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DIGESTIVE SERVICES

Diagnosis & Treatment

Gastroesophageal Reflux Disease (GERD)

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How is GERD Diagnosed?

Diagnosis

There are quite a few treatment options available for individuals suffering from GERD. Lifestyle adjustments and medication will be enough for most people to lessen and even prevent symptoms. In more severe stages of GERD, surgery may be considered.

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 diagnosis may include:

  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy). A gastroenterologist inserts a flexible camera (an endoscope) through your mouth to look at your esophagus, stomach and small bowel for any abnormalities and possibly take tissue samples of any abnormal tissue (such as Barrett’s esophagus).
  • Wireless pH capsule (Bravo). 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 4 day period. You will also keep a diary of any symptoms, and your physician will determine if they are related to acid reflux. The capsule detaches on its own and is passed in the stool. The information obtained is interpreted later by a gastroenterologist trained in esophageal diseases.
  • Esophageal pH Impedance: A thin tube is placed through your nose into your esophagus to measure the amount of fluid coming into your esophagus from the stomach (reflux) over a 24-hour time period. It also measures if your symptoms occur at the same time as your reflux episodes.
  • 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.
  • Esophagram: in this test, you are given liquid barium and x-rays are taken to evaluate your swallow as well as your entire esophagus as it empties into your stomach. A tablet may also be given and x-rays taken to assess if it passes.

How is GERD Treated?

Treatment

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 who do not respond to or do not wish to take medication long-term may be candidates for a variety of endoscopic or surgical GERD treatments.

Prescription Medication/Non-prescription medication

Medications used to treat GERD symptoms are available over the counter and by a doctor's prescription. Be aware that medicine can cause side effects, so talk to your doctor about which option is best for you.

  • Histamine 2 blockers. Reduces stomach acid production, which can help with symptoms of heartburn and regurgitation. This medication is available both over the counter (OTC) and through prescription for higher doses.
    • Examples include famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid).
  • Proton pump inhibitors (PPIs). These are stronger medication than H2 blockers and control the amount of acid your stomach makes over a longer period of time. Doctors can prescribe a higher dosage, and lower dosages are available OTC.
    • Examples include omeprazole (Prilosec), esomeprazole (Nexium), (esomeprazole), lansoprazole (Prevacid), pantoprazole (Protonix) (Rabeprazole (Aciphex), dexlansoprazole (Dexilant)
  • Antacids. This OCT is typically used for occasional and mild acid reflux symptoms. But if you take antacids almost daily, you may need a stronger medication.
    • Examples include Maalox, Mylanta, Rolaids, Gaviscon, TUMS (calcium carbonate)
Dietary changes

Food triggers can make heartburn and regurgitation worse. Trying to avoid the following foods may help identify what causes your symptoms. Avoid the foods and beverages that make your symptoms worse.

  • Fatty Foods, like fried foods
  • Spicy foods
  • Citrus fruits and juices
  • Acidic foods like tomatoes
  • Onions
  • Garlic
  • Mint
  • Coffee
  • Carbonated beverages
Surgical options

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 surgery, 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, this surgery can be performed robotically.
  • Transoral Incisionless Fundoplication (TIF): For this procedure, an interventional gastroenterologist reconstructs the barrier between your esophagus and stomach using an endoscope (a camera inserted through the mouth) and a TIF device to wrap the stomach reinforcing the lower esophageal sphincter.
  • Magnetic Sphincter Augmentation (LINX device): during this surgery, a special magnetic sphincter created of magnetic beads is implanted to the bottom of the esophagus at the lower esophageal sphincter. This creates a barrier to reflux.

FAQs

FAQs

Acid reflux can be effectively treated and even prevented. Making dietary changes such as eating smaller meals, avoiding food triggers, and not lying down after eating are good ways to begin managing frequent acid reflux symptoms. For more treatment options, consult our gastroenterology team at NewYork-Presbyterian.

GERD can cause chest pain, but it is important to ensure it is not from your heart. Many people with GERD report feeling a burning sensation in the upper chest, commonly known as heartburn. However, if you are having chest pain it is important that you see a physician to evaluate your symptoms.

It is important to adopt healthy lifestyle behaviors. Maintaining a healthy body weight, eating a healthy diet, getting adequate exercise, and reducing stress as much as possible are critical factors in preventing acid reflux. If you have symptoms that are not improved with lifestyle modifications, it is important to see a doctor as soon as possible.

It takes time to heal from GERD, depending on the severity of symptoms and the amount of damage to the esophagus. If you are started on a proton pump inhibitor (PPI) for GERD, your symptoms can take up to 8 weeks to resolve. In some cases, you may need to remain on medications indefinitely, depending on the severity of your disease.

In some cases, symptoms of acid reflux may be permanent or improved by following your doctor's instructions and adopting healthy lifestyle choices. If you have severe disease with changes to your esophagus including Esophagitis (inflammation and redness of the lower esophagus) or Barrett’s Esophagus, you likely will need to remain on medications called proton pump inhibitors (PPI).

Various treatment options range from home remedies to over-the-counter and prescription medication. Lifestyle modifications include eating smaller meals, remaining upright for at least 3 hours after eating, and avoiding food triggers. Many look to over-the-counter (OTC) medication like Histamine 2 blockers and antacids to control and neutralize stomach acid. Currently, the strongest medications available OTC are the proton pump inhibitors.

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Trust NewYork-Presbyterian for GERD Treatment

Everyone will, at some point in their lives, experience occasional acid reflux symptoms. But frequent occurrences could mean the development of GERD. That’s when expert care at NewYork-Presbyterian can offer the help by offering the support you need.

Our esophageal care centers provide the necessary testing to diagnose and treat GERD symptoms. Our highly experienced gastroenterologists and surgeons can provide effective treatment therapies. Call us and make an appointment to see what we can do for you.