Gastroesophageal Reflux Disease (GERD)

Because the lower esophageal sphincter (LES) fails when you have GERD, surgical treatments may be necessary to make a new “valve” at the bottom of your esophagus. Discuss surgical options with your doctor if you:

• Continue to experience symptoms while taking medicines
• Do not want to take medicine every day
• Experience disease complications
• Are diagnosed with a hiatal hernia
• Take medicines that cause unpleasant side effects

Our primary method of treating GERD is with laparoscopic surgery through several small abdominal incisions.

Surgeons insert plastic tubes through the incisions to pump carbon dioxide gas through the tubes, which expands the abdomen. Surgeons pass a camera and instruments into the abdomen through the tubes to perform the surgery. Laparoscopic surgery is minimally invasive and causes less pain, leaves small scars and speeds recovery.

During Laparoscopic 360º Fundoplication, a 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.

During Laparoscopic 270º Fundoplication, the surgeon partially wraps the top of the stomach around the bottom of the esophagus and esophagus valve mechanism.

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.

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.

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 that look similar to those used to attach store clothes tags. The stomach is partially wrapped around the far end of the esophagus and esophagus sphincter valve.

After the procedure, patients may need less medicine or none at all 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. Some small hiatal hernias can be fixed during this procedure. General anesthesia is used.

Because reflux symptoms are similar to other conditions, we will evaluate the common symptoms below to identify the cause of your GERD pain:

• Chest pain
• Difficulty swallowing
• Frequent heartburn
• Nausea
• Regurgitation or belching

Individuals experiencing symptoms of reflux disease or other GI motility (movement) disorders will receive diagnostic testing from gastroenterologists at the center.

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

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

Our team treats GERD on an individual basis with a variety of techniques such as any of the following:

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

If medication is unsuccessful, surgical options we may offer include any of the following:

• 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.
• LINX^TM procedure – involves placing a flexible ring of small magnets around the lower esophageal sphincter (LES). The strength of the magnets is precisely calibrated to help keep the weak LES closed so as to prevent reflux.
• TIF is not as effective at stopping severe GERD but has few side effects.