How Can I Treat My GERD?

There are two ways in which we treat GERD. One way is non-operatively by changing your diet, lifestyle and taking certain medications. The other method is with surgery.

How Do I Treat My GERD Medically or Without Surgery?

• There are many ways to address your GERD. One important method is to change your diet and eating habits. We recommend avoiding certain foods (see list), eating smaller portions, eat sitting up and eating your last meal of the day several hours before going to sleep.
• Losing weight to achieve an ideal body weight will help decrease pressure in the abdomen and may help decrease symptoms.
• Medications can also be useful by decreasing the acid production and can decrease the burning that you may feel in your chest area. Some medications have also been shown to improving healing from damage due to GERD in the esophagus2. It is important to understand that medications will not stop the physical process of stomach contents moving back up into your esophagus if you have a hiatal hernia or your Lower Esophageal Sphincter (LES) does not work properly.

How Do I Treat My GERD with Surgery?

If you have GERD which does not respond to medications and lifestyle changes or you have a hiatal hernia which is contributing to your GERD, surgery can help to fix the problem.

What Is Involved In The surgery?

Surgery to fix your GERD is done robotically (see robotic insert). This is done with small incisions, takes approximately 1-2 hours and will allow you to return home the same day. We will close the hernia with suture and absorbable material. To complete the procedure, we will either place a portion of your stomach in front of, or behind your esophagus (a partial “wrap”) or we will place magnetic beads around your esophagus. Please see the “Surgery Procedures” inserts for more details.

Which type of procedure you have will be discussed with your surgeon to see what option is the best fit for you.

Both types of surgery will require you to change your diet for the first few weeks during recovery (see diet information after surgery). Also, because we are fixing a hernia it is recommended that you refrain from strenuous activities or heavy lifting over 20 pounds for approximately 6 weeks.

Which Treatment Should I Choose For My GERD?

Treatment of your GERD depends on several factors. Your surgeon will discuss which option you may want to consider.

• The two most common reasons why people choose one treatment over another is based on your quality of life with GERD and how much damage has been done to your esophagus from reflux.
• GERD can affect how you eat and live your life. It may also require you to take medications for longer periods of time. If you can control your symptoms and are able to have a good quality of life, then a medical management is a good fit for you.
• However, many people with GERD do not want to take medications for long periods of time, may have regurgitation which affects their quality of life, can have pain and may have damage to their esophagus or don’t want to have further damage done placing them at a risk for esophageal cancer. This is where surgery can help in many ways.

It is important to remember that medications can decrease acid production and eliminate burning but medications cannot fix a hiatal hernia nor eliminate reflux or regurgitation. Surgery will provide the best option for eliminating reflux and can allow people to resume a more normal diet, improve their lifestyle and likely minimize or eliminate any need for further GERD medications.

Surgical Procedures To Resolve GERD

Surgery to eliminate your GERD has two steps: 

• Step 1) fixing the hiatal hernia
• Step 2) Recreating the Lower Esophageal Sphincter with a Linx device or a partial fundoplication.

The most important part of the surgery is fixing the hiatal hernia. This is where we close the diaphragm around the esophagus in order to restore the proper anatomy and function.

It is important to understand that repairing the diaphragm is a type of hernia surgery.

Unfortunately, hernias can come back. It is likely that a larger hernia has a higher chance of coming back in the future. This is due to the complex structure of the diaphragm and the fact that the diaphragm is constantly moving.

Because this part of the surgery is a hernia repair, it is important that you refrain from any strenuous activities, heavy lifting or any other activities that increase your abdominal pressure for at least 6 weeks. This will give you the best chance of healing the hernia repair. However, even in the best of situations, hernias can return several years in the future.

This portion of the surgery can be fairly uncomfortable during the immediate recovery phase.

You may feel pain in the back of upper abdomen/chest when coughing, sneezing or any type of increase in abdominal pressure.

This discomfort will resolve over the 1-2 weeks of recovery. 

Magnetic Sphincter Augmentation Using The Linx Device

• The Linx device is a ring of expandable titanium beads which help to keep the Lower Esophageal Sphincter closed
• This will then help prevent gastric material from refluxing back into your esophagus
• This device has been available for many years and the results have been overall positive3

• The FDA has now approved the Linx for those patients with severe esophageal damage from GERD such as Barrett’s esophagus4.

  

• Many people prefer the Linx device over a partial wrap surgery because they are able to resume a normal diet sooner
• However, the discomfort of the Linx device can last up to 6 months while the body heals around it.
• Some people are concerned about the erosion rate which is very low at 0.1-0.3%

The Partial Fundoplication (“Wrap”)

• A partial fundoplication, also known as a partial “wrap” is when we wrap a portion of the stomach around the esophagus.
• This can be done behind or in front of your esophagus.
• The “wrap” increases pressure around your lower esophagus to prevent stomach contents from moving up into your esophagus.
• With a partial wrap you will be able to burp

• This type of procedure is quite common
• Because this procedure has been around for a long time, many people prefer this over the newer Linx device and the absence of risk of any erosion
• There is less discomfort over the 6 month recovery period when compared to the Linx device. However, your diet will change significantly more during the recovery period due to the swelling of the wrap.
• During the first few months, you may only be able to tolerate liquids or smoothies until the swelling resolves.