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Bruce E. Freedman, M.D., F.A.C.S.
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As long as I take my medication for heartburn I don't get the acid burning, however, when I lie down, I still notice regurgitation of stomach contents into my throat and mouth. Can anything be done for this?
Your acid symptoms are well controlled with the medication because they prevent the stomach from producing acid. However, you need to reconstitute a high-pressure zone at the esophagogastric junction to prevent regurgitation. Your lower esophageal sphincter is incompetent. This can be corrected with surgery.


For the past few years Iíve had difficulty swallowing. My doctors have told me I have achalasia. Is there anything that can be done surgically?
Achalasia implies there is a very hypertonic area at the esophagogastric junction as well as no peristaltic activity (contractions) of the esophagus. The procedure of choice for most patients is a laparoscopic Heller esophagogastric myotomy. This cuts one of the muscle layers of the esophagus and enables complete relaxation of the hypertonic area. Because of this, an anti-reflux procedure also done with the myotomy should be done to prevent heartburn. There are often non-surgical procedures as well as Botox injection and preventative dilations, but these options tend to be transient.


My doctor says I have Barrett's Esophagus on endoscopy. Will medication cause regression of my Barrett's?
Most likely, medication will not cause regression, but can keep the disease in check. Surgery with a fundoplication has been shown to cause regression with very little morbidity.


My heartburn medication is no longer effective. Are there any other more permanent solutions?
For those patients resistent to medical management, laparoscopic fundoplication provides a safe, effective, and long lasting treatment for patients with severe gastroesophageal reflux. An overnight stay is all that is usually required, and most patients return to their normal activities within 1-2 weeks.


What side effects might I experience after surgery for severe GERD?
Most patients have some dysphagia (difficulty swallowing) following surgery, which is self-limiting. After surgery, it is very important you eat slowly and chew carefully. Other common side effects include diarrhea, flatulence (excessive "gas") and early satiety (feeling full quickly). These symptoms will also resolve with time. Most patients are eating whatever they prefer within a 3-6 week period of time.

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