FS: Fundoplication, Yes or No ????

[CRG__0]

  I am a 34 year old male with a history of chronic reflux problems.
  Within the last 5 years I have had numereous tests and procedures
  including three endoscopy's, two of which included streching of my
  esophagus for strictures.  I have a small hiatal hernia as well.  
  I have been on about every acid reducing medication known to man,
   and I sleep with my bed elavated at night.  I've learned to live
   with my reflux on a day to day basis and it's impact on my
  lifestyle is tolerable.  However, based on what I've read,  I have
   concern about the long term effect that this has on my esophagus
   (barrets, cancer, etc.).  My physician has recommended a
  fundoplication procedure.  I am concerned about having surgury for
  somthing that doesn't give me much day to day pain.  However, I
  don't want to drop dead prematurely due to esophagal cancer either.
  I have no idea what the statistics or odds are of getting barrets/
  cancer, etc.  If I did it might aid my decision.  I also understand
  that if I have this, I may never ne able to throw up again. It's
  not that I enjoy doing it, but it seems that if I get a stomach bug
  or something this could be painful and potentially harmful.  I guess
  I'm looking for someone help me weigh the odds here.  I'm tending to
  lean toward having the surgery.  Any feedback would be greatly
  appreciated.
  Thanks
  CRG
________
Dear CRG,
Your email suggests rather substantial reflux-related problems, although you write that you do not have much in the way of day-to-day symptoms.  Fundoplication is indicated for people who remain symptomatic despite maximal medical therapy (acid inhibitor as well as prokinetic agent) or those who can not accept the fact that they will need to take medications daily for the rest of their lives.
Barrett's esophagus is found in 10-20% of patients with chronic reflux.  In our experience, Barett's esophagus is usually found at the time of the initial endoscopy.  It does not develop in subsequent years.  Moreover, most people with Barett's esophagus who develop esophageal cancer have the cancer at the first study.  A Veterans Administration study from Boston showed tha t8% of people with Barrett's and cancer had the cancer at the initial endoscopy.  Subsequent incidence of cancer was 1 case per 175 person years of follwo-up; i.e. if you followed 175 people for 1 year, there would be one case of cancer.
This information is preseneted for educational purposes only.  Always consult your personal physician for specific medical issues.
HFHSM.D.-rf
*keywords: esophageal reflux, fundoplication, Barrett's esophagus, esophageal cancer
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