Who is a good candidate for endoscopic surgery for GERD?

When medical management fails and severe GERD symptoms persist, patients may want to consider surgery. The standard surgery is called a Nissen fundoplication. For this surgery the upper part of the stomach is wrapped around the lower esophageal sphincter. This is the valve that normally keeps the acid from backing up from the stomach to the esophagus. The surgery will strengthen this and repair a hiatal hernia if that is contributing to the problem.

Surgery for gastroesophageal reflux disease (GERD) should be considered in patients with well-documented reflux disease who cannot tolerate medications or continue to have regurgitation as a primary symptom. If symptoms persist despite medical treatment, a comprehensive evaluation should be completed prior to considering surgery.

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For those patients in whom a medical regimen has not been successful, anti-reflux surgery can offer gratifying, lasting results for relief of GERD. While GERD can have several causes, surgery is most effective for those patients whose GERD is caused by a defective lower esophageal sphincter (LES), the muscle connecting the esophagus with the stomach. In general, more than 90 percent of patients who undergo surgery have no reflux after surgery. Fundoplication, done as either an open or a laparoscopic procedure, treats the reflux by making a new valve mechanism at the lower esophagus as a barrier to reflux.

Surgery to correct GERD is considered in younger patients to help them from a lifetime of ongoing reflux. Your doctor may consider surgery for you if GERD medications have not helped ease your symptoms, or if you want to stop taking medication.

Dr. Lawrence S. Friedman, MD

Medication and lifestyle changes can successfully control 95 percent of gastroesophageal reflux disease (GERD) cases, but for a few patients, surgery is the best option. For example, surgery might be preferable for younger patients who want to avoid taking drugs known as proton pump inhibitors (PPIs) for many years. However, the relief provided by surgery may not be permanent, and medications might be necessary again at some point. 

Other indications for surgery are occasional cases of erosive esophagitis that do not improve with drug therapy, strictures that recur despite treatment or pneumonia or recurrent respiratory problems due to acid reflux that don't improve with drug therapy. The goal of surgery is to tighten the lower esophageal sphincter (LES)—the muscle connecting the esophagus and stomach that acts as a barrier to protect the esophagus against the backflow of gastric acid from the stomach. The operations are generally effective and can eliminate the need for all GERD medications for some time.

Endoscopic repair of GERD is ideal for patients who, have a positive pH test, are at least partially responsive to proton pump inhibitor medicines (PPIs), who have significant non-acid regurgitation and who prefer to be off medication.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.