Reflux and revision question

I posted in the revision board, but was told to post here so I get more feedback, so here I go!

I have suffered from minor reflux with regurgitation almost my entire adult life. When I'd decided to have WLS, I had decided to go with the sleeve because I liked the idea of no malabsorption and rerouting things. I figured I'd lived with the minor reflux this long, I could live with it after. My husband, who at the time had been successfully post RNY 8 years, was trying to talk me into the RNY because he loved his results with minimal complications. 

From the start, the reflux was an issue and got worse.  I was regurgitating everything I was was drinking, and kept on full liquids for 6 weeks post op. I was kept on Omezerpole (SP?) for a solid year, and since have been on several others to try to control it. I've had 2 upper endoscopy's, and surprisingly they found nothing wrong. No erosion, hernias, ulcers, nothing. They are just chalking it up to the surgery itself for the increase in the severity of the reflux. As of late, it's almost becoming unbearable and getting in the way of my quality of life. 

Has anyone had a revision without there being any evidence of physical damage to the esophagus and had it approved by insurance? I'm also at a steady weight of 145 for well over a year, so I really wouldn't need to lose any further weight, although I certainly could and still be within the healthy range. 

I know hindsight is 20/20, and of course now I'm kicking myself about going with the sleeve as opposed to the RNY. I also wish my surgeon would have warned me about how it more likely would have gotten worse with the surgery. Other than the obvious, I am still thrilled with my sleeve and couldn't be happier with the results I've had ;)

Yes.  I revised from VSG to RNY on 7/1/16.  I had two very small spots of erosion, but nothing to write home about.  What I did have were other test results that showed if my acid remained unchecked, I was on the road to Barrett's esophagus and potential esophageal cancer.  I had manometry and pH testing which sucked beyond belief (here, swallow this probe that we're shoving in your nose and wear it for 24 hours.  Oh, and go ahead and eat things you know will give you reflux)  What it showed was my pH level was 409% higher than normal.  I was forced to sleep sitting up.  I would have to stop on runs and throw up stomach acid.  It was affecting me every single day and my quality of life sucked.  At the time of my revision, I was basically at goal, but had gained about 12 lbs since the only thing that offered any relief from the acid was crackers.  Since my revision, I have lost my regain and am back at goal.  So, I did not revise for weight loss.  Also, I have a gene mutation that affects the rate I metabolize PPIs, so Omeprazole, protonix, etc. don't work at all for me.  The only thing that offered any relief was Dexilant, which my insurance specifically excluded from my policy.  Also, we looked into Stretta which limits reflux by strengthening the LES, which prevents the acid from coming back up.  My insurance said hells to the no on that one.  I even took them to the California Department of Insurance, but gave up the fight when it was clear that my reflux was only getting worse.

My advice (based on my experience)

1.  Get tested for the gene mutation.  It's a blood test and I can actually give you more detail as to what gene they're looking for once I go back through my records.  If you have the mutation, and you haven't tried Dexilant, see if you can get insurance to approve it.  It was prohibitively expensive for me ($450-$500 a month) so even though it worked (it utilizes a different channel through the liver), once it was excluded from my coverage I was out of medical options.
2. As much as it sucks, see if you can have the manometry and pH study.  If it shows acid at a very high level, it will go a long way in forcing the insurance companies to approve conversion to RNY.

I know first hand how much it sucks.  Don't kick yourself, just make a plan to make it better.  I basically had immediate relief and slept on one pillow in the hospital after my surgery.  I still have acid every now and then, but it's nothing a zantac won't cure.  

Sorry if this is kind of rambling, but I'm at work and hoping to get it out before I get interrupted.  If you have any other questions, feel free to ask away.  As people on here (particularly on the RNY daily menu thread) know, I'm pretty much an open book about my issues, my conversion and living with a slouch (sleeve + pouch = slouch)

Thank you so much! This gives me a starting point at least! 

And I had the same problem with Dexilant. My inuisance won't cover it :(

That's really what pushed me to convert to RNY.  Insurance wouldn't cover Stretta (claimed it was experimental and investigational) and then after first approving the Dexilant, specifically excluded it from my policy mid-year (allowable under CA law)  I had no choice (except to pay for Stretta out of pocket on the off chance it would have worked).  I thought it was interesting that the Insurance Co. was willing to pay for a $158,000 surgery (I get they didn't pay that amount, but just paid the contracted rate, but still) rather than a $5,000 procedure that could have cured me.  

The thing that sold me on the conversion was when my surgeon told me that if I was his sister, I'd already have had the surgery, since the acid is so dangerous.  

Again, if you have any specifics, please feel free to ask.  I really am an open book and did soooooo much research prior to agreeing to convert, that I can probably answer any question you can come up with.

As I understand it, the sleeve creates a "tight" system because the pyloric valve is retained.  Pressure from that system creates acid.  Revision to RNY relieves that pressure.  Many people have revised due to acid concerns.

While you search a long term solution.  Have you tried high dose Lansoprazole (Prevacid)?  Dexilant is just a mirror image molecule of lanso.  High dose Prevacid might give you similar relief.  I did see that Takeda has some copay programs available on their website for Dexilant, can you qualify for those?  I worked for the pharma company TAP in the day and worked in analytics on Prevacid.  Takeda developed Prevacid and the enantiomer (means stereo image) Dexi.  Nexium is the mirror image of Omeprazole (Prilosec) and could also be a possibility if you haven't tried it yet.  These mirror images for some products lower side effects while raising the effectiveness of the original molecule.  Hope something helps for you soon.

I don't know who this was directed at but if it was me, I no longer need a long term solution as I converted to RNY. Unlike Dexilant, Prevacid did absolutely nothing for me. It was like taking a placebo. I did use the discount program offered by the manufacturer which saved me $50 a month, but on a $500 prescription, $50 offered little relief. Hope your info is helpful to other readers/posters!

Sorry.  Originally read this on my iphone and somehow combined the original request with your input.  

No apologies needed. It was good info that may be helpful to others!!

I am on dexilant now - over one year..

Question - If I try the prevacid, do you think I should I try take it same amount as dexilant? I.e. 60 mg? 

(Omeprosole does not do much for me if any)