Anti-reflux surgery is a treatment for acid reflux, also known as GERD (gastroesophageal reflux disease). GERD is a condition in which food or stomach acid come back up from your stomach into the oesophagus. Reflux often occurs if the muscles where the oesophagus meets the stomach do not close tightly enough.
What is gastroesophageal reflux disease (gerd)?
Although “heartburn” is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastroesophageal reflux disease. In this condition, stomach acids reflux or “back up” from the stomach into the oesophagus.
Gerd signs and symptoms include:
- A burning sensation in your chest (heartburn), sometimes spreading to your throat, along with a sour taste in your mouth
- Chest pain
- Difficulty swallowing (dysphagia)
- Dry cough
- Hoarseness or sore throat
- Regurgitation of food or sour liquid (acid reflux)
- Sensation of a lump in your throat
When you eat, food travels from your mouth to your stomach through a tube called the oesophagus. At the lower end of the oesophagus is a small ring of muscle called the lower oesophageal sphincter (LES). The LES acts like a one-way valve, allowing food to pass through into the stomach. Normally, the LES closes immediately after swallowing to prevent backup of stomach juices, which have a high acid content, into the oesophagus. GERD occurs when the LES does not function properly allowing acid to flow back and burn the lower oesophagus. This irritates and inflames the oesophagus, causing heartburn and eventually may damage the oesophagus. A few patients may develop a condition in which there is a change in the type of cells in the lining of the lower oesophagus, called Barrett’s Oesophagus. This is important to know because having this condition increases the risk of developing cancer of the oesophagus.
Medical and surgical treatment options
GERD is generally treated in three progressive steps:
- Lifestyle changes
- Drug Therapy
Initial treatments to control heartburn
In many cases, changing diet and taking over-the-counter antacids can reduce how often and how harsh your symptoms are. Losing weight, reducing or eliminating smoking and alcohol consumption, as well as altering eating and sleeping patterns can also help.
Over-the-counter treatments that may help control heartburn include:
- Antacids that neutralize stomach acid. Antacids, such as Maalox, Mylanta, Gelusil, Gaviscon, Rolaids and Tums, may provide quick relief. But antacids alone won’t heal an inflamed oesophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation
- Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) or ranitidine (Zantac). H-2-receptor blockers don’t act as quickly as antacids do, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions of these medications are available in prescription form
- Medications that block acid production and heal the oesophagus. Proton pump inhibitors are stronger blockers of acid production than are H-2-receptor blockers and allow time for damaged oesophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec, Zegerid OTC)
If heartburn persists despite initial approaches, your doctor may recommend prescription-strength medications, such as:
- Prescription-strength H-2-receptor blockers. These include prescription-strength cimetidine (Tagamet) and ranitidine (Zantac)
- Prescription-strength proton pump inhibitors. Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix)
- These medications are generally well-tolerated, but long-term use may be associated with a slight increase in risk of bone fracture and vitamin B-12 deficiency
- Medications to strengthen the lower oesophageal sphincter. Baclofen may decrease the frequency of relaxations of the lower oesophageal sphincter and therefore decrease gastroesophageal reflux. It has less of an effect than proton pump inhibitors, but it can be used in severe reflux disease. Baclofen can be associated with significant side effects, most commonly fatigue or confusion
Patients who do not respond well to lifestyle changes or medications or those who do not wish to continually require medications to control their symptoms, may consider undergoing a surgical procedure. Surgery is very effective in treating GERD. The most commonly performed operation for GERD is called a fundoplication (usually a Nissen fundoplication, named for the surgeon who first described this procedure in the late 1950’s). A fundoplication involves fixing your hiatal hernia, if present, and wrapping the top part of the stomach around the end of the oesophagus to reinforce the lower oesophageal sphincter. This recreates the “one-way valve” that is meant to prevent acid reflux. This can be done by using several small incisions, called laparoscopic surgery.