Better surgical procedures make correction of reflux disease easier

Maybe last night you had the greatest dinner in the world. Even so, you only want to taste it once.

As many as 19 million Americans can’t always keep food in their stomachs. Their food and stomach juices sometimes flow “upstream,” back into the esophagus. This painful condition is called gastroesophageal reflux disease (GERD).

Surgery, using minimally invasive techniques, allows doctors to treat this illness.

“There’s simply no need to suffer from chronic heartburn,” says Dr. Carlos Pellegrini, Henry Harkins professor and chair of the Department of Surgery in the School of Medicine.

Reflux problems usually begin with a weakness in the lower esophageal sphincter. That’s a ring-shaped muscular valve that is supposed to allow flow only one way. It lets food slide from your esophagus into your stomach, but prevents the stomach’s contents from coming back up.

In reflux disease, the valve doesn’t work well. The valve allows stomach juices, hydrochloric acid and pepsin, to rise into the esophagus. The esophagus does not have the proper lining to protect itself from the stomach juices. So its victims suffer vicious heartburn, and even permanent esophageal damage and esophageal ulcer.

An estimated 25 million Americans each day suffer from heartburn. They likely won’t talk to their doctors about it. But if they have heartburn more than twice a week, they probably should. Acid reflux can cause serious problems. And chronic exposure to all that acid can lead to Barrett’s esophagus, which has been linked to adenocarcinoma, a form of cancer.

If the condition is mild, your doctor may recommend you change some habits. Among possible ideas: elevating your head at night, eating smaller meals, not eating before bed and losing weight. You might also avoid foods that promote acid reflux, such as coffee, fatty foods, spicy foods, carbonated beverages and tomatoes. And it’s a good time to quit smoking and cut back on drinking alcohol.

There are medications, both over-the-counter antacids and prescription drugs, that also alleviate reflux. These help a good majority of sufferers.

It used to be that surgery was a last resort. However, surgeries have progressed to the point where they are a good alternative for even moderate cases of acid reflux, Pellegrini says.

“People with moderate to severe reflux face what may be severe lifestyle changes, and may have to take medicine for the rest of their lives. In contrast, surgical therapy offers complete and long-standing relief,” Pellegrini says.

What surgery does is improve the barrier between stomach and esophagus. The surgeon creates a “wrap” with part of the stomach, for reinforcement of the valve. Surgeons today can use laparoscopy to do this. It requires only five very small incisions to enter the body. Doctors have used this minimally invasive surgery on more than 640 patients at UW Medical Center.

Laparoscopic surgery is good all around, Pellegrini says, because it allows the surgeon to use top-notch optics and tools without having to make a traumatic incision, and without having to move other organs by hand to get a clear field. ¶

Walter Neary