Barrett's Esophagus and Nissen Surgery: Reader Comments

Q:  I was glad to see your column on Barrett's Esophagus because I too have been diagnosed with Barrett's. I was unable to get my questions answered by the specialist and my family doctor knows nothing of the disease so most of my information comes from searching the web. It is still in the early stages and I am on Prevacid and Propulsid, which apparently helps the food to move through your digestive tract more quickly. Unfortunately medication does nothing to help the nausea I get after eating, especially in the evening. I do eat very small meals and eat nothing 4 hours before I go to sleep.

I believe my problem is caused by weak sphincter muscle and I was wondering if you could write an article explaining a surgery called Laparascopic Nissen Fundoplication. I am thinking about having this surgery done. How do I find out who has had the most experience doing it, and what is the down side?

Q: I enjoyed your column on the history of Barrett's, the medical therapy and lifestyle modification one can undertake to treat the disease. I am concerned however that those readers who have severe gastrointestinal reflux disease (GERD) might get the impression that there is no long-term cure. Your article did not address the positive results available through surgery for those refractory to medication. Articles on laparoscopic Nissens report up to 98% symptom-free cure rate after 3 to 4 years follow-up. Many surgeons throughout Milwaukee and Wisconsin cure severe GERD sufferers with this minimally invasive procedure. These patients experience a significant change in their lifestyle and face a much reduced possibility of Barrett's esophagus progressing into a malignancy.

Q: In your column on Barrett's Esophagus, you didn't mention the surgery where the stomach is wrapped around the esophagus as a means of correcting the cause of the problem. My 69-yr-old husband has a Barrett's Esophagus due to having acid reflux most of his life from a hiatal hernia. He had the above mentioned surgery a year & a half ago with much success. He no longer has any acid reflux & doesn't need to take any medication. He will continue to have an endoscopy every year or two to monitor his condition.

A:  Thank you all for bringing the Nissen procedure to the attention of our readers. This operation involves taking the top of the stomach and wrapping it around the bottom of the esophagus where it connects to the stomach. This creates a one-way valve so food can go down, but acid can't go back up.

Michael Demeure, MD, formerly an Associate Professor of Surgery at the Medical College of Wisconsin, leads a team of surgeons who perform laparoscopic Nissen surgery at Froedtert Hospital. He says the laparoscopic technique requires a 2-day hospital stay, has less complications than the old open approach, and the patient is back at work in 2-3 weeks.

About 20-30% of patients will have some symptoms of food sticking for a few weeks after the operation because of edema (fluid) around the sutures. About 10% may feel they can't burp and get "gas bloat" for about 4-6 months post-op, especially if they've eaten a large meal or drank carbonated beverages. If these symptoms don't subside, it may indicate that the wrap is too tight. For these patients dilation of the esophagus (by endoscopy through the mouth) may help. A small percentage of patients (about 2%)may need a re-do surgery. Dr. Demeure routinely schedules a barium swallow study 6 months after the surgery to check on the functioning of the esophagus. Long-term, there is about a 10% chance that the wrap will loosen after 10 years.

It is very important to choose a surgeon who has experience with the procedure. I would ask the surgeon for statistics (how many he/she has done, complication rate, etc). Personally I would want someone to have done the procedure at least 20 or so times before I would let him operate on me.

While the relief from heartburn is excellent, there is no evidence that Barrett's regresses or disappears, so people with severe Barrett's really need their esophagus removed, not a Nissen procedure. For people with milder Barrett's who have had a Nissen, a yearly endoscopy is still crucial.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.