Surgery Advocated as Primary Treatment for Many Cases of GERD
I consider this topic, and this article, especially disturbing. To Western medicine, there are only two options to reflux disease: acid blockers or surgery. My gosh!! Have we forgotten that food allergy is known to play a strong role in lower esophageal tone? Cow’s milk allergy and GERD are well accepted bedfellows in infants–why do we forget this concept when the patient becomes an adult? How about avoiding the nightshade vegetables, caffeine and alcohol long before any pharmaceutical intervention?? Remember–it is not the acid causing the problem, it’s acid getting where it’s not supposed to be…
87th Clinical Congress of the American College of Surgeons Surgery is the only way to cure gastroesophageal reflux disease (GERD) and should be the preferred treatment for Barrett esophagus, according to Dr. Jeffrey H. Peters of the University of California, Los Angeles. Dr. Peters made the case for Nissen fundoplication during a debate on surgical versus medical management of GERD at the 87th Clinical Congress of the American College of Surgeons. In an interview with Reuters Health, Dr. Peters challenged a recent report in The Journal of the American Medical Association, in which Dr. Stuart Jon Spechler and others concluded that antireflux surgery does not obviate the need for medications in most GERD patients. According to Dr. Peters, Dr. Spechler’s group reported that 40% of GERD patients treated with surgery died within 10 to 13 years, and most of the surviving patients required proton pump inhibitors. Dr. Peters challenged the accuracy of those data and said that most of the surgery patients who were put on medical therapy following surgery had no indication for treatment. “If you look carefully at these patients, you will find that only 10% had acid indications that required proton pump inhibition,” he said. Dr. Peters added that surgery should be offered to patients with pH-positive, non-erosive GERD and said surgery is the “preferred treatment for patients with endoscopic esophagitis — but it should be the primary treatment for Barrett’s esophagus.” He said, too, that successful GERD surgery is often more dependent on “repair of the hiatal hernia rather than lower sphincter repair.” Dr. Joel Richter, head of gastroenterology at the Cleveland Clinic Foundation, represented the medical side of the debate and disagreed with Dr. Peters’ claim that surgery can cure GERD. “In some patients you may get a good result for 5 or 10 years, but these patients are going to once again become symptomatic. I think it is more accurate to call surgery a functional repair.” He added that “abdominal stressors don’t go away just because you perform surgery.” But Dr. Peters responded, “In a sense abdominal stressors do go away, because after a good repair, these patients can’t vomit.” Dr. Richter pointed out that surgery is “very dependent on good surgeons performing good operations on the right patients.” Before a standing-room-only crowd of surgeons, Dr. Peters’ remarks received long ovations, while Dr. Richter’s remarks were greeted with polite applause.