Question of the week: GERD Treatment Options
I am 30 years old. I have had reflux for almost five years now. It used to be present mostly at night, so I used Zantac 150 mg every night for about 4 and a half years. Last year, I felt the feeling of dysphagia and I added Omeprazole 20 mg to my nightly dose. I don’t drink coffee, eat chocolates sparingly, I’m a vegetarian so don’t eat any meat, try to avoid overly spicy food, I use more than 2 pillows at night. I tried eliminating PPI and Zantac respectively from my routine, but the reflux and dysphagia returns. What do you think are my options regarding this issue?
Dear Patient,
Gastroesophageal reflux disease, GERD, is a chronic and progressive disease. GERD related symptoms tend to increase in intensity and frequency over time. GERD is the result of a weak anti-reflux barrier between the esophagus and the stomach. The first approach to GERD is to examine the anti-reflux barrier to confirm and stage the diagnosis. Your symptoms are progressing, and currently, they indicate stage 3 GERD. Your symptoms are no longer controlled with lifestyle changes. You avoid trigger foods like coffee, chocolate and spicy food, you elevate the head of your bed… You still, however, need Zantac and Omeprazole to take the edge off. Of note, these medications do not address the underlying GERD pathophysiology; Medications do not restore the anti-reflux barrier and therefore you will never be able to eliminate H2 receptor blockers and proton pump inhibitors unless you restore the anti-reflux barrier.
Currently, the only reliable approach to restoring the anti-reflux barrier is Nissen fundoplication with hiatal hernia surgery. The procedure is safe and effective. Prior to surgery, you complete a comprehensive GERD workup to confirm and stage your disease. This includes an upper endoscopy, ambulatory pH testing, esophageal manometry and UGI contrast study. Patients with stage 3 or 4 GERD are offered hiatal hernia repair and Nissen fundoplication to stop reflux. Patients with achalasia causing dysphagia and heartburn are offered laparoscopic Heller myotomy with Toupet fundoplication.