I've had GERD for many years and tried most medications. I don't want to have to go on taking Prilosec or Nexium for the rest of my life. Are there any alternatives? (I've tried raising the head of the bed.)

I've had GERD for many years and tried most medications. I don't want to have to go on taking Prilosec or Nexium for the rest of my life. Are there any alternatives? (I've tried raising the head of the bed.)

Surgery for GERD?

July 11, 2005

Question

I've had GERD for many years and tried most medications. I don't want to have to go on taking Prilosec or Nexium for the rest of my life. Are there any alternatives? (I've tried raising the head of the bed.)
 

Answer

There are indeed alternatives to medication - but they involve surgery. The general purpose is to make the valve at the bottom of the esophagus (gullet) stronger, so that stomach contents can't regurgitate so easily.
 

One approach that's been used in the US since 2001 is called the Stretta Procedure. It involves passing an endoscope (a thin flexible tube down the gullet and using a radio-frequency current to scar the lower end of the esophagus, producing narrowing and thus preventing reflux of stomach contents. (It also damages some of the nerves at the site, so that they can't send pain impulses back to the brain.)
 

Other techniques, also using an endoscope, make use of sutures to narrow the opening. Unfortunately, the sutures sometimes dislodge after a year or so, and the sewing has to be done again.
 

Another promising method involves injecting a liquid polymer (Enteryx®) into the tissues around the valve; this quickly hardens into a spongy solid which is gradually covered by normal tissue. Several thousand patients in the USA have been treated this way, with good results; over half the patients were able to stop their GERD drugs completely.
 

One drawback to all these methods, however, is the lack of long-term information. How well do they work 10 years out?
 

Endoscopy is the key to all these techniques. It doesn't require a general anesthetic, and is painless; you can usually go home the same day. And it's useful for the doctor to be able to visualize the lower end of your esophagus to make sure you haven't developed a condition known as Barrett's esophagus (see below).

Related Links
WebMD/Cleveland Clinic: the Stretta procedure
Cleveland Clinic: Barrett's Esophagus