I've been suffering from heartburn for almost a year now. I take Prilosec twice daily. My doctor has suggested laparoscopic fundoplication, but I am reluctant to have surgery. Because of this, my doctor suggested that I lose 10 pounds. I'm five-foot-four and weigh 135 pounds. The weight loss is supposed to allow me to reduce my dosage of Prilosec. What is your take on this?

D.E.

Heartburn is a symptom of GERD (gastroesophageal reflux disease), a common problem caused by reflux of stomach acid into the esophagus. The first line of treatment for this disease is lifestyle modification. This includes weight loss, adjustment of meal times (no eating before sleep), adjusting the types of food eaten (less caffeine and fatty foods) and even raising the head of the bed (for those who experience nighttime symptoms).

Although lifestyle modifications bring lasting relief to a few patients, most still have some symptoms even after making these changes, and many find it difficult to continue these changes for long periods of time. Keep in mind that GERD is a chronic disease that often recurs when treatment is discontinued. The second-line therapy for GERD is medications -- and for people with severe or complicated GERD, medications are a first-line treatment. The medications used include H2-blockers, such as ranitidine (Zantac) or cimetidine (Tagamet), which inhibit acid production in the stomach. Patients often require high doses of these medications, but they tend to be effective. The advent of proton-pump inhibitors, such as omeprazole (Prilosec), has simplified the drug therapy for GERD. These are the most potent acid-inhibitors available and are more effective than the H2-blockers.

Another therapy for GERD is surgery. The procedure, called fundoplication, involves wrapping the upper stomach (fundus) around the lower esophagus to increase the pressure at that location and prevent reflux. Candidates for surgery include those who have obtained good relief from medications but who do not wish to take medications for the rest of their lives. Also, patients who have had complications of GERD, such as esophageal strictures or pneumonia, are often referred for surgery. Patients who do not respond to medications (and truly have GERD by accurate testing) also may benefit from surgery.

In your case, weight loss may aid somewhat, although you are certainly far from obese. If you are young and your symptoms are well controlled with Prilosec, you might consider fundoplication to avoid long-term medication. You should discuss these issues with your doctor. You should also discuss the options with a surgeon who is experienced in fundoplication (especially the laparoscopic type), paying special attention to the risks of the procedure and its potential benefits.