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Case Reports
. 2025 May 17;17(5):e84301.
doi: 10.7759/cureus.84301. eCollection 2025 May.

Refractory Diarrhea After Dor Fundoplication: The Long-Term Impact of Proton Pump Inhibitor Therapy

Kyle Mangum  1 , Mark Bazemore  1 , Jeannette Sandoval  2 , Nathan Kragh  2 , Basem Soliman  2
Affiliations
Case Reports

Refractory Diarrhea After Dor Fundoplication: The Long-Term Impact of Proton Pump Inhibitor Therapy

Kyle Mangum et al. Cureus. .

Abstract

Persistent diarrhea following hiatal hernia repair is a rare but noteworthy postoperative complication. In this case, we present a 62-year-old female with a longstanding history of gastroesophageal reflux disease (GERD) responsive to proton pump inhibitors (PPIs). After undergoing robotic-assisted hiatal hernia repair with partial fundoplication, the patient discontinued PPI therapy and subsequently developed chronic diarrhea. Extensive testing, including stool cultures, returned negative, and antidiarrheal medications provided minimal relief. Interestingly, reintroduction of PPI therapy resulted in a complete resolution of symptoms within days. This case suggests a possible correlation between cessation of long-term PPI use and gastrointestinal dysfunction, with chronic diarrhea manifesting as a withdrawal-like effect. Further investigation into the role of PPI discontinuation on gut microbiota and its clinical outcomes is necessary to understand this phenomenon better.

Keywords: gerd; hiatal hernia; partial fundoplication; proton pump inhibitor; refractory diarrhea.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. IRB, Texas Tech University Health Sciences Center, Lubbock issued approval Exempt. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Esophagogastroduodenoscopy image of the paraesophageal hernia.
Figure 2
Figure 2. Hiatal hernia on esophagram.
Figure 3
Figure 3. Gastric reflux on esophagram.
See this image and copyright information in PMC

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