Dumping syndrome can cause inflammation of the duodenum, diarrhea, weight loss, malnutrition and hypoglycemia. 6 Because the Nissen procedure does not relieve the underlying problem causing reflux, which is mostly upper intestinal dysbiosis, your reflux disorders eventually return in a few months or years, as the constant pressure of flatulence weakens Nissen over time. I do not recommend the LINX procedure because I believe the overwhelming anecdotal evidence of the problems associated with the LINX device outweighs any therapeutic potential of surgery to cure reflux disease. Gaseous” bloating syndrome occurs in 41% of people who have had Nissen surgery, and in some, the condition can improve within two months; occasionally, some people suffer from it until the Nissen surgery is repeated or reversed. 5 Gastric emptying syndrome rarely occurs after surgery and occurs when the stomach empties its contents into the duodenum before complete digestion has occurred. After reading these statistics, you may wonder why John doesn’t recommend the LINX procedure more than a TIF. First of all, I do not recommend any of the surgical procedures against reflux when it is necessary due to the risks and side effects, but if you absolutely must have one, TIF is probably the best. After the procedure, patients are put on a diet early in the post-operative period, even on the day of surgery, to determine the effectiveness and complications of the procedure and the device. With an average follow-up of 48 months, 11 of the 164 patients who underwent MSA have been exposed to the Linx device, usually between 12 and 24 months after the operation. In the 2010 Linx device feasibility study by Bonavina et al, early dysphagia was the most common complaint, occurring in 43% of patients. Nissen fundoplication can also be reversed over time and occurs on average in approximately 10% of people who have had surgery, so it must be repeated. 4 Gas bloat syndrome is a syndrome in which the stomach is not able to adequately expel gas through burping. The TIF procedure appears to cause less scarring than a Nissen fundoplication, and healing rates appear to be better with less invasive surgery. A Nissen fundoplication is a laparoscopic surgery that is rarely necessary and, in my opinion, detrimental to people with reflux disorders. The LINX band contracts and puts pressure on the lower oesophageal sphincter at rest, keeping it closed and preventing reflux from entering the oesophagus. During discussions about EDM, the Linx device was successfully removed without oesophageal leakage or other long-term consequences.