I recently received this question from a patient suffering from acid reflux:
Dr. Johnson, thank you for the opportunity to ask questions. I have had GERD for twenty years and taking PPIs for many of those years seemed to work fine. However, last year my symptoms returned and my physician doubled my dose. I’m still having issues today and I think it might be time for me to consider surgery for acid reflux disease. My doctor has not recommended this option, but I would really like to learn more. I don’t want my symptoms to get worse and I am very afraid of getting Barrett’s or cancer in the future.
This is a topic that is being discussed more and more frequently with my patients. The “valve” you described is the lower esophageal sphincter (LES), which is a muscle designed to keep the contents of your stomach from reaching the esophagus. Unfortunately, when the valve becomes damaged or weak, its barrier function fails; creating regurgitation that is often accompanied by significant pain.
Learn more: What causes heartburn? The role of the LES
I’m sure you know by now that medications only reduce acid reflux symptoms; they do not stop reflux and they cannot stop the progression of your disease. Since acid reflux, or GERD, is a problem with the anatomy of the esophagus, only surgery for acid reflux disease can honestly stop both the symptoms and the progression of the disease. Fortunately, there are some very good choices that you can consider!
Learn more: GERD medication: What you need to know
Surgery for acid reflux disease
This is considered the “gold standard” of surgical antireflux therapy. A Nissen is a minimally invasive procedure that restores the function of the LES by wrapping a portion of the upper stomach loosely around the LES. It is performed under general anesthesia using minimally invasive techniques. It requires several small incisions and typically requires a one-day hospital stay. This operation stops the reflux in approximately 80%+ of all patients and eliminates the need for powerful antireflux medications. There are side effects with this procedure including swallowing difficulty (< 5%), bloating (10-20%), and the inability to belch and vomit (30%). However, this procedure also has a very high patient satisfaction rate estimated around 90%.
LINX Reflux Management System
This procedure places a ring with magnetized titanium beads around the LES to support the failed LES. This 30-minute procedure is also minimally invasive and it can be reversed if necessary. A recent study found 85% eliminated PPI use after 3 to 5 years, and 94% would recommend the procedure to others. Only 2% reported swallowing difficulty that can be simply and effectively treated. This procedure cannot be performed for anyone with a moderate to large hiatal hernia and there are no studies to validate long-term effectiveness. This is the newest surgery for acid reflux disease having been approved by the FDA in March 2012.
Learn more: Ten things you need to know about LINX
TIF and Stretta
These two procedures are performed orally and do not require surgical incisions since the esophagus is accessed via the mouth. TIF is similar to a traditional Nissen in that a portion of the stomach is wrapped around the LES. Stretta uses radiofrequency energy delivered via a catheter to stimulate the fibers in the LES muscle. The long-term effectiveness of these two procedures is still being evaluated, however the lack of any surgical incisions is very attractive to many considering surgery for acid reflux disease.
Learn more: Managing your diet to avoid disease progression
Consider your alternatives
You should consider and evaluate all surgical alternatives. Anyone unable to manage their symptoms using powerful PPI medications has very few alternatives. I also think your use of proton pump inhibitors daily for many years is a “red flag” and a concern about the potential for disease progression and the negative side affects of these medications. Finally, your concern about the potential for serious complications and a reduced quality of life from GERD should lead you to learn more about this proven treatment model to stop reflux.
If you’re wondering if surgery is right for you, search our directory to find a GERD expert near you.