Erik B. Wilson MD, Medical Director of Bariatric Surgery at Houston UT MIST, explains various treatment options for patients who suffer from chronic acid reflux. These options depend on each patient’s severity and duration of GERD symptoms. Although first-line treatment begins with lifestyle modification and acid-suppressing medications, for select patients, acid-reflux surgery remains an important and often underutilized tool in providing safe, long-term relief from GERD symptoms.http://www.utmist.com/
Gastroesophageal reflux disease (GERD) is a common digestive disorder that occurs when stomach acids or food particles travel back into the esophagus, the digestive passageway between a person’s stomach and mouth. The stomach acids irritate and inflame the delicate esophageal lining, creating a burning sensation commonly called heartburn or acid reflux. Though most people occasionally experience heartburn, those who suffer from GERD symptoms many times each week—a condition known as chronic GERD—should seek treatment from a medical professional who can identify the underlying cause and recommend appropriate treatment.
At Houston’s UT MIST Center for Bariatric and Metabolic Surgery, our approach to treating chronic GERD symptoms includes controlling pain and discomfort, preventing further complications, and healing the damaged esophageal tissue. Our gastrointestinal surgery specialists have successfully treated thousands of Houston-area patients suffering from chronic GERD symptoms.
Our first course of action includes lifestyle changes, followed by pharmaceutical intervention. For patients who are still unable to obtain satisfactory relief, we offer advanced robotic, laparoscopic, and endoscopic reflux surgery, all of which have an impressive safety profile. Approximately 85 to 90 percent of our patients experience complete reversal of their GERD symptoms following minimally invasive or noninvasive reflux surgery at our institution. For morbidly obese patients (BMI over 35) who suffer from chronic GERD, bariatric weight-loss surgery remains the gold standard of treatment for this patient population.
GERD Symptoms and Causes
Common GERD symptoms include the following:
Individuals who suffer from one or more of these GERD symptoms should seek treatment as soon as possible, especially if their symptoms have been present for many years. Left untreated, chronic GERD can lead to serious complications. Chronic GERD symptoms often cause inflammation and a thickening of the esophageal lining, a defense mechanism in response to repeated exposure to stomach acid. Over time, these cellular mutations can lead to cancer of the esophagus.
The following are the most common causes of gastroesophageal reflux disease:
Because many of these GERD causes are potentially reversible, patients often experience relief from their GERD symptoms just by addressing the underlying cause. If morbid obesity (BMI 35 and over) is the primary cause of a patient’s chronic GERD, weight-loss surgery can improve both the acid reflux and other obesity-related comorbidities.
For others, however, GERD is most likely caused by a functional disorder related to the lower esophageal sphincter (LES) muscle, which exists at the junction between the esophagus and the stomach. Because this sphincter does not completely close, food and acid can travel back into the esophagus from the stomach, causing painful heartburn.
Preliminary Heartburn Treatment Options
According to Shinil K. Shah, DO, Medical Director of Research in the Division of Elective General Surgery at UT Health McGovern Medical School, to treat chronic heartburn, UT MIST physicians begin by assessing the severity and longevity of a patient’s GERD symptoms. Those who have mild reflux are advised to modify their lifestyle to control symptoms. These conservative changes might include one or more of the following: weight loss, abstaining from eating before bedtime, restricting meal size, eliminating foods and beverages known to trigger GERD symptoms, exercising regularly, and raising the head of the bed by six or eight inches. We also recommend that patients stop smoking.
In addition to lifestyle modification, early intervention for GERD symptoms typically includes taking over-the-counter medications to suppress acid and provide relief: antacids, H-2-receptor blockers (H2RAs), or proton-pump inhibitors (PPIs) that block acid production and allow the damaged esophageal tissue to heal. Some patients find that they need to increase the strength of their acid suppressors over time, so they may eventually require prescription-strength H2RAs or PPIs. Once a patient discontinues medication, symptoms will likely return.
Short-term use of proton-pump inhibitors appears to be safe, though the latest scientific research suggests that long-term use could lead to serious complications. An April 2016 original investigation published in JAMA Neurology points to a potential link between long-term use and cognitive decline. Another February 2016 original investigation published in JAMA Internal Medicine shows a strong correlation between long-term use of PPIs and chronic kidney disease. Other studies suggest a causal connection between PPIs and osteoporosis, pneumonia, and heart disease. For these reasons, we recommend that all patients relying on extended pharmaceutical therapy to control their GERD symptoms seek treatment from a medical professional.
Advanced GERD Treatment Alternatives
Some patients either do not obtain relief from medication or prefer not to expose themselves to the risks associated with long-term use. For these patients, Houston’s UT MIST Center for Bariatric and Metabolic Surgery offers a variety of truly innovative surgical solutions. The focus of surgical intervention for GERD is either to strengthen the lower esophageal sphincter (LES) or to repair the hiatal hernia using Fundoplication, Laparoscopic Surgery, or Endoscopic Incisionless Surgery.
Fundoplication: the most common reflux procedure, fundoplication repairs anatomical structures to prevent abnormal acid reflux. During fundoplication surgery, the upper part of the stomach, called the fundus, is wrapped around the esophagus and sewn into place to restrict reflux into the esophagus. Our board-certified gastrointestinal surgeons generally perform fundoplication surgery using a minimally invasive or completely non-invasive approach, although it can also be performed as an open procedure if needed. Following surgery, 85 to 90 percent of patients enjoy fewer or no GERD symptoms, and most can completely discontinue taking heartburn medications.
Laparoscopic Surgery: Minimally invasive laparoscopic surgery eliminates heartburn in approximately 85% of patients and cures most GERD-induced asthma. Laparoscopy surgery is performed through very small incisions in the abdomen. A laparoscope, which contains a small camera, is inserted into one of the incisions to enable the surgeon to visualize on a nearby monitor the surgical field. Surgical instruments are then inserted through the other incisions. Laparoscopic surgery enables a quick recovery time, reduced postoperative pain, and a faster return to work.
Endoscopic Incisionless Surgery: In certain cases, endoscopic incisionless surgery may be indicated. UT MIST proudly offers the most advanced endoscopic surgical options currently available. One is the revolutionary EsophyX® Transoral Incisionless Fundoplication (TIF) procedure for select patients seeking relief from their GERD symptoms. This noninvasive procedure is performed through the mouth and involves no incisions. Patients recover quickly and generally return to work in less than one week. EsophyX® TIF® has one of the lowest complication rates of any GERD surgery, along with an impressive safety profile.
Another Transoral Incisionless Fundoplication (TIF) approach to chronic GERD involves the Medigus Ultrasonic Surgical Endostapler (MUSE™) device. This new, FDA-approved device combines direct endoscopic video visualization with ultrasound guidance to assist a surgeon in creating an anterior partial fundoplication by placing surgical staples in the soft tissue of the esophagus and stomach. According to Dr. Shah, UT MIST is one of only a few medical facilities to offer this effective, safe procedure. TIF with MUSE™ presents another viable option for patients who would like to reduce or discontinue taking GERD medications, but prefer to avoid potential side effects associated with traditional fundoplication surgery.
Finally, UT MIST also offers the Stretta® incisionless approach to chronic GERD. This FDA-approved, minimally invasive procedure involves inserting a catheter through the mouth and into the esophagus to the lower esophageal sphincter (LES) and upper stomach. Radiofrequency energy is then applied to the surrounding muscles, causing them to thicken and tighten, which decreases the size of the opening and prevents or decreases gastric reflux. Patients enjoy a shorter recovery time, no scars, and generally fewer complications following incisionless procedures. UT MIST gastrointestinal surgeons can help patients determine whether they might be good candidates for one of these non-invasive procedures.
For additional information about Gastroesophageal reflux disease (GERD) symptoms and treatment options, or to schedule an appointment at the Houston UT MIST Center for Bariatric and Metabolic Surgery, visit our website.
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