Gastroesophageal Reflux Disease (GERD)
Lifestyle changes, such as avoiding certain foods and not eating before bedtime, can reduce the incidence of heartburn, but may not be sufficient to control even mild cases of GERD. For mild yet uncontrollable cases and for moderate to severe cases, GERD is treated first with drugs and, if this is unsuccessful, with surgery.
Two types of drugs are generally used for reflux disease treatment. H2-blockers such as Tagamet, Pepcid, Axid, and Zantac help cut the stomach’s production of acid and work best for people with mild GERD. For moderate or severe reflux disease, proton pump inhibitors can be used, which are 6 to 10 times stronger than H2-blockers. These include drugs such as Prilosec, Prevacid, Aciphex, Nexium, and Protonix, which turn off the acid pumps that stimulate the production of acid from the stomach.
Surgical treatment is reserved for patients who fail medical therapy or for patients who are drug-dependent (ie. their symptoms return as soon as they stop the medication) and do not wish to purchase medication for the rest of their life. Surgery for GERD (and for other esophageal disorders) is routinely performed laparoscopically and has an excellent success rate. Surgical therapy most commonly consists of a Nissen fundoplication. This operation restores a normal length of esophagus within the abdominal cavity and wraps a portion of the stomach around the lower esophagus. This improves the function of the lower esophagus by creating a valve effect which prohibits reflux.
A hiatal hernia repair is also performed when this is present. Compared to traditional “open” surgery, the laparoscopic approach allows for a faster recovery period, less postoperative pain, a shorter hospital stay, and a much smaller scar.