Gastroesophageal reflux disease (GERD) is a common digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus. Also known as reflux, or heartburn, nearly 44 percent of Americans experience recurrent GERD and 18 percent of these individuals use some type of nonprescription medication for their problem.
In normal digestion, food travels from the mouth, through the esophagus and into the stomach. In the stomach, the gastric secretions, which include acid, fluids, and enzymes, break down the food as it moves into the intestines. Normally, following a swallow, the lower esophageal sphincter (LES) relaxes and allows food to pass into the stomach. It then closes to prevent this food from backing up into the stomach. However, for some people, the LES stays relaxed. This allows the acidic contents of the stomach to reflux back into the esophagus and damage the lining.
Gastroesophageal reflux disease can be successfully treated most of the time. However, chronic GERD can lead to other problems in the esophagus including inflammation, ulceration, scarring, stricture (narrowing) and precancerous changes (Barrett’s esophagus). In a very small percentage of patients, the changes in the esophagus can lead to esophageal cancer.
The Division of Thoracic Surgery at Brigham and Women’s Hospital (BWH) provides specialized services for GERD, such as extensive diagnostic testing. Our board-certified surgeons are experts in the latest minimally invasive thoracic surgical techniques, including Nissen fundoplication, Toupet fundoplications, the Linx procedure and transoral incisionless fundoplication.
Many people experience occasional heartburn. However, there are known factors that can increase your risk of developing long term GERD/reflux.
Other conditions associated with heartburn include:
Heartburn typically occurs after a large meal or when you bend over or lie down. Certain foods tend to make GERD worse. These foods include:
Most children younger than 12 years of age, and some adults, will not experience typical symptoms of heartburn. Their symptoms may include:
Heartburn is usually not associated with physical activity.
The symptoms of GERD/reflux may resemble other medical conditions or problems. If your thoracic surgeon discovers another cause for your symptoms, he will refer you to an appropriate Brigham and Women’s Hospital physician.
There are many ways your thoracic surgeons can help you to manage and treat your GERD/reflux. Typical treatment ranges from lifestyle changes to medications. In more serious cases of GERD, surgery is considered. The goal of treatment is to pinpoint the cause of your GERD, so you can make changes to prevent it from recurring.
Diet and lifestyle changes can have a huge impact on your GERD symptoms. Actions you can take to relieve your symptoms are:
Medications may be needed if changes in your lifestyle do not offer enough relief for your symptoms. There are many options for medications and they can be extremely helpful. In some cases, patients may need lifelong medication:
For some patients who do not get relief from GERD/medications and lifestyle changes, surgery is often advised. The goal of surgery is to fix the anatomy rather than just treating the symptoms of GERD/reflux. Thoracic surgeons at BWH have excellent long-term success in these procedures, resulting in a cure rate of 90 percent.
Surgery should be considered for patients who:
Minimally Invasive Surgery:
You will receive a thorough diagnostic evaluation and receive treatment by a board-certified thoracic surgeon who specializes in GERD/reflux. Careful monitoring and the involvement of an experienced thoracic surgeon are important to the successful outcome for patients with GERD/reflux.
If you need surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with thoracic problems. After surgery you will go to the recovery room (Post Anesthesia Care Unit) and then you will be transferred to the Thoracic Intermediate Care Unit (TICU) where you will receive specialized comprehensive care by an experienced medical and nursing staff to get you better rapidly.
Brigham and Women's Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialties. If your thoracic surgeon discovers an underlying illness or concern, you will be referred to an appropriate BWH physician for an expert evaluation. Learn more about the our Thoracic Surgery team.
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