I will briefly talk about a patient with severe heartburn, suffering for the past 7 years. I saw him a year back with his latest endoscopy report showing Grade A esophagitis that is a mild form of damage to the food pipe due to acid coming back into the food pipe from the stomach. But his was despite high dose of acid suppressing medications he was having since past few years.
He was unable to stop them due to severe heartburn giving him sleepless nights and a affecting his daily work. Significantly affecting his quality of life. I suggested him to undergo a 24 hr pH with Impedance study and undergo surgery for a permanent solution. The pH with impedance study showed severe reflux and also suggested that all his symptoms are due to reflux (good symptom reflux correlation by high Symptom association probability or SAP). All this point to surgery as a permanent solution. Surgery is laparoscopic with very quick recovery.
But like all humans he being scared of surgery, differed it. Took opinion of multiple doctors physicians, gastro physicians, surgeons and G I surgeons. All having their own opinion further confusing him. After a year that showed further worsening of his symptoms he is finally planned for surgery in a couple of days.
While I am sure of giving him a permanent solution to his problems with a Laparoscopic Fundoplication surgery, the question is when a patient should say enough is enough? Many doctors not used to see the outcomes of these surgeries may not be confidant in suggesting surgery for your problems. Again in our society sleepless nights and a poor quality of life is considered acceptable. But in doing so we just defer the inevitable to a later date rather than able to prevent it completely. In doing so we just push the patient to have a few more years with a poor quality of life.