UPMC Comprehensive Reflux Program

Gastroesophageal Reflux Disease (GERD), commonly known as acid reflux or heartburn, is one of the most common — yet most neglected — diseases in the United States. Our collaborative team of experts, led by Leader Surgical Associates-UPMC, has created a comprehensive program to help diagnose and treat GERD. The Reflux Program will provide a personalized, coordinated plan of care for each patient.

What is Gastroesophageal Reflux Disease?

Gastroesophageal reflux disease (GERD) is when stomach contents (often with acid) travel backwards (reflux) up the esophagus, or swallowing tube. This is a normal occurrence to some extent, but becomes a problem when it causes regular symptoms or complications, such as heartburn, regurgitation (bitter taste), a “stuck sensation” in the throat, or chest and abdominal pain.

Is heartburn a big deal?

Uncontrolled GERD can lead to major problems. Acid exposure in the esophagus can cause narrowing, severe inflammation, ulcers, and Barrett’s esophagus. Left untreated, Barrett’s esophagus can even lead to cancer of the esophagus.

What causes GERD?

A number of factors can lead to GERD. Genetics play a role, and diet and lifestyle factors are major contributors too. Often, there is a problem with the lower esophageal sphincter, a muscle complex where the esophagus turns into the stomach. This can be related to muscle tone, medications, or a total disruption (for example, a hiatal hernia). We get reflux when the lower esophageal sphincter is not working properly.

What testing will my doctor do?

There are a few tests to diagnose GERD and figure out the best treatment. Some examples include:

• Upper Endoscopy or EGD – probably the first test to be done. Like a colonoscopy, your doctor will use a flexible camera to look directly into your stomach and esophagus. Biopsies can be done to learn more, and complications such as Barrett’s can be looked at directly.
• Bravo pH Testing – done at the same time as your EGD, this is a wireless capsule attached to your esophagus. It is not painful and falls off on its own. You will keep a diary for 48 hours, and your doctor can see exactly how bad your reflux is. pH testing is the gold standard test.
  • Impedence Testing – if your doctor suspects nonacid or weak acid reflux, you may have this 24-hour test. It involves a small tube with sensors placed through the nose, and like the Bravo test, you go home and keep a diary.
• Manometry Testing – another outpatient test. This involves a small tube with sensors placed through your nose into your esophagus (like impedence testing), but this time you don’t go home with it. The test looks for movement problems of the esophagus, which can sometimes be confused with GERD and are crucial to planning the best treatment.
• UGI or Barium Swallow – this test is done in the Imaging Department. You will swallow dye, and the radiologist will take multiple pictures. This test may show some esophagus function, but it isn’t as good as manometry testing. However, it is better at showing hiatal hernias.

How can I treat my reflux disease effectively?

The first step in treatment of GERD is lifestyle change. Trigger foods, caffeine, alcohol, and nicotine should be avoided entirely. Timing your meals at least four hours before laying down can help. Some people need to sleep with their mattress on blocks, which allows gravity to fight nighttime symptoms. If you are overweight, even a modest weight loss can really help.

Are there any medications to try?

Yes! In conjunction with lifestyle changes, medicine can be very effective. This ranges from short-acting (e.g. Tums) to long-term (e.g. Prilosec). Ask your doctor what may be best for you.

What if I don’t want to be on medicine but have bad reflux, or I have complications such as Barrett’s esophagus?

Surgery may be right for you. Here are some examples that can be discussed with your doctor:

• Endoscopic Interventions – this includes radiofrequency ablation of the esophagus. These treatments can destroy Barrett’s but require medication and/or surgery down the line for a more permanent fix. Endoscopic interventions are done similarly to endoscopy, with twilight anesthesia and no cuts.
• LINX® Magnetic Sphincter Augmentation – this is a minimally invasive surgery. You are put to sleep and any hiatal hernia is repaired. A magnetic “bracelet” is placed around your esophagus to recreate the lower esophageal sphincter.
• Laparoscopic Toupet or Nissen Fundoplication – this is also a minimally invasive surgery. You are put to sleep and any hiatal hernia is repaired. The top of your stomach is wrapped around itself on your esophagus to recreate the lower esophageal sphincter.
• Laparoscopic Gastric Bypass / Gastric Exclusion – this is also a minimally invasive surgery. The previously mentioned procedures are less successful for patients who are significantly overweight. In that case, the best procedure is a bariatric surgery, which will help with weight loss and cure your reflux at the same time.

What surgery is best for me?

Each procedure has its advantages and disadvantages. After you have had a complete set of testing, you will be able to discuss with your doctor what makes the most sense for you.

GERD is a lifetime disease.

Many people also don’t realize that anti-reflux surgery may only last 10 to 15 years. This may ultimately result in the need for repeat surgery or resuming a small dose of anti-acid medicine down the line. Your surgeon and the team in the Reflux Program will work with you to minimize your need for revisional surgery or increases in medication.

Thank you for entrusting us with your care. Please don’t hesitate to call if you have any questions: 717-741-3449.

Need more information?

Leader Surgical Associates-UPMC: 717-741-3449