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Digestive Diseases

Gastroesophageal Reflux Disease (GERD)

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• About GERD
• Symptoms of GERD
• Risk Factors for GERD
• Diagnosis of GERD
• Treatment for GERD
• Research for GERD
• Contact Information

Gastroesophageal reflux disease (GERD) develops when the muscle between the esophagus and the stomach, the lower esophageal sphincter (LES), which normally acts as a valve to let food enter the stomach, opens spontaneously or does not properly close, resulting in stomach contents backing up into the esophagus. This reflux, or backwash of food, acid and enzymes into the esophagus may cause a burning sensation in the throat or chest. If this occurs more than once or twice a week, such acid reflux is considered to be GERD, and may lead to serious health problems.

GERD irritates the esophagus and can lead to a narrowing and/or ulceration of the esophagus, a risk of Barrett's esophagus, and a slightly increased risk of esophageal cancer.

Symptoms include heartburn or acid indigestion – a sense of burning in the mid-chest behind the breastbone or mid-abdomen, especially when bending or lying down, and regurgitation of food or sour liquid. Less frequently, GERD may cause trouble swallowing, hoarseness, coughing, wheezing, sore throat, and asthma.

Risk factors for GERD include obesity, hiatal hernia, smoking, pregnancy, and diabetes. Eating large meals, lying down right after eating, some foods, such as spicy foods, alcohol, chocolate, caffeine, tomato sauce, onions, and carbonated beverages may worsen GERD.

GERD is initially diagnosed by symptoms and a patient's response to a class of drugs called proton pump inhibitors which reduce the stomach's production of acid.

We diagnose complicated GERD with endoscopy. Our gastrointestinal specialists may also conduct a test, called esophagogastroduodenoscopy (EGD), in which a thin, flexible tube with a light and camera – an endoscope – is inserted into the throat to visualize the esophagus and stomach to determine if there is inflammation or an ulcer. A tissue sample can be taken to test for Barrett's esophagus, a precancerous condition in which cells in the esophagus become abnormal.

A barium swallow x-ray may also be performed to determine if structural abnormalities such as a hiatal hernia, an ulcer, or narrowing of the esophagus exist. Patients are given a liquid solution to drink, and x-rays are then taken to visualize the esophagus.

Another test may be performed, called a Bravo pH test, which uses a tiny acid-measuring probe to determine when and for how long reflux occurs. While sitting, a patient's throat is numbed with a spray, and using an endoscope, the physician inserts a tiny probe into the throat and attaches it to the lower area of the esophagus. The probe transmits a signal to a small computer worn around the waist for two days, after which the probe is excreted through the stool.

Physicians will usually begin by prescribing long-acting prescription-strength proton pump inhibitors to suppress the production of stomach acid. Other medications used include H-2-receptor blockers, which also reduce acid production, and prokinetic drugs, which help the stomach empty faster and may tighten the LES.

For most cases of GERD which medication does not correct, anti-reflux surgery may be performed. Called fundoplication, this surgery is performed at NewYork-Presbyterian laparoscopically using general anesthesia. The surgeon makes a small abdominal incision and tightens the LES with sutures to prevent reflux.

Hospital stays and recovery time are shortened from 4-6 days and two weeks recovery time with an open surgery to 1-2 days in the hospital and one week recovery time with this method. Studies show that 90% of patients who undergo this procedure will be symptom-free 10 years after surgery. Patients who cannot take medication long-term or for whom it does not work may be candidates for fundoplication. Risks include those associated with anesthesia, bleeding, and infection, discomfort from gas buildup, or difficulty swallowing. Some patients may need to continue taking some medication.

We are also evaluating several new methods to treat GERD. With one method, radiofrequency energy is used to heat and coagulate tissue around the LES. This creates scar tissue, which alters the sensory nerves that cause the LES to open and close.

Another minimally invasive method of treating GERD we are testing is the plication procedure, which is done endoscopically while the patient is under conscious sedation. In this procedure, a device called a plicator folds is installed at the junction between the esophagus and stomach. The device grabs and holds tissue and helps tighten the valve between the esophagus and stomach. Patients usually return home the same day.