Gastroesophageal Reflux Disease (GERD)

With comprehensive services and expertise focused on problems related to the esophagus, the University of Chicago Center for Esophageal Diseases offers a full range of medical and surgical options for treating gastroesophageal reflux disease (GERD). Here, you’ll find a team that specializes in esophageal disease, including some of the most experienced surgeons in the world. Our surgeons are experts at performing laparoscopic fundoplication (Nissen, Toupet, Dor), a minimally invasive operation that can cure GERD--providing lasting relief without the side effects of taking medications for many decades.

A Center Focused on Esophageal Diseases

Dr. Angelos and Dr. Patti Surgeon Marco Patti, MD, (right) director of the Center for Esophageal Diseases, meets with surgeon Peter Angelos, MD.

The University of Chicago Medicine is home to one of the few centers in the United States that is solely dedicated to diagnosing and treating disorders of the esophagus, including GERD. Because this is such a specialized program, our physicians have the focused expertise and depth of experience that comes from working with many patients who have problems of the esophagus. We also can offer a full range of medical, surgical and minimally invasive treatment options to meet each patient’s needs.

About GERD

GERD is more than simple 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. In people with GERD, a higher-than-normal amount of gastric juice (acids, bile and pancreatic secretions) refluxes from the stomach back into the esophagus. Over time, this gastric juice can cause injury to the mucous lining of the esophagus (“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. And, a small percentage of people with Barrett’s esophagus will progress to esophageal adenocarcinoma--a form of cancer in the esophagus. A different type of cancer--squamous cell carcinoma--also can develop in the esophagus. However, squamous cell carcinoma of the esophagus 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. Treatment of GERD and Barrett’s esophagus both aim to prevent progression to cancer.

Diagnosing GERD

Proper diagnosis is the first step toward effective treatment. GERD can produce a broad variety of symptoms including heartburn, regurgitation, difficulty swallowing (dysphagia), voice problems, feeling of a lump in the throat (globus), excess saliva (water brash), hoarseness, chest pain, bloating, early satiety (feeling full after eating a little food), belching, nausea, lung aspiration, asthma, wheezing, chronic cough or shortness of breath (dyspnea). Also, people with cystic fibrosis are more likely than average to also have symptoms of GERD.

Because of the diversity of symptoms, patients may turn to physicians who specialize in different areas, including esophageal disease, ear-nose-throat care, cardiology, gastroenterology or pulmonology for solutions. The University of Chicago Center for Esophageal Diseases draws together specialist physicians 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:

  • X-ray--barium swallow) to see if there is a hiatal hernia or a stricture of the esophagus.
  • 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 motility: how well the muscles of the esophagus are functioning. Specifically, it provides information about the function of the valve located between the esophagus and the stomach (lower esophageal sphincter), and the ability of the esophageal muscles to squeeze (esophageal peristalsis).
  • 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.

Treatment Options for Adults with GERD

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.

Medical Treatment

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 voice problems are present. In addition, they can cause decreased calcium absorption, which can cause bone problems, particularly in post-menopausal women. This is because reflux, even with less acid, persists. 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.

Surgical Treatment

Approximately 20 percent of adults with GERD may be appropriate candidates for surgical treatment using a procedure called Nissen fundoplication (also called anti-reflux surgery). This procedure stops reflux of stomach contents by tightening the valve located between the stomach and the esophagus (lower esophageal sphincter). Unlike medications that provide only palliation of heartburn, surgery can cure GERD for most patients.

Surgery should be recommended for:

  • Patients who are young, to avoid the side effects and diminishing effectiveness of taking medications for many decades;
  • Post-menopausal women, for whom some anti-GERD medications raise the risk of osteoporosis;
  • Individuals with voice or respiratory problems, including hoarseness, cough or asthma due to reflux;
  • Patients who have a large hiatal or paraesophageal hernias that make it difficult to eat.

Nissen fundoplication has been the standard surgery for GERD for nearly 50 years, and is performed by skilled esophageal surgeons at the University of Chicago hospital.

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 University of Chicago surgeon works through five tiny incisions--each measuring about one-half inch.

Nissen fundoplication illustration
Nissen fundoplication surgery creates a 360-degree wrap around the esophagus. At the University of Chicago, our surgeons typically perform Nissen fundoplication using laparosopic 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 open surgery, laparoscopic fundoplication offers patients:

  • Faster recovery (usually only one night in the hospital);
  • Significantly less pain because the incisions are so small;
  • Minimal scarring.

When performed by a surgeon with much experience in this minimally invasive technique, laparoscopic fundoplication offers the same high success rate for treating GERD as achieved through the traditional open fundoplication procedure. The Esophageal Center team includes some of the most experienced surgeons in the world at performing laparoscopic fundoplication.

Research

Providing the very best treatment options for patients is a key priority here. We continually evaluate the results (“outcomes”) of our treatment approaches and pursue opportunities to fine-tune surgical and medical solutions for patients.