Acid Reflux Surgery: Who Needs It?

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Sheila Wartel suffered from acid reflux and the related condition of adult onset asthma for more than 20 years and couldn’t take it anymore.

She was taking plenty of medicine, but it wasn’t relieving her symptoms. In fact, the side-effects were making her feel worse.

“For years I was taking antacids,” said Wartel, who is in her mid-60s and lives in Woodbridge, Conn. “Then I graduated to proton pump inhibitors (PPIs). I tried all of them. Then, I got adult onset asthma and started taking asthma medications. When you take these meds, your body doesn’t absorb iron, so I was taking iron pills, and the doctors told me I had to take vitamin C with the iron pills. I needed to do something.”

In early August, Wartel elected to have laparoscopic fundoplication, a surgery that permanently stops the acid from washing up into her esophagus.

“Before the surgery, I had to avoid things like orange juice, tomato sauce, salad dressing . . . balsamic vinaigrette was the worst,” Wartel said in a phone interview. “Anything with acid, and milk products too. Now, I can eat whatever I want. At night, even though I raised the head of my bed, it didn’t matter, all my food regurgitated. It was the most debilitating thing.”

Now, Wartel said, she is able to enjoy eating any food or drink she wants.

Wartel’s surgery was performed by Dr. Robert Bell, an assistant professor of surgery at Yale University School of Medicine, who explained the procedure as wrapping the top part of the stomach around the lower esophageal sphincter.

Since it is done laparoscopically, the incision is small and most patients are released from the hospital the same day or the next day.

However, out of the millions of Americans who experience acid reflux on a regular basis, only a small fraction need fundoplication, Bell said.

They are:

1. People who take very high doses of PPIs at least twice a day. “These are the people who pack Nexium before they pack their underwear when going on vacation,” Bell said. “These are the people who can’t live without their medication . . .if they miss a dose, they aren’t OK. Or, if someone is young, and doesn’t want to live on high-dose meds for the rest of their life.”

2. Patients whose symptoms are refractory to the high-dose regimen. These people are having breakthrough symptoms while on their high-dose medications, Bell said.

3. Patients who have large volume reflux, such as regurgitation. “The food stays in the stomach for six hours after eating,” he said. “You can’t expect a person to sit for six hours after eating.”

4. People who have complications of gastroesophageal reflux disease (GERD). There are two categories of GERD complications: esophageal (acid-related strictures and Barrett’s esophagus) and bronchial (asthma and aspiration pneumonia, where the patient inhales the regurgitated food). If medications aren’t controlling these complications, it might be time for surgery.

“The patient can eat all the stuff that bothered them right away,” Bell said. “And, one of the nice things is they end up with a little weight loss.”

The surgery takes a little more than an hour, assuming the patient does not have a hiatal hernia that needs fixing, and people of all ages are eligible for it.

“Some patients, not all, experience 24-hour nausea from the manipulation of the stomach,” Bell said. “But afterwards, the vast majority won’t need medicine anymore.”

Like any surgery, there are a few risks, but they are few and far between:

— Anesthesia always involves a small risk;

— There is a less than .1 percent chance of bleeding (and a transfusion is needed);

— Esophageal injury (this happens to 1/500 to 1/1000 patients).

— Long-term risks include a mild difficulty in swallowing, which will normalize over time (this only happens to 10 to 15 percent of patients)

These days, Wartel isn’t taking any medicine for acid reflux, nor is she taking her iron pills or vitamin C. She has cut back on her asthma medication and hopes with time she can go off it completely.

“It’s the best thing I ever did,” she said.