GERD or gastroesophageal reflux disease affects about 20 percent of the population.
We interviewed Dr. Michael Antiporda, a general surgeon with Premier Surgical Associates with fellowship training focused on esophagus and stomach surgery, to explain surgical options for GERD patients.
When should one consider surgery?
“When GERD is proven by testing and medicines do not adequately control symptoms, then surgery is an excellent option. Surgery is best for patients who have more severe symptoms or who have had symptoms for years that are worsening despite higher doses of medication. Surgery is very safe and effective when performed by surgeons who dedicate themselves to completely understanding the physiology and outcomes of esophageal and gastric surgery.”
The terms acid reflux, heartburn, and GERD are often used interchangeably.
Acid reflux occurs when the acid from the stomach moves backward into the esophagus. This typically occurs as a result of a weak or dysfunctional lower esophageal sphincter (LES) or when a hiatal hernia is present.
Heartburn, on the other hand, refers to the mild to severe pain in the chest caused by acid moving back into the esophagus. The lining of the esophagus is more delicate than the stomach lining so when acid moves back, you can feel a sharp, burning pain.
Finally, the term GERD refers to chronic acid reflux causing symptoms on a regular basis, typically weekly or more often.
Dr. Michael Antiporda, General Surgeon
What are the symptoms of GERD?
“The most common symptoms are heartburn and regurgitation, especially when happening after eating or when lying down or bending forward. Other associated symptoms may include chest, back, or upper abdominal pain, trouble swallowing solids or liquids, feeling full quickly, or bloating. Symptoms can also affect the airways and lungs and cause voice changes, hoarseness, or aspiration and lung infections.”
What are the surgical options for GERD patients?
“The gold standard is laparoscopic Nissen fundoplication. This was first performed in the early 90s and has undergone much evolution and refinement. Essentially, this is a minimally invasive procedure done under general anesthesia with five keyhole incisions that wraps part of the upper stomach around the lower esophagus in order to create a one-way valve that prevents stomach contents from moving backward but still allows food or liquid to pass from the esophagus into the stomach.
Another option is the Toupet fundoplication which is similar to the Nissen, but the stomach wrap is partial in that it wraps around the esophagus for 270 degrees, rather than 360 degrees like the Nissen. This is performed for patients who have a weaker esophageal function in which I would worry that a complete wrap would cause too much trouble with swallowing.
Magnetic sphincter augmentation with the LINX device is an option that has very good data from randomized controlled trials showing excellent reflux control with minimal side effects. Sometimes the Nissen fundoplication can cause some bloat or difficulty trying to belch, but the LINX allows some venting because it can be opened with enough pressure from the stomach.
What can patients expect after the surgery?
“After anti-reflux surgery, patients will no longer experience troublesome reflux symptoms like heartburn or regurgitation, and they will no longer need those medications they were reliant on before like antacids and proton pump inhibitors. There is a short period of time (a few weeks) right after surgery when swallowing may be slightly more difficult due to swelling caused by the surgery itself, but this always gets better with time and patients are able to eat all the foods they used to enjoy before they suffered from GERD. They will be able to lie flat at night and not worry about being woken up by acid reflux.”
Who are not candidates for the surgery?
“Anti-reflux surgery is not indicated when pre-operative testing shows that symptoms are caused by something other than GERD. Sometimes this is an esophageal motility disorder or even not something related to the stomach or esophagus. And, in some instances, GERD is early-stage or mild and we realize that it may be better to remain on medications rather than to go ahead with the surgery. It’s a mutual decision that is made after a lot of discussion and education between the patient and surgeon.”
Premier Surgical Associates of Knoxville and Cleveland, TN, surgically treats patients with acid reflux and GERD. To request an appointment with one of our experienced surgeons, visit https://www.premiersurgical.com/acid-reflux-appointment-request/.
References:
https://www.healthline.com/health/gerd/heartburn-vs-acid-reflux#gerd
https://www.memorialhermann.org/digestive/laparoscopic-nissen-fundoplication/