If patients still want to wait until they are 40 or 50 years old when their symptoms are severe before surgery, will the results of surgery then be the same as if they had surgery when they were younger? Drs: First of all, I would like to talk about long-term medication. Although long-term medication can reduce the damage to the esophageal mucosa after the symptoms are controlled, long-term use of acid suppressants, which do not produce gastric acid, can affect digestive function on the one hand and have certain side effects, such as liver and kidney function damage, and some patients will have reduced white blood cells. Of course, purely in terms of surgical results, there is not much difference between a patient undergoing anti-reflux surgery at the age of 30 or 50, but in terms of the body’s ability to tolerate the surgery, it is definitely the younger patients who have a better cardiopulmonary tolerance, get out of bed earlier and recover faster after surgery. For the prevention of Barrett’s esophagus, which is better, surgery or medication? Drs: Surgery is better than medication. Medication suppresses acid but not reflux, and the mucosa of the lower esophagus is still irritated by the stomach contents, only less irritated; surgery can completely control reflux. In a five-year clinical trial in Australia, it was found that after laparoscopic fundoplication in patients with preoperative Barrett’s esophagus, the majority of patients no longer had progression of Barrett’s esophagus, and some patients had healing of Barrett’s esophagus. This is the advantage of surgery over drug therapy. How do doctors determine that a patient is due for surgery? Drs.: UF is a close collaboration between general surgery and gastroenterology. The patient’s first visit is to the gastroenterology department, where the gastroscopy examines the lower esophagus for mucosal changes and the mildness or severity to make a diagnosis and grade the patient’s condition. The patient is then treated with medication by a gastroenterologist for eight weeks. Some patients who have been on medication for five or six years do not need to undergo this step. The next step requires an upper gastrointestinal tract imaging, which is often referred to by the people as drinking a barium meal, followed by fluoroscopy under radiation. This test not only shows whether there is any stricture in the esophagus, whether there is a hiatal hernia in the esophagus, but also whether the esophageal dynamics are good. If the esophagus peristalsis is good, the barium can reach the stomach smoothly, and then the stomach will discharge the barium down. Gastroscopy can only be seen in a static manner, while imaging can be seen in a dynamic manner, and the two need to be combined. Finally, the gold standard for diagnosis is 24-hour acid and pressure measurement of the lower esophagus. This test can be performed on an outpatient basis, does not require hospitalization, and is not painful for the patient. A plastic hose about two millimeters in diameter is delivered to the esophagus through the nasopharynx with a probe at the tip of the hose that squirts water, and the pressure of the lower esophageal sphincter is measured based on the pressure of the squirted water reflecting back from the esophageal wall. This device needs to be carried for 24 hours and the patient can wear it home and eat, move around, go to work and sleep without being affected. If the patient feels reflux, he or she presses a button on the instrument. The next day the instrument is removed when the patient returns to the hospital. The doctor then uses software to analyze the recorded information, counting how many times the patient has had acid reflux in 24 hours, what factors are associated with these refluxes, and derives a score for acid reflux. If the score is greater than 14 it is above normal, greater than 50 is moderate reflux, and greater than 100 is severe reflux. These four steps are very necessary in a standard treatment protocol. After such a systematic evaluation, the patient is finally confirmed to have an indication for surgery. Which patients are not candidates for surgery? Drs: For patients with insufficient esophageal motility, with the further development of laparoscopic surgery, a different surgical approach, such as laparoscopic partial fundoplication, can be appropriately selected, which can effectively control reflux without affecting esophageal motility due to a too tight anti-reflux valve, causing the patient to be unable to eat.