Gastroesophageal Reflux Disease (GERD) Treatment

At Memorial Hermann, we take a comprehensive approach to treating GERD since many don't find relief through standard treatments. Our treatment options are customized to each individual, and may include:

• Lifestyle Changes, like bed blocks, nutritional counseling, and weight loss
• Medications, like antacids, H2 blockers and proton pump inhibitors (PPIs)
• Surgical Treatments

Despite dietary and lifestyle changes, some patients still require medications to control their reflux symptoms. The medications can be given for a short period of time to help with the acute symptoms and to give time for the lifestyle and habits to change. However, some patients require lifetime GERD treatment.

Surgical Treatment of GERD

More severe cases of heartburn and acid reflux may actually be a symptom of GERD. In these cases, surgery for GERD may be recommended.

About 25% of patients with reflux disease will develop progressive disease and complications such as hiatal hernia and Barrett’s esophagus. In these patients, surgical treatment should be considered.

In addition, surgery should be discussed with patients who:

• Continually regurgitate despite the reduction of acidity
• Have evidence of lung damage due to aspiration of fluid from the esophagus into the lungs
• Have intolerance to medications used for treating gastroesophageal reflux
• Respond well to these medications but do not want to continue taking them for the rest of their lives.

Goal of Surgical Treatment

The aim of surgical treatment of GERD is to restore the function of the lower esophageal sphincter (the valve between the esophagus and the stomach) and to prevent the reflux of acid and bile from the stomach into the esophagus. The most common procedure to restore the function of the lower esophageal sphincter is a minimally invasive procedure called laparoscopic Nissen fundoplication.

Laparoscopic Fundoplication

A laparoscopic fundoplication, performed through two small incisions in the abdomen, strengthens the valve between the esophagus and stomach by wrapping the fundus around the esophagus. This prevents stomach acid from backing up into the esophagus.

Transoral Incisionless Fundoplication (TIF)

Transoral Incisionless Fundoplication (TIF) is a unique form of Natural Orifice Surgery that treats the anatomical cause of GERD. Compared to conventional laparoscopic or open GERD surgery, patients undergoing the TIF procedure have shorter hospital stays, reduced discomfort, shorter recovery time, no visible scars from the procedure and higher overall satisfaction.

By inserting a scope through the mouth, a device is able to reconstruct the lower esophageal sphincter (LES) inside of the stomach. By recreating the LES, stomach acid is blocked from refluxing back into the esophagus. This effectively eliminates the sensation of heartburn and acid reflux. Because there are no incisions made during the TIF procedure, there are fewer complications, less pain and faster recovery time in comparison to other GERD surgeries. Even though an overnight hospital stay is still required for the TIF surgery, recovery from the surgery is short and relief from symptoms is immediate.

Dietary and Lifestyle Changes

Many patients succeed in relieving most if not all the symptoms of gastroesophageal reflux disease (GERD) by changing the way they eat, what they eat and when they eat.

Foods

Several foods can decrease the pressure at the lower esophageal sphincter, which works as a gateway preventing the acid from getting to the esophagus. Avoiding those foods will help control GERD, including:

• spicy foods
• fatty foods
• alcohol
• sodas
• smoking cigarettes
• chocolate
• coffee and all caffeinated products
• peppermints
• tomato-based juices and products
• citrus products

Lifestyle Changes

Some day-to-day lifestyle modification should be initiated and continued throughout the course of treatment for reflux disease. These include:

• avoiding tight clothes
• elevating the head of the bed
• avoiding large meals
• fasting for three hours before going to bed
• losing 5% of one’s body weight

Medications

Many medications have been used to control gastroesophageal reflux disease (GERD). Proton pump inhibitors (PPI) are the mainstay of treatment. They are potent acid reducers that block the pumps responsible for supplying the acid to the stomach. PPIs include:

• Omeprazole
• Lansoprazole
• Pantoprazole
• Esomeprazole

These medications are generally safe and can be taken once or twice per day (half an hour before breakfast or dinner).

• Antacids neutralize the acidity of the stomach and provide short-term relief.
• Other medications such as sucralfate provide a barrier that lines the esophageal and stomach mucosa and protect it from the gastric juices, thus providing the needed time to heal.
• Antihistamines such as ranitidine and famotidine also can be used to decrease the secretion of acid into the stomach lumen.

Effect of Bile

Most commonly the refluxed gastric contents are acidic, and typical medical therapy for reflux aims to suppress gastric acidity. However, bile (non-acidic fluid) may also be present within the gastric juice that is refluxed up into the esophagus. Neutralization of acid does not prevent injury to the esophagus from the non-acidic fluid. Therefore, even with suppression of acid production and decrease or elimination of heartburn, damage to the lining of the esophagus may continue despite medical therapy in patients with bile (non-acidic fluid) reflux.