Some doctors may recommend certain medications if lifestyle management fails to solve the problem. These usually start with over-the-counter antacids and progress to prescription medicines that reduce or stop acid production in the stomach.
Patients who see no improvement through lifestyle changes or use of medications may require a third tier of treatment: surgery. Surgery to prevent reflux often involves creating a “valve” where your esophagus and stomach meet to prevent stomach acids from re-entering the esophagus.
Your doctor may recommend surgery in cases of serious GERD complications. For example, stomach acid can cause inflammation of the esophagus, leading to bleeding or ulcers. Scars from tissue damage can constrict the esophagus and make swallowing difficult.
Untreated GERD can also develop into a pre-cancerous condition called “Barrett’s esophagus,” which can lead to cancer over time. There are several surgical options that may help to relieve GERD symptoms and manage complications.
The standard surgical treatment for GERD is called fundoplication—specifically, Nissen fundoplication. This anti-reflux surgery involves tightening and reinforcing the lower esophageal sphincter. The surgeon will wrap the upper part of the stomach around the outside of the lower esophagus to strengthen the sphincter and prevent reflux.
Fundoplication can be performed as an open surgery, in which the surgeon makes a long incision in your stomach to access the esophagus. It can also be performed as laproscopic surgery, in which the surgeon makes several smaller incisions in your abdomen. The surgeon inserts instruments that hold a tiny camera (endoscope) into the incisions to guide the procedure.
An Esophyx procedure may be recommended if your doctor determines that fundoplication isn’t right for you. This type of surgery creates a barrier between the stomach and the esophagus to prevent reflux of stomach acid.
During the procedure, the surgeon inserts a device called an Esophyx through your mouth into the stomach to fold the tissue at its base. This creates a replacement for the sphincter that keeps acid from washing into your esophagus. Research is ongoing to determine which types of patients are best suited for this procedure.
Stretta procedure uses an endoscopic device along with electrode energy to heat your esophageal tissue and create tiny cuts in it. The cuts form scar tissue in the esophagus, damaging the nerves that respond to refluxed acid.
The scar tissue that forms as your esophagus heals also helps strengthen the surrounding muscles, improving reflux symptoms. As with Esophyx surgery, researchers are still trying to determine who is best suited for this type of treatment.
Bard EndoCinch System
This system uses an endoscopic device approved by the Food and Drug Administration (FDA) to treat chronic heartburn. The system works by stitching the lower esophageal sphincter. These stitches create small pleats that help strengthen the muscle. The Cleveland Clinic notes that the long-term effects of both the Stretta procedure and the Bard EndoCinch system are yet unknown.
Linx type of surgery involves a new device that the FDA has recently approved to help strengthen the lower esophageal sphincter. A surgeon wraps the Linx device—a ring of tiny magnetic titanium beads—around the junction of your stomach and esophagus during this minimally invasive procedure.
Because the beads are magnetized, they move together to keep the opening between the stomach and esophagus closed to refluxing acid, but allows food to pass through normally.
The FDA recently approved an implant that may help people with GERD avoid more invasive surgery. In this procedure, Enteryx solution is injected during endoscopy. The solution becomes spongy, providing reinforcement to the lower esophageal sphincter to keep stomach acid out of the esophagus. The implant is specified for use by GERD patients who require a class of drugs called proton pump inhibitors (PPIs).
Surgery should be a last resort option used only when diet modification, lifestyle changes, and medicine fail to relieve symptoms of GERD. Surgery may also offer a preferable alternative to a lifetime managing drugs and discomfort. Speak with your doctor for guidance on the best approach to manage and treat your specific condition.