Treatment for GERD

Medication

The most common treatment of GERD is taking medications to improve symptoms. There are a host of medications available both over the counter and by prescription that all function the same way. They either neutralize or decrease the production of stomach acid. These drugs include antacids such as Tums, H2 blockers such as Zantac and Pepcid and the most powerful acid suppressants called PPIs (Nexium, Prilosec and others). The medications do not address the actual cause of reflux, which is the damaged lower esophageal sphincter (LES, located at the end of the esophagus at the point where it joins the stomach) The reflux continues, but it no longer contains acid. This controls symptoms in most people. These medications must be taken for life and have both short and long term side effects. Since the valve is not improved, these drugs can sometimes fail and other methods are required.

Another approach to the treatment of GERD is to directly restore the function of the damaged LES. Restoring LES function can stop the reflux, eliminate symptoms as well as the need for medications. There are several procedures intended to accomplish this.

Minimally Invasive Surgical Options

The gold standard to which all reflux procedures are compared is the laparoscopic Nissen fundoplication (Nissen). This minimally invasive surgical procedure is performed under general anesthesia through 5 small incisions ¼ to ½ inches long. A slender scope (laparoscope) is inserted into the abdomen that produces a high-resolution image on a monitor which the surgeon carefully observes as he performs the procedure through the small incisions. The procedure involves recreating a functional valve by wrapping part of the stomach around the lower esophagus at the site of the LES. The procedure takes approximately 1-2 hours and the hospital stay is usually 1 night. Most are back to light, everyday activity within a week. A successful laparoscopic Nissen fundoplication stops the reflux approximately 80-85% of the time and 90% of patients are satisfied with the procedure after 5 years. Side effects can include the inability to belch or vomit in about 30% as well as excess gas and bloating. A small number have swallowing difficulty. The Nissen stops the reflux with greater reliability than all existing procedures. Experienced surgeons who perform the Nissen obtain excellent results.
A new procedure now available is called the LINX Reflux Management System. This is performed using the same minimally invasive technique as the Nissen, however it is much less complex. A specially designed bracelet of magnetic beads is placed loosely around the esophagus, augmenting the damaged LES. As food passes, the magnetic beads separate allowing the food to pass and then closes thereafter, preventing reflux. The procedure takes approximately 30 minutes and the hospital stay is overnight. Full activity and a normal diet are resumed immediately. Reflux is stopped in most patients but the side effects are minimal. Presently, this procedure is only available at select centers. The Heartburn Treatment Center is one of the first places in the US to offer this revolutionary procedure.
Transoral Incisionless Fundoplication (TIF) , is a procedure where the poorly functioning lower esophageal sphincter is reconstructed using an endoscopic approach. This procedure reconstructs the sphincter from the inside of the esophagus using a highly specialized instrument and therefore avoids any abdominal incisions. This endoscopic sphincter reconstruction still requires a general anesthesia and can be utilized in specific situations. Suitability for the TIF procedure is determined during the Heartburn Treatment Center diagnostic evaluation.

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