GERD/Reflux Disease

Gastroesophageal reflux disease (GERD), also known as reflux, is a common digestive disorder that occurs when a muscle at the end of your esophagus does not close properly. This allows the contents of the stomach to leak back, or reflux, into the esophagus and irritate it. Characterized by a burning in the chest or throat known as heartburn, GERD/reflux disease can be caused by a number of conditions such as hiatal hernia and by lifestyle choices such as smoking. Learn more about GERD, including causes and symptoms.

Chronic GERD can lead to other esophagus problems: inflammation, ulceration, scarring, stricture (narrowing) and precancerous changes (Barrett’s esophagus). Rarely, the changes in the esophagus can lead to esophageal cancer.

Board certified general and gastrointestinal surgeons at Brigham and Women’s Hospital (BWH) specialize in treating GERD/reflux disease. Our surgeons are experts in the latest minimally invasive surgical techniques, including Nissen fundoplication, Toupet fundoplication, the Linx procedure and transoral incisionless fundoplication.

Diagnosis of GERD/Reflux Disease

General and gastrointestinal surgeons at BWH offer a range of procedures for diagnosing GERD:

Watch this video of an upper endoscopy (EGD) used to diagnose GERD/Reflux Disease.

Treatment for GERD/Reflux Disease

Treatment for GERD ranges from lifestyle changes to medications to surgery. The goal of treatment is to find the cause, so you can prevent it from recurring.

Surgical Treatment

Surgery should be considered for patients who:

Have not had medication success

Minimally Invasive Surgery

Nissen fundoplication repairs the hiatal hernia and tightens the lower esophageal sphincter (LES) and helps to decrease acid from coming up from the stomach into the esophagus. Fundoplication is usually performed as a laparoscopic procedure. Although a Nissen fundoplication is the most common form of fundoplication, other types of fundoplication are also sometimes performed based on surgical assessment and recommendation.
LINX (magnet sphincter augmentation) is a minimally invasive procedure that is indicated for patients with GERD who are seeking an alternative to acid suppression therapy (proton-pump inhibitors) or fundoplication. LINX is a flexible ring of small magnets that is placed around the lower esophageal sphincter (LES) to dynamically augment the lower esophageal sphincter and improve GERD symptoms.
Transoral incisionless fundoplication (TIF), a transoral (through the mouth) procedure in which the EsophyX device is used to wrap around the esophagus and create a fold. This is then repeated several times to create a tight valve to prevent stomach contents from flowing back up into the esophagus.

Do not want to take chronic medication
Have symptoms attributable to a large hiatal hernia
Have complications of GERD (stricture, Barrett's esophagus grade III or IV esophagitis)
Have atypical symptoms (asthma, hoarseness, cough, chest pain, aspiration) and documented reflux

Non-Surgical Treatment

Diet and lifestyle
- Add foods to your diet that tend to improve GERD:
  - Non-acidic fruits (bananas, apples, pears)
  - Foods lower in fat and calories
  - High fiber foods (whole wheat, oatmeal, brown rice, beans)
- Avoid foods that aggravate your symptoms
- Lose weight
- Avoid overeating
- Stop smoking
- Reduce alcohol and caffeine consumption
- Wait a few hours after eating to lie down or go to bed
- Raise the head of your bed six to eight inches
- Avoid medications that irritate the lining of your stomach or esophagus (aspirin, ibuprofen)
Medications may be needed if changes in your lifestyle do not offer enough relief for your symptoms:
- Over-the-counter H2 blockers, such as Tagamet™, Pepcid™, Zantac™
- Over-the-counter oral antacids, such as Tums™, Maalox™, Mylanta™
- Proton pump inhibitors, such as Prilosec™ and Prevacid™
- Medications that make your stomach empty faster, such as Reglan™
- Stronger, prescription-strength antacids

What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have GERD/reflux disease and what course of treatment is needed. Careful monitoring and the involvement of an experienced general and gastrointestinal surgeon are important to the successful outcome for patients with GERD/reflux disease.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with GERD. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

Multidisciplinary Care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating GERD/reflux disease and esophageal conditions. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.