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. We offer a full range of medical, surgical and minimally invasive treatment options to meet each patient’s needs, including a minimally invasive operation that can cure GERD — providing lasting relief without the side effects of taking medications for decades.
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 (“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. People with GERD experience a higher than normal amount of gastric juice that comes up from the stomach and back into the esophagus. Over time, this gastric juice (acids, bile and pancreatic secretions) can cause injury to the mucous lining of the esophagus, causing esophagitis. 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.
Because GERD can lead to more serious conditions, it is especially important to obtain proper diagnosis and treatment.
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.
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.
For most patients, treatment recommendations follow a stepped approach that begins with changes in diet, losing weight and other lifestyle changes.
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
Nissen fundoplication has been the standard surgery for GERD for nearly 50 years and is performed by skilled esophageal surgeons at UChicago Medicine.
In recent years, select surgeons have turned to laparoscopic fundoplication — a minimally invasive technique that accomplishes the same results but offers patients much faster and easier recovery. Instead of making a large incision, the surgeon works through five tiny incisions, each measuring about one-half inch.
Nissen fundoplication surgery creates a 360-degree wrap around the esophagus. UChicago Medicine surgeons typically perform Nissen fundoplication using laparoscopic techniques. Nissen fundoplication is very effective for treating reflux and helps patients avoid the need for life-long use of anti-reflux medications.
Compared to traditional surgery, laparoscopic fundoplication offers patients:
- Faster recovery (usually only one night in the hospital)
- Minimal scarring
- Significantly less pain because the incisions are so small
When performed by a surgeon with extensive experience in this minimally invasive technique, laparoscopic fundoplication offers the same high success rate for treating GERD as achieved through the traditional fundoplication procedure. UChicago Medicine's Center for Esophageal Diseases team includes some of the most experienced surgeons in the world at performing laparoscopic fundoplication.Learn more about minimally invasive esophageal surgery.
At UChicago Medicine, providing the very best treatment options for patients is a key priority. We continually evaluate the results of our treatment approaches and work to improve surgical and medical solutions for patients.
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