Heartburn After Nissen Surgery

Q:  For thirty of my 54 years, I have suffered with heartburn. For the first twenty years, it was sporadic. I could be heartburn-free for a year, then would experience it almost daily for a month. For the past five years, however, there is hardly a day I don't wake up with it.

My diet seems to have no effect on the heartburn. Likewise, medications to alleviate heartburn do not effect it either. Raising the head of my bed does not help. Nothing helps.

In January 1997, I had surgery to treat it (Laparoscopic Nissen Fundoplication). The surgery did not help. In fact it caused a second problem. If I don't eat slowly and swallow only small portions at a time, I experience great discomfort as the food passes through my esophagus. (This side effect was never mentioned during pre-surgery consultations.)

I have no other health problems, but the daily discomfort from the heartburn has me extremely discouraged, and I fear the constant rawness in my esophagus may lead to cancer. Do you have any suggestions?

A:  "Heartburn," known medically as Gastroesophageal Reflux Disease (GERD), has been the subject of many letters to me lately. Your experience shows that some people have GERD that is very refractory to treatment, even surgery.

In the last column I discussed some of the complications of the Nissen procedure. It sounds like you may need dilation of your esophagus (the wrap may be too tight). A gastroenterologist can do the dilation, check for pre-cancerous changes, and give you suggestions for your heartburn.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.