Acid Reflux Surgery
Acid reflux affects virtually everybody at some point in their lives. However, when acid reflux becomes particularly severe or when it occurs on a regular basis for several weeks, it is considered chronic and can be classified as GERD or gastroesophageal reflux disease. GERD is estimated to affect tens of millions of Americans but is often left undiagnosed, as most either live with the constant acid issue or take over-the-counter medications over the long term. Unfortunately, this increase in GERD has led to higher rates of complications including, over the longer term, esophageal cancer.
Causes of GERD
The most common reason for GERD is weakness in the lower esophageal sphincter, the valve between the esophagus and the top of the stomach. A normal LES allows food and drink to pass down, but then closes fully. This stops stomach contents from pushing back up. However, when the LES malfunctions, highly acidic stomach juices push into the sensitive lining of the esophagus and cause pain and other dysfunctions. This acid may travel all the way up to the mouth where it can cause bad breath, yellowing teeth, chronic dry cough and other issues.
Another possible cause of GERD is a hiatal hernia. This is where the hiatus – the hole in the diaphragm through which the esophagus passes – stretches and allows stomach tissue to push up through the diaphragm. Hiatal hernias are very common in the obese population and are often found and corrected during a primary bariatric surgery. Learn more about hiatal hernias.
Persistent or chronic acid reflux is also a potential complication of a Lap-Band or gastric band. This has become more apparent as longer-term band patients complain of this and other negative effects. The band can be removed, which would likely cause weight regain or converted to another procedure such as a gastric bypass or gastric sleeve.
Treatment for GERD – Lifestyle Change and Antacids
Typically, the first step in treating GERD is lifestyle change. Losing weight and avoiding highly acidic foods is a surefire way to reduce the number of bad reflux days. However, as with any diet and exercise program, about 95% fail and the acid reflux is not resolved longer-term. At that point, many patients start on antacids such as Tums which use chalk-like compounds to absorb acid in the stomach. While the stomach contents are still refluxing into the esophagus, they are not as acidic and therefore not as painful.
Treatment for GERD – Medications
When antacids fail, most patients turn to medications that were once prescription, but are now over the counter including proton pump inhibitors like Omeprazole. The easy availability at just about any drugstore implies that they are extremely safe, however this may not be the case. They are typically indicated for six weeks of use, but most people take them for many months and years. The result is an increase in potential side effects from a higher risk of H. Pylori infections up to and including bones that become more brittle, increasing the risk of fracture. Further, medication only treats the symptoms – it does not address the underlying issue.
Surgery for GERD
Surgery may seem like a dramatic option, but it may be the only solution for some people suffering from severe or uncontrolled GERD. The gold standard in GERD surgery is known as a fundoplication, where the upper part of the stomach is wrapped around the lower part of the esophagus to add pressure to the LES. The stomach is sutured in place and upwards of 90% of patients experience complete resolution of their reflux immediately after surgery. The Nissen Fundoplication, which involves a 360 degree wrap around the esophagus was often too restrictive, so newer fundoplication techniques – partial wraps known as Dor and Toupet – only wrap the stomach around 230 to 270 degrees of the esophagus. Learn more about a fundoplication.
Severe GERD in obese patients is also very common and many patients are referred to us for a gastric bypass which not only helps the patient lose weight but also improves or eliminates many obesity related conditions including acid reflux. Unfortunately, the gastric sleeve, while a great procedure, may actually worsen existing acid reflux or cause acid reflux de novo. As such, patients with severe or uncontrolled GERD are guided towards a bypass.
Next Steps
The first and most important next step is to understand more about GERD and whether you have it. A proper diagnosis can be made with a simple in office procedure along with a discussion about your medical history. We encourage you to contact our office to schedule a consultation with Dr. Higa to understand whether you may be a good candidate for GERD surgery.