Why Choose Surgery for GERD or Acid Reflux?
I’m Taking PPIs for GERD, Isn’t That Enough?
Let’s review GERD, or gastroesopahgeal reflux disease. GERD is where fluid from your stomach comes up into your esophagus and causes symptoms. GERD is NOT caused by too much acid production, it IS caused by a valve not working properly and this allows fluid to come up into the esophagus. Medications such as PPIs help some people by reducing the amount of acid the stomach makes. Since acid is one of the more irritating substances in the fluid, it helps with the symptom of heartburn.
When PPIs such as Nexium, Prilosec and Prevacid first came to market, they were celebrated by many suffering from Acid Reflux or GERD. They offered relief of heartburn to many people with seemingly few side effects. The medications were believed so safe, that the FDA allowed them to go over the counter in 2003, available to the public without a prescription. The directions for use are for 14 days up to 3 times a year. They are not indicated for everyday use. Since GERD is caused by a defective valve, then unless you fix the valve, 14 days of a medication will only help for those 14 days. When you stop the medications, your valve is still not working and your symptoms will return.
Now that there have been patients taking these medications for years, we have a little more insight into the long term problems with the medications.
Some long-term problems associated with PPIs are:
- Changing gut ecology
- Heart attacks
- Kidney disease
- Vitamin and mineral deficiency
Other negative side effects may include:
- Recurrent Clostridium difficile Infection
- Clostridium difficile
- Clostridium difficile associated diarrhea
- Risk of death with known cardiovascular disease
- Risk of developing cardiovascular disease
Acid belongs in the stomach. The only way to keep the acid in the stomach and not suffer from GERD is to fix the valve between the stomach and esophagus. There are several procedures available today that can accomplish this.
This surgery has been around for over 50 years. It works very well at controlling reflux. A hiatal hernia if present is fixed, and the stomach is wrapped around the esophagus to help re enforce the valve between the stomach and esophagus. This procedure is very safe, effective and has excellent long term success. Some patients had some gas/bloating and more flatulence after the procedure, and some patients have mild difficulty swallowing right after the procedure. For more information, please visit our surgery page.
This is a laparoscopic procedure where a hiatal hernia is fixed if present, and a small ring of magnets is placed around the valve between the stomach and esophagus. This helps the valve stay closed when it is supposed to be closed. When you swallow, the esophagus pushes the magnets apart and allows the food/liquid to go through and then closes again. This has been very effective in treating reflux. The gas/bloating and flatulence has not been an issue with this procedure. Some patients may have some difficulty swallowing after the procedure. This is usually while healing from surgery and not long term. Learn more about LINX
This procedure is done through the mouth. It is a device that fits over an endoscope and wraps the stomach around the esophagus from the inside. We are not able to fix a hiatal hernia with this procedure. It is not as effective as the laparoscopic fundoplication or Esophyx, however, there are minimal side effects. It had good durability and is an excellent procedure for patients with no or minimal hiatal hernia.
This procedure is done through the mouth, so this procedure is best for patients with no or minimal hiatal hernia. It is a device that is placed through the mouth and energy is applied to the valve between the stomach and esophagus. Although we do not fully understand the mechanisms, the valve seems to strengthen after this procedure. It can take a few weeks to months to notice improvement in symptoms. There are minimal to no side effects.
We are pleased to be one of the sites in the US to be part of the FDA trial for Endostim. It is a neurostimulator that is placed laparoscopically on the valve between the stomach and esophagus. If present, a hiatal hernia is repaired at the same time. There is a small battery that is placed under the skin on the left side of the abdomen. The stimulator increases the strength and function of the valve between the stomach and esophagus. This is available in South America and Europe and early studies look very promising in control of symptoms and minimal side effects. For more information, click here.