There is a mechanical and physiologic barrier where our esophagus and stomach meet (Gastro-esophageal junction or GEJ) that works to prevent reflux. Over time this mechanism can breakdown and not work as well. Some degree of GERD is normal in everyone. Unfortunately we often are our own worst enemies- our over eating, lack of exercise, smoking, and drinking alcohol can all hamper the ability of our GEJ to prevent reflux and this leads to debilitating symptoms.
First you need to take an honest look at your life style and take ownership of this problem. The first line treatment of GERD is lifestyle modification. Bolster your nutrition, exercise sensibly, and stop smoking. You likely need to lose weight as fat deposits in your abdomen push the GEJ into the chest and make GERD worse. Nicotine, caffeine, and alcohol all contribute to a loose lower esophageal sphincter (LES) which makes GERD worse. Additional maneuvers such as eating more than 3 hours prior to sleeping or elevating the head of your bed may also help symptoms. Get the help of others in these areas because this is not an easy area to change our habits. On the bright side, if you can accomplish the above you may not need medications or surgery. As most things in life it’s up to you
Acid-suppressive therapy is the most common method of treating GERD. Proton pump inhibitors, also known as PPIs, are used to decrease the amount of acid your stomach produces. They are the most potent type of acid suppressive therapy, irreversibly binding acid-producing cells in the stomach. Antagonists such as H2 blockers have also been used for a similar purpose. Antagonists decrease acid production, but are not effective in healing an injured esophagus (esophagitis) or preventing the relapse of esophagitis. PPIs have been shown to be superior to H2 blockers in the healing of esophagitis in multiple studies.
However, there has been increasing concern about the side effect profile of acid-suppressive medications:
Medical studies have demonstrated that PPIS can contribute to:
- Vitamin B12 deficiency
- Hip fractures
- Blood clots
This has lead physicians to increasingly recommend surgery to treat GERD.
So who should get surgery for GERD? Failure of optimal medical management is the most common indication for this kind of surgery. Other reasons to consider surgery include the desire to not take lifelong acid-suppressive medication, or the development of complications of GERD, such as Barrett’s esophagus or scarring of the esophagus. Less common reasons for surgery include choking of refluxed material, asthma, dental erosions, and frequent laryngitis.
LAPAROSCOPIC NISSEN FUNDOPLICATION (LNF)
Most surgeons agree that the laparoscopic Nissen fundoplication is the gold standard procedure that all other anti-reflux procedures need to be measured against. In the right hands it is a safe and effective procedure for eliminating GERD. Unfortunately, while simple in concept, individual surgeons’ variations in technique, have led to some poor functional outcomes (inability to swallow, bloating, excessive gas) that dampen the enthusiasm for surgical intervention. The goal is to reduce any herniation of the GEJ (gastroesophageal junction), repair the diaphragm opening if needed, wrap the top part of the stomach around the GEJ to augment the LES (lower esophageal sphincter) pressure, all without tension on the esophagus. Once done, reflux symptoms should be controlled, the patient should be able to swallow normally, and usually medications can be discontinued.
The Linx Reflux Procedure
The Linx procedure is the latest addition in the fight against GERD. It consists of a small, flexible ring of magnetic beads which are laparoscopically placed around the lower esophageal sphincter to control reflux.Learn more about Linx
The transoral incisionless fundoplication (TIF) is an endoscopic technique that helps to eliminate GERD in the properly selected patients. The exciting part of the TIF procedure is that it does not require any incisions; the entire procedure is done through an endoscope placed through the mouth. At University Thoracic Surgeons, we will assess you to determine if this procedure is right for you.