GastroEsophageal Reflux Disease Treatment

Most signs and symptoms of GERD can be treated successfully medications, such as:

  • Antacids that neutralize stomach acid, e.g. Maalox, Gaviscon, Gelusil etc.
  • H2-receptor blockers decreasing acid production, e.g. Cimetidine, Famotidine, Ranitidine etc.
  • Proton-pump inhibitors that block acid production, e.g. Lansoprazole, Omeprazole, Pantoprazole etc.

Moreover, patients are advised to follow certain dietary and lifestyle changes including:

  • Eat smaller and frequent meals
  • Stop smoking
  • Avoid foods and drinks that trigger heartburn, like fatty food, spicy food, garlic, onion, sauces, alcohol and chocolate
  • Elevate the head of your bed
  • Do not lie down or go to bed after a meal
  • Do not wear tight-fitting clothes

However, some people with GERD may need surgery because of poor response to medical treatment or because of the incidence of GERD complications, such as esophagitis and Barrett’s esophagus. Surgery is very effective in treating GERD. The most commonly performed anti-reflux operation is a Nissen fundoplication (see the video). 

Nissen Fundoplication

The operation can be done laparoscopically with great success in experienced hands. It involves fixing the hiatal hernia, if present, and then wrapping the top part of the stomach called the fundus, around the distal esophagus to reinforce the lower esophageal sphincter and create a new, competent one-way valve.

As in almost every laparoscopic operation, the surgeon will make several small incisions in the abdomen through which the working ports, or trocars are inserted. In the beginning, the abdomen is insufflated with carbon dioxide gas in order to create enough working space and visualize better the internal organs.

The entire operation is performed “inside” the inflated abdomen using special elongated instruments that are inserted through the trocars.

In a small number of patients, the procedure cannot be performed laparoscopically due to several reasons including inability to safely recognize the anatomical structures, bleeding during the operation etc. In that case, the surgeon may decide to convert to an open procedure and this is not considered to be a complication. The decision is based strictly on patient safety.

What should i expect after surgery?

  • Post-operative pain is generally very mild. Patients are prescribed pain medication for a short period of time.
  • Anti-reflux medication is usually not required after surgery.
  • Most patients are discharged on day 2 after the operation and are encouraged to engage in light activity for a short period of time, avoiding strenuous exercise and heavy lifting.
  • Most surgeons will modify a patient’s diet for the next 3-4 weeks after the operation. In general, you will be on clear liquid diet (juices, jellies, broths etc) immediately after surgery and gradually progress to a nissen soft diet (yoghurt, custard, mashed potatoes, ground meats etc).
  • Patients are advised to eat small, frequent meals, take small bites and chew food well. 
  • Any food or drink that may cause stomach distension and gas should be strictly avoided. These include broccoli, cauliflower, peas, lentils, onions and carbonated drinks.
Nissen fundoplication