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The General Surgeon

The General Surgeon, Dr. David Johnson

Dr. Johnson, I have had GERD for twenty years and have taken PPIs (proton pump inhibitors) for many of those years. However, last year my symptoms returned and my physician doubled my dose. I’m still having issues today and think it might be time to consider surgery on my valve. 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.

Dear GERD Sufferer: 

This is a topic I am discussing more and more frequently with my patients. The “valve” you describe 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.

I’m sure you know by now that medications only reduce acid reflux symptoms; they do not stop reflux and cannot stop the progression of your disease. Since GERD (acid reflux) is a problem with the anatomy of the esophagus, only a surgical treatment can honestly stop both the symptoms and the progression of the disease. Fortunately, there are some very good choices you can consider.

Nissen Fundoplication. This is considered the “gold standard” of surgical antireflux therapy. A Nissen 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 a one-day hospital stay. This operation stops the reflux in approximately 80%+ of patients and eliminates the need for medications. Side effects include swallowing difficulty (< 5%), bloating (10-20%), and the inability to belch and vomit (30%). However, this procedure has a very high patient satisfaction rate around 90%.

LINX Reflux Management System. This procedure places a ring with magnetized titanium beads around the failed LES. This 30-minute procedure is also minimally invasive and can be reversed if necessary. A recent study found 85% eliminated PPI use after 3 to 5 years, and 94% would recommend the procedure. Only 2% reported swallowing difficulty (which is easily amended). This procedure cannot be performed for anyone with a moderate to large hiatal hernia and there are no studies to validate long-term effectiveness.

TIF and Stretta. These two procedures 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. 

 Finally, your concern about the potential for serious complications and a reduced quality of life from GERD should lead you to learn more about proven surgical options to stop reflux.

Dr. Johnson welcomes your questions and can be reached at (760) 424.8224. For more information, visit www.palmspringsdesertsurgeons.com or www.RefluxMD.com where there is an abundance of information on GERD and antireflux surgical procedures.

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