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I am a Bariatric patient suffering from 2 years with esophagitis grad B with GERD and suffering like hell with the burning sensation and regurgitation and not able to sleep in the night at all. I am also having swallowing issues and food is passing very slowly from the oesophagus. I did as per doctor suggestion manometry and the report I am attaching it here. Even a biscuit is giving me acidity. I was into PPI's for 2 years and finally it stopped working. Tried to do a crural repair of the hiatus hernia last year robotically didn't work and this year again the hiatus hernia is back with me.
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Reports uggests that hiatus hernia and gastroesophageal reflux disease due to sleeve gastrectomy. So acid backflow damage your esophagus that's why you have burning sensation. Please discuss your surgeon regarding this because gerd t/t is only ppi is doc.
Next Steps
H. pylori test ??
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Hello.
For now you can try elevating the head end of your bed, that decreases the reflux while lying down.
For complete cure you’ll have to consult your bariatric surgeon to decide further possible treatment options.
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Need few more details
Kindly consult
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Avoid fried and spicy food
Water intake kore
Do connect and consult
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Can help you with the next course of action and treatment plan. Kindly consult via whatsapp at nine zero two nine six zero zero four seven zero.
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If you want to discuss your problem in more detail, feel free to message me on WhatsApp at nine one one nine two five five six nine nine for a free detailed discussion
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Did you do the h pylori test.. biopsy??? review with reports in practo
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You can consult me directly on Practo, or reach out via WhatsApp:
Eight Seven Six Two Seven Four Nine Nine Seven Four
I’ll guide you step-by-step with easy-to-follow treatment plans.
Early consultation helps avoid complications — feel free to connect.
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Your reports show that your oesophagus is not pushing food down properly, you have a recurrent hiatal hernia, and the sleeve gastrectomy anatomy is causing high pressure in the stomach. These three issues together are the main reason you are having severe acidity, burning, regurgitation, and difficulty swallowing, and why medicines are no longer giving relief. In your situation, the most effective and recommended long-term treatment is converting the sleeve to a gastric bypass along with repairing the hernia again, as this surgery lowers the pressure in the stomach and greatly reduces reflux. Procedures like fundoplication or LINX are not suitable because of your weak oesophageal motility. I advise you to meet a bariatric surgeon who is experienced in revisional surgery to discuss this option, as it offers the best chance for lasting improvement and relief from your symptoms.
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Thanks for your endoscopy and manometry reports , it clearly explain why your symptoms are so severe. After your sleeve gastrectomy, your stomach became a narrow, high-pressure tube that naturally pushes acid upward. On top of this, you now have a recurrent hiatal hernia, which allows the stomach to slip upward into the chest and makes reflux even worse. The most important finding is from your manometry: ineffective esophageal motility, meaning your esophagus is too weak to push food down properly. Because of this, food and acid remain in the esophagus for a long time, causing burning, regurgitation, difficulty swallowing, and the constant nighttime discomfort you described. This also explains why PPIs stopped working — the problem is not excess acid alone, but the combination of a high-pressure sleeve, a hernia, and a weak esophagus.
Next Steps
In this situation, no amount of medication or repeated hernia repairs will give lasting relief, and anti-reflux surgeries like fundoplication or LINX are not suitable because they can worsen swallowing problems when the esophagus is weak. According to bariatric and foregut surgery guidelines, the gold-standard and most effective treatment for someone in your condition is conversion from sleeve gastrectomy to a Roux-en-Y gastric bypass (RYGB). This procedure dramatically reduces acid reflux, lowers stomach pressure, prevents bile reflux, helps the esophagus heal, and is the safest option when esophageal motility is poor. It is also the most reliable way to stop your night-time burning, regurgitation, and swallowing problems.
Health Tips
Until you undergo the definitive surgery, symptoms can be managed temporarily with high-dose PPIs twice daily, a motility-enhancing medicine at bedtime, alginate syrup at night, strict dietary control, and sleeping with the head elevated. But it is important to understand that these will only reduce symptoms — they will not fix the underlying anatomical issues. You are not imagining your suffering; your reports perfectly match your symptoms. Converting to gastric bypass is the treatment that can give you long-term relief and allow you to live normally again.
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Dr Nityanand have answered in detail
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Your symptoms (persistent GERD, Grade-B esophagitis, slow swallowing, PPIs not working, recurrent hiatal hernia after bariatric surgery) strongly suggest mechanical reflux + motility issue that medicines alone cannot fix.
When PPIs fail and symptoms are severe, the usual next steps your surgeon/GI considers are:
Repeat evaluation of the hiatal hernia (since it returned, it can cause constant reflux and delayed emptying).
Manometry results (you shared the setup but not the values): if it shows weak peristalsis, that explains the slow swallowing.
Surgical options may be needed again:
• Redo hiatal hernia repair
• Roux-en-Y conversion (if sleeve was done earlier) — this is the most effective for severe, PPI-refractory GERD after bariatric surgery.
Lifestyle gives only partial relief at this stage.
Your condition is treatable, but medicines alone won’t solve it now. You should follow up with a bariatric surgeon experienced in revisional surgery.
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Kindly get a opinion of Gastroenterologist.
Thank you.
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Hello,
You need to consult with a gastroenterologist, a retry at surgery or other surgical options need to be discussed.
Have you tried different PPIs or with increased dosage when they became ineffective?
You also need to make certain lifestyle changes if not already done, like,
1. Elevate your bed by 6-8 inches towards your head.
2. Don't eat 2-3 hours before going to sleep.
3. Eat in small frequent meals, no large meals.
4. Sit upright etc
Next Steps
Visit a Gastroenterologist, online consultation cannot help much.
Health Tips
Don't delay
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Need few more details for proper understanding of your issue.
You can consult with me online on Practo or whatsapp on eight three one eight four six nine eight eight six for proper diagnosis, conclusion and management
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Dr. Sajid Ali
General Practitioner
4 yrs exp
Kanpur
Consult Gastroenterologist
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Dr. B R S Kumar
General Physician
25 yrs exp
Hyderabad
Really sorry to be reading this.
You need to take 2 prong approach with following steps:
1. Combine a different PPI that you have not used before along with Famotidine and Sucralfate sachets daily to help with reflux symptoms
2. Find out if you can have any medical assistance for weight loss like GLP-1 agonist injections.
As you will know weight makes reflux worse and people try to use various food items to get relief from reflux. So patients like you basically get caught in this.
While this is all going on, you will have to make sure your muscle mass is not affected. So need enough protein and maintaining activity become important measure too.
All the best.
J G S R (online) clinic
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Dr. Chaithra H
General Physician
5 yrs exp
Bangalore
Gastro
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Dr. Ravi Kumar Nadella
General Physician
18 yrs exp
Hyderabad
Have bland diet
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Dr. Anuj Mothsra
General Physician
6 yrs exp
Jhunjhunu
Can help you, kindly consult and provide detailed history for proper diagnosis and further management
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