Gastroesophageal Reflux Disease (GERD)

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Specialists at Houston Methodist Lynda K. and David M. Underwood Center for Digestive Disorders provide advanced individualized therapies, cutting-edge research and clinical trials to treat GERD.


Gastroesophageal reflux disease (GERD) is a serious condition where the valve in the lower esophagus (swallowing tube) does not close completely. Digestive acids in the stomach travel back up into the esophagus, which causes inflammation and pain.


Warning signs of the gastrointestinal (GI) disease include — but are not limited to — a burning sensation in the back of the mouth and heartburn. If these symptoms occur two to three times per week, it could be GERD and you should consult with your doctor.


Our gastroenterologists have decades of experience. We channel our vast knowledge and work as a team to provide compassionate care and treatments for patients with GI pain or inflammation. U.S. News & World Report ranks Houston Methodist Hospital best in Texas and No. 5 in the nation for Gastroenterology & GI Surgery. U.S. News & World Report also named us No. 1 in Texas for the 12th year in a row and a nationally ranked Honor Roll hospital in 10 specialties.

Advanced Diagnostic Procedures for GERD

The Underwood Center drives research on gastrointestinal (GI) diseases to help patients with a wide variety of digestive conditions. Our team of GI specialists diagnoses GERD by performing procedures such as:


We use cutting-edge research and clinical trials in a collaborative environment to recommend the best medication, lifestyle changes or surgery for your reflux disease symptoms. 

GERD Symptoms, Risk Factors & Treatments

What are the signs and symptoms of gastroesophageal reflux disease?

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.

What are the risk factors of gastroesophageal reflux disease?

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 

How is gastroesophageal reflux disease treated?

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.
  • LINXTM 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.

More About the Surgical Options for GERD

Why may I need surgery, and what should I expect?

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
  • 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.

What should I expect with Laparoscopic 360º Fundoplication?

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.

What should I expect with 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.


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.

What should I expect with 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.

What should I expect with 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 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.

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