I have GERD with bile and acid reflux. Drugs have not controlled it in two years. I take Prevacid and about 15 Gaviscon per day. Otherwise I am in excellent health, but I did have a stent placed in my heart three years ago. Would that mean I cannot have laparoscopic fundoplication surgery for GERD?

Robert

Treatment of GERD is remarkably successful in almost all patients if drugs are carefully prescribed and their effectiveness monitored. If your symptoms are not improving on Prevacid, it is possible you are not taking enough or are not taking it correctly. For example, it is best to take Prevacid about 15 minutes before breakfast; if you are taking it twice a day, the second dose should be 15 minutes before dinner. Food activates the acid-producing cells and allows the drug to work at its best.

If you are taking Prevacid twice a day and still have symptoms, you should ask about having a prolonged pH monitoring study -- to assess the stomach acidity and acid exposure in your esophagus -- while still on the drug, to be certain it is working effectively. Your gastroenterologist can adjust your drugs and add additional doses if your acid is not controlled.

I do not advise having surgery until you are certain that GERD is causing your symptoms. The best surgical outcome occurs in people whose symptoms are relieved with medicine who choose to have surgery so they do not have to take pills any more. The cardiac stent should not prevent laparoscopic surgery if you choose to have it.