Gastroesphageal Disease
Surgery for Gastroesophageal Reflux Disease (GERD) and other Esophageal Disorders
What is GERD?
Gastroesophageal reflux disease (GERD) or heartburn is a very common condition among Americans. The classic symptoms include a burning sensation in the chest (heartburn), sour-tasting fluid in your throat, and regurgitation. Other less common symptoms are difficulty swallowing, chest pain, and hoarseness. If left untreated, complications such as ulceration, bleeding or stricture of the esophagus may result over time. A condition known as Barrett’s esophagus can develop with chronic, severe GERD which is a risk factor for esophageal cancer.
What causes GERD?
The acid that is normally produced in your stomach can enter into your esophagus through a weakened one-way valve at the top of your stomach. This acid can travel backwards all the way up your esophagus and into your throat. Habits such as smoking, caffeine use, and alcohol use can increase the level of acid causing even more heartburn.
How can I relieve my symptoms through lifestyle changes?
There are several measures to treat heartburn through changes in your habits. For instance, cessation of smoking, caffeine, and alcohol intake may lessen your heartburn. Other measures include raising the head of your bed, avoiding food just before bedtime, and weight loss.
Can I take medicine to relieve GERD?
The vast majority of patients who suffer from GERD can be treated by medications that are designed to reduce the amount of acid in your stomach. Some of these medications are available over the counter, while others require a prescription from your doctor. Be sure to inquire about the appropriate timing for your medications, since several medications must be taken before eating.
What about surgery for GERD?
For some patients, medications do not work to control symptoms or prevent damage to your esophagus. Surgery may be indicated in these situations. The operation is called a
laparoscopic (Nissen) fundoplication
in which the one-way valve at the top of the stomach is recreated keeping the acid in the stomach where it belongs. The surgery has been performed for over 40 years and offers partial to complete relief in over 90% of patients.
What does surgery involve?
Prior to any operation, all patients will have a consultation with a surgeon to discuss options for treatment. Patients may need to undergo tests to determine if you are a good candidate for surgery. These tests often include an upper GI series, endoscopy, 24-hour pH monitoring and esophageal manometry.
Patients come to the hospital on the day of their surgery. The procedure is performed under general anesthesia and takes approximately 2 hours total. Following the surgery, patients stay overnight in the hospital, then return home the following day. Some patients may need extra time in the hospital for recovery. For the first 2 weeks after surgery, patients must remain on a soft diet and liquids. In addition, patients are encouraged to refrain from vigorous activity. The first postoperative visit will be 2 weeks after surgery. At that time, further instructions regarding diet and activities will be given.
What is the recovery time?
Each patient recovers at their own pace, but in general, most patients can return to light-duty work about 1-2 weeks after surgery. Vigorous activity such as exercise and sports is restricted for the first month.
What about other esophageal disorders?
Other benign conditions affecting the esophagus include achalasia, para-esophageal hernias, and hiatal hernias. These conditions may resemble GERD, but often have their own unique symptoms. A very similar surgery is available for these conditions.
How do I make an appointment?
The surgeons listed below have extensive training and experience with this type of surgery. An appointment can be made for a consultation regarding this procedure by contacting either of their offices:
Miguel Burch, MD: (617) 414-8052
Lily Chang, MD: (617) 414-8080