When Heartburn Won’t Quit: How Anti-Reflux Surgery Can Relieve GERD

Your stomach is full of acid; it's necessary to break down the foods you eat into substances your body can use for energy. When the acid leaves the stomach, though, it can cause painful sensations as it burns the tissues. While medications can help some cases of reflux, some require a surgical approach.

At Advanced Surgical Associates of Northern Minnesota, board-certified general surgeon Dr. John Bollins and our experienced team offer anti-reflux surgery for patients with gastroesophageal reflux disease (GERD), a chronic form of acid reflux, who haven't responded to medication.

If you've got heartburn that just won't quit, here's what you need to know about anti-reflux surgery.

What is acid reflux, and what problems does it cause?

Acid is a strong irritant, whether it comes into contact with tissue outside your body (skin) or inside. Acid reflux occurs when the acid from your stomach, which is necessary for digestion, moves back up the esophagus (food tube), irritating and inflaming the tissues in the process.

Occasional reflux can lead to indigestion (a burning in the stomach) or heartburn (a burning sensation in the chest), both of which can be managed with over-the-counter (OTC) medications and dietary changes.

Some people, though, develop a chronic form of reflux known as GERD. The condition is considered chronic if you have it at least twice a week for several weeks.

GERD develops when the mechanisms that keep acid out of your esophagus aren't working properly. And it's a condition that's more common than you probably think, affecting about 20% of adults and 10% of children in the US.

In addition, GERD can trigger a condition called Barrett's esophagitis, in which acid-induced changes in the esophageal lining occur. These cells become thicker and turn from pink to red. Barrett's esophagus is associated with an increased risk of esophageal cancer. It's a small risk, but if you have GERD, the doctor will need to monitor your esophagus for such changes.

What causes acid reflux?

A number of different problems can cause reflux and GERD:

Lower esophageal sphincter (LES) damage

The LES is the valve responsible for preventing stomach acid from moving back up the esophagus. It closes tightly as soon as food passes into the stomach. However, if it's damaged, it may not close completely, allowing acid to back up into the esophagus and trigger heartburn.

Hiatal hernia

A hiatal hernia is a common condition in which the upper part of your stomach pushes upward through the opening in your diaphragm. This is the same hole through which your esophagus passes. The extra tissue compresses both the esophagus and the stomach, trapping acid within it.

In addition, a hiatal hernia elevates your LES above the diaphragm, reducing its muscular support. Without that support, the valve can't close completely, allowing acid to back up into the esophagus.

Obesity

Obesity increases the pressure on your abdomen, and it's also a known factor contributing to hiatal hernias. In addition, fatty tissue secretes estrogen, which can relax the LES.

Treating acid reflux

If you have a mild case of reflux, OTC antacids can help control the problem. If you’ve progressed to GERD, however, you’ll probably need prescription-strength medication to manage the problem.

Prescription medications for GERD include:

• Histamine receptor antagonists (H2 blockers): reduce stomach acid by blocking histamine, which instructs your body to produce it
• Proton pump inhibitors (PPIs): stronger acid blockers that also trigger healing
• Baclofen: a muscle relaxant that reduces the frequency of LES relaxation

These medications are designed to manage the problem, not cure it.

What is acid reflux surgery?

If you have GERD and both H2 blockers and PPIs have not significantly improved the problem, you could be a candidate for anti-reflux surgery. It's a minimally invasive procedure designed to tackle the underlying problem. Whenever possible, the team performs robotic-assisted surgery using the da Vinci® Surgical System, which provides the doctor with extreme precision in all of his movements.

The procedure we use is called a Nissen fundoplication, and it's the most common surgery for GERD. Dr. Bollins wraps the top of the stomach around the lower esophagus, securing it in place with stitches to tighten the connection. As an interesting side note, this is the same procedure used to fix a hiatal hernia.

If you have GERD and haven't seen success with prescription medications to control it,  Advanced Surgical Associates of Northern Minnesota can help. Please schedule a consultation with our office by calling us in Hibbing, Duluth, or Ely, Minnesota, or by booking your appointment online.

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