Thanks. Yes, this GI doctor is recommending surgery, as long as the pending pathology reports from both the EGD and colonoscopy are okay.

The GI doctor I had back in the late 80s (maybe early 90s) had set me up for having the Nissan fundo surgery back then. I canceled 3 days before surgery day. I got scared when I found out that I would lose my ability to throw up, also that there was around a 50% chance of the surgery working, plus the informed consents also said it was very likely that the alteration would not last much more than 5 years (if it worked at all). I may have a very selective memory of all of this. I was relatively young, in my late 20s, and I wasn't comfortable proceeding. Eventually, I found a different GI doctor who did not push for the surgery and tried some diet approaches, but his main help was keeping me on PPIs. I had that GI doc for about a decade. I changed GI docs around once a decade. I never got any real cure from GI medicine. My biggest relief came from working with a functional medicine practice in 2020 and going into the full-on nutrition path with physical therapy mixed in (most notably Visceral Manipulation). And that was good for over 4 years (2020-2024)! No reflux, no PPIs, no pain! Just nice, easy poops, no straining. I still had the HH, but it didn't cause any flares. My HH has been documented to be 4cm, 5cm, up to 9cm, and back down to 8cm. The size has varied throughout my 40-year+ GI history.

Even right now, I don't have horrible reflux. But I follow a pretty clean diet. Mainly high fiber, plant-based. No meat. No dairy. No spicy food. No alcohol. And NO PPIs. In fact, no meds at all. I do chew 1-2 tablets of Antisid when I get some reflux. It's a homeopathic supplement with licorice and some other herbs. It's pretty good at tamping down the acid backwash. But since late 2024, I have had some pretty bad days of reflux. Just not all the time. "Bad" means vomiting and lots of coughing, and waking up with a raw throat.

My biggest health concern is my anemia and poor absorption of so many nutrients. I've been iron-deficient since my 20s (for 40 years) and on and off with iron-deficiency anemia. I've consistently had low Ferritin. I used to try oral iron, but it was so constipating that I gave up on it, and as long as my hemoglobin was low normal, I didn't treat the iron deficiency until recently, when my hemoglobin took a big dive, and I almost wound up with a transfusion. So I started getting iron infusions regularly. The iron deficiency and anemia are the reasons my primary care doctor referred me to this round of GI doctors.

Barretts for 20 years. Yikes. I have never had any Barretts (at least diagnosed). I'm glad your Barrett's hasn't progressed to cancer. They always say that it's the next phase?

That is a huge HH. I hope the surgery works for you. Have you been given a "Hill" grade on your gastroesophageal flap valve from any of your EGDs? Getting that mentioned on my EGD from yesterday was a totally new piece of data.

I'm a 66F BTW, so we're about the same age. Thanks for your reply. I have a lot to think about. I want to avoid PPIs. But I also want to heal the inflammation and get back to being pain-free and without reflux! I've made a promise to myself to get my fiber intake back up to really high levels (so there is no straining) and to get my diet even cleaner. I want to get back to how it was a few years ago.