Surgeon's Perspective on Reflux

Gastroesophageal reflux disease (GERD) affects 10 to 20% of people in the United States. Classic symptoms of gastroesophageal reflux disease are heartburn and regurgitation. 22% of people in a population study reported heartburn or regurgitation within the last month and 16% had regurgitation. Less common symptoms include difficulty swallowing, chest pain, chronic cough, hoarseness, and wheezing. 

Quite commonly a patient will present to their primary care physician, urgent care, or an emergency room with these symptoms. Especially when having classic symptoms they are often told they have GERD and put on reflux medications, often a Proton Pump Inhibitor (PPI) like Omeprazole. At that point, the diagnosis of GERD is put into their chart, along with their new medications and they stay on those meds for a long time. 

Thankfully for many, the PPI medications help their symptoms or their symptoms completely resolve. I find it much less common that patients are formally worked up for the disease. If you take all patients who describe symptoms of reflux and actually do a reflex test on them, the rate of them being actually positive is not much better than a coin flip. 

Unfortunately many are never formally tested with endoscopy and reflux testing and a handful of outcomes come from this. Frequently patients take PPI medications for life, and feel great, but may not even have true reflux. Then they are exposed to the long-term risks of PPI use with the benefit. I also meet a lot of patients who have been on medications for decades but never got relief and sadly either never got worked or never was referred to a surgeon to discuss the options of reflux surgery. The most unfortunate outcome is if patients have long-standing acid reflux that is not controlled with meds. In some cases this can lead to esophagitis, ulcers, bleeding, and can damage the bottom of the esophagus leading to Barrett's esophagus and even more rarely, cancer. 

As a minimally invasive gastroesophageal surgeon, I can definitively say that anti-reflux surgery is safe and durable. Often performed laparoscopic or robotic (4-5 small incisions) hiatal hernias and reflux surgery can be accomplished in a matter of an hour or two (in most cases) and most patients are ready to discharge the next morning. This durable surgery very common allows patients to come off medications and give long-standing reflux control. 

In summary, for those battling the common disease of GERD, it's imperative to get a formal workup with endoscopy and reflux testing, especially if your symptoms are not controlled with medications or if you would like to come off medications. Lastly, anti-reflux surgery is safe and durable and should be offered to patients as an alternative to medications.