24-Hour Crisis Hotline: (877)SAFEGBC or (877)723-3422 Mental Health & Substance Abuse Issues

6502 Nursery Drive, Suite 100
Victoria, TX 77904
(361)575-0611
(800)421-8825
Fax: (361)578-5500

Medical Disorders
Resources
Basic InformationLookupsLatest News
Health Tip: Do's and Don'ts for Calling 911Experimental Injection May Protect Against Peanut AllergyReblozyl Approved to Treat Anemia in Patients With Beta ThalassemiaAHA News: High Blood Pressure Common Among Black Young AdultsAHA News: Congenital Heart Disease Linked to Neighborhood Pollution, PovertySome Headway Made Against 'Superbugs,' but Threat Remains: CDCHealth Tip: A Well-Stocked First-Aid KitLung Cancer Report Delivers Good, Bad NewsAHA News: Millions Unaware of Common Heart Attack SymptomsWant Extra Years of Life? Keep Blood Pressure Tightly ControlledTestosterone Supplements Double Men's Odds for Blood Clots: StudyHealth Tip: Treating Post-Nasal DripOpioids Won't Help Arthritis Patients Long-Term: StudyCommon Muscle Relaxant Could Pose Mental Dangers for SeniorsKratom May Cause Liver Damage: StudySupplements Don't Prevent Kidney Disease in Type 2 DiabeticsNew Tool Predicts Odds of Kidney DiseaseVitamin E Acetate Is Leading Suspect in Vaping-Linked Lung Illnesses: CDCVaping-Linked Lung Illnesses Top 2,000, CDC SaysAHA News: Stroke Death Rate Increasing for Middle-Aged AmericansRural Americans Dying More From Preventable Causes Than City DwellersWhy Hand-Washing Beats Hand SanitizersSleepless Nights Could Raise Heart RisksScreening Truckers for Sleep Apnea Cuts Health Insurance CostsDo You Take Biotin Supplements? They Could Affect Your Medical TestsAHA News: Heart Disease Down Over A Generation Among American IndiansRisks Mount for Lonely Hearts After Cardiac SurgeryDaylight Saving Time Bad for Health, Experts ClaimHealth Tip: Prevent BloatingCould a Blood Test for Breast Cancer Become a Reality?One Dead, 8 Hospitalized in Salmonella Outbreak Tied to Ground BeefMost Americans Fear Cancer, but Feel Powerless to Prevent It: SurveyFewer Opioids After Eye Surgery Don't Mean More Post-Op PainDrug Trio Could Give Patients With Cystic Fibrosis a New OptionCould Tissue-Sealing Tape One Day Replace Stitches?Deep Sleep May 'Rinse' Day's Toxins From BrainClose to 1,900 Cases of Vaping-Linked Lung Illness, CDC SaysMeasles Leaves People More Vulnerable to Future InfectionsHealth Tip: Nausea After EatingSooner Is Usually Better for Gallbladder SurgeryProtect Your Heart Through the Holiday SeasonReport Finds Americans' Health Is FlaggingAHA News: Retina Changes Offer Glimpse Into Body's Heart HealthWildfire Smoke Threatens Health for Miles AroundHealth Tip: Hand Swelling During ExerciseToo Many Seniors Back in Hospital for Infections Treated During First StayHealth Tip: Cold, Flu or Allergy?Health Tip: What Your Urine Color May MeanNew Database Shows 'Rare' Diseases Are Not So Rare WorldwideIs Head Injury Causing Dementia? MRI Might Show
Questions and AnswersLinks
Related Topics

Diabetes

Surgery Helps Tough-to-Treat Acid Reflux

HealthDay News
by By Serena Gordon
HealthDay Reporter
Updated: Oct 17th 2019

new article illustration

THURSDAY, Oct. 17, 2019 (HealthDay News) -- For people with gastroesophageal reflux disease (GERD) that doesn't respond to the usual treatments, a complex surgery may help, a new study finds.

In carefully selected patients, the surgery provided much more relief than two different types of medication treatment -- 67% for surgery compared to 28% for "active" drug treatment and 12% for the "control" (placebo) drug treatment.

"GERD is an extremely common problem. About 1 in 5 people has GERD. Heartburn is the main symptom. Drugs called proton pump inhibitors [PPIs] are the best treatments we have for GERD, but as many as 30% of people still have symptoms when taking PPIs," said study lead author Dr. Stuart Jon Spechler. He's chief of gastroenterology at Baylor University Medical Center in Dallas.

In that group of people who don't improve on PPIs, many have what's known as functional heartburn. That means doctors can't pinpoint a specific disorder that's causing the heartburn. Surgery won't help them, he said.

"If someone has heartburn, it was thought to be reflux-related. The thinking was that if it's burning, there must be acid in the esophagus. But there are a lot of other things that can cause that burning feeling," Spechler said.

He said patients can't tell if they have reflux or another kind of heartburn. And, if their heartburn isn't reflux-related, surgery won't provide relief.

"We only want to operate on the group that will benefit from the surgery," Spechler explained.

So, for the first part of the new study, Spechler's team took several steps to identify which patients would be good candidates for the surgery called fundoplication.

This surgery is done under general anesthesia with a laparoscope, a thin tube with a tiny video camera. The surgeon sews the top of the stomach around the esophagus. This adds pressure to keep the esophagus from opening back up and allowing reflux, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

"It's a big operation, but it does fix the plumbing problem and prevents the reflux of all material," Spechler said. "There are some side effects. The surgery creates a very effective valve that may cause problems with belching or vomiting" because the valve no longer opens in that direction.

The study included 366 patients referred to Veterans Affairs clinics for heartburn that didn't respond to PPI treatment. Their average age was 48.5 years; 280 were men.

All were given 20 milligrams of omeprazole twice daily for two weeks. If their heartburn persisted, they were scheduled for procedures to determine the cause.

In all, 288 patients didn't move on to the study's treatment phase. Some had relief from the initial treatment. Many didn't complete all of the tests. Some had other esophageal disorders, or were excluded for other reasons.

That left 78 patients who were randomly selected to receive one of three treatments: surgery; active treatment with omeprazole and baclofen, and possibly a third drug; or the control treatment, which was omeprazole plus a placebo.

In the "highly selected subgroup, surgery was superior to medical treatment," the authors wrote.

Dr. Anthony Williams, chief of gastroenterology at Sinai-Grace Hospital at Detroit Medical Center, reviewed the findings and said the study group was small, but the research confirms what gastroenterologists are doing in practice.

"This was a good review that reiterates that we don't need to send many people to surgery," he said, adding that in 30 years of practice, he has sent only a few people for surgery.

When people do choose to have this surgery, Williams said, it's very important to find a surgeon who has done the procedure many times.

"The success of this surgery is really operator-dependent. You need a surgeon who does hundreds of these surgeries a year," Williams advised.

The findings were published Oct. 16 in the New England Journal of Medicine.

More information

Learn more about GERD from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.