People want to see a doctor without surgery if they can take medicine, so can GERD be cured by taking medicine? Surgeon: Surgeons also hope that patients will not operate if they can, but only when surgery is indicated. The systemic treatment of GERD has become very standardized, and most patients are first treated with medication by a gastroenterologist after diagnosis. There are several types of medications used: the main one is acid suppressants, which are less acidic in the stomach and will not irritate the esophageal mucosa even if it refluxes, and will not easily lead to further lesions; another common oral medication is gastric motility medication, which makes the stomach move faster and the pressure in the stomach less, which will also reduce reflux. The vast majority of patients can get their condition under control with medication. That’s why we also ask patients to have at least eight weeks of systematic treatment with medication before surgery. In layman’s terms, the purpose of the medication is to reduce the acidity in the stomach, but it doesn’t solve the “bad interface” between the stomach and the esophagus. Doctor: Yes, acid suppressants do not control reflux, and there are no medications that can effectively increase the pressure of the lower esophageal sphincter. When is surgery needed instead of just medication? Doc: It depends on how well the medication works. The vast majority of patients whose symptoms have disappeared with medication can have their medication dose reduced or even discontinued. This includes patients with mild reflux, whose symptoms basically disappear after eight weeks of medication and can be discontinued, but of course this is a minority of patients; there are some patients whose symptoms disappear after eight weeks of medication, but they cannot stop the medication and rely on it for a long time to control their symptoms. Such patients need regular review of gastroscopy, and if no barrett’s esophagus occurs, they can continue drug control. However, some patients start taking medication with good results, but then reflux becomes more and more severe, and even respiratory complications appear, even if the medication is used to the maximum dose still can not control the symptoms, this part of the patients are not recommended to wait any longer, and should choose surgery. What are the specific indications for surgery? Doctor: There are several types of surgical indications, the first one is moderate to severe GERD. The first category is moderate to severe gastroesophageal reflux. The criteria for assessing moderate to severe is that the gastroscopic diagnosis reveals mucosal congestion and edema in the lower esophagus, with ulcers or mucosal changes. In this group of patients, it is not recommended to continue taking medication because moderate to severe changes in the esophageal mucosa cannot be cured even with large amounts of acid-suppressing medication. In the second category, although the patient’s reflux esophagitis is not particularly heavy, but the gastroscopic finding of Barrett’s esophagus, there is a risk of esophageal cancer, it is recommended not to wait any longer, which is also an indication for surgery; in addition, 30% to 40% of patients with gastroesophageal reflux disease are also combined with esophageal hiatal hernia, in this case it is recommended to operate as soon as possible, the effect of drugs on the treatment of gastroesophageal reflux caused by esophageal hiatal hernia is The effect of medication on GERD caused by esophageal hiatus hernia is very poor. Gastroesophageal reflux disease used to be a disease of the middle-aged and elderly, but now more and more young people are also developing this disease. What are the differences in treatment options for young people? Drs.: The reason for the younger age of GERD is that the Chinese lifestyle is becoming more and more westernized. In Australia, we found that the incidence of GERD in their country is much higher than in China, and it develops very early in young people, one reason being obesity and the other being smoking and drinking alcohol. The diagnosis of whether to operate in young people is also based on these diagnostic criteria. However, some young people can have surgery early in order to improve their quality of life, not to take medication every day, and to avoid the greater risk of surgery when they are older.