Treatment

Surgery

Surgery may be indicated under certain circumstances:

• If lifestyle changes and drug treatments have failed.
• In patients with other medical complications.
• In younger people with chronic GERD, who face a lifetime of expense and inconvenience with maintenance drug treatment.

Some physicians are recommending surgery as treatment of choice for many more patients with chronic GERD, particularly since minimally invasive surgical procedures are becoming more widely available. Also only surgery improves regurgitation. Furthermore, persistent GERD appears to be much more serious than previously believed, and the long-term safety of acid suppression using medication is still uncertain.

Nevertheless, anti-GERD procedures have many complications and high failure rates (ranging from 30% at five years to 63% at 10 years) and, as with medications, current surgical procedures cannot cure GERD. About 15% of patients still require anti-GERD medications after surgery. Furthermore, about 40% of surgical patients are at risk for new symptoms after surgery (e.g., gas, bloating, trouble swallowing), with most occurring more than a year after surgery. Other studies have reported similar results. Finally, evidence -- notably an important 2002 Swedish study -- now strongly suggests that the procedure does not reduce the risk for esophageal cancer in high-risk patients, such as those with Barrett's esophagus. New procedures may improve current results, but at this time patients should consider surgical options very carefully with both a surgeon and medical physician.