Gastroesophageal Reflux Disease (GERD) is very common. In fact, nearly 2 in 10 Americans suffer from this chronic condition. Not as common? People suffering from severe GERD symptoms. But it's those GERD sufferers that experience complications with the chronic condition.

Treatment will vary depending on your symptoms—and the damage and complications it has caused. But when do you know if, and when, you need surgery?

Maybe drugs help alleviate your GERD symptoms, but you don't want to spend the rest of your life taking medications. Or, while you've heard surgery can be successful in treating severe GERD symptoms, you don't want to go under the knife.

Here's what you need to know, and what you need to ask your doctor.

Major Symptoms of GERD

  • Burning in the chest, radiating from the stomach to the throat and on occasion, into the mouth (heartburn).
  • Regurgitation of fluid from the stomach into the throat and mouth.
  • Difficulty swallowing.
  • Extraesophageal symptoms such as wheezing, chronic cough, atypical chest pain and dental erosions (cavities).

The critical news: "There is only a mild-to-moderate correlation between the severity or frequency of the symptoms and the severity of the disease," says Mitchell S. Cappell, MD, PhD, chief of Gastroenterology & Hepatology at Beaumont Hospital in Royal Oak, Michigan.

In order to determine the severity of the disease, and, if you actually have GERD, your doctor will use an endoscope to assess the damage in the lower esophagus, in a test called upper endoscopy. Cappell says this test is used to determine how bad is the disease, not the symptoms. "We do not rely on symptoms for the diagnosis for determining the severity of the disease.

"If we see ulcers, erosions, bleeding, or edema (swelling of the lining)—all these things indicate that the condition is serious. We then take biopsies and look under the microscope too. If we see a lot of inflammatory cells, that demonstrates further evidence of damage. It's much more accurate than just symptoms."

Complications of GERD

While severe symptoms don't necessarily lead to complications, they can occur. They include:

  • Bleeding in the esophagus, called hemorrhagic esophagitis.
  • Ulcers in the esophagus.
  • A stricture—a narrowing of the esophagus, or food pipe, that can cause problems with swallowing.
  • Barrett's esophagus, which is a change to an abnormal esophageal lining that can lead to throat cancer.

While all the above scenarios may benefit from surgery, some may be treatable with other procedures. Each case is unique and needs to be assessed by your doctor.

Questions to Ask Your Doctor About GERD Surgery

  • Is it GERD? Could it be something else, like a heart attack?
  • What types of surgeries are available?
  • What are the risks of surgery?
  • Are there other procedures to consider?
  • Can I get the procedure done laparoscopically?
  • What is the recovery time?
  • Am I a good candidate for this type of surgery?
  • Will I still need to take medication?

When to Call Your Doctor

Unfortunately, if you're not able to control symptoms with medication, you may not respond well to the surgery. On the flip side, if you're taking daily medication to relieve your heartburn symptoms, you may be a good candidate for surgery, says Richard Desi, MD, the Institute for Digestive Health and Liver Disease at Mercy Medical Center in Baltimore. He says the ideal patient is someone who is able to control symptoms with medication, but if they go off the medication, their symptoms will keep coming back.

"There are the rare people that have refractory symptoms and are willing to try something else because they can't get their symptoms under control. I'd send them to a surgeon to see if it could possibly benefit them."

Ask yourself these three questions before asking your doctor for a referral to a surgeon:

  1. Are you interested in surgical procedure instead of medical therapy?
  2. If you've tried coming off the medications, do the symptoms keep returning (refractory reflux symptoms)?
  3. If you don't like taking medications, do you want to rely on medications for the rest of your life?

"If you're not interested in surgery, then I wouldn't recommend it," says Desi. "There's no inherent advantage to the surgery vs. symptomatic therapy by taking antacids."

Mitchel S. Cappell, MD, PhD, and Richard Desi, MD, reviewed this article.




Mitchell S. Cappell, MD, PhD, Chief, Gastroenterology & Hepatology at Beaumont Hospital in Royal Oak, Michigan

Richard Desi, MD, The Institute for Digestive Health and Liver Disease at Mercy Medical Center in Baltimore