When Should a Reflux Patient Consider Surgery?

Virtually all of us, no matter how healthy or unhealthy, older or young, have experienced reflux at some point in our lives. Reflux can occur for several reasons, and having it occasionally is nothing to be concerned about. However, if there is an underlying condition causing the reflux, there’s a chance it can worsen, become chronic, and ultimately require more invasive treatment. Before we go there, however, many patients wonder when they may need surgery for a reflux problem. Let’s first talk about the continuum of treatment options for most patients.

Diet and Exercise

If excess weight and obesity are among the most common causes of reflux, diet and exercise improvements would diminish the problem. This is true. Excess weight increases intra-abdominal pressure, which means the pressure within the abdominal cavity can push on the stomach and ultimately cause gastric juices to push up into the esophagus. Patients often improve or resolve their reflux by losing weight and notably dropping visceral fat accumulating around the organs.

Other patients may benefit from over-the-counter medications, including antacids and proton pump inhibitors, or PPIs. Antacids are specially formulated chewable or soluble tablets that introduce alkaline substances to neutralize stomach acid. These are best used for occasional and mild reflux.

PPIs or proton pump inhibitors slow the production of stomach acid at the source. By slowing the production of acid, patients do not feel the burn. However, proton pump inhibitors come with significant potential risks, including long-term risk of bone fracture, an increased risk of dementia, and the possible proliferation of bacteria in the stomach, including c-diff.

Both medications mentioned above treat, neutralize, or reduce the acid in the stomach. This is only half the cause of reflux-related damage. Gastric juices contain enzymes and other caustic liquids, which can slowly damage the sensitive esophageal lining. While most patients may not feel the burn when taking these medications, they could still be doing damage without even knowing.

When It’s Time for Surgery

For many, surgery is indicated sooner than they think. Typically, when antacids stop working, patients move on to proton pump inhibitors, which should only be taken for six weeks. Often, patients take these medications for years, if not decades, with potentially problematic consequences. To that end, surgery is not as drastic as one may think, especially considering that the incidence of pre-cancerous and full-blown esophageal cancer has been on the rise over the past decade or two.

Fortunately, there are more anti-reflux options today than ever before. The traditional “grandfather” of reflux surgery is the Nissen fundoplication, in which the upper portion of the stomach is wrapped around the lower end of the esophagus to support the lower esophageal sphincter and reduce the risk of gastric juice entering the esophagus. This procedure is performed minimally invasively but has several drawbacks during the postoperative period.

The LINX reflux management system is a small magnetic beaded bracelet made of titanium beads and a magnetic clasp. It is implanted during a quick 15-minute laparoscopic procedure and has a similar satisfaction rate to a fundoplication but addresses several drawbacks of the more traditional surgery.

For patients who also suffer from obesity, gastric bypass may be an excellent option to address both their weight and the concurrent reflux. This is especially useful if the reflux is severe and patients are living with poorly controlled type 2 diabetes. Sleeve-caused reflux may be managed with a conversion to bypass.

The most critical next step for anyone considering reflux surgery who has not been successful with lifestyle modifications or medications is to visit a highly experienced and qualified bariatric and general surgeon specializing in reflux procedures, like Dr. Tsuda. In addition to performing the surgical procedures, Dr. Tsuda has been instrumental in testing and bringing many surgical systems and devices to Las Vegas. He remains a leader in the field, having trained many other bariatric and reflux management surgeons. Call us for a consultation to learn more about your options.