Dr. Kenneth Schwartz is a board-certified surgeon at MidState Medical Center.
An estimated 40 percent of Americans suffer from the daily effects of heartburn, and approximately 20 percent have been diagnosed with GERD, or gastroesophageal reflux disease. What some people don’t realize, however, is that there are highly effective and safe surgical options to help relieve them of this uncomfortable, painful and oftentimes disruptive disease.
What is GERD? GERD occurs when the reflux of stomach contents causes troublesome symptoms and/or complications, which can affect a person’s health, comfort, and well-being. To know how to treat GERD, your doctor first needs to understand what may be causing it. In an effort to make a proper diagnosis, your doctor may first try prescription antacid medications, such as Nexium, Protonix or Prilosec.
When the symptoms are not well-controlled with any of these, it’s often reason to do further testing to see what may be causing the pain and discomfort. Testing may include endoscopy, barium esophagram, manometry or pH studies. In some cases, a structural cause may be found, which may require a procedure to address. These may be from an injury, a narrowing of the esophagus, a hernia, or in more rare cases, from cancer. Knowing which of these problems the patient has can help steer the course of treatment.
For patients who show no anatomical abnormalities, and have only mild reflux symptoms, it is often recommended that they try lifestyle modifications. These may include changing their diet to avoid foods which are known to cause reflux, weight loss, along with antacid medication. For those individuals with more severe disease, longer term antacid medication has traditionally been the standard approach.
However, research has shown that long-term use of some antacid medications, such as PPIs (proton pump inhibitors) can potentially be associated with unintended side effects, including the inability to absorb calcium, heart rhythm issues related to reduced magnesium absorption and increased risk for certain infections. And some people simply do not want to be on medication for the rest of their lives.
When medications and lifestyle changes are exhausted and no longer effective (or only partially effective) at controlling a patient’s symptoms, surgical options can correct the problem and greatly decrease, if not eliminate, symptoms and need for medication. For most patients, surgeons are able to make 5 very small incisions in the abdomen (each ½ centimeter wide) and fix the underlying cause in approximately 1 ½-2 hours.
During the surgery, they are checked with an endoscope to see down the esophagus into the stomach to ensure the best result has been achieved. Patients awake from general anesthesia with no catheters or drains, begin a liquid diet on the same day, and are generally discharged home the next morning. It is recommended that the patient stay on a pureed diet for two weeks, after which time they can return to normal healthy eating. Approximately 90% of patients report complete resolution of their reflux symptoms and no longer have a need for medication. In a study that followed patients 5 years after surgery, the patients reported fewer heartburn and belching episodes, and generally had better feelings of health and vitality as compared to medical therapy.
Thankfully, advances in minimally invasive surgical techniques have given patients more and better options to find relief from their symptoms. If you’re suffering from heartburn or reflux, it’s best to see your doctor and discuss your options so that together, we can find the best treatment for you.