Long-Term GERD: When to Consider Specialty Evaluation
For many patients, acid reflux becomes a long-term condition managed with medication, lifestyle changes, or both. But patients with persistent symptoms, prolonged acid-suppression therapy, dysphagia, or risk factors for complications may benefit from formal reflux evaluation.
Aaron N. Sachs, MD, a Northern Virginia surgeon with UVA Health, specializes in minimally invasive surgery and flexible endoscopy, with a focus on weight-loss and anti-reflux surgery. He encourages referring providers to consider specialty evaluation earlier for patients with chronic reflux — even when the patient is unsure whether surgery is right for them.
“Acid reflux is a lifetime disease with many different treatment options,” Sachs says. “By honing in on surgical options early, even if a patient is not sure if surgery is for them, often a better understanding can be gained on the range of possibilities and outcomes.”
Patients Who May Benefit From Reflux Evaluation
Sachs recommends formal reflux evaluation for patients with:
- Long-standing acid reflux symptoms
- GERD symptoms without prior endoscopy
- Antacid therapy lasting more than a few months
- Dysphagia or swallowing concerns
- Known or suspected Barrett’s esophagus
- Peptic stricture
- Obesity with concurrent reflux
- Reflux with metabolic comorbidities, including diabetes, PCOS, sleep apnea, or arthritis
“Not only can this help figure out a good long-term plan, but complications such as Barrett’s esophagus can be ruled out,” Sachs says.
For patients with obesity and reflux, a referral may be especially appropriate because treatment planning may need to account for both conditions. Sachs notes that patients with obesity and reflux, diabetes, PCOS, sleep apnea, or arthritis may benefit from evaluation to understand the full range of treatment options.
For patients with long-standing reflux symptoms, prolonged acid-suppression therapy, dysphagia, or no prior endoscopy, UVA Health offers formal reflux evaluation and foregut surgery services in Northern Virginia.
Early Referral Helps Patients Understand Their Options
A reflux referral does not commit a patient to surgery. Instead, Sachs sees early evaluation as a way to help patients make more informed decisions about long-term disease management.
“Even if surgery is not right for a specific patient or it isn’t the right time, an educated patient who understands their options is more likely to have a good long-term health management plan,” he says.
During a new patient visit, Sachs begins by asking patients to share their story, including their symptoms, goals, concerns, and priorities. From there, he discusses available pathways and whether surgical or nonsurgical management may be appropriate.
“If the answer is surgery — great,” Sachs says. “If not — that’s okay, too. There are multiple avenues to achieve healthy goals.”
What You Can Expect After Referral
When a patient is referred, Sachs emphasizes communication with the referring provider.
“We make sure to forward all our consultation and follow-up notes in addition to copies of any operative procedures we do,” he says. “Referring practitioners should also never hesitate to reach out directly with a question or concern.”
His team also contacts referring offices when needed to coordinate care.
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