Information about GERD Symptoms, Diagnosis, Treatment options, and GERD Medication
For information on Irritable Bowel Syndrome (IBS) visit:



Irritable Bowel Syndrome (IBS)



Surgery & Endoscopy for GERD


GERD is a lifelong disease that requires lifelong treatment. 

The ideal candidate for surgery is the patient who has complete elimination of symptoms with medications but does not want to take them long term.

With PPIs availability and elimination of acid reflux, surgery for GERD may be more appropriate for “volume refluxers”, i.e., those with regurgitation with or without supraesophageal complications.

Follow-up of a randomized controlled trial shows that 62% of patients who have undergone antireflux surgery will go back on antireflux medications (JAMA 2001, 285:2331-2338).

A recent modification of a longstanding open-procedure known as the "Nissen's Fundoplication" has been developed. This is called the laparoscopic Nissen's Fundoplication, and involves wrapping the stomach around the esophagus. This surgery may cause temporary dysphagia and a chronic condition called gas-bloat syndrome. Esophageal manometry is recommended before surgery to make sure the patient is not suffering from "lead pipe esophagus".

The treatment for reflux laryngitis and chronic cough is high dose proton pump inhibitors (PPI)for several months. Patients with intractable reflux induced cough may benefit from surgery.


In a recent invited editorial published in the June 2002 issue of Current Gastroentrology Reports, Dr. JP Galmiche from France writes: “Endoscopic therapy for GERD is an attractive concept that needs to be performed in reference centers and in the context of well designed studies comparing different PPI strategies, eg, continuous or intermittent and on-demand PPI therapy. Relevant outcome measures, including economic endpoints and long-term assessment, are necessary before these novel approaches can be proposed in routine practice”.

Finally, do we need an alternative for uncomplicated GERD now that medical therapy is becoming better and cheaper?  Do we burn any bridges by endoscopic therapy if a patient eventually needs surgery?


  • Suturing, EndoCinch (Bard)

    • Full-thickness Plication (NDO Surgical)

    • Flexible Sewing device (Wilson Cook)

  • Radiofrequency Energy (Stretta System)

  • Injection/Implant

    • Enteryx (Boston Scientific)

    • Gatekeeper Hydrogel Prosthesis (Medtronic)


Non-Surgical candidates who suffer from the following conditions:

  • Poor or absent peristalsis with bad reflux

  • Elderly patients who fail medical therapy

  • Volume refluxer








         This is an educational site created by M. Farivar, M.D. The information provided is the author's opinion based on years of clinical experience and research.  You are advised to consult your own physician about the applicability of this information to your particular needs.  Also, keep in mind that symptom response to therapy does not preclude the presence of more serious conditions. 

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