Surgery to Avoid #4: Heartburn Surgery

by Curt Pesmen
The fourth of 5 operations you don’t want to get—and what to do instead.

A whopping 60 million Americans experience heartburn at least once a month; some 16 million deal with it daily. So it’s no wonder that after suffering nasty symptoms (intense stomach-acid backup or near-instant burning in the throat and chest after just a few bites), patients badly want to believe surgery can provide a quick fix. And, for some, it does.

A procedure called nissen fundoplication can help control acid reflux and its painful symptoms by restoring the open-and-close valve function of the esophagus. But Jose Remes-Troche, MD, of the Institute of Science, Medicine, and Nutrition in Mexico, reported in The American Journal of Surgery that symptoms don’t always go away after the popular procedure, which involves wrapping a part of the stomach around the weak part of the esophagus.

“That may be because surgery doesn’t directly affect healing capacity or dietary or lifestyle choices, which in turn can lead to recurrence in a hurry,” he says.

The surgery can come undone, and side effects may include bloating and trouble swallowing. Remes-Troche believes it’s best for very serious cases of long-standing gastroesophageal reflux disease (GERD) or for those at risk of Barrett’s esophagus, a disease of the upper gastrointestinal tract that follows years of heartburn affliction and can be a precursor to esophageal cancer.

What to do instead
Make lifestyle changes. A combination of diet, exercise, and acid-reducing medication may help sufferers beat the burn without going under the knife. But it’s a treatment that requires perseverance.

“It took me four years of appointments, diets, drugs, sleeping on slant beds—and even yoga—to keep my heartburn manageable,” says Debbie Bunten, 44, a Silicon Valley business-development manager for a software firm, who was eager to avoid surgery. “But I did it, and am glad I did.”

Pose for a picture. Another technological development can make a heartburn diagnosis easier to swallow—a tiny camera pill that beams pictures of your esophagus (14 shots per second) through your neck to a receiver or computer in the doctor’s office; it passes harmlessly out of your system four to six hours later. The $450 Pillcam (a similar camera capsule from Olympus is awaiting Food and Drug Administration approval) can be used instead of standard endoscopy to screen chronic-heartburn sufferers for various esophageal complaints, including GERD, which can develop into the potentially precancerous Barrett’s esophagus. Unlike an endoscopy, in which you’re sedated and a lighted tube is snaked down your throat, a capsule camera leaves you wide awake and is finished within 20 minutes, says Pillcam guru David Fleischer, MD, a staff physician in gastroenterology and hepatology, and professor of medicine at Mayo Clinic College of Medicine. If anesthesia makes you sick, the capsule camera may be for you.