Acid reflux occurs when highly acidic gastric juices from the stomach push up into the esophagus, irritating its sensitive lining. Gastroesophageal reflux disease or GERD is the medical term for chronic acid reflux – reflux that occurs several times per week over the course of several weeks or months. GERD is estimated to affect upwards of 20 million Americans with millions more suffering from less frequent, but still significant, acid reflux symptoms.
The most common symptoms of GERD include:
Symptoms commonly get worse after a meal consisting of acidic, spicy, fatty, carbonated, or caffeinated food and drinks. Symptoms may also worsen when the patient lies down, especially shortly after eating.
The most common cause of GERD is dysfunction of the lower esophageal sphincter or LES – a one-way valve between the esophagus and the stomach. If this sphincter does not close completely, it may allow acid to push back up in the esophagus. Common LES disorders stem from excess abdominal pressure including obesity, pregnancy, and more. The problem may also be congenital – meaning that it has existed since the patient’s childhood. Some patients may also experience new or worsened GERD after a Gastric Sleeve.
As the acidic contents of the stomach wash onto the sensitive lining of the esophagus, the cellular composition of the esophagus may change. This is known as Barrett’s Esophagus, which is diagnosed via biopsy. Rarely, Barrett’s Esophagus may lead to esophageal cancer. We believe that the increase in esophageal cancer in the United States today is, at least in part, due to the obesity epidemic that has caused an increase in gastric reflux disorders.
There are several treatments for GERD but almost all patients will be encouraged to change their lifestyle by losing weight, eliminating reflux triggers from their diet, and exercising more. Lifestyle changes often improve the symptoms of GERD significantly, but many patients are not able to maintain these changes.
The next course of action is medication in the form of antacids that neutralize stomach acid, or PPIs – Proton Pump Inhibitors – that block the production of stomach acid. Most patients find significant relief from medication, but a significant number may find that a) the medication does not offer sufficient relief or b) the side effects of the medication impair their lifestyle and are unacceptable.
For those for whom lifestyle change and medication have not offered significant relief, we offer two surgical options for the treatment of GERD: