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Importance of Surgery in GERD

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Gastroesophageal reflux disease is the reflux of gastric content back into the esophagus, mostly treated by medication; if not possible, surgery is advised.

Medically reviewed by

Dr. Jagdish Singh

Published At October 12, 2022
Reviewed AtOctober 31, 2022

Introduction:

GERD - Gastroesophageal reflux disease is the reflux of acidic gastric contents from the stomach and duodenum back into the esophagus(food pipe connecting mouth and stomach).

This condition will cause many symptoms in patients, like heartburn, cough, vomiting, difficulty swallowing (dysphagia), and feeling like food is getting stuck in the throat.

The main cause of gastroesophageal reflux is the valve at the esophagus and stomach junction called the lower esophageal sphincter, which does not close properly when food reaches the stomach, causing the reflux or backward flow of food and gastric juice(acidic). Thus it causes a burning sensation in the esophagus, heartburn, vomiting, etc. It is almost customary to have gastroesophageal reflux once in a while, which can be controlled by lifestyle modification and medications.

But the occurrence of gastroesophageal reflux increases more than twice a week; it will cause other complications like esophageal ulcer, Barrett’s esophagus (change in the cells of the esophagus occurs due to acidic gastric reflux), stomach ulcer, and surgery is recommended. Surgery is taken into consideration only after specific assessments like tests to check the condition of esophageal muscles, esophageal manometry, upper endoscopy, barium swallow, etc. Therefore after confirmation of diagnosis, assessment of patient surgery is done to provide a long-term effect.

What Are the Lifestyle Modifications for GERD?

  • Weight loss is recommended in obese and overweight patients.

  • Elevate the head with an extra pillow (at least 6 inches) while sleeping.

  • Regular exercise.

  • Quit smoking.

  • Certain medications also cause gastroesophageal reflux, like medication for asthma.

What Are the Medications for GERD?

  • H2 Blockers - It reduces acid production in the stomach and helps the esophagus to heal.

  • Proton Pump Inhibitor - It also lowers the acid production in the stomach, more efficient than H 2 blockers.

  • Antacids - This medicine is only for mild gastroesophageal reflux or heartburn symptoms.

In conditions like - esophageal ulcer, erosive esophagitis, Barrett's esophagus, stricture, and adenocarcinoma of the esophagus, surgical treatment is found to be more effective.

Surgery also opts when modifying lifestyle and medication seems to be ineffective or when the patient needs to stop the medication.

What Are the Assessments of Patients for Surgical Treatment?

  • Ambulatory pH Monitoring: It is a test to evaluate how often acids from the stomach enter the esophagus.

  • Esophageal Manometry: This test measures the function of the lower esophageal sphincter and esophagus muscles.

  • Upper Endoscopy (Esophagogastroduodenoscopy): This test examines the lining of the esophagus, stomach, and first part of the small intestine(the duodenum).

  • Barium Swallow: Also called esophagogram. It is an imaging test to check problems in the upper gastrointestinal tract (the upper gastrointestinal tract includes the mouth, back of the throat, esophagus, stomach, and the first part of the small intestine). Hiatal hernia is a condition that will worsen the symptom and condition of gastroesophageal reflux.

What Are the Surgical Treatments for GERD?

1) Fundoplication is the most common type of surgery in treating gastroesophageal reflux- it gives a long-term permanent improvement and is the most effective. It can be done as an open surgery or as laparoscopic fundoplication. Surgery is done mostly under general anesthesia.

2) Open Surgery: In open surgery, the surgeon will make a large cut on the patient's abdomen. The surgeon will make a stitch on the top of the stomach and at the end of the esophagus(food pipe). This will increase the pressure in the lower esophageal sphincter. Thus it helps to prevent the reflux of stomach contents back into the esophagus.

3) Laparoscopic Fundoplication: In laparoscopic fundoplication, a device called a laparoscope (a thin tube with a light and camera at the end) is used. The advantage of using laparoscopy is that it helps the surgeons operate from outside. This is more common. In this procedure, the laparoscopy is connected to a video monitor, and the surgeon will do the procedure by seeing through the video monitor. In laparoscopic fundoplication, the surgeon will put small incisions in the abdomen. Therefore laparoscopic fundoplication leaves multiple small incisions, and open surgery will leave a single large open cut. In case of any difficulty or complications, the surgeon will switch to the open procedure.

4) Endoluminal Fundoplication: This is a procedure to do the procedure by avoiding making a cut or multiple cuts. In this procedure, an endoscope is inserted through the mouth into the esophagus, and the surgeon will put clips in that area at the junction of the esophagus and stomach. Thus this clip will prevent the reflux of stomach content into the esophagus.

5) Bariatric Surgery: If a patient's gastroesophageal reflux is caused due to obesity, then this procedure is done. This is a weight loss surgery done to reduce obesity and thus control gastroesophageal reflux.

6) LINX-Procedure: In this procedure, the surgeon uses a laparoscope to put a ring of titanium beads on the outside of the lower esophageal area. This will strengthen the lower esophageal sphincter, thus preventing the reflux of gastric content back into the esophagus.

What Is the Food to Avoid in Patients With GERD?

Certain food will trigger the symptoms and may make the condition worsen in the patient who has gastroesophageal reflux. So, in this case, they should avoid food like acidic food like citrus food, chocolate, caffeinated food like coffee, spicy food, fatty food, and alcohol.

What Are the Outcomes of GERD Surgery?

Surgery for gastroesophageal reflux disease will generally give better long-term relief. After surgery patient's gastric reflux, regurgitation, and heartburn have improved by more than ninety percent. Laparoscopic surgery provides an effective and long-term barrier to acid reflux. Gastroesophageal reflux-associated airway symptoms are also improved. Very few patients only require repeated surgery.

Conclusion

In patients with severe symptoms like esophageal ulcer, Barrett's esophagus, and stomach ulcer, to control complications, surgery is recommended. Before surgery, a patient assessment should be taken. Laparoscopic surgeries reduce the risk of incision, and it has a speedy recovery rate.

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Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology

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