We were asked about surgical options for treating gastroesophageal reflux disease (GERD). GERD occurs when stomach contents, including acid, go "backwards" from the stomach up into the esophagus. It is sometimes referred to as heartburn or acid reflux. GERD is common in infants and children with Down syndrome and it can continue to be a problem for adolescents and adults with Down syndrome (1).
Before considering surgery, other ways to reduce and treat GERD typically will be recommended. These include lifestyle changes and medications. More information about these options can be found in this GERD resource on our website.
If lifestyle changes and medications do not alleviate the symptoms of GERD, antireflux surgery may be considered. In August 2019, a multidisciplinary group released international consensus guidelines .png "The preceding link opens in a new tab or window.")
for surgery (2,3). 
According to the guidelines, antireflux surgery may be indicated for:
- Patients with heartburn who demonstrate a satisfactory response to proton-pump inhibitors (PPIs) who desire definitive, one-time treatment
- Patients with symptoms that are not completely controlled by PPIs
- Patients with a hiatal hernia (a type of hernia involving the stomach)
- Patients with esophagitis (inflammation of the esophagus) of Los Angeles grade B or higher
- Patients with Barrett esophagus (pre-cancerous changes)
- Patients who struggle with medication compliance
- Patients who are postmenopausal women with osteoporosis (PPIs can contribute to osteoporosis)
Poor candidates for antireflux surgery include:
- Patients with functional heartburn (symptoms similar to heartburn but not caused by acid reflux)
- Patients with eosinophilic esophagitis (a particular type of inflammation in the esophagus not caused by reflux)
Prior to surgery, other procedures such as an endoscopy or a barium swallow study may be recommended.
While we have not been able to find research on surgery for GERD specifically in adults with Down syndrome, we have had some adults with Down syndrome who have been patients at the Adult Down Syndrome Center whose GERD has been treated successfully with surgery. However, surgery is not the right option for everyone. Ultimately, the decision to pursue surgery is one that should be discussed and made with your health care provider.
More information about GERD can be found at this link and in the references listed below.
References
- Macchini F, Leva E, Torricelli M, Valade A. Treating acid reflux disease in patients with Down syndrome: Pharmacological and physiological approaches. Clin Exp Gastroenterol. 2011;(4):19-22. doi:10.2147/CEG.S15872
- International Society for Diseases of the Esophagus. Antireflux surgery selection guidelines (2019). Medscape. https://reference.medscape.com/viewarticle/917393?src=WNL_drugguide_190909_MSCPREF&uac=136474EX&impID=2085343&faf=1 . Published September 3, 2019. Accessed October 28, 2019.
- Patti MG. Gastroesophageal reflux disease treatment and management: Surgical care. Medscape. https://emedicine.medscape.com/article/176595-treatment#d3 . Published May 23, 2019. Accessed October 28, 2019.