moderated (though I know they'll accept it as they have before). If you go to DownWithAcid org uk you'll find the site.

If you click on the "Down With Acid" image shown top left of all pages, it'll take you to the "Order/donate" page from where the current pdf file may be downloaded. It is FREE. The pdf will always be free. Printed copies of the book will be sold at cost. This book is not being produced to make anyone money, it is being produced to provide factual information to counteract the snake-oil salesmen who charge the gullible $29.95 to download a pdf on "How to cure you Barrett's" (which we know isn't possible).

Chris I just quietly gargle it and then swallow half a mouthfull. Takes 5 minutes to work. Dont overdo it if you have high BP though. I use one teaspoon in 6 oz of water at room temperature. Coconut water is a great thing to sip  after the bicarb if the taste offends you. Its amazing all these band aids we have to get us thru the loooooooooong nights!

Hi *6 Barretts,

I wish I had found your forum a year ago. My daughter had LINX and diaphragm repair in Dec 2016. She was 19 and has suffered for 19 years with mainly sinusitis issues. After many years of ENTs and Pulmonologists it was suggested she might have GERD (silent congenital GERD.) Upon testing, upper endoscopy and swallow test, doctor recommended to do the LINX. The endoscopy showed extreme damage but no Barretts of the eapophagus and a heital hernia.

My question now for her is she is returning to a college sport and I can't find any rehabilitation after this surgery.

Done laproscopically but 4 incisions on the front of her abdomen and one on the right side. I feel there should be some recommend core that would be "safe" with a LINX and diaphragm repair and rebuilding her abdomen and preventing scare tissue.

The Doctor's recommendations were to return to core 2 months after surgery, which she has done. But she is "jumping" back into major, extreme exercise and has had to limit because of different pain/tinges. But really think there should be some recommended protocol.

Do you have any suggestions or know where to start looking?

Physical therapists?

Pilates/yoga?

Sports Med?

I just feel there some be some building blocks to start with to bring her back to a normal level safely.

Thank you for sharing your information.

Starcleaner

you are right Sir

I have undergone linx surgery in Los Angeles UCS.

The surgery went well and had small problems in swallowing but unfortunately the acid never stopped coming up and then I contacted doctor.

He told to use Priolosec for few days until Linx ring works.I used medicine for 15 days and then stopped.

I can feelthe symptoms start within a day.I got frustated with this procedure, the only advantage is If I use medcine everyday atleast the symptoms are very less.

I used medcines for three years as of sudden even my medcines stopped working , now I'm screwed up.I hate going to doctors and going through all procedures

Don't play with your life with these fancy devices please..