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Dr. Andrew Rynne

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Taking nexium for non reducible hiatal hernia and reflux problem. Should I go for surgery?

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Dr. Om Lakhani

Endocrinologist

Practicing since :2004

Answered : 319 Questions

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Posted on Thu, 14 Feb 2013 in Digestion and Bowels
Question: I have a moderate sized,sliding,non reducible hiatal hernia and have had reflux problems for 7 years, I take nexium and sometimes when I bend forward I have regurg of acid.On a recent upper GI they identified a schatzki ring as well.
Would surgery be indicated in this type of case?
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Answered by Dr. Om Lakhani 2 hours later
Hi XXXXXXX

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) have proposed the following Indications for surgery in GERD:

1) have failed medical management (inadequate symptom control, severe regurgitation not controlled with acid suppression, or medication side effects)

OR

2) opt for surgery despite successful medical management (due to quality of life considerations, lifelong need for medication intake, expense of medications, etc.)

OR

3) have complications of GERD (e.g., Barrett's esophagus, peptic stricture) 18, 19

OR

4) have extra-esophageal manifestations (asthma, hoarseness, cough, chest pain, aspiration)

In your case we can reasonably say that there are some regurgitation symptoms despite medical therapy so you can be considered as a surgical candidate. However practically speaking surgery is generally a personal choice. If you are okay with the symptoms and can deal with the occasional regurgitation, you do not need any surgery, however if you are unhappy with the symptom profile, surgery might help.

Schatzki ring and Hiatus hernia are often seen with GERD and are per-se NOT INDICATIONS FOR SURGERY.

Remember surgery does carry some risk and hence you must discuss with your GI surgeon the risks and benefits of the surgery. As a personal opinion I would advice you against the surgery. What I would advice you apart from your medications is loosing some weight. At 200 lbs loosing a few pounds itself would help you with your GERD.

Hope this answers your question.

Regards
Dr. Om Lakhani, MD


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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