Esophageal Diseases

Gastroesophageal Reflux Disease (GERD)

The Latest GERD Therapies

Gastroesophageal reflux disease (GERD) occurs when stomach contents back up into your esophagus and cause symptoms or damage. At New York-Presbyterian, our experts offer the latest medical and surgical treatments. Our goal is to relieve symptoms, improve your quality of life, and prevent the risk of more serious esophageal problems.

What causes GERD?

It is not clear why some people develop troublesome GERD and others do not. GERD is more common in people who:

• Are overweight
• Have a hiatal hernia
• Smoke
• Have a connective tissue disorder, such as scleroderma

Signs & Symptoms of GERD

If you have GERD, you may experience:

• Heartburn
• Regurgitation (food or liquid coming up into your mouth without warning)
• Trouble swallowing food or liquid
• Chest pain
• Hoarseness or other change in your voice
• Cough and other asthma-like symptoms
• Acid taste in the mouth

How We Diagnose GERD

The first step toward treating your GERD effectively is confirming what is causing your symptoms. Your doctor may initially diagnose GERD by assessing your symptoms and seeing how well you respond to acid-reducing medications. Testing for GERD may include:

• Esophagogastroduodenoscopy (also called EGD or upper endoscopy). A gastroenterologist uses a fiber optic instrument (an endoscope) to see the inside of your esophagus and possibly take tissue samples of any abnormal tissue (such as Barrett’s esophagus).

• Ambulatory pH monitoring. During an endoscopy a tiny capsule is attached to the inside of the esophagus. You will carry a recording device that keeps track of how much acid reflux occurs over a 2-4 day period. The capsule detaches on its own and is passed in the stool. The information obtained is interpreted later by a physician on a computer. You will also keep a diary of any symptoms, and your physician will determine if they are related to acid reflux.

• Impedance testing is used to determine if you are having non-acid reflux as a cause of your symptoms.

• High-resolution esophageal manometry with or without impedance testing measures the pressure, strength, and coordination of the muscles in your esophagus and esophageal sphincter. A very thin tube is passed through your nose and down into your stomach. Esophageal muscle function is measured while you swallow sips of liquid.

Our Approach to Care

Your healthcare team includes gastroenterologists, surgeons, nurses, and others with experience caring for people with GERD and other disorders of the esophagus. Your team will evaluate your symptoms and choose the most appropriate treatment. With a range of medical and surgical options, our team works with you to determine which approach is best for you.

GERD treatments

Treatment for GERD includes dietary and lifestyle changes such as weight loss, not lying down after eating, avoiding eating before bed, smoking cessation, avoiding trigger foods, and/or elevating the head of the bed. Medications that reduce damaging acid may be prescribed. Patients with GERD who do not respond to or do not wish to take medication long-term may be candidates for a variety of endoscopic or surgical treatments.

NewYork-Presbyterian's gastroenterologists and surgeons have exceptional experience in the care of people with GERD. Some of the advanced endoscopic and surgical GERD treatments we offer include:

• Laparoscopic fundoplication. During this procedure, your surgeon supports the weakened lower esophageal sphincter by wrapping the top portion of the stomach around the lower esophagus to create a barrier to reflux. In some cases we can perform this procedure using robotic surgery.
• Transoral incisionless fundoplication (TIF). This less invasive endoscopic alternative to fundoplication surgery can be completed without any incisions. The endoscopist inserts a specially designed device through a tube placed in your esophagus to partially wrap your stomach around the base of the esophagus and create a new valve.
• Magnetic beads (LINX). Our surgeons are experienced in a procedure using a small expandable ringed band of magnetic beads that is wrapped around the base of the esophagus during minimally invasive laparoscopic surgery. The magnetic attraction between the beads keeps it closed when you aren't eating, and the band expands when food and liquid pass through to your stomach.

Why Choose Us

The causes and treatment of GERD can vary from person to person and require the kind of integrated, personalized care offered at a medical center such as NewYork-Presbyterian. Our esophageal care centers offer all of the testing needed to accurately diagnose GERD and effectively manage it. Your care team will get to know you, your symptoms, and your lifestyle and offer the treatment that is most effective for you. Our gastroenterologists and surgeons are highly experienced performing all of the available therapies for GERD — so you know that whichever one is recommended for you, you will be in good hands. Give us a call and make an appointment to see what we can do for you.