Gastroesophageal Reflux Disease Treatment Options
Surgery may be an option in GERD patients with hiatal hernia, stricture, and/or severe inflammation of the esophagus who cannot take medications, or for whom medications are not effective. The goal of surgery is to strengthen the lower esophageal sphincter.
Nissen fundoplication is a procedure in which the surgeon removes tissue from the top of the stomach and wraps it around the lower esophageal sphincter to tighten the seal. Following this procedure, symptoms of GERD often are relieved for 2 to 5 years. Some patients still need to take medications for GERD after surgery, but symptoms usually are much less severe.
Other types of surgery (e.g., Toupet fundoplication, Hill repair, Belsey Mark IV operation) also can be used to restructure the esophagus to prevent reflux.
Newer forms of surgery, including endocinch endoluminal gastroplication and the Stretta procedure, are performed using a long, flexible tube similar to those used in an endoscopy. They do not require incisions and in most cases, they are performed as outpatient procedures (i.e., patients do not need to be hospitalized overnight). These procedures may be used to treat patients with a hiatal hernia or Barrett's esophagus. Short-term side effects include throat or chest pain. Long-term effects are not yet known.
In endocinch endoluminal gastroplication, the surgeon stitches the top of the stomach near the lower esophageal sphincter. Over time, these stitches become a barrier that prevents stomach acid from entering the esophagus.
In the Stretta procedure, tissues surrounding the lower esophageal sphincter are fused together, resulting in scar tissue and changes in the sensory nerves that react to the reflux.
It is important for patients who have GERD to see their physician regularly so that symptoms and progress can be monitored. If symptoms persist despite treatment, the condition may be more severe than originally thought and further testing or changes in treatment may be needed.