Anti-reflux surgery

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.

Reflux disease is becoming increasingly more common, 1 out of 5 people experience heartburn on a weekly basis in the United States.  When reflux begins to affect a person's daily life, medication is prescribed to reduce the symptoms and prevent complications from occurring. In some people, medications aren't enough or they don’t want to take a pill the rest of their lives, so surgery can also be an option. There is an extensive process to consider one’s candidacy for surgery which will be discussed at the office visit. 

The two surgical options for this disease both include closure of the Hiatal Hernia which almost always accompanies GERD. 

One is placement of a LINX device which is a titanium magnet that is placed around the lower end of the esophagus that recreates a barrier to acid reflux. 

The other option is call a Nissen Fundoplication and involves wrapping the stomach around the esophagus to prevent reflux. 

We will discuss both at length and determine which, if any, would be ideal for you. Both of these surgeries can be done minimally invasively, either laparoscopically or robotically.

Symptoms

Common signs and symptoms of GERD include:

• A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
• Chest pain
• Difficulty swallowing
• Regurgitation of food or sour liquid
• Sensation of a lump in your throat

If you have nighttime acid reflux, you might also experience:

• Chronic cough
• Laryngitis
• New or worsening asthma
• Disrupted sleep

When to see a doctor

Seek immediate medical care if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be signs and symptoms of a heart attack.

Make an appointment with your doctor if you:

• Experience severe or frequent GERD symptoms
• Take over-the-counter medications for heartburn more than twice a week

Causes

GERD is caused by frequent acid reflux.

When you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again.

If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus. This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed.

Risk factors

Conditions that can increase your risk of GERD include:

• Obesity
• Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
• Pregnancy
• Connective tissue disorders, such as scleroderma
• Delayed stomach emptying

Factors that can aggravate acid reflux include:

• Smoking
• Eating large meals or eating late at night
• Eating certain foods (triggers) such as fatty or fried foods
• Drinking certain beverages, such as alcohol or coffee
• Taking certain medications, such as aspirin

Complications

Over time, chronic inflammation in your esophagus can cause:

• Narrowing of the esophagus (esophageal stricture). Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing.
• An open sore in the esophagus (esophageal ulcer). Stomach acid can wear away tissue in the esophagus, causing an open sore to form. An esophageal ulcer can bleed, cause pain and make swallowing difficult.
• Precancerous changes to the esophagus (Barrett's esophagus). Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer.