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To cut or not to cut

We need to start with a few simple statements of fact. Proton pump inhibitors (PPIs) are a very safe short term treatment. By reducing the amount of acid in the stomach, they reduce the risk of irritation or damage to the esophagus if the sphincter does not close properly. You could get a comparable effect by changing your diet and always eating at least three hours before you intend to go to bed. That way, you will have all the food absorbed into your stomach before you lie down and there is a lower risk of leakage. If your esophagus can begin to heal during the nights, there will be less pain following eating during the day. However, changing lifestyle is not always possible so, in the short term, PPIs are a good way of controlling the problem. But PPIs do not solve the underlying problem of the leaking sphincter. That’s inevitably a physical problem. So, unless you are prepared to consider surgery, the only option is to keep taking the PPIs.

This May, the FDA announced its intention to change the labeling to warn people aged more than 50 there’s a steadily increasing risk of fracturing bones if you take any of the PPIs for more than a year. This means any slight slip or fall could end you in an Emergency Room if you instinctively put down your hands to steady yourself. The wrist can easily break in older people. If you ask the gastroenterologists about this, they will tell you that GERD is not a life-threatening disease. The more obvious symptoms of heartburn can be controlled with drugs. Because there’s always a slight risk of complications during or following surgery, the small risk of fractures is a better option.

So what do the surgeons say? Well, the PPIs are only an effective treatment in about half the cases where you have chronic heartburn. The damage to your esophagus can be caused by bile leaking. It does not have to be stomach acid. More importantly, even when you buy online, the cost of long-term treatment using a PPI for stomach acid can become significant. Most people do not want to be dependent on a drug. The standard surgical procedure to strengthen the sphincter has been in use for more than 60 years. It’s considered routine and safe, now usually performed using laparoscopy. This is allows surgery through a very small incision and allows faster recovery time. There are also procedures accessing the damaged areas through the mouth, causing even less damage. More importantly, if the actual cause of the heartburn is a hiatal hernia that can be cured at the same time. Assuming the surgery, you can go back to eating whatever you want. Unlike continuing use of a PPI like Aciphex, no lifestyle changes are required. None of this undermines the importance of Aciphex or any of the other PPIs. It simply means you should have a long talk with your doctor about the options. Surgery may be a better and more economical solution to your problem.