Managing Gastroesophageal Reflux Disease (GERD): Surgical and Non-surgical Options

Gastroesophageal Reflux Disease (GERD) is a condition in which stomach acid flows back up into the tube connecting the mouth and oesophagus. It is also known as acid reflux, and it can become a disease when it happens repeatedly over time. The occurrence of GERD varies by gender, and according to a study, women have a higher prevalence of GERD than men. 

What are the Symptoms of GERD?

Common symptoms of GERD include:

• Burning sensation in the chest

• Sore throat or mouth

• Trouble swallowing

• Shortness of breath

• A feeling of a lump in the throat

A thorough physical examination, including upper endoscopy, reflux testing, esophageal manometry, and barium esophagram, is required for the proper diagnosis of GERD. If you have severe and frequent symptoms of GERD, it is essential to talk to your doctor. 

Obesity, pregnancy, bulging of the top of the stomach, and delayed stomach emptying are some conditions that can increase the risk of GERD.

If the symptoms are not taken seriously, major steps must be taken for proper treatment. Several approaches to GERD treatment exist, including medication, surgery, and lifestyle and dietary changes. Depending on the severity, this disease can be treated by surgical or non-surgical procedures.

Non-surgical Treatment Options for GERD

If you are experiencing mild symptoms of GERD, a combination of lifestyle and dietary changes and medications can manage them. 

Lifestyle Changes

It is the initial treatment recommended for GERD. Individuals should eat smaller meals frequently to prevent their stomachs from overfilling. These smaller meals can reduce the pressure on the lower esophageal sphincter (LES) and decrease the risk of acid reflux. One should also avoid eating 2-3 hours before going to bed. Staying upright for a few hours after eating can also help to prevent the symptoms.  

To manage GERD, one should also quit smoking and lose weight. Certain foods can trigger GERD symptoms, including fried foods, tomato-based products, chocolate, alcohol, garlic, spicy foods, and caffeine. That's why it is suggested to avoid consuming all these products to maintain healthy digestive health. 

Medications

There are certain medicines that your healthcare providers suggest to manage GERD symptoms. It includes:

• Antacid: to neutralise stomach acid

• Histamine (H2) blockers: to lessen the amount of acid that your stomach produces

• Proton Pump Inhibitors (PPI) block stomach acid production that causes acid reflux twice a week. 

Surgical Treatment Options for GERD

Approximately 40% of people with GERD find partial or no relief from their symptoms with lifestyle, dietary changes, and medication. In these cases, surgery may be recommended. Surgery for GERD is usually the last and best option in certain instances. 

Some people also opt for surgery to avoid taking long-term medications. For severe GERD complications, a doctor may recommend surgery to manage the condition. The cost of the surgery can vary depending on factors such as the hospital, the type of surgery, and the doctor's experience. 

Usually, patients travel overseas to seek affordable treatment for GERD. Some of the best destinations are India, Turkey, and Thailand. The gastroesophageal reflux disease treatment cost in India, gastroesophageal reflux disease treatment cost in Thailand, and gastroesophageal reflux disease treatment cost In Turkey are cost-effective without compromising the quality.  This is the major reason why, every year, a large number of patients prefer these destinations for high-quality medical care. 

Fundoplication

It is a standard surgical treatment for GERD that involves reinforcing the LES to recreate the barrier that stops reflux from occurring. During this procedure, the surgeon wraps the upper portion of the stomach around the lower oesophagus to strengthen the LES.

The most common type of fundoplication is Nissen fundoplication, which is always chosen to control GERD. It can be performed as open surgery or as laparoscopic surgery. During open surgery, the surgeon will make a long incision in the stomach to access the esophagus. Laparoscopic surgery involves several small incisions and results in less pain, a shorter hospital stay, and smaller scars.

The surgery's outcomes are excellent, and the long-term success rate is good. Nearly all patients are taken off of reflux medication after the surgery. 

LINX Reflux Management

It is a laparoscopic surgery that uses a special device called LINX, a ring of tiny magnetic titanium beads. The LINX device strengthens the sphincter when it is wrapped around the LES. 

The magnetised beads move together to keep the opening between the stomach and the esophagus closed. Since it's a minimally invasive surgery, recovery time is generally shorter than traditional surgery. This procedure is very effective in relieving acid reflux disease. 

Endoscopic Therapy

Endoscopic therapies are more effective than medications and can decrease GERD symptoms. 

The two primary endoscopic therapies are:

• Transoral Incisionless Fundoplication (TIF): In this procedure, the doctor uses an endoscopic device to fold the upper part of the stomach around the lower esophagus. This prevents stomach contents from flowing backwards into the esophagus. It works for patients with hiatal hernias 0-3 cm in size.

• Stretta Procedure: This procedure treats GERD with radiofrequency energy. The doctor inserts a tube in the patient's throat that delivers radiofrequency energy to the LES. This creates a tighter junction between the esophagus and stomach that can prevent acid reflux. It works for patients with hiatal hernias that are 0-2 cm in size.

Which GERD Treatment is Best for You?

Both surgical and endoscopic procedures can minimise the symptoms of GERD. However, the best treatment will depend on the presence and size of the hiatal hernia and the severity of the symptoms. It is essential to speak to your healthcare provider to understand which procedure is appropriate for your condition.

The Takeaway  

While surgery is usually the last resort for treating GERD, one should consider all other options before deciding on the surgery. Sometimes, non-surgical options can also be beneficial if the symptoms are not severe. The decision between the surgical and non-surgical options should be made in consultation with your healthcare provider. With proper management, most individuals can improve their quality of life and achieve substantial relief from their symptoms.