Howard,
If you may recall, my latest gastro had to abandon my bravo test mainly
due
to the duodenal ulcers he found during the EGD, and the surgeon at Hopkins
I
told you all about was all ready to perform a robot assisted lap nissen
(per
my phone con with him on 9/27) without a bravo or manometry (and just
based
on an UGI and cine), *but I said no and insisted on having the bravo
first*,
and he agreed.
The surgeon has now changed his tune 180 degrees and is now making it
sound
like it is not wise to proceed without further testing. You wouldn't
believe the politics involved and the "cover your ass" letter writing that
has been going on, since the surgeon got a copy of my office visit and my
EGD re****t from the new gastro. It is incredible.
Barring all that, here is something the new gastro (and now the surgeon)
have said, and I have read it on researching in the past also, and I
believe
you may have said it in the past in our group - but I want to get your
thoughts on it, and what the mechanism and logic is behind the statement.
The statement is this - "Surgical therapy for GERD is usually most
effective
in patients who respond well to PPI therapy, and not effective in patients
who do not respond well". This is a quote from the gastro's consultation
notes. I would like to know what the logic is for that and what is the
mechanism that drives that thinking. As you may recall, I used to respond
well to PPI therapy in years past, but no longer now, and this is the
second
time they have quit working on me (in 2004, and now).
I have read many times (and I think you have said repeatedly in the past)
that there are three main reasons for performing anti reflux surgery
(assuming acid reflux has been confirmed). And they are as follows:
- Lifestyle changes don't help.
- Patient does not (or no longer) responds to PPI therapy .
- Patient responds to PPI therapy, and does not want to take pills the
rest
of his/her life along with the associated side effects.
I do not understand the logic or mechanism of the statement I made above
regarding the lap nissen surgery being ineffective for patients who do not
respond well to PPI therapy. It would seem to me that if you tighten up
the
LES by wrapping the stomach around it, then that is a physical, or
mechanical type solution to stopping reflux of any kind (although it is
pur****ted to be less effective for bile reflux).
But lets assume a person has do***ented acid reflux confirmed by ph
testing,
and he/she does not respond, or no longer responds to PPI therapy. Please
explain why the surgery wouldn't be as effective on such a person as it
would be on a person who did respond well to PPI therapy.
Thank you Howard. I (and I hope others in the group) will be very
interested in your response.
Pete
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