How is GERD Surgically Treated?

A few bouts of acid reflux once in a while isn’t usually a hardship for your body to repair. However, regular acid reflux symptoms can cause problems. If you experience minor pain at least twice a week, or moderate to severe pain once a week, it’s worthwhile to find out if you have gastroesophageal reflux disease (GERD).

Unfortunately, GERD affects an estimated 20% of the U.S. population. While GERD is common and feels similar to heartburn, it can cause troublesome symptoms like chest pain, difficulty swallowing and wheezing, and can even cause more complications without treatment.

We’re here with valuable information on the long-term effects of GERD, how to best care for it and surgical treatment options thanks to AdventHealth board-certified general surgeon Melissa Bagloo, MD, FACS, FASMBS.

The Long-Term Effects of GERD

Repeated acid reflux can lead to many different problems, but they generally have the same cause: stomach acid that flows up into the esophagus. A few of the potential complications from GERD include:

• Barrett's esophagus: After years of acid reflux, the cells in your esophagus can start to change. This doesn’t cause symptoms, but puts you at higher risk for esophageal cancer
• Esophageal cancer: Thousands of new cases of esophageal cancer diagnosed in the U.S. each year are caused by GERD; early diagnosis is essential to give the best chance of long-term survival
• Esophagitis: When your esophagus is irritated by stomach acid, it can become inflamed or ulcerated, causing pain, difficulty swallowing, and possibly bleeding
• Lung problems: Adult-onset asthma is frequently associated with GERD
• Pulmonary problems: Examples include asthma, pneumonia and chronic cough
• Tooth decay: If acid from your stomach reaches your mouth, it can wear away at your teeth. Tooth decay can be the first symptom of GERD, in addition to pain

Catching Esophageal Cancer Early

A few months of heartburn is highly unlikely to cause cancer. It usually takes many years of damage before cancer becomes a risk, yet heartburn is a problem that too many people easily dismiss as “just a nuisance.”

As with most cancers, diagnosing esophageal cancer early is vital. When cancer is found before it spreads beyond the esophagus, an estimated 43% of patients are still alive five years later. However, if it spreads to nearby tissues, the survival rate declines to 23% — and, when it spreads to other organs, sadly, it drops to 5%.

The good news is that esophageal cancer forms slowly, and we have the tools to stop the acid reflux that leads to the development of Barrett’s esophagus and cancer.

How to Best Care for Your GERD

“Your first line of defense against GERD is to change the foods you’re eating or the behaviors that cause your acid reflux,” explains Dr. Bagloo.

For some people, this may mean making one or more of the following lifestyle changes: 

• Avoiding spicy and greasy foods
• Losing weight if you’re carrying extra pounds
• Quitting smoking
• Staying upright after meals 
• Taking care not to overeat before bedtime
• Wearing loose clothing (tight clothes squeeze your stomach and can push acid out)

There are many medications to treat GERD, including:

• Antacids: Because they act quickly, antacids are available over the counter without a prescription and are inexpensive. Antacids like Tums, Mylanta and Rolaids are the most common treatment for heartburn. They work by weakening your stomach acid, reducing the ability to burn your esophagus
• Histamine-2 blockers: Medicines like Zantac work differently, decreasing the amount of acid your stomach produces. They’re available both over the counter and by prescription
• Proton pump inhibitors: While these medications take longer to take effect, proton pump inhibitors like Prevacid and Prilosec can provide long-lasting relief

“Some of the above medications may have long-term side effects and prolonged use may increase those risks. Additionally, medications and lifestyle changes on their own sometimes don’t provide relief. In either of these cases, anti-reflux surgery may be the better option,” says Dr. Bagloo.

Surgical Treatment Options for GERD

Surgery focuses on restoring the anti-reflux mechanism at the bottom of the esophagus that normally keeps acid from moving backward from the stomach into the esophagus. This mechanism is composed of a valve (the lower esophageal sphincter, or LES) and the hole in the diaphragm that the esophagus travels through (the hiatus).

When to Choose Surgery for GERD

Dr. Bagloo recommends considering surgery for GERD when:

• Biopsy proves early Barrett’s esophagus
• Considering the long-term side effects of acid medications
• Medications do not control acid reflux
• The patient also has a hiatus, or hiatal, hernia (can also be called a paraesophageal hernia)

There is severe inflammation of the esophagus (esophagitis) that may lead to bleeding or ulcers (scar tissue can constrict the esophagus and make swallowing difficult)

“If you and your physician decide surgery is the best path for you, there are three different options to consider,” she says. These include:

Fundoplication

This is the standard surgical treatment for GERD and has the best results in published studies. Fundoplication:

• Tightens and reinforces LES (lower esophageal sphincter)
• Involves the upper part of the stomach being wrapped around the outside of the lower esophagus to strengthen the sphincter
• Is performed via laparoscopic or robotic surgery (minimally invasive surgery through small incisions, about ¼ inch)

The LINX® Device

A special device called a LINX is a ring of magnetic titanium beads that can be surgically placed to help stop GERD symptoms. Here’s how the LINX works:

• It wraps around the LES and strengthens the sphincter
• The beads move together to keep the opening between the esophagus and stomach (LES) tight, while still allowing food to pass through normally
• It is performed via laparoscopic or robotic surgery

Both fundoplication and the LINX device usually require one to two days in the hospital, with you being able to return to work within one week.

Transoral Incisionless Fundoplication (TIF)

Preformed endoscopically (thus, not a surgical procedure), a device called EsophyX is inserted through the patient’s mouth. This procedure works by creating several folds at the base of the esophagus, and these folds form a new valve. This is a non-invasive alternative option if medications do not relieve symptoms. However, patients who also have a hernia should be treated with one of the surgical procedures to fix the hernia as well.

Guiding Your GERD Treatment Journey

If you’re struggling with GERD, don’t simply put up with your symptoms. Learn more about our approach and connect with Dr. Bagloo to discuss your GERD treatment options here.