Long-Term Outcomes and Risks of Anti-Reflux Surgery for GERD

Jump To Section

• Surgery Success and Limitations
• PPI Medication After Surgery
• Endoscopic Cancer Surveillance
• Life-Threatening GERD Complications
• Reflux Aspiration and Pneumonia
• Full Transcript

Surgery Success and Limitations

Anti-reflux surgery offers a highly effective initial treatment for severe gastroesophageal reflux disease. Dr. Jari Rasanen, MD, confirms that a successful fundoplication procedure can completely prevent ongoing reflux. This surgical intervention creates a valve mechanism to stop stomach acid from entering the esophagus.

However, Dr. Rasanen's research reveals a significant long-term limitation. The surgical flap formed during fundoplication often loosens over time. This mechanical failure typically occurs 10 to 15 years after the initial operation. Patients cannot expect a single anti-reflux surgery to last a lifetime. The maximum warranty period for the procedure's effectiveness is approximately 15 to 20 years.

PPI Medication After Surgery

Proton pump inhibitor (PPI) medication plays a different role after surgical treatment. Dr. Jari Rasanen, MD, explains that PPIs provide no extra benefit if anti-reflux surgery is completely successful. A properly functioning fundoplication eliminates the need for ongoing acid suppression therapy.

The conversation with Dr. Anton Titov, MD, highlights an important clinical distinction. Medication management and surgical intervention are not synergistic when the surgery works perfectly. Patients should not automatically continue PPI therapy after a successful operation. This approach avoids unnecessary long-term medication use and its potential side effects.

Endoscopic Cancer Surveillance

Regular endoscopic monitoring is essential after any GERD treatment. Dr. Jari Rasanen, MD, emphasizes the critical importance of upper GI endoscopies and gastroscopies. This surveillance strategy helps doctors stay one step ahead of esophageal cancer development.

Endoscopy allows for the early detection of precancerous changes, known as dysplasia. Identifying dysplasia in the esophageal mucosa enables proactive intervention. Doctors can treat these abnormal cells before they progress to invasive adenocarcinoma. This vigilant monitoring is a cornerstone of long-term GERD management, regardless of treatment method.

Life-Threatening GERD Complications

Untreated or poorly controlled gastroesophageal reflux disease can have fatal consequences. Dr. Jari Rasanen, MD, describes how acidic gastric reflux is toxic to esophageal tissue. This chronic irritation can lead to deep ulcers forming in the esophageal mucosa.

These ulcers represent a serious medical emergency. In severe cases, they can progress to a complete perforation of the esophageal wall. An esophageal perforation allows stomach contents to leak into the chest cavity. This condition causes severe infection and requires immediate surgical intervention to prevent death.

Reflux Aspiration and Pneumonia

Another deadly complication of GERD involves pulmonary aspiration. Dr. Jari Rasanen, MD, explains how gastric reflux can travel into the lungs. This occurs when stomach contents are regurgitated into the throat and then inhaled.

Aspiration of acidic stomach material causes severe lung inflammation. This condition, known as aspiration pneumonia, is particularly dangerous and often fatal. The interview with Dr. Anton Titov, MD, underscores that GERD is not merely a quality-of-life issue. The disease poses genuine risks of mortality through both cancerous and non-cancerous complications.

Full Transcript

Dr. Anton Titov, MD: If one finds inflammation in the esophageal mucosa after anti-reflux surgery, do PPI inhibitors or other medications help? Can they reduce the inflammation and therefore the risk for esophageal carcinoma in people with gastroesophageal reflux disease, even if it's treated successfully?

Dr. Jari Rasanen, MD: If anti-reflux surgery is successful, it will prevent the ongoing reflux completely. It makes the PPI medication not give any extra help. So basically, the anti-reflux surgery is enough.

The only thing that the patient needs is to be followed up by upper GI endoscopies and gastroscopies. By that, we can stay one step ahead of cancer.

If there are any signs of dysplasia in the mucosa, then we can react before it develops into cancer. This is very important to know.

In one of your publications, you also mentioned that when you investigated patients several years after anti-reflux surgery, you found that the expected results of gastroesophageal anti-reflux surgery were not there anymore. That is one of the problems.

Although in the beginning you are very successful in your anti-reflux surgery, when time goes by—after like 10 to 15 years—it is very common that the flap that is formed after fundoplication will get loose.

By that, it won't prevent reflux anymore. So basically, you cannot say to a person who is having anti-reflux surgery that it will last for the rest of his life.

You can only give a warranty of maybe 15 years, at a maximum of 20 years. After that, it is possible that you still can have reflux, although you had successful surgery in the beginning.

Dr. Anton Titov, MD: Gastroesophageal reflux disease is common. Still, it can also be a cause of death. Why and how do people die from gastroesophageal reflux disease? You have published some important research on that topic.

Dr. Jari Rasanen, MD: The gastric reflux itself is toxic to the esophageal mucosa. It means that especially when the reflux is acidic, it can cause ulcers in the esophageal mucosa. Those ulcers can even lead to perforation of the esophagus.

That's certainly a very dangerous situation for the patient.

Dr. Anton Titov, MD: When you have gastric reflux, that reflux can end up in your lungs. You can get aspiration pneumonia, which is also very fatal.

Dr. Jari Rasanen, MD: So these factors can be very harmful to the patients besides cancer.