While medications can control the acidity of reflux, they do not stop the physical movement of stomach contents into the esophagus, according to a July 31 report. For some patients, increasing volumes of reflux can lead to a need for surgical options rather than just medication.
Dr. Eric Volckmann, a director of the University of Utah Health Bariatric Surgery Program, explained that medications like proton pump inhibitors decrease acidity but do not prevent the reflux itself. As reflux becomes more voluminous, patients may experience symptoms such as a hoarse voice, coughing, or the inability to lie flat at night. In severe cases, patients may experience aspiration or choking.
Surgical procedures, such as Nissen or Toupet fundoplications, provide a mechanical barrier by wrapping the stomach around the lower esophagus to augment pressure. These minimally invasive laparoscopic or robotic procedures typically involve small incisions, and patients often return home the following day. Recovery often requires a liquid diet for a couple of weeks to allow swelling to settle.
The choice of procedure can depend on a patient's weight. For patients with a body mass index of 35 or higher, a gastric bypass may be a more appropriate option than standard anti-reflux surgery. Gastric bypass can mitigate issues like delayed gastric emptying and can also help manage weight-related medical problems such as diabetes or high blood pressure.
Before undergoing surgery, doctors typically perform a workup including an upper endoscopy, esophageal manometry, and pH testing to confirm the presence of reflux. While all surgeries carry risks, such as the potential for a hiatal hernia to recur or injury to surrounding organs, the risks are described as being less than 1%.
