Our members and visitors to our website send us excellent questions that can help others suffering from GERD. Today’s question highlights one of the most confusing treatment alternatives for GERD, acid reflux surgery. There are so many conflicting opinions about this as a treatment plan, that most GERD sufferers are simply confused. Let’s see if we can add some clarity to the subject.
I’ve been complaining about my GERD for more than two years. I did two tests, an oesophageal manometer test and 24-hour pH study. My surgeon recommends surgery, while my GI doctor does not. I don’t know what to do! Would you be able to help me decide about the surgery?
Thank you for sending us your question concerning acid reflux surgery. It’s a very common one with our readers as they become more aware of the downsides associated with daily long-term use of PPI medications. We are also happy to assist you to make that decision, however, it is your decision and all we can do is provide you with information for you to make an informed decision.
Medical specialties are creating much of the confusion
You are experiencing a common issue; your GI wants to keep you on PPIs and advises against surgery. We hear this quite often. In fact, in a recent RefluxMD survey of over 275 website visitors diagnosed with GERD by a gastroenterologist, only 13% were offered anti-reflux surgery as an option. Certainly, surgery is not an option for everyone, but that percentage should be much higher.
Treatment Alternatives – RefluxMD’s Hierarchy
We think there is a hierarchy to the various treatment alternatives: 1) weight management (if that is an issue), 2) diet modifications and avoidance of trigger foods, 3) trial and error with different home remedies, 4) lifestyle changes, 5) less powerful over-the-counter medications, such as antacids and H2 blocker, and finally 6) intermittent/short-term use of more powerful medications. Dietary and lifestyle modifications aim to reduce the frequency of reflux (and reduce symptoms as a result), but they are only as effective as your ability to stick with them. Medications provide effective symptom relief, but do nothing to stop reflux from happening. Unfortunately, none of those options can permanently stop reflux or restore the function of the damaged lower esophageal sphincter (LES).
Acid reflux surgery is an alternative to a lifetime of PPI medications
Dr. Dengler responded to a patient with a similar question last year, “Although there are quite a few reasons why someone would consider surgery for acid reflux, the vast majority of the procedures in the United States are performed for the one reason: failure of medical therapy. This means that the maximum dose of reflux medication, presumably along with lifestyle changes that can improve GERD symptoms, has failed to provide relief at a level of satisfaction for that particular individual.” However, as more consumers seek to end the use of these very powerful medications, acid reflux surgery is being performed more frequently. A good example is Ron, a RefluxMD member who elected anti-reflux surgery after being educated by our newsletter: “I was reading the newsletter from Laura that PPIs will take care of it (symptoms), but they don’t heal the problem. I was thinking, at this point, I don’t want to go through the rest of my life taking PPIs. I don’t want to worry that I didn’t take my PPI one day or something. I want to take care of this while I’m still relatively young.” Surgery was clearly the right decision for Ron.
Acid reflux surgery is the only treatment that can stop reflux permanently
The goal of acid reflux surgery is to repair the damaged lower esophageal sphincter (LES) and stop reflux. This is a permanent fix and, if performed properly, should result in no further painful symptoms. The most commonly performed procedure is the Nissen fundoplication, but there are other alternatives to consider which are discussed in our article, Overview of Antireflux Surgical Alternatives. We have many more articles on these procedures at our website, so we suggest you read about the available procedures and then discuss what you have learned with your doctor. One final note, anti-reflux surgery has the best outcome when performed by an experienced surgeon, so we always suggest finding a GERD expert if you’re considering surgery. For more information about what to look for, check out our article How do I select a doctor for my anti-reflux surgery.
I hope this helps you make your decision.
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