When Is Surgery Necessary?
Surgical correction of GERD is recommended in the following cases:
- Continued pain or symptoms despite maximum medical therapy
- The presence of Barrett's esophagus
- Recurrent stricture formation on medical therapy
- Recurrent bleeding or ulcer formation on maximum medical therapy
- Continued regurgitation despite elimination of heartburn with medications
- Need for lifelong therapy with medications, especially in a young person
- Poor compliance with medications or patient desire not to take medications
Which works better-medicine or surgery?
All studies that have examined this question in a randomized, prospective manner, have found that surgery is at least equal to medical therapy with regard to symptom resolution and elimination of esophagitis. These studies have also documented a high rate of relapse if the medications are stopped in the medical treatment group. In most studies, the results are numerically better (but not statistically better) in the surgical group than in the medical group. Unfortunately, by the time these studies are complete, new drugs become available which confuse the issue. However, surgery is at least as effective as proton pump inhibitors in the treatment of GERD.
Why doesn't everyone with GERD have surgery?
About 25% of patients with GERD will get better once their lifestyles are changed, and will no longer need medication. An additional 25% to 50% will have symptoms, but will only require occasional use of medicines or low dose, constant medication. Only about 25% of people with GERD will have severe symptoms and fall into the categories noted above. Surgery has complications, side effects that may last from months to a lifetime and a definite failure rate associated with it.