Nearly a quarter of Americans suffer from gastroesophageal reflux disease, or GERD. In fact, nearly half of American adults have popped an antacid for heartburn in the past six months, contributing to industry sales of more than $1 billion in 2017 alone. As a surgeon specializing in treatment of reflux disease, I regularly see patients who no longer tolerate these medications, or who simply want to avoid antacids and acid blockers. And for good reason. New findings are shedding light on long-term effects of proton pump inhibitors, the potent and popular class of acid blockers available over the counter and by prescription.
What is GERD?
GERD occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash, or acid reflux, can irritate the lining of your esophagus, causing an uncomfortable burning sensation. While proton pump inhibitors can be effective in stopping cells from producing too much acid, long term use has been found to block the body’s ability to absorb calcium and magnesium and has been linked to C. diff, a dangerous bacterial infection of the colon. Medications also fail to address the underlying problem of reflux, which is an incompetent lower esophageal sphincter – the stomach muscle that prevents backflow of stomach acid.
It’s no surprise that more and more reflux patients are ditching their pills and looking to surgery as a viable option. When a patient visits my office, we typically schedule an upper endoscopy to rule out additional health concerns, such as hernias. Because not every patient is a candidate for surgery, we carefully consider each patient’s medical history to provide the best treatment.
For years, the gold standard in reflux surgery was the Nissen fundoplication. During Nissen, the upper end of the stomach is wrapped around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter. While the procedure remains popular, many surgeons are now opting for the LINX Reflux Management System, which consists of a small band of magnetized titanium beads wrapped around the lower esophageal sphincter. This band helps prevent gastric acids from pushing back up into the esophagus from the stomach, yet also safely allows the sphincter to open when required to allow for easy swallowing. Both procedures result in a 95 percent or higher reduction in symptoms, while LINX patients experience less bloating and dysphasia, or difficulty swallowing. LINX patients also return to a soft diet immediately following surgery, where Nissen patients remain on a liquid diet for two weeks.
Weighing your options
In today’s world, reflux patients have seemingly endless options. However, I recommend that patients first adopt lifestyle changes, which often include losing weight and cutting caffeine, chocolate and alcohol, particularly at night. Regular exercise also can prevent symptoms. If those changes are ineffective, medications can bring short-term relief. If symptoms persist, patients should understand that an incompetent sphincter is a muscular issue, which can really only be resolved through surgery. And while surgery might seem like a drastic action to some, the prospect of living with GERD can be even more frightening. As the prevalence of reflux increases, doctors are seeing more and more cases of esophageal cancers (once linked primarily to tobacco), as well as Barrett’s Esophagus, a precursor to cancer.
If you have reflux, don’t ignore it. Talk to your primary care provider about possible treatment options and lifestyle changes that may prove helpful, and consider surgery as a viable and lasting alternative to a lifetime of medications.
About Dr. Brown:
Preston Brown, M.D., F.A.C.S., is a general surgeon at Williamson Medical Group. His office is located adjacent to Williamson Medical Center at 4601 Carothers Parkway, Suite 360, in Franklin. To schedule a consult with Dr. Brown, call (615) 435-7777.Share this Article