Question: When is surgery considered to treat GERD (gastroesophageal reflux disease)?
Answer: The primary surgical treatment for gastroesophageal reflux disease is Nissen fundoplication. This is a procedure in which the upper part of the stomach is wrapped around the lower part of the esophagus --thereby creating a high pressure area to prevent the reflux of stomach contents into the lower esophagus.
Surgery is reserved for two broad groups of patients. First, patients with severe disease especially something called nocturnal reflux in which acid reflux tends to occur in the nighttime while the patient is lying flat. This type of reflux is more severe and has been associated with higher rates of complications such as esophagitis, which is an inflammation in the esophagus, as well as Barret's esophagus, where the lining of the esophagus changes from one type of cell to another. Barret's esophagus is a risk factor for esophageal cancer and these patients should be treated surgically when appropriate.
The second group of patients are young patients who have typical symptoms of reflux such as heartburn and regurgitation, who opt not to take daily medications such as proton pump inhibitors. Studies have shown that in these patients, surgery can often give them relief from needing to take medications for up to ten to twelve years and can be the right decision in young patients.