GERD & Endoscopy, and surgery

[jscuba]

  I am a 28 year old female who suffered from GERD six years ago. After a year or so on
  Zantac, I was free of it. This past year it has came back stronger then ever. I tried the over the counter
  peptic AC, but finally went to a doctor who put me on Prilosec for two months and a upeer GI series where he diagnosed me with GERD.
  . I do not have the heartburn while taking Prilosec, but I do have the Belching problem with almost constant
  belching that is a burden in my life.
    The doc then recommended surgery and sent me to a surgeon. Is this proper precedure? Should I have been sent to a gastro-doc first?
  I thought so, so I called and requested a referal to one, but he refused demanding I see the surgeon first.
    After some prompting by my husband, the surgeon finally mentioned an endoscopy first.
  MY QUESTIONS:
    1. If the upper GI series showed the GERD, is Endoscopy still nessasary?
     2. Could an Endoscopy find something, or fix something so I won't need
  surgery?
     3. The surgeon asked me some questions, felt my stomach, and told me he recomended surgery
  even though he did NOT see my upper GI series. Is this alright?
  4. I understand GERD symtoms mimic other things. If so, what, and what tests should be done before surgery?
  I should also mention my husband & I want to  begin a family which we are told should not be done on Prilosec.
Dear jjscuba,
The cornerstone of therapy for GERD remains lifestyle modification and medical therapy. Antireflux measures can sometimes obviate the need for medicines or help them work better for you. Your doctor can give you a list of these dietary and lifestyle changes. Antireflux surgery is generally reserved for patients who are refractory to medical therapy or young patients who anticipate having to take medicines such as omeperazole (Prilosec) or lansoprazole (Prevacid) for very prolonged periods of time.
Prior to contemplating antireflux surgery many gastroenterologists and surgeons will perform a fairly extensive work-up in order to be sure that the diagnosis of GERD is correct and to exclude other esophageal motility disorders. An endoscopy can look for inflammatory changes (esophagitis), strictures (areas of narrowing), rings or the presence of a hiatal hernia. Although there would be no therapeutic role for endoscopy unless a stricture was present, the endoscopy would complement the findings on the upper GI series.  A biopsy of the lower esophagus can histologically confirm the presence of reflux esophagitis and could confirm the presence of intestinal metaplasia (a change in the lining of the lower esophagus-also called Barrett's esophagus). The radiologist who performs the upper GI series can detect gastroesophageal reflux during the dynamic fluoroscopic study. The x-ray pictures would probably be normal and not show evidence of reflux. Other tests that might be important would be an ambulatory pH study to confirm GERD and to correlate symptoms with periods of acidity and esophageal manometry to measure the pressures along the esophagus and to rule out an esophageal motor disorder. A gastric emptying study is also helpful at times to document delayed stomach emptying as a cause of symptoms.
You mentioned that you were concerned about the safety of  omeperazole (Prilosec) during pregnancy. Omeperazole (Prilosec) is considered a Category C drug. This means that there are no adequate or well-controlled studies in pregnant women. There have been sporadic reports of congenital abnormalities in the infants born to women on omeperazole (Prilosec) during pregnancy. It is currently recommended that omeperazole (Prilosec) should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus.
Finally, before you consider surgery you should be comfortable with the risks, benefits and alternatives of the operation. Good luck to you. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: gastroesophageal reflux, antireflux surgery, omeperazole (Prilosec)

[HFHSM.D.-ym]

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