How long would you wait before going ahead for surgery?

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Regular Member

Date Joined Jun 2013
Total Posts : 93
   Posted 6/19/2013 10:21 AM (GMT -6)   
For us who are suffering from Gerd/LPR, would you like to stay on PPI forever or you believe you will sooner or later chose to have a surgery done?

If you think that you will need a surgery sooner or later, how long would you wait?

I personally believe that too long wait is not a good thing since more damages may have happened already.

Veteran Member

Date Joined Oct 2009
Total Posts : 739
   Posted 6/19/2013 10:35 AM (GMT -6)   
Hi hopegood,

As Richard Dawkins says, he isn't particularly interested in what anyone believes, he is interested in the evidence. So I would say don't base your decisions on what others believe, but look at the evidence. I'll try to sum a bit of it up here. I'll also include what I believe I would do :)

I would say that it absolutely depends on what your clinical profile is and what your test results have been. If I had NERD or low-grade esophagitis (LA Grade A or B), then I would probably wait a long-time. I would definitely wait a long-time if my motility test and PH tests came back suggesting that surgery wasn't a great option for me (in fact, as they do).

If, however, I came back with lots of acid exposure during the PH test and it was clear that I suffered severe reflux, with or without Barrett's, I'd probably get the surgery sometime relatively soon. If I had Barrett's I would seriously consider the surgery despite the fact that it hasn't been shown to reduce cancer risk in GERD patients with Barrett's.

Overall what you are asking is based on two assumptions/beliefs:

Firstly, you are scared of more damage happening. This actually is not the norm. Most people remain in their same category (level of esophagitis, or non-erosive disease), or get better. A very, very low % of them progress to Barrett's (i.e. in the area of 1-8% over 7-20 years, depending on your level of esophagitis). Believe it or not, I have had a well-known doctor (and head of an esophageal disease center at a major university) tell me that, since I have a history of just NERD and level A esophagitis, I really don't need to be on PPI's. If they aren't improving my symptoms, they aren't really necessary. If you look at the AGA guidelines for GERD this is in fact included among their guidelines (PPI's have, however, been shown to have a moderate effect on cancer risk if you have Barrett's).

Secondly, you are assuming that the surgery automatically reduces cancer risk. In fact, studies to date have not shown that it does. In fact, many doctors will tell you that surgery should actually never be considered from the perspective of reducing cancer risk, but from the perspective of improving quality of life. Pretty counter-intuitive, huh? A lot of things about medicine are, at the end of the day, counter-intuitive, unfortunately.

So I would say consider those two issues in particular before making a decision. But, ultimately, the decision is up to you and you have the prerogative to make it based on what you believe and what you value, and based on how you feel. So the decision that you make is up to you...I am just saying anyone should definitely do some research and get some facts before pursuing surgery as a panacea to their GERD and potential cancer risk.

darn I'm good...

Veteran Member

Date Joined Oct 2009
Total Posts : 739
   Posted 6/19/2013 10:52 AM (GMT -6)   
I forgot to mention, 10+ specialists I've reached out to (researchers and doctors on the board of the gastroenterology journals, heads of esophageal centers, authors of cited studies and leads on Barrett's surveillance studies, studies on genetic links to Barrett's and EAC, etc.) have literally all given me the same professional opinion. I know that this opinion will shock some of us.

A patient presenting with NERD or low level esophagitis (LA grade A or B), does not ever need a follow-up endoscopy as standard practice. EVER. Even if they are young, and even if they have risk factors...

In fact, some of us may know that endoscopic surveillance of Barrett's has yet to be shown to improve cancer mortality rates for EAC. It is such a wide-spread practice, but it has yet to pay dividends (according to studies).

I followed up with one Dr. and asked why follow-up endoscopies were not necessary, if it was due to the low cancer risk or because endoscopies themselves have yet to prove their worth in reducing cancer outcomes. His response was that, if all of the sudden endoscopies were excellent tools to reduce EAC mortality, he still wouldn't deem follow-up endoscopies necessary for non-Barrett's patients.

Of course, I am making a big assumption myself assuming that your interest in cancer risk (since you mentioned a worry of additional damage being done)....I know that some people are more worried about symptoms themselves, and whether to get surgery to control your symptoms is really an individual decision based on your test results and the probability of the surgery being successful at it....

Regular Member

Date Joined Jun 2013
Total Posts : 93
   Posted 6/19/2013 11:00 AM (GMT -6)   
Hi refluxman,

Thanks so much for your detailed information. This is really very helpful.

Forum Moderator

Date Joined Feb 2009
Total Posts : 7188
   Posted 6/19/2013 11:21 AM (GMT -6)   
I just copied and pasted your responses for my GERD and Surgery file.  What a great and helpful response.  As I've said, you're a wealth of knowledge! 
Darn, you are good!
I waited far too long for my surgery, as my symptoms were atypical.  I had breakthrough reflux/heartburn, but my worst problem was my lungs.  My GI doc was afraid surgery wouldn't help my lungs, as my PH tests came out consistently low.  I was fearful because of all the scary internet posts.  I waited 6 long years while my lung condition deteriorated.  Finally it seemed it was my only option.  I had it done in February 2009, and have never looked back.  It was a health AND quality of life issue in my case.  Lung tissue is much, much more sensitive than esophageal tissue. 
Once my GI finally referred me to a surgeon, I scheduled my surgery immediately and had it three weeks after seeing the surgeon.  After two and a half months of healing, my lungs were finally healthy again!  My situation was different, though.
I think, as ARM mentioned, quality of life issues are the most important.  Good luck making you decision!
Best wishes,
GERD/Heartburn Moderator
Nissen Fundoplication 2/09

"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”
Eckhart Tolle

Veteran Member

Date Joined Apr 2012
Total Posts : 707
   Posted 6/19/2013 1:25 PM (GMT -6)   
You're such a stud! yeah    Glad to see you back on the board bro.

Regular Member

Date Joined Jun 2013
Total Posts : 93
   Posted 6/19/2013 2:12 PM (GMT -6)   
Thanks for sharing your experience, Dencha.

For me, quality of life is also the most important issue. Living a normal life and sleeping flat is so good....I know, to decide on a surgery is difficult because I don't know whether I can be cured or not, let alone the side effects. You are lucky, I am very glad for you.

So I am looking closely at linx. Hope it can work as a relatively minimal invasive procedure.

Veteran Member

Date Joined Dec 2008
Total Posts : 4961
   Posted 6/19/2013 2:14 PM (GMT -6)   
I waited until it was my last resort. It was either quadruple PPIs or have surgery to close the open LES. I also was dx with barretts. Since the tests showed I was a good candidate for surgery I went that route. Best decision for me.

Take care,
Moderator: GERD/Heartburn
Nissen 6/06 and 5/09
#3 on 8/24/11

Regular Member

Date Joined Jun 2013
Total Posts : 172
   Posted 6/19/2013 6:55 PM (GMT -6)   
good question. I would wait as long as I could/can.
We are in a similar situation. I see my GI tomorrow . He is good. Teaches at Stanford in the Bay Area of CA. Months back I asked about the nissen and he said the LInx is better for me. He ablated my Barrett's, checked it with cellvizio and a biopsy. Told me to come back in three years. ( I too was shocked at the 3 years). But I had to come to terms with their reality: the numbers are in my favor. I like that. So I accepted it, but made another appointment because if I had heartburn or a sour taste in my mouth to come back. Then we would discuss the LInx. That day is tomorrow.
I want to rule out everything first. For example, my reflux is strange and a typical. My symptoms could be my allergies. It's up high in my throat but sometimes lower. I don't want to rush to surgery to find out it was still here and just allergies. Or from smoking so many years ago. My body took a lot of abuse. I have to rule all that out and then make sure my symptoms are purely reflux. It is also possible my throat issues are caused by ppi's. what a catch 22.
Look forward. To reading more from you.
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