Too Many to Choose? Comparing GERD Treatment Options

One of the fastest growing cancers in the United States is that of the esophagus. This is, in part, due to the staggering increase in untreated or undertreated Gastroesophageal Reflux Disease or GERD also known as chronic acid reflux. As a result, novel treatments are being developed to improve or eliminate acid reflux with the ultimate goal of preventing reflux-related discomfort and esophageal cancer.

NYU Langone Long Island Surgical Associates prides itself on offering a wide range of treatments for GERD. However, we also understand that choosing which procedure is best can be overwhelming, especially with so many and varied options. Below, we will briefly discuss each procedure, however a consultation with a qualified surgeon such as those here at our practice is the best way to fully understand the options. Before we begin

• No procedure comparison is complete without mentioning that lifestyle changes are the safest and most effective way of preventing acid reflux. Indeed, the rise in esophageal cancer is strongly correlated to increasing obesity rates. Excess pressure on the abdomen caused by visceral fat increases the risk of acid reflux.
• We should also mention that acid reflux can be caused by hiatal hernias, where the upper part of the stomach pushes through the small hole in the diaphragm. Hiatal hernias themselves rarely have outward symptoms and most are found incidentally. We typically repair these during a bariatric procedure, as most obese patients experience this condition.
• Finally, most cases of chronic acid reflux are managed with medication. However, medications do not treat the underlying condition and therefore require continuous, permanent use. Medications cause side effects, sometime significant, and may lose effectiveness over time.

There is also a growing number of surgical, minimally invasive and endoscopic, procedures that reinforce the lower esophageal sphincter. Some of these procedures have been performed for decades while others are brand-new. Each have their own benefits and risks, which will be discussed during consultation. Procedures we offer here at NYU Langone Long Island Surgical Associates include:

• The LINX Device – a bracelet, about the diameter of a quarter, made up of tiny titanium beads with a magnetic clasp. LINX is placed around the lower esophageal sphincter and the magnetic force helps the LES stay closed when food is not passing through the esophagus. The magnetic properties of the device also allow it to open for food and drink. Results have been excellent, and most patients significantly reduce or eliminate their acid reflux problem. Of course, as with any implant, there is a risk of migration and other complications that would require replacement or removal of the device. The LINX device is ideal for patients with moderate to severe GERD but do not have Barrett’s Esophagus. Patients should be comfortable with the idea of having a long-term implant in their body and should not be allergic to titanium or related metals.
• Stretta is a novel approach to strengthening the lower esophageal sphincter using concentrated radiofrequency waves directed at the LES, to bulk up its musculature. The results are virtually instant and long-lasting and additional procedures, if ever needed, represent relatively low risk. Strata is appropriate for patients who do not wish to undergo a surgical procedure for their chronic reflux and do not have a large hiatal hernia.
• Fundoplication is a minimally invasive surgical procedure that wraps the top part of the stomach around the lower esophageal sphincter to create additional compression. Fundoplication has been used for decades and while proven, is the most invasive of our GERD treatment options. Because of the various forms of fundoplication that include a full wrap (Nissen) as well as partial wraps (Dor, Toupet), fundoplication is often a viable option for patients with Barrett’s esophagus, larger hiatal hernias, paresophageal hernias and recurrent acid reflux that has not been resolved by other treatments.

So which procedure is best for you? A consultation with one of our surgeons will be able to determine that. However, it is important to know that you have several options when considering ideal treatment. Fully understanding these options and choosing the procedure based on that knowledge offers a greater chance of long-term relief from the symptoms related to GERD. As a rule of thumb, depending on the severity of the GERD, we choose the least invasive, most effective and safest procedure for the individual patient.