What Is the Best Treatment for Acid Reflux or GERD?It is estimated that more than 60 million Americans suffer from heartburn, acid reflux or gastroesophageal reflux disease (GERD) — approximately 20% of the U.S. population. People with these conditions typically experience regurgitation of stomach juices, which are highly acidic, leading to heartburn symptoms, such as burning in the chest, burping and hiccupping, discomfort or nausea after meals, pain and inflammation of the throat, hoarseness and coughing.
Here we discuss the best acid reflux or GERD treatments, including the LINX Reflux Management System and Nissen fundoplication surgery, and explain why over-the-counter antacids and prescription medications don’t always offer relief from acid reflux symptoms.
What is acid reflux or GERD, and what are the dangers?Acid reflux or GERD is a condition in which your stomach acids back up into your esophagus — the muscular tube that connects the mouth to the stomach. Studies show that chronic or longstanding acid reflux and GERD can become dangerous. When acid reflux isn’t treated early and effectively, a person can sustain damage to the tissue of the esophagus, where the ulcerations and scarring can develop into a precancerous condition called Barrett’s esophagus and, eventually, esophageal cancer.
Damage caused by GERD impacts more than the esophagus. People with severe GERD can aspirate stomach acids into their lungs, causing lung damage and respiratory problems. Negative effects also extend downward through the digestive tract, contributing to irritable bowel syndrome (IBS) and other gastrointestinal problems.
What Causes Acid Reflux, Heartburn and GERD?The common belief is that heartburn, acid reflux and GERD are caused by too much stomach acid. This is a reasonable assumption, and it follows that the aim of treatment should be to decrease stomach acid. Unfortunately, decreasing acid levels with medications or dietary changes doesn’t always work to prevent reflux or regurgitation, and here is why.
Researchers now believe that acid reflux is caused by two primary factors: 1) a lack of the “good” type of stomach acid (rather than too much stomach acid) that is necessary for breaking down foods, and 2) a weak or malfunctioning muscular valve known as the lower esophageal sphincter, or LES.
The absence of “good” acid in the stomach means carbohydrates and other foods aren’t broken down properly, leading to indigestion and bacterial overgrowth. This causes gas, which exerts extra pressure on the LES. With added pressure, a weak or malfunctioning LES cannot stop stomach acids from entering the esophagus, resulting in GERD and heartburn.
According to this theory, rather than prescribing medications to reduce stomach acid, the aim of treatment should be: 1) to cultivate an optimal level of the “good” type of stomach acid that efficiently breaks down carbohydrates and other foods, and 2) to protect against damaging regurgitation by treating a malfunctioning LES with a minimally invasive surgical procedure.
Why Surgery is Considered Better Than Acid-Reducing MedicationsTreating acid reflux and GERD with medication is still a common approach, even though it isn’t always effective at stopping regurgitation and doesn’t treat a dysfunctional LES. Many people rely on over-the-counter antacids (e.g., Rolaids® or Tums®), H2 receptor blockers Ranitidine (e.g., Zantac) and Famotidine (e.g., Pepcid®), or proton pump inhibitors (PPIs) such as Esomeprazole (Nexium®) or Omeprazole (Prilosec). These medications are intended to reduce or block acid production in the stomach.
When OTC medications don’t resolve symptoms, people consult a gastroenterologist who may prescribe a stronger H2 receptor blocker or PPI medication. Problem solved? Not necessarily.
These medications disrupt the optimal pH level of the stomach and intestine, exacerbating carbohydrate malabsorption, bacterial overgrowth, gas, reflux and pressure on the LES — with no resolution of LES dysfunction.
Some studies indicate that acid-reducing medications can actually make acid reflux worse over time. In one study, 44% of previously asymptomatic study participants experienced heartburn, acid reflux, or dyspepsia after a course of PPI medication. H2 blockers and PPI medications may suppress acid production for a while, resolving some symptoms in the short-term. Unfortunately, many people end up taking these medications for years.
“Acid reducing medicines, at best, offer partial and temporary relief, are not intended for chronic use and are associated with side effects and health risks,” says microbiologist Norm Robillard, PhD. It is known that H2 and PPI medications cause side effects, such as:
• Calcium deficiency and bone loss
• Vitamin B12 deficiency
• Overgrowth in the stomach and intestine of H. pylori and other bad bacteria, which lowers resistance to infections
Stopping therapy with H2 blockers and PPI medications can cause rebound or withdrawal symptoms, with reflux increasing by up to 50% for a period of 2-3 months after cessation of medication. For this reason, many GI doctors recommend that patients wanting to stop taking acid reflux medication should first undergo surgery to protect the esophagus from reflux and regurgitation.
Surgical Treatment for Acid Reflux and GERD TreatmentLINX® Reflux Management System — The LINX is a relatively recent surgical advancement in gastrointestinal medicine for GERD treatment. This treatment utilizes a small, flexible band of interlinked titanium beads with magnetic cores that is wrapped around the top of the stomach during a minimally invasive surgical procedure. The magnetism between the beads helps the LINX band resist opening due to gastric pressure, preventing acid regurgitation from the stomach through the esophagus and into the throat and mouth.
Nissen Fundoplication — This procedure is essentially a stomach wrap for acid reflux that has become the standard surgical method for treating GERD. With a fundoplication, the physician wraps the top of the stomach around the lower esophagus to reinforce the LES, thus reducing the likelihood that acid will back up into the esophagus. Traditionally done laparoscopically, a more recent advancement of the “fundo” is to offer a minimally invasive robotic-assisted version, which allows the surgeon greater precision and high-def 3D visibility for less impact on the patient.
How does hiatal hernia treatment improve acid reflux?Hiatal Hernia Repair Surgery — A hiatal hernia occurs when the top portion of the stomach protrudes through a small opening in the diaphragm known as the hiatus. This protrusion allows stomach acid to flood the esophagus. Some people are born with a large hiatus, but hiatal hernias may also result from obesity or pregnancy, where added pressure on the hiatus muscles can weaken them. Hiatal hernia repair surgery involves tightening the junction between the stomach and esophagus, thus stopping the regurgitation of stomach acid.
Do you still have to take PPI medications after LINX surgery or related procedures?The LINX surgery, Nissen fundoplication and hiatal hernia repair generally provide good protection against acid reflux and regurgitation, reducing cancer risk and eliminating the need for H2 receptor blockers and PPI medications. However, to boost the protection provided by the surgery, patients can utilize milder OTC antacids (e.g., Tums®) for a few weeks post-surgery as their bodies adjust to cessation of H2 or PPI medications.
Patients are also encouraged to restore a healthy pH balance to their stomachs and digestive tracts by reducing bacterial overgrowth and replacing beneficial bacteria to improve digestion and health. A low-carbohydrate diet helps prevent bacterial overgrowth, and consuming kefir, kombucha and Greek yogurt can help replace beneficial bacteria and restore digestive function.
This article was medically reviewed by Sergey Lyass, MD, as part of miVIP’s Healthy Living Recommendations.
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