Gastroesophageal reflux disease (GORD), or acid reflux, occurs when acid from the stomach enters the food pipe (oesophagus). You may notice symptoms of heartburn, chest pain, and coughing. Most people can manage the condition either with antacids (which neutralise the acid), lifestyle changes, or preventative medications, like H2 blockers or PPIs.
Severe cases of acid reflux occur when the condition does not respond to treatment. The discomfort is so severe that surgery is the only option.
Below, we cover the different surgical options for acid reflux in the UK. We detail what acid reflux surgery involves and when it is necessary.
In this guide:
- Treatment Options for Severe Acid Reflux
- When is Surgery Necessary for Acid Reflux?
- Types of Acid Reflux Surgery
Treatment Options for Severe Acid Reflux
Acid reflux occurs when the acid from the stomach moves up into the oesophagus. Non-surgical treatments cannot prevent food and other stomach contents from entering the oesophagus. Therefore, the only treatment option is to reduce the acid.
Lifestyle changes, such as smoking cessation, weight loss, dietary changes, and reducing alcohol consumption, aim to target behaviours that increase acid production. Meanwhile, medications like proton pump inhibitors (PPIs) and H2 blockers prevent the stomach from producing more acid. Together, the majority of cases will benefit from these treatments.
However, in some cases, the acid reflux is so severe that GORD surgery is the only viable alternative. These surgical procedures aim to reinforce and restore the function of the lower oesophageal sphincter (LOS), which prevents the stomach contents from moving upwards.
Surgical options include:
- Nissen Fundoplication
- Linx Reflux Management System
- Transoral Incisionless Fundoplication (TIF)
- Toupet Fundoplication
- Stretta Procedure
When is Surgery Necessary for Acid Reflux?
Surgery is never the first option for treating acid reflux. It’s only considered when other options have failed. Your doctor will initially trial lifestyle changes and medications. But, if these fail to improve your symptoms, then acid reflux surgery is a potential option.
You are a good candidate for GERD surgery in the UK if:
- Medications like proton pump inhibitors (PPIs) are ineffective in relieving your acid reflux.
- You want to discontinue the use of medication.
- You are young and wish to avoid the long-term use of PPIs.
- You experience ongoing symptoms such as hoarseness, wheezing, coughing, or tooth enamel erosion.
- You have esophagitis.
- You have a hiatal hernia.
- You have Barrett’s oesophagus.
- You have a narrowing of your oesophagus (oesophageal stricture).
Types of Acid Reflux Surgery
Nissen Fundoplication
Laparoscopic Nissen Fundoplication is the most common surgical treatment for GORD. It involves the surgeon creating a new valve at the bottom of the oesophagus by wrapping the upper portion of the stomach (the fundus) around the oesophagus. This new valve acts like the original, preventing acid from moving up and out of the stomach.
The procedure has a high success rate, with up to 90% of patients reporting significant symptomatic improvement. Combined with a low complication rate, it’s the preferred surgical option for most patients.
LINX Reflux Management System
The LINX Reflux Management System is an innovative procedure that uses a ring of magnetic beads to tighten the LOS. Due to the magnetic attraction, the beads prevent the stomach contents from moving upwards.
One of the key benefits of the procedure is its low complication rate. Patients can often return home on the same day and begin eating solid foods immediately.
Transoral Incisionless Fundoplication (TIF)
Transoral incisionless fundoplication achieves the same results as the Nissen procedure without any incisions. Instead, the procedure is carried out via the mouth. Using a specialised device, the surgeon creates folds of tissue, suturing them together to tighten the LOS. This results in a narrower passageway that prevents the acid from backflowing.
Due to its minimally invasive nature, it has a lower complication rate and faster recovery time. But, due to the tightening, patients can experience difficulty swallowing, bloating, gas, and discomfort in the abdomen.
Toupet Fundoplication
The Toupet Fundoplication is a partial wrap procedure in which the surgeon wraps only a portion of the stomach (approximately 270 degrees) around the lower oesophageal sphincter (LOS). This allows for reinforcement of the LOS while preserving its ability to relax, reducing the risk of swallowing difficulties associated with a full wrap.
The procedure is indicated in patients with weak oesophageal motility. Patients can expect the recovery time to be longer than that of TIF or LINX. However, it is effective in less severe acid reflux compared to a full wrap like the Nissen Fundoplication.
Stretta Procedure
The Stretta procedure is recommended in people with a loose gastroesophageal junction valve or silent acid reflux. It relies on an endoscope to thicken and fortify the LOS using radiofrequency energy. This procedure is the least minimally invasive option. However, it isn’t always effective and isn’t suitable for people with severe GERD, large hiatus hernias, or Barrett’s oesophagus.
Early Detection of Reflux Disease
Surgery is the last line of defence for people with reflux disease. Tackle the issue early with a reliable diagnostic procedure. If you experience heartburn, chest pain, hoarseness, persistent cough, or other associated symptoms, you can benefit from a gastric reflux test.
It involves inserting a probe into your oesophagus for 24 hours to monitor the acidity levels. This test for acid reflux disease notes any decreases in pH, confirming the condition.
You can then take the necessary steps to deal with your condition. Usually, that means medications, lifestyle changes, or surgery in more severe cases. Either way, it’s important to get diagnosed as early as possible to reduce the risk of complications.
Ready to take a gastric reflux test? Call us on 0207 486 7777 or send us an email at admin@thefunctionalgutclinic.com.