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GERD - Surgery?

  I am a 23 year old female.  About 2 years ago I was diagnosed with GERD.  After trying Tagament, Pepcid, and other diet modifications and over the counter medicines without any success the doctor performed an endoscopy and put me on Prevacid.   While being on the Prevacid I did not have any of the severe heartburn.   I stayed on Prevacid for about 6 months.  Though this took care of the heartburn, I did have side effects of stomach cramping and diarrhea.   He took me off the medication saying that it was not good to stay on that medication for extended periods of time.   After 3 or 4 months of being off the medicine, I starting experiencing pain again even with the dietary changes.   I started using over the counter medication and this helped for several months until it became very severe again.  This time because of the side effects of Prevacid he put me on Prilosec.   I stayed on the Prilosec for two months and then just took the medication when the pain was more severe.   The cost of the medication is too much for me to afford.   This continued for about a year.   I went to a different doctor since I moved and he recommended that since the Prilosec was too expensive and because of my age to take Zantac.   Like the previous doctor he stated that this would be a life long cycle of taking medications to control the pain.  The zantac does not work as well as the prevacid and prilosec and I am still having to take a lot of over the counter antiacids to help control the heartburn.  This doctor also said that he thought I should consider the surgery for GERD, because of my age.  
  My main questions are this.   Is surgery really the only cure for GERD?   Is it healthly to be taking all of this medication?  My husband and I are wanting to have childern soon and I have heard that the heartburn gets worse with pregancy.  Is this true?  Can you take any of the medication while you are pregant?  What are the complications and success rates of the surgery?  My doctor also said that GERD gets worse with age, Is this true?  Also, would you recommend this surgery for someone my age, even though the Prevacid and Prilosec did work?  My only concern is the amount of money that I am paying for the drug and the long term side effects of taking a drug like this.
  I know that is a lot of questions, but I am real curious about this surgery.   I have not been able to find out a lot about it and I certainly do not want to jump into something.   It almost sounds too good to be true and I am very nervous about someone operating on me and something going wrong.   Any information that you could provide or any references to books or sites that have good information would be appreciated.   Thanks alot!!!!!
Dear Lara,
You are correct t hat esophageal reflux can be a life long problem and that surgery is the only way to definitively treat the condition.  Several recent large surgical series have reported excellent to good symptomatic improvement in reflux symptoms among patients with GERD who had a laparoscopic surgical procedure (mini scar) .  You should realize, however, that the average length of followup is only three years.  Whether the results will be as good 10 and 15 years after surgery (an important question for you in view of your age) is currently unknown.
The proton pump inhibitors and H2 receptor antagonists such as Zantac and Tagamet are very safe drugs.  Their effects on fetal development and miscarriage rates appear good, but the data is limited.  Zantac and Tagamet do not appear to have any effect on female fertility or fetal development but are usually not prescribed during pregnancy because the data is inconclusive that these medications do not affect the fetus.  In rabbits, there have been reports that Prilosec may increase embryo death, but there is no available data for humans.
You are correct that heartburn can get worse with pregnancy.  Pregnant women with heartburn are encouraged to use oral antacids and lifestyle modifications described below.  These modifications are also effective in nonpregnant women. Lifestyle changes include:
1) eat only 3 meals, avoid snacks
2) avoid coffee, tea, carbonated beverages, peppermint, chocolate
3) do not eat foods that contain fat
4) do not lie down for 3 hours after you eat
5) sleep with the head of your bed elevated to an angle of approx. 45 degrees. This can be done by placing several books under the legs at the head of the bed
6) Chew gum or suck candies during the day to increase saliva production. Swallowing the saliva has two benefits. The act of swallowing will clear acid from the esophagus. The saliva being a base will also neutralize acid
7) Take antacids or Gaviscon during the day when you have heartburn. These over-the-counter medications will supplement the
effects of the Tagamet HB
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital, in order to review your records and investigate your symptoms.  You can arrange an appointment with Dr. Fogel, one of our experts in the treatment of esophageal disease.  He can be reached by calling the Henry Ford Physician Referral Line at (800) 653-6568.
*keywords: esophagitis, esophageal reflux

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