How is GERD Treated?

In many patients, mild symptoms of reflux disease are treated effectively with over-the-counter medications, such as antacids that neutralize the effects of stomach acid. However, when these drugs no longer work other medications, including prescription-strength H2 blockers and proton pump inhibitors, may be prescribed that reduce gastric (stomach) acid production.

Lifestyle changes also significantly - and positively - affect GERD symptoms. These measures include:

  • Losing weight
  • Stopping smoking
  • Restricting caffeine and alcohol use
  • Eliminating fried, fatty foods from the diet as well as other foods that trigger heartburn
  • Eating smaller portions
  • Not lying down after eating
  • Raising the head of the bed

Patients who have longstanding reflux of stomach acid into the esophagus will be evaluated for Barrett's esophagus, a precancerous condition in which the cellular lining of the esophagus has changed due to the irritating effects of GERD.

SURGERY
In some cases, surgery is recommended when medications are no longer tolerated or effective. Surgery also may be indicated to repair the esophagus to help reduce or eliminate GERD symptoms. These conditions include hiatal hernia, when the top of the stomach protrudes up into the lower esophagus; esophageal strictures, which is narrowing of the esophagus; and procedures to strengthen the lower esophageal sphincter (LES) muscle that sits between the top of the stomach and the lower esophagus.
 
One such LES surgical technique, the Hill repair, was perfected by Virginia Mason Surgeon Lucius Hill, MD. Today, the Hill repair is the preferred surgical treatment for GERD and is performed most often laparoscopically.
 
In the laparoscopic approach, three or four small incisions, about ¼ to ½ inches in diameter are made in the abdomen. Small surgical instruments and a miniature camera are then inserted through these "ports." The surgeon performs surgery while viewing images of the esophagus on a video monitor.
 
Because the Hill repair is more technically difficult, surgeons may choose the more common Nissen fundoplication procedure, which involves wrapping the top of the stomach around the lower esophagus, which eliminates symptoms of GERD. This procedure also can be performed laparoscopically.