The University of Chicago Medicine is home to one of the few centers in the United States that is dedicated to diagnosing and treating esophageal disorders, including gastrointestinal reflux disease (GERD). Our program allows our physicians to specialize in esophageal conditions and help patients with GERD on a daily basis.
Providing the very best treatment options for patients is a key priority. We offer a full range of medical, surgical and minimally invasive treatment options to meet each patient’s needs, including minimally invasive surgery that can provide lasting relief without the side effects of taking medications for decades. We continually evaluate the results of our treatment approaches and work to improve surgical and medical solutions for patients.
What is GERD?
Gastrointestinal reflux disease (GERD) is more than just heartburn. Untreated, GERD can develop into more serious conditions, including cancer for a small percentage of individuals.
It’s normal to experience gastroesophageal reflux (also known as acid reflux) once in a while after eating. For most people, this acid reflux is a mild form of heartburn that can be controlled with over-the-counter medications, changes in food choices or changes in the quantity eaten at one time. If mild heartburn persists, your primary care doctor may prescribe a stronger medication. In comparison, gastroesophageal reflux disease (GERD) is less common but more troublesome than periodic acid reflux.
GERD can produce a broad variety of symptoms, including:
- Chest pain
- Chronic cough
- Difficulty swallowing (dysphagia)
- Early satiety (feeling full after eating a little food)
- Excess saliva (water brash)
- Feeling of a lump in the throat (globus)
- Lung aspiration
- Shortness of breath (dyspnea)
- Voice problems
People with cystic fibrosis are more likely to experience GERD symptoms than the average person.
A one-way valve — called the lower esophageal sphincter (LES) — allows food to pass into your stomach and prevents stomach acid from flowing back up into the esophagus. When this valve is weakened and not functioning properly, gastric juice comes up from the stomach and back into the esophagus causing irritation and inflammation (esophagitis). Over time, this can damage to the lining of the esophagus. Nearly half of patients with GERD will develop esophagitis, and up to 15 percent of patients with GERD may develop a pre-cancerous condition called Barrett’s esophagus. A small percentage of people with Barrett’s esophagus will progress to esophageal adenocarcinoma — a form of cancer in the esophagus. A second type of esophageal cancer — squamous cell carcinoma — is not related to GERD or Barrett’s esophagus.
GERD can lead to more serious conditions if not diagnosed and treated properly. If you have experienced GERD for a number of years, it is important to have your esophagus checked for changes.
Proper diagnosis is the first step toward effective treatment. Depending on their unique symptoms, patients may turn to different types of physicians for solutions, such as gastroenterologists, otolaryngologists, cardiologists or pulmonologists. UChicago Medicine's Center for Esophageal Diseases draws together specialists from all of these areas to collaborate as needed.
Doctors may recommend some or all of the following tests to pinpoint the cause of symptoms:
- Ambulatory impedance-pH monitoring: This test measures the frequency and amount of gastric contents (acid and non-acid) that refluxes from the stomach to the esophagus, usually over a 24-hour period. This test involves threading a very thin tube (catheter) through the nose and down the esophagus. The catheter is attached to a monitoring system. “Ambulatory” means that you can walk around and do your normal activities while wearing this monitor.
- Endoscopy: A thin, flexible tube equipped with a tiny camera and light is inserted through the mouth and down the throat. Diagnostic endoscopy enables the physician to see inside the throat and into the stomach.
- Esophageal motility testing: Our state-of-the-art esophageal motility lab has advanced technology to evaluate how well the muscles of the esophagus are functioning. Specifically, testing provides information about the function of the valve located between the esophagus and the stomach and the ability of the esophageal muscles to squeeze.
- X-ray: Involving a barium swallow to see if there is a hiatal hernia or a stricture of the esophagus.
In most cases, GERD is a chronic condition that people live with for the rest of their lives. The only curative treatment is surgery, but medications and lifestyle changes are helpful for managing the symptoms of GERD. Our physicians and surgeons can help patients decide which treatment option best fits their needs.
For most patients, treatment recommendations follow a stepped approach that begins with changes in diet, avoiding food close to bedtime, losing weight and reducing and eliminating smoking and alcohol use.
When lifestyle changes do not work, medications designed to suppress the production of excess acid are typically the next step. Antacids or histamine H2 receptor agonists therapy can be effective for many individuals with mild to moderate symptoms. Additional H2 blocker therapy or proton pump inhibitor medications may be prescribed for symptoms that are more persistent. Medications, however, are less effective when a large hiatal hernia, regurgitation, aspiration, cough and/or voice problems are present. While medications can lessen or control the symptoms of GERD, they do not cure this chronic disorder. Therefore, patients take the medications for the rest of their lives or as symptoms dictate.
A number of patients with GERD may be appropriate candidates for surgical treatment with an anti-reflux procedure. This procedure tightens the valve located between the stomach and the esophagus, called the lower esophageal sphincter, which prevents the stomach contents and acid from refluxing back into the esophagus. Unlike medications that provide only symptomatic heartburn relief, anti-reflux surgery can stop GERD symptoms for most patients, including regurgitation, trouble swallowing and voice changes.
Surgery can be offered to all patients with GERD, but should be strongly considered for:
- Patients that do not experience relief of symptoms with medications
- Patients with voice or respiratory problems, including hoarseness, cough or asthma due to reflux
- Patients with a hiatal or paraesophageal hernia, making it difficult to eat
- Young patients, to avoid the cost and diminishing effectiveness of taking medications for many decades
- Patients with Barrett's esophagus
- Individuals with a BMI greater than 35
- Post-menopausal women, for whom some anti-GERD medications raise the risk of osteoporosis
Anti-Reflux Surgery Options for GERD
Anti-reflux surgery is very effective for treating gastroesophageal reflux disease. The different anti-reflux operations described below are performed by specialized esophageal surgeons at UChicago Medicine through small incisions using minimally invasive techniques. These procedures all work by recreating the damaged valve between the esophagus and stomach.
The different types of anti-reflux surgeries include:
Nissen Fundoplication. Nissen fundoplication has been the standard operation for GERD treatment for nearly 50 years. This operation involves a wrap of the stomach around the esophagus to reconstruct the lower esophageal sphincter to function as a one-way valve again. This wrap of the stomach is called a fundoplication. A “Nissen” fundoplication is a full 360-degree wrap, which allows for the best reconstruction of the valve to control reflux.
LINX Procedure. The LINX System is a new treatment option for patients with GERD. This removable device is a small, flexible ring of magnetic, titanium covered beads that acts as a valve to stop reflux from the stomach. The LINX system is designed to stay closed at rest to prevent acid reflux back into the esophagus, but then will expand with a normal swallowing mechanism to allow food and drink to pass into the stomach.
Gastric bypass surgery. Gastric bypass surgery may be an option in a select group of patients that have other medical conditions in addition to reflux. This operation works to treat reflux as well as diabetes, hypertension, sleep apnea, arthritis and allows for dramatic weight loss. Patients with a BMI 35 or higher may be a candidate for this treatment and can be discussed as a treatment option for you.
Which GERD surgery is best for me? Our surgeons understand that every patient is unique. Depending on each your personal goals after surgery, your comfort with the procedure and your overall health, our team will help you make the right choice for you.
Minimally Invasive GERD Surgery
Our expert surgeons at UChicago Medicine with specialized training in minimally invasive techniques use high definition laparoscopy and advanced robotic technology, making anti-reflux surgery a very safe and effective treatment option. These operations are performed using small, less than ½ inch cuts in the skin. This allows for not only less scaring, but also faster and easier recovery and less pain for patients. Using these minimally invasive techniques most patients go home later that day or the next day.
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