Severe GERD is hard to live with: Heartburn, regurgitation, difficulty swallowing, and long-term complications that include strictures in the esophagus, Barrett's esophagus, and even esophageal cancer.

But talk to a gastroenterologist and he'll say you can effectively control your symptoms and heal damage to your esophagus with medicinal therapy. Talk to a surgeon and she'll say a procedure to strengthen the lower esophageal sphincter (LES) will prevent acid from refluxing and therefore reduce or completely eliminate your need for medicine.

Who's right? Well, they both are. In a 2011 study published in the Journal of American Medication Association, most patients' symptoms remained in remission after a five-year period whether they were treated with drug therapy (esomeprazole) or surgery (laparoscopic antireflux surgery, or LARS).

QualityHealth spoke with a GI and a surgeon to break down the pros and cons of each treatment. This way, you can confidently discuss treatment options with your doctor. 


Proton pump inhibitors (PPIs)—the class of GERD drugs tested in the study—are usually prescribed for long-term therapy. Available over the counter or as a prescription, they include esomeprazole, lansoprazole, omeprazole, and dexlansoprazole.

"If you take a medicine that controls your symptoms and you're doing fine on it, then that would be your best solution," says Richard Desi, MD, of the Institute for Digestive Health and Liver Disease at Mercy Medical Center in Baltimore. "It's not a one-size-fits-all solution. There are people that don't want to take medications, but there are a lot of people that do."

Here's what you need to know about treating GERD with drugs:

Pros of PPIs

  • Can effectively block acid to prevent reflux and allow the esophagus to heal
  • Controls symptoms in a majority of patients
  • Available with or without a prescription

Cons of PPIs

  • Can inhibit the absorbtion of calcium, increasing the risk for osteoporosis
  • Possible malabsorption of vitamin B12 and iron, increasing the risk of anemia
  • Increased risk of C. difficile infection (a bacterial infection of the colon)
  • Increased risk of asthma and pneumonia
  • Cost of medication over a prolonged period of time


The surgery to treat GERD is called Nissen fundoplication. It's basically a wrap around the LES that supports and strengthens the valve to prevent acid and bile from refluxing into the esophagus, says Carson Liu, MD, board-certified surgeon in Santa Monica, CA. It can be performed using a laparoscope (a thin tube that enters the body via small incisions in the belly), which is preferred over an open procedure, because it is less invasive and has a quicker recovery period. (Dr. Liu performs a procedure using an endoscope, but it was not included in the study cited above.)

"It's important for people to understand that if they're being treated with medications and their symptoms are gone that it doesn't mean they're not refluxing. You can still be refluxing a neutral pH but the bile salts are still irritating the lining of the esophagus," says Dr. Liu. Your doctor can perform an endoscopy to determine if there's any damage. "By repairing the valve, we can prevent the bile salts from touching the esophagus."

Another reason to consider an endoscopy: prolonged treatment of PPIs may mask symptoms of GERD-associated esophageal cancer, says Liu.

Here's what you need to know about treating GERD with surgery:


  • Reduces or eliminates the need for drug therapy
  • By strengthening the LES, you're not reducing the stomach acid, which is a defense in destroying viruses or bacteria in the stomach
  • After a brief period of being on a liquid diet, you can usually resume eating foods you once had to avoid


  • Anesthesia complications
  • Bleeding
  • Gas bloat
  • A feeling of tightness in the throat
  • Initial cost of surgery

Only you and your doctor can make the decision that's right for you. If you experience severe GERD symptoms, talk to your doctor about treatment options today.

Richard Desi, MD, reviewed this article.




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

Carson Liu, MD, board-certified surgeon in Santa Monica, CA.

Laparoscopic Antireflux Surgery vs. Esomeprazole Treatment for Chronic GERD: the LOTUS Randomized Clinical Trial. JAMA. 2011 May 18. Web.

Treatment Options for GERD or Acid Reflux Disease: A Review of the Research for Adults. U.S. Department of Health & Human Services. Set 23, 2011. Web.