Gastroesophageal reflux disease (GERD), which causes heartburn and chest pain due to stomach acid flowing back into the esophagus, affects one in ten Koreans. For patients whose condition does not respond to medication or who have been taking drugs for five to ten years, anti-reflux surgery may offer an alternative solution.
Park Sung-soo, a professor of gastrointestinal surgery at Korea University Anam Hospital and a leading expert in surgical treatment for refractory GERD, said medications only reduce stomach acid but do not address the fundamental cause of the disease—reflux itself.
"After precise diagnosis through detailed examinations, patients who are appropriate candidates should consider anti-reflux surgery," Park said. "For refractory patients, surgery is far more effective than medication, and the evidence supporting this has accumulated over time."
Park will appear on Seoul Economic TV's "Now, Medical Experts" program airing at 9 p.m. on the 7th to discuss anti-reflux surgery as a treatment for refractory GERD. Although the procedure has been established as a standard treatment for decades, it has not been widely performed due to patient reluctance toward surgery and the perception that it should only be a last resort.
Accurate Diagnosis Essential for Refractory GERD
GERD occurs when stomach acid and food flow back into the esophagus after meals, causing inflammation and symptoms. Proton pump inhibitors (PPIs) are commonly prescribed, but these only reduce acidity rather than blocking reflux at its source.
"GERD is closely related to lifestyle habits, so even if symptoms improve with medication, the condition easily recurs when trigger factors such as alcohol, overeating, or greasy foods are present," Park explained. "That's why many patients feel it's a disease that doesn't get better."
Symptoms play an important role in diagnosing GERD. Typical symptoms include heartburn and acid regurgitation, while atypical symptoms include chronic cough, hoarseness, and a sensation of a lump in the throat. For patients considering surgery, detailed examinations including 24-hour esophageal pH monitoring and esophageal motility tests are essential.
"When we examine refractory patients with precision tests, about 30% turn out not to have GERD," Park noted. He added that recent findings show stomach contents other than acid can also cause the same symptoms—a condition called non-acid reflux—for which acid suppressants may be largely ineffective.
Surgery Recommended When Medications Fail After 6-8 Weeks
Not all patients are candidates for surgery. Park said patients who respond well to medication without side effects are not surgical candidates. However, those who show insufficient improvement after six to eight weeks of medication, or whose quality of life significantly deteriorates despite long-term treatment, may be considered for surgery.
Candidates for anti-reflux surgery include those who continue to experience heartburn and acid regurgitation despite medication; those whose symptoms are controlled but who struggle to maintain dietary restrictions due to active social lives; and those who experience side effects such as intestinal infections or osteoporosis from long-term medication use.
Surgical Mechanism: Creating a Check Valve
Anti-reflux surgery involves wrapping the upper part of the stomach around the lower esophagus to create a check valve structure at the gastroesophageal junction. This physically blocks reflux by allowing food to pass downward while preventing stomach contents from flowing back up, even when lying down or when abdominal pressure increases.
The technique was developed by German surgeon Rudolf Nissen in the 1950s and has nearly 70 years of clinical history. The procedure is typically performed laparoscopically. Post-operative symptoms such as bloating and difficulty swallowing usually improve within eight weeks, or at most three months, according to Park.
90% Improvement in Heartburn, 70% in Atypical Symptoms
The surgical outcomes are favorable. Park said typical symptoms such as heartburn and acid regurgitation improve by approximately 90% after surgery, while atypical symptoms including throat discomfort and chronic cough improve by about 70%, resulting in high patient satisfaction.
Recovery is relatively quick, with patients typically discharged two days after surgery. A soft diet is recommended for about six weeks to allow for post-surgical swelling.
Regarding concerns about difficulty swallowing, Park said experienced medical teams design surgeries to minimize this complication. "A few weeks of adjustment may be needed immediately after surgery due to swelling, but lifelong persistence is rare," he explained.
Park emphasized that patients with refractory GERD should not rush into surgery but should first confirm their diagnosis through detailed examinations. "Anti-reflux surgery is covered by national health insurance," he added. "Rather than reserving this effective option only as a last resort, it should be actively considered at the appropriate time."
