Gastroesophageal Reflux 

Disease (GERD)

Gastroesophageal reflux disease (GERD) is a serious condition caused by a problem with the valve in the esophagus not closing completely, which causes stomach acid to travel back up into the esophagus. Warning signs can include a burning sensation in the back of the mouth, a fowl taste in your mouth and heartburn. If these symptoms occur frequently, such as two or three days out of the week, it could be GERD and you should consult with your doctor.

Patients with a hiatal hernia may have increased risks of developing GERD. Other risk factors may include obesity or being overweight, pregnancy and smoking. Certain medicines (such as Viagra and Cialis) and foods, as noted below, can also cause reflux symptoms and should be limited if symptoms are severe.

  • Citrus fruits
  • Chocolate
  • Caffeine
  • Alcohol
  • Fatty foods (especially fried) 
  • Garlic
  • Onions
  • Spicy dishes
  • Tomato-based dishes, such as spaghetti sauce, salsa, chili or pizza

Symptoms of GERD
Individuals experiencing symptoms of reflux disease or other gastrointestinal (GI) motility disorders may be referred to the Houston Methodist Reflux Center & GI Physiology Lab by your physician for diagnostic testing. Because reflux symptoms are similar to those of other diseases and/or conditions, it is important to have the following conditions evaluated for a proper diagnosis:

  • Frequent heartburn (especially before bedtime)
  • Regurgitation or belching
  • Difficulty swallowing
  • Nausea
  • Chest pain

Diagnosing and Treating GERD

Houston Methodist plays a leading role in helping patients with a wide variety of digestive conditions and drives research on digestive diseases. Our team of gastroenterology specialists can diagnose GERD by performing an endoscopy, manometry testing, 24-hour pH testing or an esophagram/upper GI X-ray. We use the most advanced individualized therapies, cutting-edge research and clinical trials, all in a collaborative and compassionate environment to recommend the best treatment option ( medication, lifestyle changes or surgery) for your case of GERD. 

Medications

  • Antacids can help neutralize stomach acid.
  • Foaming agents, such as mucosal protective agents, can protect the esophagus lining from deterioration.
  • H2 blockers (H2-receptor antagonists) will reduce the amount of acid produced in the stomach.
  • Proton pump inhibitors (PPI) inhibit the final production step of stomach acid, diluting the content of the fluid.
  • Prokinetic or promotility agents can help empty the stomach faster to prevent acid from going back up the esophagus (acid reflux).

Surgery & Endoscopic Procedures
Surgery or an endoscopic procedure may be a treatment option for GERD patients:

  • Continuing to experience symptoms while taking medicines
  • Unwilling to take medicine every day
  • Avoiding foods that cause increased gastroesophageal reflux to control symptoms
  • Taking medicines that cause unpleasant side effects
  • Suffering disease complications

All GERD surgical treatments involve making a new “valve” at the bottom of your esophagus to help your own valve, which doesn’t work properly. Typically, the primary surgeries performed to treat GERD are done laparoscopically through several small abdominal incisions. Surgeons insert plastic tubes through the holes, and carbon dioxide gas pumped through the tubes expands the abdomen. Surgeons then can see and work through the tubes. They pass a camera and instruments into the abdomen through the tubes to operate. This type of surgery causes patients less pain, leaves small scars and speeds recovery.

Procedures performed to treat GERD are:

Laparoscopic 360º Fundoplication

During Laparoscopic 360º Fundoplication, the surgeon wraps the top of the stomach around the far end of the esophagus and on top of the esophagus valve mechanism, shutting the valve and preventing GERD. Pressure in the stomach rises as patients eat and fill their stomachs. Without the procedure, the increasing pressure would pull open the esophageal sphincter valve from below, causing GERD. With the top of the stomach wrapped around the bottom of the esophagus and esophageal sphincter valve, the rising pressure squeezes the esophagus valve and keeps it from opening. The valve this procedure creates is so effective it can be difficult for patients to burp or vomit after surgery. Many patients complain of gassiness and bloating after surgery. Some complain they can feel food pass when swallowing. Surgeons also will fix hiatal hernias during surgery.

Laparoscopic 270º Fundoplication
During Laparoscopic 270º Fundoplication, the surgeon partially wraps the top of the stomach around the bottom of the esophagus and esophagus valve mechanism. Some surgeons perform this operation if they think the patient’s esophagus is weak, while others often perform it. Generally, this procedure allows patients to burp and vomit more easily than the 360° fundoplication, leading to fewer complaints about gassiness or bloating after surgery. Patients also complain less about swallowing the first year or two following 270º fundoplication. Surgeons also will fix hiatal hernias during surgery.

Laparoscopic Linx Magnetic Esophageal Sphincter Augmentation
During Laparoscopic Linx Magnetic Esophageal Sphincter Augmentation, the surgeon makes a small opening behind the far end of the esophagus, at the bottom of the esophageal sphincter valve mechanism and just above the stomach. The surgeon passes a small titanium ring of magnets through the opening at the front of the esophagus. The ring of magnets sits on top of the far end of the valve and prevents the esophagus sphincter valve from being pulled open from below when the stomach is full. A patient with a normal esophagus can push hard enough to easily open the magnets from above when they swallow. Most patients will not fill their stomach enough to pull open the magnets from below, preventing GERD. Patients usually burp and vomit easily through the magnetic ring. Few patients complain of gassiness or bloating after surgery.

The surgeon can remove the ring and perform a 270° or 360° fundoplication if the device stops working. 

In rare cases, a surgeon will undo a 360° fundoplication and perform a 270° fundoplication. A surgeon will not undo a 360° or 270° fundoplication to insert a Linx magnetic ring.

Transoral Incisionless Fundoplication (TIF)
During Transoral Incisionless Fundoplication (TIF), a flexible endoscope is passed through your mouth and esophagus into your stomach. A device attached to the endoscope grabs the place where the esophagus and stomach meet. As the device pulls down, the stomach folds up around the esophagus. The device staples the stomach to the esophagus with plastic fasteners look like those used to attach store clothes tags. The stomach is partially wrapped around the far end of the esophagus and esophagus sphincter valve. Some small hiatal hernias can be fixed during this procedure. General anesthesia is used. TIF can alleviate some GERD symptoms. After the procedure, patients may not need medicines or as much medicine to treat GERD. TIF causes fewer side effects such as gassiness, bloating or swallowing than other procedures. However, it is less effective than some surgeries in preventing GERD. A fundoplication surgery usually can be performed after TIF.

Stretta
During Stretta, a flexible endoscope is passed through your mouth into the far end of the esophagus. A balloon covered with small metal pins is put at the esophageal sphincter valve in your esophagus. The balloon is inflated, pushing the pins in the esophageal sphincter valve tissue. The device uses a form of electrical energy called radiofrequency to heat the tissues, stiffening the valve to improve its function and prevent GERD. Stretta can alleviate some GERD symptoms. After the procedure, patients may not need medicines or as much medicine to treat GERD. Stretta causes fewer side effects such as gassiness, bloating or swallowing than other procedures. However, it is less effective than some surgeries in preventing GERD. A fundoplication or Linx magnetic ring surgery usually can be performed after Stretta.

Of all the procedures, Laparoscopic 360º Fundoplication is best at stopping GERD, but has the most side effects. Laparoscopic 270º Fundoplication is good at stopping GERD and comes with fewer side effects. However, GERD is more likely to reoccur after the procedure. TIF and Stretta are least effective at stopping GERD and have fewest side effects.

TREATMENT LOCATIONS

Physicians at Houston Methodist specialize in managing gastroesophageal reflux disease (GERD) at the following convenient locations.