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Acid Reflux (GERD) Treatments Phase 3 : Surgery

j Surgery

The drugs described above usually are effective in treating the symptoms and complications of GERD. Nevertheless, sometimes they are not. For example, despite adequate suppression of acid and relief from heartburn, regurgitation, with its potential for complications in the lungs, may still occur. Moreover, the amounts and/or numbers of drugs that are required for satisfactory treatment are sometimes so great that drug treatment is unreasonable. In such situations, surgery can effectively stop reflux.

The surgical procedure that is done to prevent reflux is technically known as fundoplication and is called reflux surgery or anti-reflux surgery. During fundoplication, any hiatal hernial sac is pulled below the diaphragm and stitched there. In addition, the opening in the diaphragm through which the esophagus passes is tightened around the esophagus. Finally, the upper part of the stomach next to the opening of the esophagus into the stomach is wrapped around the lower esophagus to make an artificial lower esophageal sphincter. All of this surgery can be done through an incision in the abdomen (laparotomy) or using a technique called laparoscopy. During laparoscopy, a small viewing device and surgical instruments are passed through several small puncture sites in the abdomen. This procedure avoids the need for a major abdominal incision.

Surgery is very effective at relieving symptoms and treating the complications of GERD. Approximately 80% of patients will have good or excellent relief of their symptoms for at least 5 to 10 years. Nevertheless, many patients who have had surgery--perhaps as many as half--will continue to take drugs for reflux. It is not clear whether they take the drugs because they continue to have reflux and symptoms or if they take them for symptoms that are being caused by problems other than GERD. The most common complication of fundoplication is swallowed food that sticks at the artificial sphincter. Fortunately, the sticking usually is temporary. If it is not transient, endoscopic treatment to stretch (dilate) the artificial sphincter usually will relieve the problem. Only occasionally is it necessary to re-operate to revise the prior surgery.

k Endoscopy
Very recently, endoscopic techniques for the treatment of GERD have been developed. One type of endoscopic treatment involves suturing (stitching) the area of the lower esophageal sphincter, which essentially tightens the sphincter. A second type involves the application of radio-frequency waves to the lower part of the esophagus just above the sphincter. The waves cause damage to the tissue beneath the esophageal lining and a scar (fibrosis) forms. The scar shrinks and pulling on the surrounding tissue, thereby tightening the sphincter and the area above it.a third type of endoscopic treatment involves the injection of material into the esophageal wall in the area of the LES. This increases the pressure in the LES and prevents reflux.

Endoscopic treatment has the advantage of not requiring surgery. It can be performed without hospitalization. Since these endoscopic techniques are new, however, it is not yet clear how effective they are or for how long they will be effective. More studies with endoscopic treatments are necessary.

l Prevention of transient LES relaxation
Transient LES relaxations appear to be the most common way in which acid reflux occurs. Although there are available drugs that prevent relaxations, they have too many side effects to be useful. Much attention is being directed at the development of drugs that prevent these relaxations without accompanying side effects.

Phase 1 Lifestyle Changes ; Phase 2 Medications Treatment

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