I've seen a few posts about acid reflux / GORD / GERD here recently, so I thought I'd share my recent and ongoing experience.
I've had what is described as "moderate" reflux over the past few years. The kind that you can almost eliminate with about 40mg of omeprazole once daily. That's what I used to do, and life was fine.
After my CML diagnosis, it was clear that PPIs (such as omeprazole) and TKIs (dasatinib in my case) don't mix well. The PPI neutralises stomach acid, and I believe the TKI relies upon the stomach acid to break it down properly. So, PPIs effectively reduce the potency of TKIs.
My PCRs have been OK, but after 15 months I haven't achieved MMR - the closest I've got to is about 0.4%. I want to get this much lower. This is after reducing the PPI to 20mg, then to 10mg and using some antacids to help control the reflux. Unfortunately this just couldn't control my reflux, so I felt pretty rotten with that, slept badly and in general would be putting myself at risk of serious oesophageal problems down the line. Long term use of PPIs has undesirable effects too, and I'm not an old chap (yet!) so it's not a bad idea to get off them somehow, at my age.
So something had to be done. We investigated a device called a Linx, which is a magnetic implant which helps close the oesophagus - but these are quite new and have a pretty high failure rate so it wasn't really a viable option. The gold standard is a procedure called a Nissen Fundoplication, which is a procedure which wraps the top of the stomach around the bottom of the oesophagus, creating a tighter junction which should stop acid coming up. It's a delicate procedure because anything that stops things coming up, stops them going down and obviously that can be a problem. So a very skilled surgeon is essential!
To assess suitability for this operation, a oesophageal manometry (which tests the function of the oesophagus muscle), a videofleuroscopy, which invokes a barium swallow and a video x-ray to watch the movement of the organs and finally a Bravo pH study which over 48 hours measures the pH levels in the oesophagus. All of these tests showed a slam-dunk result which made it a no-brainer to go ahead with the fundoplication.
So, on Monday this week I had it done. The operation takes the surgeon a couple of hours, and of course this is under general anaesthetic. I suffered a pneumothorax and a subsequent collapsed lung during the surgery, so ended up in the ICU for 24 hours after the surgery. It was spotted quickly so there ought to be no lasting damage at all. I've just been discharged, 4 days later after recuperating at the hospital. All in all, besides the pain of the lung problem at the start, it has been less sore than I thought it would have been (except if I hiccup or laugh - that's sore!). Most of the pain is actually in the left shoulder, due to referred pain from the diaphragm - nothing a bit of tramadol and oral morphine doesn't sort out. Breathing deeply is still sore, but it's improving. I guess I was just expecting it to be worse somehow!
I'll be on a "sloppy food" diet for the next while, ramping up to fairly normal food within 6 weeks. Getting the calories in will be hard, I think. Right now, everything is blended or already very soft (soggy weetabix, that kind of thing).
However, so far so good. There's still a reasonably long way ahead in terms of full recovery from this operation but already it's great to wake up in the morning without a taste of acid in my mouth.
But most important, I don't need to take the PPIs any more so the dasatinib can work at its full potential. That's really the reason that we went ahead with this operation.
So for others who are reading this, trying to work out their own problems with GORD/GERD/reflux I hope my experience may shed a little light on some options. I'll post again in a couple of weeks with an update as to how the recovery is going. I guess this surgical option is not for everyone - it's a fairly drastic step and a serious enough piece of work to keep you in the hospital for 4 or 5 days - but for me, it seemed like the right thing to do.
David.