Treatment of GERD: Overview for Patients, continued. Apart from LSMs and medicines, heartburn can also be treated with endoscopic procedures or surgery. Different procedures that can be performed at endoscopy may or may not be available in different countries. These are designed to tighten the sphincter that separates the stomach and esophagus so that the reflux of stomach contents into the esophagus is reduced. They have had limited and variable success and there have been serious side effects from some procedures. Choosing to have one of these procedures is a difficult decision that must be discussed in detail with the doctor performing the procedure. This must include an understanding of the possible risks of the procedure. These procedures may be helpful in improving regurgitation, which is otherwise not well controlled with medicines. Endoscopic treatment may also be used in some countries for the treatment of some patients with Barrett’s esophagus (BE) and even early stages of the cancer that can arise from BE – called esophageal adenocarcinoma (EAC). (See elsewhere in this handbook for more information on BE and EAC.) BE that is at high risk of developing into EAC can be treated endoscopically by a procedure called radiofrequency ablation (RFA), although this may not be generally available in all countries. Surgery is also an option for some people with troublesome heartburn and other symptoms of GERD 6. Various surgical operations can tighten the sphincter separating the esophagus and stomach so as to limit the total amount of reflux from the stomach. This is highly specialized and is not done by all general surgeons. People having surgical treatment for GERD should be managed in a specialist center by a surgeon with a lot of experience with this type of surgery. The people who do best with surgery are generally young and otherwise healthy (without significant heart or lung problems, for example). Also, it is important to understand that surgery is most helpful for people whose heartburn improved during treatment with a PPI. This is not always well understood by patients and their doctors. People with heartburn that did not improve with PPI treatment probably do not have GERD and should avoid surgical treatment for GERD. (There is more information on non-GERD conditions that may be confused with GERD elsewhere in this handbook.) REFERENCES 1. Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with Gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med 2006;166:965– 71. 2. Kahrilas PJ, Shaheen NJ, Vaezi MF. American Gastroenterological Association Institute Technical Review on the management of gastroesophageal reflux disease. Gastroenterology 2008;135:1392–413. 3. Kahrilas PJ. Gastroesophageal reflux disease. N Engl J Med 2008;359:1700–7. 4. Fackler WK, Ours TM, Vaezi MF, Richter JE. Long-term effect of H2RA therapy on nocturnal gastric acid breakthrough. Gastroenterology 2002;122:625–32. 5. Chen J, Yuan Y, Leontiadis GI, Howden CW. Recent safety concerns with proton pump inhibitors. J Clin Gastroenterol 2012;46:93–114. 6. Wileman SM, McCann S, Grant AM, Krukowski ZH, Bruce J. Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Database Syst Rev 2010, Issue 3. Att. No.: CD003243. DOI:10.1002/4651858. CD003243.pub2 World Digestive Health Day WDHD May 29, 2015 WGO HANDBOOK HEARTBURN: A GLOBAL PERSPECTIVE 16
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