Laparoscopic Fundoplication
Fundoplication is the standard surgical treatment for GERD. Usually a specific type of this procedure, called Nissen fundoplication, is performed. During the Nissen fundoplication, the upper part of the stomach is wrapped around the LES to strengthen the sphincter, prevent acid reflux and repair a hiatal hernia.
The Nissen fundoplication may be performed using a laparoscope, an instrument that is inserted through tiny incisions in the abdomen. The doctor then uses small instruments that hold a camera to look at the abdomen and pelvis. When performed by experienced surgeons, laparoscopic fundoplication is safe and effective in people of all ages, including infants. The procedure is reported to have the same results as the standard fundoplication, and people can leave the hospital in one to three days and return to work in two to three weeks.
Lifestyle changes
Changing lifestyle and diet are usually the first steps recommended by healthcare providers to relieve symptoms of GERD. Here are some of the changes you can make:
- If you smoke, stop.
- Avoid foods and beverages that worsen symptoms.
- Avoid alcohol, caffeine and chocolate.
- Lose weight if needed.
- Eat small, frequent meals.
- Avoid lying down for three hours after a meal.
- Raise the head of your bed six to eight inches by securing wood blocks under the bedposts. Just using extra pillows will not help.
Medications
Your healthcare provider may recommend over-the-counter antacids or medications that stop acid production or help the muscles that empty your stomach. You can buy many of these medications without a prescription. However, see your health care provider before starting or adding a medication.
Antacids, such as Alka-Seltzer®, Maalox®, Mylanta®, Rolaids® and Riopan®, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts—magnesium, calcium and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.
Calcium carbonate antacids, such as Tums®, Titralac™, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.
Foaming agents, such as Gaviscon®, work by covering your stomach contents with foam to prevent reflux. H2 blockers, such as cimetidine (Tagamet HB®), famotidine (Pepcid AC®), nizatidine (Axid AR®), and ranitidine (Zantac 75®), decrease acid production. They are available in prescription strength and over-the-counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms.
Proton pump inhibitors include omeprazole (Prilosec©, Zegerid®), lansoprazole (Prevacid®), pantoprazole (Protonix®), rabeprazole (Aciphex®), and esomeprazole (Nexium®), which are available by prescription. Prilosec is also available in over-the-counter strength. Proton pump inhibitors are more effective than H2 blockers as they can relieve symptoms and heal the esophageal lining in almost everyone who has GERD.
Proton pump inhibitors have traditionally been considered as quite safe. However, new evidence suggests that in certain patients long term use of PPIs can increase the risk of osteoporosis and increase the incidence of hip fractures. Another recent study has shown potential risk for patients taking Clopidogrel (Plavix) and proton pump inhibitors and the risk of heart disease. The combination of drugs can cause potential harmful interactions. If you have required PPIs for a prolonged period of time you should consult a physician to discuss alternative treatment options for GERD.
Prokinetics help strengthen the LES and make the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness—fatigue, sleepiness, depression, anxiety and problems with physical movement.
Because drugs work in different ways, combinations of medications may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, and then the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Our doctors are the best source of information about how to use medications for GERD.
For many patients, medicine does not completely control the symptoms of GERD, while other patients are unable or unwilling to take medicines for a long time. Both of these types of patients often benefit from a curative mechanical repair of reflux.
Surgery
Surgery is an option when medicine and lifestyle changes do not help to manage GERD symptoms. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort for people who are not candidates for transoral incisionless fundoplication because of the severity of their disease or their anatomy.
Incisionless FundoplicationOhio State is the first Center in the United States to perform the transoral incisionless fundoplication (TIF) using EsophyX ™. Our physicians have been leaders in the field of transoral and minimally invasive surgery and have extensive experience in offering the latest technology to address esophageal disorders. Learn more about
Ohio State's Center for Minimally Invasive Surgery
Endoluminal Tissue Fusion is performed using the EsophyX device that is passed into the stomach through the mouth with the guidance of an endoscope, or small flexible camera. Once the device is passed through the mouth and into the stomach, small plastic fasteners that fold the upper stomach into itself and recreate the lower esophageal sphincter (LES) are placed by the surgeon. Recreation of the LES stops the stomach acid from backing up into the esophagus, thus providing relief from the sensation of heartburn. This approach does not require any skin incisions and is therefore associated with fewer complications, less pain and a faster recovery when compared to other surgical options. While the procedure often requires an overnight hospital stay, the recovery is rapid and the procedure provides prompt improvement in symptoms.
This information is not intended to replace a visit with your physician. If you have further questions, please contact the Division of General and Gastrointestinal Surgery at (614) 293-3230.
Linx™
Surgeons at The Ohio State University Medical Center are currently participating in a clinic research study examining an investigational procedure that might help reduce or eliminate acid reflux symptoms.
The LINX™ System is an investigational device designed to restore the function of the Lower Esophageal Sphincter; preventing reflux and many of the symptoms that accompany it. The device is made of titanium beads that are linked together to take the shape of a small bracelet. Each of these beads contains a magnetic core that attracts it to the beads next to it. Using a surgical technique called laparoscopy, the LINX™ device is placed around the esophagus in the area of the Lower Esophageal Sphincter. Once in place, the magnetic attraction between the beads may help support the esophagus to prevent reflux episodes.
We are currently screening interested patients for participation in the LINX Reflux Management System clinical trial. If you have questions about this study, please contact Rebecca Dettorre, CCRC, at (614)-293-8549.
