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Dear Dr. Roach: For years, my 80-year-old aunt has been suffering from profound reflux problems that result in vomiting. Her esophagus was surgically detached from her stomach for over a year. Now that it is reattached, she undergoes "stretching" of her esophagus to curb reflux and vomiting. She has some short-lived improvement so far.
I struggle to understand how such a severe condition occurs and what the prognosis can be. Would you explain? -- J.H.
Answer: If you're really saying what I think you're saying, I am very surprised. A diverting esophagostomy is a procedure where the esophagus is truly detached from the stomach. Of course, this would mean that all food and water would have to come through a tube, such as a gastric tube that is placed through the abdominal wall.
I have never seen this procedure done, but my reading says that it is done primarily in people with neurological problems where there is no other choice or those who have failed other treatments.
When lifestyle treatments alone fail, standard medical treatments for reflux disease include medications to reduce acid and promote food to go out of the stomach into the intestines. If people do not do well with these, standard surgical treatments include fundoplication, which tightens the lower esophageal sphincter (the muscular valve-like structure at the bottom of the esophagus).
There are several surgical approaches to do this, including both laparoscopic and endoscopic options. My experience with these has been generally favorable. A recent procedure, magnetic sphincter augmentation, has been shown to have similar effectiveness, and I have had a few patients (and several readers) write in to tell me that they have also been generally pleased with this treatment.
When all other surgical treatments have failed, esophagostomy has been attempted, but experts recommend a very careful consideration beforehand. Complications include a stricture (a partial blockage of the esophagus), which needs to be treated through stretching it, usually with a balloon procedure. This may be what is happening with her.