Gastroesophageal Reflux Disease (GERD)

GERD can produce a broad variety of symptoms, including:

• Asthma
• Belching
• Bloating
• 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)
• Heartburn
• Hoarseness
• Lung aspiration
• Nausea
• Regurgitation
• Shortness of breath (dyspnea)
• Voice problems
• Wheezing

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.

Medical Treatment

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.

Surgical Treatment

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.

If you have GERD, you have a higher risk for Barrett’s esophagus. People with this condition can develop a rare type of esophageal cancer. Although the overall risk for esophageal cancer is extremely low, we recommend getting a screening test called a surveillance esophagogastroduodenoscopy (EGD) every three to five years if you have GERD.

During an EGD, a doctor uses a thin tube, or endoscope, with a camera to check for changes inside of your esophagus.

If you have GERD and your symptoms still bother you even though you take medication, you may be a candidate for surgery.

Even if your symptoms are controlled with medication, you may want to see a gastrointestinal surgeon so you can understand your options. Surgery may provide better control of your symptoms and reduce your need for medication.

Several procedures are available to help reduce GERD symptoms, from fundoplication to weight loss surgery, if needed. At UChicago Medicine, we’ll work with you to determine the best option so that you can find relief from your symptoms.

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

Our surgeons use the latest techniques in robotic surgery and can perform many procedures using “hidden” incisions, so small scars are concealed below the waistline.

Each surgery we perform is personalized to the needs of each patient. For example, our surgeons use special technology called impedance planimetry during your GERD surgery to customize your procedure. This allows surgeons to measure the pressure and movement inside your esophagus and the connection to your stomach in real time so they can tailor your surgery based on your specific anatomy.