- Refractory reflux despite maximal medical management (PPI plus H2 receptor antagonist)
- Complications of reflux e.g. oesophageal ulceration or structuring
- “Volume” reflux i.e refluxing or vomiting on physical activity that involves stooping, unable to lie flat due to reflux with associated sleep disturbance
- Patients who respond to acid suppression therapy but this is not tolerated e.g electrolyte disturbance
- Patients requiring daily reflux medication despite lifestyle modification with a strong desire to discuss surgery rather than continue acid suppression therapy long-term. This may be particularly relevant to young fit patients on high doses of PPI
Anti-reflux surgery (Guidelines)
Audience
- Highland HSCP
- Primary and Secondary Care.
Please see upper GI reflux guideline for the initial medical management of patients presenting with reflux.
Lifestyle modifications and drug therapy remain the mainstay of treatments for reflux.
Some patients with symptoms that are not well controlled with medical management may benefit from anti-reflux surgery (usually, laparoscopic fundoplication). This is however only indicated in a minority of patients with reflux.
If reflux symptoms have not responded at all to anti-acid therapy, please consider an alternative diagnosis in the first instance. Failure of acid suppression to make any difference to symptom control is a predictor of poor outcome to anti-reflux surgery.
In carefully selected patients the outcome of surgery can be life changing but carries with it the risks of slippage of the “wrap” with resultant ongoing/recurrent symptoms, dysphagia (which is very common in the first few weeks but usually settles spontaneously), gas bloat (the sensation of “trapped wind” after eating due to the inability to “burp” after surgery) and persistent diarrhoea (exact mechanism unclear).