Learn About GERD Symptoms, Treatment, and More
Gastroesophageal reflux disease (GERD) is a condition that causes food to reflux (travel backward) from the stomach to the esophagus (the swallowing pipe). This action can irritate the esophagus, causing heartburn and other symptoms, including belching, coughing, difficulty swallowing, nausea and vomiting, regurgitation, sore throat, hoarseness, and chest pain, to name a few. In severe cases of GERD seen in Houston and elsewhere, the reflux may lead to damage of the lower part of the esophagus.
What is GERD? While not completely understood, it is believed that in most patients, gastroesophageal reflux disease (GERD) is caused by a problem with the lower esophageal sphincter (LES) muscle, a group of muscle fibers that exists at the lowest portion of the esophagus as it enters the stomach. It is thought that because this sphincter does not close completely, food and acid may reflux back from the stomach to the esophagus.
Treatment for GERD comes in many forms. For minor cases, lifestyle changes and common medications are often the best course of action. More serious issues may require surgical treatment. Our surgeons employ cutting-edge techniques and procedures to ensure patient safety and a speedy recovery.
GERD Symptoms in Houston
There are many signs that indicate the presence of GERD. Possible GERD symptoms include:
- Belching and coughing
- Difficulty swallowing
- Nausea and vomiting
- Sore throat
- Chest pain
- Esophageal damage in extreme cases
Possible Causes of Reflux Disease
Increased stomach pressure: This may be from overeating or conditions that alter stomach contractions and emptying.
Medications: Certain medications can affect stomach acid production and gastric motility or can interfere with the normal opening and closing of the LES.
Smoking: This makes reflux worse and causes peptic ulcers, esophagitis, and gastritis.
Hiatal Hernia: A hiatal or diaphragmatic hernia often accompanies gastroesophageal disease. The region of the muscular diaphragm through which the esophagus passes may enlarge and allow part of the stomach to move up through it. This alters the pressure at the end of the esophagus and allows reflux to occur.
Obesity: Stomach pressure increases with abdominal girth. As stomach pressure increases, it becomes more difficult for the LES to prevent reflux.
Nerve and Muscle Abnormalities: Opening and closing of the LES relies on normal muscular function and nerve conduction.
GERD Treatment in Houston
The treatment options for gastroesophageal reflux disease (GERD) fall into three broad categories:
Conservative methods of GERD treatment include changing lifestyle and eating behaviors that contribute to acid reflux.
Medication therapy for GERD symptoms uses both over-the-counter and prescription medications to reduce the production of acid in the stomach, protect the esophagus from acid damage, and help keep pressure at the esophageal junction low.
Surgical intervention is necessary when other methods of controlling GERD fail.
Conservative Therapy for Acid Reflux
Lifestyle and diet change are the first steps in reducing the frequency and severity of heartburn and GERD-related symptoms. These changes focus on food choices, modifying intake, and taking steps to reduce pressure within the stomach.
Control alcohol and tobacco use: Tobacco and alcohol irritate the esophagus and act on the lower esophageal sphincter (LES) to reduce its ability to stay closed.
Reduce trigger foods: Foods that stimulate acid production or relax the LES are called “trigger foods.” Eliminating these foods from your diet can alleviate many symptoms of GERD.
Adjust medications: Prescription and non-prescription medications change acidity, LES pressure, and stomach emptying. Review medications with your doctor to ensure they are not making your GERD worse.
Get active: Activity helps gastric emptying and assists with weight control. Reducing your weight by as little as 10 pounds can have a dramatic effect on stomach pressure and prevent reflux through the LES.
Stay upright: Reclining increases the pressure of stomach contents on the LES and promotes reflux, especially when your stomach is full. Staying upright for a minimum of two hours after eating can reduce GERD symptoms.
Adjust sleeping position: Raising the head of your bed about 6 inches using blocks under the front legs can decrease pressure on the LES while you sleep, reducing nighttime heartburn.
Loosen clothing: Tight-fitting clothes such as pants, belts, and back support belts increase abdominal pressure and make it more difficult for the LES to do its job. In many cases, weight gain is responsible for tight-fitting clothing, so weight loss can help tremendously with GERD symptoms.
Medications for Reflux
Both over-the-counter and prescription medication have been the mainstay of GERD treatment for many years. Medications are designed to reduce GERD symptoms by reducing stomach pressure, decreasing stomach acid production, and protecting the esophagus from acid damage. Because GERD is a progressive disease, however, medication doses will adjust upward as a reflux disease worsens. Acid-reducing medications drop acid levels in the stomach below normal to help control symptoms that are not known to improve LES functions.
Types of Medications
Antacids: Reducing stomach acidity with over-the-counter antacids is the most frequent remedy for infrequent and mild heartburn.
H2 Blockers: Histamine turns on acid production at a cellular level in the stomach. Histamine blockers are frequently used to stop acid production as part of stomach ulcer treatment. Reducing stomach acid production also reduces the severity of acid reflux symptoms.
Proton Pump Inhibitors (PPIs): More powerful than H2 blockers, PPIs reduce acid production in the stomach by up to 80%. They have quickly become the most important class of drugs used in GERD treatment and are usually part of a lifelong drug therapy regimen to control chronic acid reflux.
Coating Agents: These types of prescription drugs protect damaged tissue in the stomach and esophagus from exposure to acid, reduce pain, and allow damaged tissues to heal.
Motility-promoting drugs: Improving the rate at which stomach contents empty into the intestines with motility drugs can reduce stomach pressure and prevent reflux through the LES.
Surgical Treatment for GERD
Minimally invasive surgery has increased the popularity of surgery as a long-term solution for chronic GERD. Surgical intervention focuses on strengthening the lower esophageal sphincter, correcting hiatal hernias, and in some cases, helping obese patients reduce their weight.
Surgical repair of the LES is considered when:
- Conservative and medication-based therapies are ineffective at controlling GERD symptoms
- Complications are developing from GERD, despite medication treatment
- Atypical GERD symptoms such as asthma, sinus problems, and chronic cough are uncontrolled
- GERD medication side effects are not tolerated by the patient
- Lifelong therapy with medications is cost prohibitive or too disruptive to the patient’s lifestyle
Learn About TIF EsophyX
UT MIST is proud to perform the revolutionary TIF EsophyX procedure, which typically takes only 30 to 40 minutes to reconstruct the anti-reflux barrier and strengthen the LES. In most cases, patients are in the hospital for just one day and can return to normal activities within a few days after the procedure.
What to Expect from EsophyX TIF
Since its approval by the FDA as a treatment for acid reflux disease, EsophyX TIF has demonstrated its effectiveness in eliminating heartburn in 85% of patients. Two-year studies show that more than 70% of patients remain off their proton pump inhibitor medications (PPIs).
Benefits of EsophyX TIF
- Similar effectiveness to laparoscopic procedures
- No external skin incisions, no scarring
- No internal cutting or dissecting of the natural anatomy equals more rapid recovery
- Fewer adverse events and complications
- Does not limit future treatment options
- Can be revised, if required
EsophyX TIF is Suitable for Patients Who
- Have heartburn or non-heartburn acid reflux symptoms two or more times per week
- No longer respond to acid reflux medications
- Cannot tolerate the side effects of acid reflux medications
- Do not wish to use acid reflux medications in the long term
- Have asthma or a hoarse voice related to acid reflux
- Have been diagnosed with Barrett’s esophagus
- Have dental erosions from acid reflux
Patients report a high degree of satisfaction with the EsophyX TIF procedure and its results. The high success rate combined with shorter recovery time and reduced discomfort make this incisionless GERD treatment a valuable new option for acid reflux sufferers.
Other products for treating GERD include MUSE™, an endoscopic device that combines modern microvisual, ultrasonic, and surgical stapling technology. Anti-reflux barrier creation efforts are incisionless and take about an hour.
LINX® is a quarter-sized barrier that can be installed laparoscopically. Magnets and titanium beads work to let food through on its way down, as well as to allow for burps and vomit to escape upward if necessary. Acid, however, is prevented from surging out of the stomach and into the esophagus.
Stretta® is a minimally invasive procedure that strengthens a weak LES muscle by stimulating it with radiofrequency energy. The thickened muscle reduces acid reflux symptoms as it is allowed to function as it should.
Benefits and Risks of Treating GERD in Houston
The most important goals of any GERD treatment regimen are symptom control, prevention of GERD-related complications, and healing of esophagitis. GERD is a chronic condition, and treatment of this disease involves a series of techniques, employed based on symptom severity. As such, the associated risk will vary with treatment.
Lifestyle modifications are usually the appropriate first step in the treatment for mild GERD sufferers with infrequent symptoms. Treatment consists of basic dietary and lifestyle changes so the inherent risk is minimal.
For many patients, a daily regimen of medical therapy controls heartburn and reflux symptoms. GERD sufferers with more severe symptoms may only experience partial symptom control with medical therapy. Acid suppression is the main function of medical therapy for GERD. As noted above, there are three types of medications commonly used to treat GERD: antacids, H2-receptors (H2RAs), proton pump inhibitors (PPIs).
Medication can control GERD symptoms such as heartburn by reducing the acidity of reflux. If the medication regimen is stopped, reflux-related symptoms typically recur, creating a dependence on these drugs. Over time, the medications can also lose effectiveness, requiring higher doses or more powerful drugs.
While safe and effective for most patients, studies evaluating long-term PPI use demonstrate a series of undesirable side effects. These side effects are a result in chronic suppression of acid in the stomach, since stomach acid is important to digestion and absorption of minerals and nutrients.
Side effects include:
- Increased risk of hip-fracture and osteoporosis.
- Vitamin B12 deficiency.
- Potentially harmful drug interactions with Plavix (clopidogrel).
- Increased risk of pneumonia.
- Increased risk of fundic gland polyps.
- Reduced gallbladder motility.
- Development of hypomagnesemia.
- Increased risk of bacterial gastroenteritis.
- Increased risk of small intestinal bacterial overgrowth (SIBO).
- May mask the symptoms of Barrett’s Esophagus.
If you have been on PPIs for an extended period of time and are concerned about your health, please contact your doctor immediately.
For GERD patients who experience inadequate symptom control, severe regurgitation, or side effects from medication, surgical intervention may be appropriate.
The most common anti-reflux surgery is known as a fundoplication. The primary benefit of all fundoplication procedures is the ability to treat reflux via anatomic reconstruction of the anti-reflux barrier. Rather than suppress acid as with medical therapy, anti-reflux surgery aims to eliminate abnormal acid exposure by restoring the anatomic structures that naturally prevent abnormal reflux.
The advantages of laparoscopic surgery include a shorter recovery time, reduced postoperative pain, and a faster return to work, with elimination of heartburn in about 85% of patients. Surgery is also highly effective at curing GERD-induced asthmatic or respiratory symptoms. It may also enhance stomach emptying, and it improves peristalsis in about half of patients. Another benefit for surgical patients is the ability to stop taking GERD medications, possibly for life.
An incisionless approach is also available for GERD patients with smaller hiatal hernias. This procedure, called Transoral Incisionless Fundoplication (TIF), is performed through the mouth with no abdominal incisions and patients typically return to work in less than a week. Associated complications, which usually resolve within a few weeks of surgery, are typically lower than for laparoscopic procedures.
To date, TIF surgeries have an excellent safety profile. TIF has been performed in more than 10,245 cases worldwide with no associated mortalities. Clinical studies demonstrate that TIF patients do not experience long-term complications commonly associated with conventional anti-reflux surgery such as chronic dysphagia (trouble swallowing), gas bloat syndrome, and increased flatulence.