Esophageal Disorders Program

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Gastroesophageal Reflux Disease (GERD) Diagnosis and Treatment

Esophageal Disorders Program
Columbia University Medical Center
In Affiliation with NewYork-Presbyterian Hospital
Phone: 1.800.227.2762

Afflicting an estimated 25 million Americans, gastroesophageal reflux disease (GERD) is a common digestive disorder in which stomach contents regurgitate (reflux) into the esophagus. Diagnosis and treatment of GERD are important because the condition may cause inflammation and damage to the esophagus, and occasionally to the lungs and vocal cords. Such inflammation may lead to more serious conditions, including esophageal cancer. The most common cause of GERD is when the lower esophageal sphincter (LES), a smooth-muscle barrier between the esophagus and the stomach, does not function effectively.

Diagnosis of GERD

Many people occasionally experience heartburn, which can be caused by spicy or fatty foods, alcohol, or pregnancy. However, if you experience these symptoms more than two times a week on a regular basis, you may have GERD. Common diagnostic tests for the condition include:

Endoscopy, in which a scope is passed into the esophagus and stomach,
An upper GI series (barium contrast X-ray),
Esophageal manometry, in which a sensitive probe is used to test how tightly the LES closes, and
Esophageal pH testing, in which a probe is used to measure the level of acidity in the esophagus.

Treatments for GERD

Most patients respond well to conservative treatments, including:

Dietary modification,
Lifestyle changes, such as avoiding eating two to three hours before bedtime,
Stopping smoking and drinking, and
Antacid therapy.

Lasting control of symptoms, however, is sometimes difficult to attain.

Surgery for GERD

For those patients for whom these measures are not successful, anti-reflux surgery can offer gratifying, durable results with relief of GERD. Involving creation of a new valve mechanism at the lower end of the esophagus as a barrier to reflux, surgery is most effective for those patients whose GERD is caused by a defective LES. More than 90% of patients who undergo surgery have no reflux afterward. There are two main types of procedures:

Surgical fundoplication: The upper part of the stomach is wrapped around the lower part of the esophagus to tighten the LES. This procedure may be performed with minimally invasive techniques in almost all patients.
Endoscopic Repair of GERD: Instruments and a small camera are inserted through the mouth and advanced to the junction between the esophagus and the stomach, where the stomach is tacked alongside the esophagus in order to create a more effective barrier to reflux. The surgeon performs the procedure entirely through the mouth without making any external or internal incisions.

If you are considering surgery for GERD, our team recommends seeking out a surgeon versed in both endoscopic and surgical techniques so that you have the most options available to you.

Quality of Life Interventions from the Columbia University Department of Surgery