There is widespread belief that hiatal hernia repair and Nissen fundoplication are a last resort for GERD patients. Indeed, most primary care physicians and gastroenterologists do not refer a GERD patient for surgery until it is too late. GERD patients are typically subjected to escalating dosages of proton pump inhibitors over many years. While GERD related symptoms like heartburn are masked, giving the patient a false sense of security, the disease is slowly progressing. The hiatal hernia is getting bigger, esophageal motility is deteriorating, esophageal length is shortening and the risk of esophageal cancer is increasing. Furthermore, PPIs are quite ineffective for patients with silent GERD also called LPR (laryngopharyngeal reflux). Most LPR patients have poor symptom control despite high dose PPIs. Uncontrolled LPR results in irreversible vocal cords and upper respiratory tract damage. Such damage causes chronic cough, hoarseness and sometimes COPD.
A more logical approach to GERD is to offer hiatal hernia and Nissen fundoplication surgery early in the disease process especially when patients are young. Young patients have many productive years ahead of them. Masking GERD related symptoms with PPIs does not address the underlying disease pathophysiology and these patients are committed to PPIS for most of their life. Years of PPI use result in early dementia, renal and heart failure, osteoporosis, magnesium deficiency, clostridium difficile colitis, pneumonia…
Laparoscopic hiatal hernia surgery and Nissen fundoplication when performed by an experienced acid reflux specialist, is the safest, most effective, reliable and durable solution for GERD. PPIs are no match to hiatal hernia surgery that restores normal anatomy and Nissen fundoplication that re-establishes normal physiology. The overall morbidity and mortality of the procedure is less than 1%. The recovery is fast and painless. Most patients resume regular activity in less than one week.
The earlier we intervene in a chronic disease like GERD, the more effective the treatment can be and the longer it can last. Don’t wait until it is too late. If you suffer from heartburn and acid reflux call Houston Heartburn and Reflux Center.