Gastroesophageal Reflux Disease (GERD)

UC Health Center for Gastroesophageal Reflux Surgery

The Center for Gastroesophageal Reflux Surgery delivers comprehensive, multidisciplinary care for gastroesophageal reflux disease (GERD), hiatal hernias and complex upper abdominal surgeries.  Nationally and regionally renowned surgeons at this center use state-of-the-art technology as part of its culture of academic medicine, providing patients with access to new and evolving comprehensive medical care and improving outcomes.

Conditions We Treat

Gastroesophageal reflux disease (GERD) results from the muscular opening between the stomach and the esophagus, the tube that carries food from the mouth to the stomach, weakening or not functioning properly. This muscular opening, or sphincter, should prevent normal levels of stomach acid and food from traveling up into the esophagus and causing acid reflux. While some acid reflux is normal, patients with GERD typically experience the following symptoms more than two times a week. This can cause ongoing discomfort and damage to the esophagus. Sometimes reflux symptoms occur because the esophagus does not move food or liquids into the stomach properly through a bodily process called peristalsis.

Symptoms of GERD are:

  • Heartburn—Burning feeling in the middle of the chest
  • Regurgitation—Feeling of food coming back up into the throat
  • Chest pain—Tightness in the chest, usually after eating
  • Dysphagia—Feeling of food sticking in the throat with difficulty swallowing liquid, food or pills
  • Hoarseness—Change in voice or a problem with speaking
  • Water brash—Excessive amount of saliva
  • Excessive throat clearing or throat mucus
  • Troublesome cough that won’t go away
  • Choking after eating or lying down

Often symptoms are worse at night or when lying flat and after eating certain types of foods, including spicy foods or foods high in acid (coffee, tomato-based foods and citrus juices). GERD is often found in association with a hiatal hernia, which is an abnormal opening in the diaphragm, or muscular wall, between the chest and abdomen.

There are several types of hiatal hernias. An opening between the chest and abdomen can cause the stomach to slide up into the chest (sliding hernia) or part of the stomach to move up next to the esophagus (paraesophageal hernia). These hernias can exacerbate acid reflux.

Other diseases associated with GERD include:

  • Laryngopharyngeal reflux (LPR)—Also known as “silent reflux,” LPR occurs when stomach acid travels all of the way back up into the throat and vocal cords. Symptoms include hoarseness, excessive throat clearing, coughing or trouble breathing. Traditional reflux symptoms usually aren’t present. Patients should consult an ear, nose and throat physician for diagnosis of LPR.
  • Barrett’s esophagus—In patients with long-standing GERD, cells that line the esophagus may change over time. While this disease is associated with a low risk of esophageal cancer, patients should monitor their condition with EDG/endoscopy, biopsy and possibly surgery.
  • Achalasia—Achalasia involves abnormal peristalsis, or the muscular movement that carries food and liquid down the esophagus, and the inability of the sphincter at the bottom of the stomach to relax. This disorder causes dysphagia and regurgitation and can be improved with surgery.

How We Diagnose

To find out whether a patient has GERD, a gastrointestinal (GI) physician will perform a series of tests.

These tests include:

  • Esophagogastroduodenoscopy (EGD) or endoscopy—A small camera is passed through the mouth, down the esophagus and into the stomach to take a biopsy or sample. This procedure is performed under light anesthesia.
  • pH study—A small pH probe is clipped to the inside of the esophagus during an EDG (see above). This probe measures pH, or acid, levels and transmits them to an external receiver worn for 48 hours that tracks how often symptoms occur.
  • Upper GI or fluoroscopy study—A patient swallows a contrast fluid that appears on an X-ray. This test evaluates the ability to swallow and how well the esophagus and stomach empty to detect a hiatal hernia. No anesthesia is required.
  • Manometry—A thin, flexible tube is inserted through the nose and into the esophagus that measures pressure during swallowing. This test will help diagnose abnormal peristalsis, or swallowing movements, and does not require anesthesia.

How We Treat

GERD and other associated diseases can be treated through medication, lifestyle changes and surgery.

  • Dietary modification—To reduce symptoms of reflux, patients should avoid eating late at night, lying down after eating, and foods that can worsen symptoms such as spicy or acidic foods. Patients are also encouraged to eat smaller, more frequent meals and thoroughly chew each bite.
  • Medications—Over-the-counter and prescription medication can help control symptoms of reflux by reducing stomach acid. Medications is used to treat these symptoms before surgery is considered.
  • Surgery—Performed under general anesthesia, laparoscopic (minimally invasive) surgery can repair or reconstruct the source of GERD symptoms by strengthening the sphincter connecting the esophagus to the stomach. Surgery may involve repairing the hiatal hernia by stitching the opening in the diaphragm closed, pulling the stomach back down into the abdomen and wrapping it around the lower esophagus for reinforcement, called fundoplication. Surgical solution for achalasia, called a Heller myotomy, helps food and liquid pass into the stomach more easily by partially splitting the muscles around the esophagus, thus allowing it to relax. Recovery from surgery involves a short period of hospitalized observation, ensuring patients can successfully swallow a liquid and then soft diet before they are discharged. Patients must follow strict dietary restrictions six to 12 weeks following surgery, avoiding raw fruits and vegetables, carbonated beverages and large pieces of meat or bread. A new procedure — POEM (Peroral Endoscopic Myotomy) — allows creation of the myotomy without any abdominal incisions. Follow-up includes an upper GI to assess swallowing the morning after surgery. A full liquid diet is initiated which typically lasts two weeks after which time the patient’s diet is slowly advanced. Patients are typically seen in clinic two and six weeks post procedure.

UC Health surgeons who treat GERD