Gastroesophageal reflux disease (GERD) is a digestive disorder caused by the return of acidic stomach juices, or food and fluids, back up into the esophagus. This "reflux" can irritate the esophagus, causing heartburn and other painful discomfort in the chest and throat. Longstanding GERD has been linked to Barrett's esophagus, a precancerous condition. So treating GERD early and appropriately is very important.
At the Center for Advanced Digestive Care (CADC) of NewYork-Presbyterian/Weill Cornell Medical Center, our gastrointestinal specialists offer care for patients with GERD that is based on the latest medical and surgical advances.
Causes of GERD
Factors which increase the risk of developing GERD include:
- Hiatal hernia (a condition in which part of the stomach moves above the diaphragm, the muscle that separates the chest and abdominal cavities)
- Obesity
- Pregnancy
- Smoking
- Scleroderma (an auto-immune disease)
- Alcohol (possibly)
- Certain foods can exacerbate the symptoms of GERD (such as chocolate, fatty foods, coffee, and caffeinated beverages)
For more information about gastroesophageal reflux disease, visit our Health Library.
Diagnosis of GERD
In addition to taking a complete medical history and performing a physical examination, physicians at the CADC initially diagnose GERD by assessing a patient's symptoms and the response to a class of drugs called proton pump inhibitors, which reduce the stomach's production of acid. Patients with more complicated GERD may undergo endoscopy (examination of the esophagus using a flexible tube with a camera at its tip).
Our gastrointestinal specialists may also conduct other diagnostic procedures for GERD, such as:
- Upper GI (gastrointestinal) series (also called barium swallow): this test involves swallowing a liquid that can be seen on x-rays as it goes down the esophagus.
- Esophagogastroduodenoscopy (also called EGD or upper endoscopy): a gastroenterologist uses a fiber optic instrument (scope) to see the inside of the esophagus and take tissue samples of any abnormal tissue.
- Bernstein test: a test done in a gastroenterology laboratory to reproduce the symptoms of GERD, such as heartburn.
- Esophageal Manometry: a way to test whether the muscles in the esophagus are functioning properly.
- pH Monitoring: a test to measure acid exposure in the esophagus.
Treatment for GERD
In many cases, GERD can be relieved through diet and lifestyle changes which help relieve heartburn. However, physicians usually begin treating GERD by prescribing long-acting prescription-strength medications which reduce the production of stomach acid, or help the stomach empty faster and may tighten the lower esophageal sphincter (LES, the muscle at the end of the esophagus, above the stomach, which is often weaker in GERD patients).
Patients with GERD who cannot take medication long-term, or those for whom it is not effective, may be candidates for a surgical procedure called "laparoscopic Nissen fundoplication." During this procedure, the weakened lower esophageal sphincter is supported by wrapping the top portion of the stomach around the lower esophagus as a bolster. This procedure is performed by surgeons at NewYork-Presbyterian/Weill Cornell.
Researchers at the CADC are 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, the "plication" procedure, is performed endoscopically while the patient is under conscious sedation. During this procedure, a device 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, preventing reflux. Patients usually return home the same day.
There are multiple approaches available at the CADC treating GERD. With a range of medical and surgical options, our team works to determine which approach is best for each patient. Visit the Gastrointestinal Motility Disorders Laboratory page to learn more about diagnosis and surgical treatment of GERD, and learn about thoracic surgical options as well.
Patient Centered Gastrointestinal Care
The CADC offers a range of clinical support and wellness services to patients with GERD, including short-term nutritional guidance, social work, and genetic counseling. We offer most of these services at no cost to those who see a CADC physician. Patients seeking further offerings or additional nutrition counseling can utilize the following NYP resources:
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Center for Advanced Digestive Care