Today acid suppression medication as treatment for acid reflux is so effective, indications for surgery are now very few. Indications for surgical treatment are listed below.

Medication failure: Proton pump inhibitors are so efficient in acid reflux treatment, healing and remission is extremely high. There are, however, a rare few GERD patients who do not respond to medical treatment of acid reflux. Even high doses of proton pump inhibitors fail these patients.

These patients have very severe symptoms and severe physical reflux. The reflux problem, in such an individual, is persistent in spite of medical treatment.

Severe complications: This is common in younger patients (under 50) and includes ulcers that fail to heal in Barrett’s esophagus and benign strictures.

Pulmonary Aspiration:Very uncommon and surgery is indicated especially in children. The refluxate reaches the lungs.

Alkaline Reflux Disease: This is as a result of previous surgery to the stomach and if it is associated with severe esophagitis where medical treatment for acid reflux is ineffective, then surgery is indicated.

Recurrent Relapse: This indication is no longer applicable since we now know it is safe to use proton pump inhibitors on a long term basis.

Failure to comply with regime of regular medication has been considered an indication for surgery but this is contentious. It is debatable whether poor compliance is an appropriate reason for surgery.

Dr.Phil Hariram,