Nissen Fundoplication and Esophageal Cancer

Nissen Fundoplication and Esophageal Cancer

Carol from Katy, TX sent us this question: “Does Nissen Fundoplication surgery keep esophagitis from progressing to Barrett’s and does the surgery keep Barrett’s esophagus from progressing to esophageal cancer?  Thank you!”

Dear Carol,

Properly performed hiatal hernia repair and Nissen fundoplication reliably stops acid reflux. Consequently, esophagitis and ulceration due to acid reflux resolves completely after Nissen fundoplication. Barrett’s mucosa also regresses back to normal esophageal mucosa after Nissen fundoplication. Barrett’s mucosa regression is a stepwise and gradual process. Barrett’s mucosa regresses first to gastric cardia type mucosa then to squamous cell lining over a period of several years after Nissen fundoplication.

Regression rate varies from patient to patient depending on the severity of each case. Studies have shown that short segment Barrett’s esophagus (length of Barrett’s mucosa is less than 3 centimeters) is more likely to regress back to normal than long segment Barrett’s esophagus.

It is important to know that Nissen fundoplication, unlike proton pump inhibitors, PPIs, completely stops both bile and acid reflux. Bile acids are carcinogenic, and they contribute to esophageal mucosa metaplasia (Barrett’s esophagus) and dysplasia (progression of Barrett’s esophagus to esophagus cancer).

Therefore, Nissen fundoplication surgery, when properly performed at Houston Heartburn and Reflux Center, is the best treatment for GERD patients with Barrett’s esophagus.