Surgery Preferred Response over Proton Pump Inhibitor in Younger Heartburn Patients

Cincinatti, OHThe potential for fracture and other adverse reactions when using proton pump inhibitors (PPIs) to control acid reflux should factor into a doctor's decision when recommending either PPIs or surgery for younger patients. In older patients, PPI can also lead to hip fracture, serious infection and even death.


The University of Cincinnati (UC) refers to recent studies published in the Archives of Internal Medicine suggesting that the risks of treating heartburn with PPI medications may outweigh the benefits for those patients whose acid reflux is less serious.

Thomas Husted, MD, a general surgeon with UC Health and clinical instructor at the University of Cincinnati College of Medicine, says many younger patients may be averse to the idea of taking medication long-term. For those individuals, he says, surgery is a preferred solution.

"This is especially important for people who have a low-grade Barrett's esophagus, a precancerous condition that puts certain patients at higher risk for esophagus cancer," says Husted in the UC press release. "When the problem is identified early, surgery can stop the tissue changes that lead to esophageal cancer."

Patients who had anti-reflux surgery—known medically as Nissen fundoplication—report an 87 to 95 percent improvement in symptoms one year post-surgery without medication, according to data from the Society of American Gastrointestinal and Endoscopic Surgeons.

"Several anatomic functions have to work together where the stomach and esophagus meet to avoid reflux," Husted stated in the press release. "If a part of that protective system is flawed, the patient ends up with reflux and the patient often experiences chest pain and sour tastes in the mouth.

"Proton pump inhibitors reduce the symptoms, but they do not stop the reflux or potential changes in the esophageal lining that can lead to cancer."

Acid reflux, known medically as gastrointestinal reflux disease, occurs when there is a breakdown of the protective mechanism between the esophagus and the stomach. A Proton Pump Inhibitor can serve to relieve the symptoms, but can lead to problems such as osteoporosis and PPI fracture. In some cases, PPI side effects can leave a patient prone to the potentially deadly Clostridium difficile (C. difficile) infection.