Digestive Health: What Are the Best GERD Treatment Options?

Treatments for acid reflux disease range from antacids to surgery

A young Asian-American woman grabs her chest wondering if she has heartburn or GERD or something else.

Treatments for acid reflux disease range from antacids to surgery

Some people say it feels like a hot pressure in the chest or a fire that starts behind the breastbone and spreads upward. Others experience an acidic taste, like food coming back up the throat and into the mouth. When these symptoms happen frequently, you might have gastroesophageal reflux disease or GERD.

While heartburn, difficulty swallowing and other symptoms of GERD are uncomfortable and frustrating, this chronic digestive condition is manageable for most people.

Your doctor might recommend lifestyle changes — losing weight, avoiding fatty and spicy foods — and medications for mild to moderate GERD symptoms. Treating GERD with surgery is an option when less invasive treatments fail to bring relief. A patient also may also opt for surgery if he or she does not want long-term dependence on medications and their possible side effects.

“Your doctor will work closely with you to create a treatment plan that will help resolve your symptoms and improve your quality of life,” says Cheryl Olson, MD, a general surgeon at Scripps.

“Most people can manage GERD with over-the-counter or prescription medications and a few lifestyle changes. Surgery is often the last resort when medications no longer relieve symptoms,” Dr. Olson says. “Surgery can also be considered as an alternative to a lifetime of medications."

If left untreated, GERD can lead to serious complications.

What is GERD?

GERD is a chronic digestive disorder that affects the lower esophageal sphincter (LES), the muscle that connects the esophagus and the stomach.

Normally, the LES opens to allow food to pass into the stomach. It closes to prevent food and acidic stomach juices from flowing back into the esophagus, which is known as reflux. If the LES is weak or closes improperly, GERD can result.

The esophagus may stop working properly for several reasons, including illness, injury and aging. The result can be difficulty swallowing, heartburn and GERD.

Symptoms can last up to several hours and are often worse after eating or lying down.

Who gets GERD?

Having heartburn or indigestion occasionally is common. But if symptoms happen repeatedly, it could be GERD and you should talk to your doctor. According to one study, 15 to 30 percent of the population in the United States has GERD.

Obesity and pregnancy can increase the risk of GERD. Almost half of pregnant women suffer from it.

Dietary choices also may affect GERD. Some people find that chocolate, peppermint, spicy or fatty foods, coffee and alcoholic beverages may contribute to symptoms.

Hiatal hernia

Another culprit of acid reflux is a condition known as hiatal hernia, which can weaken the LES. It occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm muscle that separates the stomach from the chest.

Studies suggest that hiatal hernia can lead to retention of acid, which can then flow back into the esophagus.

“Hiatal hernias can be caused by coughing, vomiting or sudden physical exertion that increases pressure in the abdomen,” Dr. Olson says. “They are especially common in people over the age of 50. Treatment is usually not required unless they lead to complications or cause severe GERD.”

Treatment may include minimally invasive procedures, including robotic hernia repair.

GERD medications

Treatment for GERD depends on the cause and severity. Some people may obtain quick relief for mild symptoms by taking over-the-counter antacids.

Other medications work more slowly but provide longer relief. H2 blockers and proton pump inhibitors (ppis), block or reduce the amount of acid produced during digestion. They are available over the counter and in prescription strength form.

“Long-term or overuse of medications can cause side effects and other problems. It can inhibit the absorption of important minerals, such as calcium,” Dr. Olson says. “Patients still may have to avoid certain foods. Moreover, medications don’t resolve the underlying anatomical problems with the LES that cause acid reflux.”

In chronic and severe cases, surgery may be needed to correct the problems that cause GERD.

Anti-reflux surgery

The most common surgical treatment to prevent reflux is fundoplication. In this procedure, a portion of the stomach is attached to the bottom of the esophagus. This strengthens the valve between the esophagus and stomach and stops acid from backing up into the esophagus.

Fundoplication can be done as open surgery — involving an incision in the abdomen or chest — or laparoscopically — involving several small incisions. Laparoscopic surgeries are minimally invasive procedures that help reduce pain, recovery time and scarring compared to open surgery.

Incisionless GERD surgery

A more recent treatment is Transoral Incisionless Fundoplication or TIF. It is performed through the mouth and does not involve incisions in the abdomen. This treatment allows surgeons to reinforce a weak esophageal sphincter.

Because no incision is needed, there is reduced pain, shorter recovery time and no visible scar. Most patients can return to work the next day or within a few days.

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