How GERD Is Surgically Treated

A few bouts of acid reflux once in a while aren’t usually a big deal 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.

The Long-Term Effects of GERD

Repeated acid reflux can lead to plenty of different problems, but they generally have the same cause: damage from escaped stomach acid. 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
• Esophagitis: When your esophagus is irritated by stomach acid, it can become inflamed or ulcerated, causing pain, difficulty swallowing, and possibly bleeding
• Tooth decay: If acid from your stomach reaches your mouth, it can wear away at your teeth (tooth decay is often the first symptom of GERD, in addition to pain)

Catching Esophageal Cancer Early

A few months of heartburn is very unlikely to cause cancer. It usually takes many years of damage before cancer is a risk, but heartburn is a problem that too many people easily dismiss.

As with many cancers, diagnosing esophageal cancer early is critical. When cancer is found before it spreads beyond the esophagus, an estimated 43% of patients are alive five years later. However, if it spreads to nearby tissues, the survival rate declines to 23% — and, when it spreads to other organs, 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 AdventHealth board-certified general surgeon Steve Siegal, MD.

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 also many medications to treat GERD, including:

• Antacids: Because they act quickly, are available 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 (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 sometimes do not provide relief. In either of these cases, anti-reflux surgery may be a better option”, says Dr. Siegal.

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. Siegal recommends considering surgery for GERD when:

• Considering the long-term side effects of acid medications
• Medications do not control acid reflux
• The patient also has a hiatus hernia (or 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.

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 EsophX is inserted through the mouth of the . 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. Siegal to discuss your GERD treatment options here.