Complications can occur from surgery with 5-10% of patients. These include making the wrap too tight and developing problems swallowing one’s food, accidental injury to the spleen requiring removal of the spleen, post-operative hernia formation developing diarrhea, inability to burp and loosening of the wrap over time with recurrent reflux needing medication.
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There are some special circumstances where surgery may be of value for those having troublesome retrosternal burning and extraesophageal symptoms of cough, asthma, voice change and pulmonary infections inspite of a trial with at least a double dose of a proton pump inhibitor. It is important to confirm that there is increased acid present in the esophagus with a 24 hour pH test. Some people who regurgitate fluid that is very troublesome may benefit from surgery. There are some people who respond to the drugs but have side effects from the drugs, find them too expensive or simply don’t like taking medications. This group would benefit from surgery.
People who continue to have symptoms even with a twice a day dose of a proton pump inhibitor and the 24 hour ph test is normal should look to be tested for other problems as this is not in keeping with acid reflux. |
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The medications we use to treat acid reflux are very effective. There is a very small percentage of people who continue to experience acid reflux even with the medications. However there is a group of patients who have symptoms suggestive of reflux and yet there is no increased acid present. These patients may be refluxing bile that is produced by the liver and pancreatic secretions from the pancreas. This is a very difficult diagnosis to make. Medical treatment of this group may also be difficult and a foam barrier and prokinetic drugs may be helpful. Sometimes more than one drug may be necessary to threat this problem. Some people may also experience hypersensitivity of the esophagus to normal amounts of acid or contractions of the esophageal wall. This is called visceral hypersensitivitiy. Stress may be a contributing factor to esophageal visceral hypersensitivity. A certain class of antidepressants called tricyclic antidepressants which alter the way the brain perceives painful stimuli may be of value in these situations. |
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The medications are very effective to treat reflux. However they do not cure the disease. The medications work to decrease the acid production by the stomach and once you stop the drugs the stomach returns to its normal ability to make acid. The symptoms of heartburn will therefore often recur after the medication is stopped. If altering lifestyle measures do not prevent the symptoms from recurring then individuals may require medication on a long term basis. This may include using it as necessary when symptoms recur. Some individuals need medication on a daily maintenance basis. |
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The proton pump inhibitors have been used for over 30 years and have an excellent safety profile. Some people may experience problems with headaches, skin rash, diarrhea, and abnormal liver function studies but these side effects are extremely rare. Recently, there has been some suggestion that older individuals on long-term high dose, that is twice a day, proton pump inhibitors may have an increased bone fracture rate and, therefore, should be taking a calcium and vitamin D supplement. However this has not been substantiated. |
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Important: This information should not be used as a substitute for the medical care and advice of your physician.