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A number of anti-reflux procedures are available for people with severe acid reflux.
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Acid reflux occurs when the contents of your stomach rise into your esophagus. In most people, acid reflux triggers heartburn. However, persistent acid reflux - also known as gastroesophageal reflux disease - can cause a variety of other problems, including chronic cough, hoarseness, eroded dental enamel and esophageal ulcers. GERD has even been linked to esophageal cancer. When GERD doesn't improve with medications and dietary modifications, anti-reflux surgery may be warranted. A number of procedures are available for people with persistent GERD.
Nissen fundoplication, the classic anti-reflux procedure, was introduced in 1956 and has undergone several modifications since then. During a fundoplication, your surgeon wraps a portion of your upper stomach around the lower end of your esophagus, which is the muscular tube between your throat and stomach. This strengthens the valve at the bottom of your esophagus and prevents acid reflux. Most fundoplications are performed through a laparoscope, which can be inserted through a small incision in either your chest or abdomen. Fundoplication relieves acid reflux symptoms in 85 to 90 percent of patients. The most common complications that occur after fundoplication are recurrent reflux, swallowing difficulties and вЂњgas-bloat syndrome,вЂќ which is characterized by abdominal bloating and an inability to belch.
Over the past decade or so, several вЂњendoluminalвЂќ anti-reflux procedures have been introduced. These techniques are performed through a scope passed through your esophagus, so it isn't necessary to make any incisions in your abdomen. Unlike fundoplication, which requires a short hospital stay, endoluminal procedures - Endocinch, Plicator and ELF - can be performed as outpatient procedures. Although you are heavily sedated during an endoluminal procedure, general anesthesia is not required.
Endoluminal procedures are relatively new, so their long-term effectiveness and safety have not been thoroughly evaluated. However, more than half of patients undergoing these procedures report good symptom relief and are able to discontinue acid-blocking medications. Furthermore, the complications associated with endoluminal procedures - chest pain, nausea, vomiting and sore throat - tend to be transient and resolve on their own.
Heating Things Up
One form of endoluminal anti-reflux surgery - the Stretta procedure - involves heating the lower end of your esophagus with radiofrequency waves that are delivered through a scope. This leads to scarring and tightening of your lower esophagus, which helps prevent acid reflux. Further, the Stretta procedure interrupts the nerve impulses that cause your lower esophagus to relax, thereby tightening the junction between your esophagus and stomach and reducing acid reflux.
According to a study published in 2011 in "Diagnostic and Therapeutic Endoscopy," more than 90 percent of patients who had had Stretta procedures were satisfied with the results four years after the procedure, and nearly three-quarters had completely stopped taking the medications they had previously used to control their acid reflux symptoms.
Most people with gastroesophageal reflux disease get better with medications and lifestyle changes, such as smoking cessation, weight loss and dietary modifications. For individuals whose symptoms persist, anti-reflux surgery can be a viable option. The availability of procedures that require less time in the hospital or avoid the use of general anesthesia has led many patients and their doctors to opt for surgery sooner than in past years. However, as with any surgery, the risks and benefits of anti-reflux surgery must be carefully considered before you proceed. Your doctor can help you decide which treatment is best for you.