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Antireflux Procedures

What is Reflux?

 It is the invasion of acid material from the stomach into the esophagus, which is not prepared to receive this and causes damage. Depending on the level of reflux are the symptoms and the presentation. The common, well-known symptom is heartburn. Other people develop adult-onset asthma, hoarseness, chronic cough, bad breath, and even apnea could be related to chronic acid reflux

How does it occur?

The mechanism is a defective lower esophageal sphincter and valve sometimes complicated by the presence of a hiatal hernia. 

hiatal hernia is a wide opening of the muscles that allow the entrance of the esophagus between the chest and the abdomen.

Treatment Options:

Medical therapy: 

Antacids like Tums, Maalox, H2 blockers or PPI's. These options are mainly for symptom relief and not a cure.  This will require the patient to take medications for the rest of their life. The moment you stop taking the medication the symptoms recur.

Taking these medications may have side effects that are lately the topic of many discussions in the media and the public eye, like the recent PPI issues (osteoporosis and heart issues)

 A medication regime can be customized and will be used depending on the degree of reflux the patient and what he/she wants to do. But reflux usually progresses and can cause serious issues as severe as cancer. 

Surgical Therapy options:

Nissen Fundoplication - It is the gold standard. This is what all procedures created aim to be. It has been around for many years and perfected through trial and error. In the right hands and done well the results are remarkable. Cure rates are in the 92% ratios and the 8 percent that still has some reflux control it easily and much better than prior to the surgical procedure. So 100 % of patients get improvement in their condition. 

Side effects - bloating, difficulty burping and vomiting, and diarrhea. The reason this happens is that the stomach now has to push air and contents and has no escape valve, as this is restored by the surgical procedure. But most people eventually have a resolution of these initial issues.

This procedure consists of repairing the hiatal hernia if present and using the stomach to wrap it around the distal esophagus and recreate the damaged valve.

To learn the details of Nissen Fundoplication click here: NISSEN FUNDOPLICATION

LINX Procedure - The latest innovation in the treatment of reflux is a ring made of titanium beads that stretches and restores the valve that was damaged. IF a hiatal hernia is present it will be repaired before placing the LINX. This procedure is the closest to the Nissen Fundoplication and it is marketed as having fewer side effects than the Nissen could have. There is no bloating and the risk of diarrhea is minimized as the dissection is minimal and the vagus nerve easily protected. There is some sensation of food not going down easily initially but usually goes away. this is a removable device.erosion is another issue with this, but it is rare and the few cases that erode are treated endoscopically mostly removing the device from within the esophagus. 

Dr Rafael Lugo is the woodlands surgeon that many people prefer to get either of the procedures performed due to his experience. Come see him and he can give you a professional opinion.

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