Should I Consider Surgery for My Condition?
Hello! I am a 20-year-old male diagnosed with Neurofibromatosis type 1 (NF1), standing at 5 feet 1 inch and weighing 160 pounds. I've been dealing with irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) since 2020. Initially, I was treating my condition with ranitidine at a dosage of 150 mg twice daily until its recall, after which I resorted to several over-the-counter and prescription antacids under the supervision of a pediatrician. Eventually, I began using pantoprazole upon a referral to a gastroenterologist, which provided considerable relief, but I had to stop this medication due to concerns about possible small intestinal bacterial overgrowth (SIBO). After monitoring my condition for a month, my symptoms reoccurred rapidly. I was prescribed Nexium at 20 mg along with continuing my current medications, which include amitriptyline at 10 mg and dicyclomine at 30 mg. Just two days ago, I underwent an endoscopy, which revealed LA Grade B erosions and a 5 cm hiatal hernia, despite being on Nexium for two months. I have since increased my Nexium dosage to 40 mg starting yesterday. The persistent issues I'm facing include regurgitation, night time reflux, and a burning sensation. My gastroenterologist has recommended surgery for several reasons, including the chronic nature of my symptoms, the presence of NF1, the moderate size of the hiatal hernia, and the potential hazards associated with prolonged use of proton pump inhibitors (PPIs). Should I seek a surgical consultation, or would it be wise to first try the increased dosage of Nexium at 40 mg? The procedure suggested to me is a hiatal hernia repair along with fundoplication. Thank you!
Answers (1)
6/24/2025, 10:40:57 PM
OpenHealth AI
It sounds like you're facing a complex situation with your gastroesophageal reflux disease (GERD) and hiatal hernia, along with your neurofibromatosis type 1 (NF1). Your experience with medication and the recent endoscopy results have understandably raised some concerns about your treatment options.
Main Points
- Your gastroenterologist has recommended surgery due to the severity of your symptoms and the potential complications with long-term PPI usage.
- Increasing your Nexium dosage is an option, but your underlying issues and medication history suggest that surgery could provide more effective and lasting relief.
Explanation
GERD can significantly affect your quality of life, especially when it leads to complications like erosions and regurgitation, as you've described. The presence of a hiatal hernia often contributes to ongoing reflux symptoms. While medications like Nexium can provide temporary relief, they may not address the root causes, especially if you're experiencing such persistent symptoms.
Surgery, specifically a hiatal hernia repair along with fundoplication, aims to correct the underlying anatomical issues that cause GERD. This procedure can potentially offer long-term relief and reduce or eliminate your dependence on medications, which is especially important considering your concerns about side effects from prolonged PPI use.
Next Steps
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Consider Surgical Consultation: Scheduling a consultation with a surgeon who specializes in gastrointestinal procedures will allow you to discuss your specific situation and get a comprehensive understanding of the surgery, including benefits and risks.
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Monitor Symptom Response: If you're hesitant about surgery, you can give the new Nexium dosage (40 mg) a trial period of 4-6 weeks while closely monitoring your symptoms. Document any changes or improvements, as this information can be valuable in discussions with your healthcare providers.
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Lifestyle Modifications: In conjunction with treatment, consider making lifestyle changes to help alleviate reflux symptoms. This includes:
- Eating smaller, more frequent meals rather than large ones.
- Avoiding foods and drinks that trigger your symptoms (e.g., spicy foods, caffeine, alcohol).
- Elevating your head while sleeping.
- Maintaining an appropriate weight.
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Regular Follow-up: Keep regular follow-ups with your gastroenterologist and report any significant changes in your symptoms, both positive or negative.
Given your health history and current medication concerns, the decision for surgery should be carefully considered. Evaluating both surgical and medical options will help you make an informed choice that aligns with your health goals. Please feel free to reach out if you need further clarification or support.
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