Acid Reflux and GERD
Acid reflux occurs when stomach acid flows backward into the esophagus. This causes heartburn and other symptoms. Chronic or severe acid reflux is known as gastroesophageal reflux disease (GERD).
Mild or moderate reflux symptoms can often be relieved with diet and lifestyle changes. Over-the-counter and prescription medications can also help with symptom relief. Medications used to treat GERD include:
- H2 blockers
- proton pump inhibitors (PPIs)
Unfortunately, some people aren’t helped by lifestyle changes or medications. Surgery may be an option for those people. Surgery focuses on repairing or replacing the valve at the bottom of the esophagus that normally keeps acid from moving backward from the stomach. This valve is called the lower esophageal sphincter (LES). A weak or damaged LES is what causes GERD.
Untreated GERD can develop into a condition called Barrett’s esophagus. This condition increases the risk of esophageal cancer. However, esophageal cancer is rare, even in people with Barrett’s.
Surgery may be recommended if you have serious GERD complications. For example, stomach acid can cause inflammation of the esophagus. This may lead to bleeding or ulcers. Scars from tissue damage can constrict the esophagus and make swallowing difficult.
Surgery for GERD is usually a last resort. Your doctor will first try to manage your symptoms with changes to your diet and lifestyle. This gives relief to most people with the condition. If that does not give you relief, they will try long-term medications. If these steps do not relieve the symptoms, then your doctor will consider surgery. You might also consider surgery to avoid taking long-term medications.
There are several surgical options that may help to relieve GERD symptoms and manage complications. Speak with your doctor for guidance on the best approach to manage your condition.
If your GERD requires surgery, you should be sure and discuss the cost of your surgery with your doctor and the hospital. The costs vary greatly depending on your insurance, the hospital, type of surgery, and other factors.
Surgery for GERD: Pros
- Helps avoid long-term medications
- Can help prevent complications such as inflammation of the esophagus
Surgery for GERD: Cons
- Some surgery options can be costly, depending on your insurance
- Recovery times differ based on type of surgery, but some require up to 6 weeks of rest before returning to work
This is the standard surgical treatment for GERD. It tightens and reinforces the LES. The upper part of the stomach is wrapped around the outside of the lower esophagus to strengthen the sphincter.
Fundoplication can be performed as an open surgery. During an open surgery, the surgeon makes a long incision in your stomach to access the esophagus. It can also be performed as laparoscopic surgery. This type of surgery involves several smaller incisions. Miniaturized instruments are used to make the process less invasive.
The preparation for this surgery is typical of that for any surgical procedure. It may include:
- a clear liquid diet 1-2 days before surgery
- not eating on the day of surgery
- taking a medication to cleanse your bowels the day before surgery
Ask your doctor for specific preparation instructions, as they may differ due to your individual medical history.
This type of surgery generally has a very good rate of long-term success.
This procedure is used when open fundoplication is not appropriate. It creates a barrier between the stomach and the esophagus. The barrier prevents reflux of stomach acid.
This procedure doesn’t require incisions. A device called an EsophyX is inserted through your mouth. It creates several folds at the base of the esophagus. The folds form a new valve. Since it does not require incisions, this can be a good option for people with GERD. If medications do not relieve your GERD, but you do not want more invasive surgery, this may be an option you prefer.
The preparation for this surgery is similar to that of the preparation for fundoplication, but may not require as many steps. Check with your doctor about the right preparations for you.
This procedure is performed with an endoscope. It is usually done as an outpatient procedure. This is a thin, flexible tube that can be threaded into your esophagus. An electrode at the end of the tube heats your esophageal tissue and creates tiny cuts in it. The cuts form scar tissue in the esophagus. This blocks the nerves that respond to refluxed acid. The scar tissue that forms also helps strengthen the surrounding muscles.
This procedure shows effectiveness in relieving or even eliminating the symptoms of GERD. However, this is still a fairly new procedure, so long-term results are unknown.
The preparation for this procedure is much like preparing for fundoplication. But, you should check with your doctor about the correct preparations for you.
This procedure is generally less expensive than fundoplication. It’s important to check with your insurance to be sure it is covered and what the actual cost will be for you.
This system also uses an endoscope. Stitches are made to form pleats in the LES. This strengthens the LES. The procedure is not as common as others mentioned above. However, it is another option for you to discuss with your doctor.
This procedure is not covered by all insurance carriers. It is important that you discuss the costs of this, and all, procedures with your insurance carrier, your doctor, and your hospital prior to deciding on the correct procedure for you.
This surgery uses a special device called a linx. It’s a ring of tiny magnetic titanium beads. When wrapped around the LES, the linx strengthens the sphincter.
Because the beads are magnetized, they move together to keep the opening between the stomach and esophagus closed. Food can still pass through normally.
Since this is a minimally invasive surgery recovery time is usually considerable shorter than traditional surgery. There is also less pain related to this type of surgery.
This is a relatively new procedure but shows good results for relieving acid reflux disease.
Recovery is slightly different for each type of surgery, but depends primarily on whether your surgery is laparoscopic or traditional. While laparoscopic surgery has a quicker recovery time and less pain that traditional, it may not be appropriate for every person with GERD. Your doctor and surgeon will be able to decide which is best for you.
The fundoplication surgery is the most common. The traditional or open surgery requires about a week in the hospital and then about six weeks before you are able to return to work. The laparoscopic fundoplication surgery requires only a few days in the hospital with the patient able to return to work after one week. There is also less pain after this less invasive procedure.
Prior to any surgery for GERD, your doctor will try dietary changes, then medications. If those do not give you relief then, surgery will be suggested.
For more popular surgeries used to treat GERD, the outlook is very good. In most people with GERD, they relieve or even eliminate their symptoms. Some of the newer or less common surgical procedures have not had enough studies yet to determine their long-term success.
While surgery is usually a last resort for treating GERD, it can also be considered for eliminating the need for long-term medications. You should consider all options before deciding on surgery. You should also consider the costs of each procedure, as the costs can vary. Checking with your insurance prior to deciding on a procedure is also important. Some of these procedures are not covered by insurance.
Your doctor will be able to help you determine which procedure will help you most. They will also be able to ensure that you are a good candidate for the procedures.
For people with GERD who are considering surgery, what are some situations (health conditions, age, weight, etc.) where they should absolutely not get surgery?
The patients who are at most risk for complications from surgery are those that suffer from heart failure, severe kidney disease, chronic breathing problems, propensity for bleeding, and existing issues with swallowing or motility disorders with the esophagus. Elderly patients are also at higher risk. Obese patients should be thoroughly evaluated before surgery.Mark R. Laflamme, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.