Treatments

Gastroesophageal reflux disease (GERD) is a common and potentially debilitating disorder. Typical symptoms include heartburn and regurgitation of acid tasting substances. GERD is a chronic disease and in some cases, more alarming symptoms including food sticking in the esophagus, pain with swallowing, bleeding, anemia and weight loss develop.

Non-Surgical & Diagnostic Procedures

• Upper GI Endoscopy -Esophagogastroduodenoscopy (EGD)

  A gastroenterologist or surgeon performs the EGD, most often while the patient receives light sedation.

  An EGD is a procedure used to obtain information about your esophagus, stomach and small intestine. Your surgeon can look inside of these structures by placing an endoscope, which is a small, bendable tube that acts as a video camera. If anything suspicious or abnormal is found during the exam a biopsy may be performed.

  Upper GI endoscopy can help find the cause of unexplained symptoms, such as

  Persistent heartburn

  Pain

  Bleeding

  Problems swallowing

  Nausea and vomiting

  Unexplained Weight Loss

  Upper GI endoscopy can also find the cause of abnormal lab tests, such as

  Anemia

  Nutritional deficiencies

  Upper GI endoscopy can identify many different diseases

  Anemia

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  Gastroesophageal reflux disease

  Inflammation or swelling

  Ulcers

  Precancerous abnormalities

  Celiac disease

  This is an outpatient procedure that takes approximately 15-30 minutes. You will be monitored for approximately 1 hour after the procedure before being discharged. As this procedure requires light sedation you will need to be accompanied by someone who can drive you home.

• pH (ACID LEVEL) MONITORING

  The pH test is an outpatient procedure that measures the amount of acid that flows into the esophagus from the stomach during a specific time period. These procedures are used to help confirm the diagnosis of GERD/Reflux or to identify the cause of symptoms. The tests may also be performed to evaluate the effectiveness of current treatments for heartburn or reflux. These tests are often recommended for those whose symptoms aren't helped by medications.

  There are two commonly used methods of pH testing, the Impedance pH monitoring test and the Bravo pH monitoring test.

  Impedance & Bravo pH Monitoring uses a small, gel-cap probe adhered to the inside of the esophagus. The probe is attached to a data recorder that has buttons that you will push during the study. You will also be given a diary to keep track of symptoms, eating schedule, body position (lying down, sitting or standing) using the buttons on the recording box and diary.

  These devices measure acid reflux over a 48 hour period while the patient carries on with normal activities. The capsule will come loose and fall off on its own and is disposable (will come out with a bowel movement).

  Alternating patterns of reflux throughout the esophagus can help assess the composition and duration of all types of reflux, from acidic to mildly alkaline, and the gathering data will lead to individual reflux treatments.

  pH Monitoring is usually performed at the same time as the EGD procedure. It is an outpatient procedure that takes approximately 15-30 minutes. You will be monitored for approximately 1 hour after the procedure before being discharged. As this procedure requires light sedation you will need to be accompanied by someone who can drive you home.

• Barium Swallow

  A barium swallow is a radiographic (X-ray) examination of the upper gastrointestinal (GI) tract, specifically the pharynx (back of mouth and throat) and the esophagus (a hollow tube of muscle extending from below the tongue to the stomach). The pharynx and esophagus are made visible on X-ray by a liquid suspension called barium sulfate (barium). Barium highlights certain areas in the body to create a clearer picture. A barium swallow may be performed separately or as part of an upper gastrointestinal (UGI) series, which evaluates the esophagus, stomach, and duodenum (first part of the small intestine). This is an outpatient procedure that can take anywhere from 2-3 hours, depending on how fast the barium contrast travels through your digestive system.

• Manometry

  Esophageal manometry (muh-NOM-uh-tree) is a test that shows whether your esophagus is working properly. The esophagus is a long, muscular tube that connects your throat to your stomach. Esophageal manometry measures the rhythmic muscle contractions that occur in your esophagus when you swallow. Esophageal manometry also measures the coordination and force exerted by the muscles of your esophagus. During esophageal manometry, a thin, flexible tube (catheter) that contains sensors is passed through your nose, down your esophagus and into your stomach. Esophageal manometry can be helpful in diagnosing certain disorders that may affect your esophagus. This is an outpatient procedure that takes approximately 1 hour.

• Computed Tomography (CT) Scan

  Doctors order CT scans when they want to see a two-dimensional image of your body, including a view of the lymph nodes. If contrast dye is used to improve the computer image, you may need to avoid eating or drinking for 4 to 6 hours before the test. Be sure to tell your provider prior to the test if you have any allergies or if you have kidney problems. This is an outpatient procedure that takes approximately 15-30 minutes.

• Ablation

  "Ablation" (or coagulation) is a technique where tissue is heated until it is no longer viable or alive. Physicians use ablation to treat a number of cancerous and precancerous conditions, as well as to control bleeding. The HALO ablation technology is a very specific type of ablation, in which heat energy is delivered in a precise and highly-controlled manner.

  Barrett's esophagus is a precancerous condition affecting the lining of the esophagus (the swallowing tube that carries foods and liquids from the mouth to the stomach). Stomach acid backs up into the esophagus from acid reflux or GERD, causing injury to the esophageal lining. HALO ablation technology is capable of achieving complete removal of abnormal or diseased tissue without damage to the normal underlying structures.

  Ablation therapy is performed in conjunction with upper endoscopy. The treatment is performed in an outpatient setting and no incisions are involved.

  This is an outpatient procedure that takes approximately 15-30 minutes. You will be monitored for approximately 1 hour after the procedure before being discharged. As this procedure requires light sedation you will need to be accompanied by someone who can drive you home.

Surgical Procedures

• Paraesophageal Hernia Repair

  Paraesophageal hernia is a type of hiatal hernia where the junction of the stomach and the esophagus remains in place, but part of the stomach is squeezed up into the chest beside the esophagus.

  Some patients with a paraesophageal hernia don't have any symptoms, or their complaints are so minor that it is hard to associate the complaints with the problem of the hernia. Symptoms can include a vague discomfort in the top part of the stomach or lower chest known as the epigastric and substernal regions.

  Patients can also complain of feeling very full after eating a smaller amount of food. Nausea and problems swallowing (dysphagia) may also occur from gastric volvulus. Pain from a paraesophageal hernia may sometimes be severe that patients may think that they are suffering from a heart attack.

  When a hiatal hernia is extremely large, portions of the intestines may also enter the chest cavity. These organs can compress the lungs resulting in pulmonary problems such as recurrent pneumonia or infections. Chronic compression may cause a condition known as atelectasis.

  Paraesophageal hernias are less common, however they are a cause for concern because the herniated portion of the stomach may have a portion of its blood supply choked off. This condition is known as incarceration with strangulation.

  The chronic squeezing and twisting of the stomach may also cause severe irritation of the lining of the stomach resulting in intestinal bleeding. Bleeding can occur from gastric ulceration, gastritis, or erosions within the hernia.

  Surgeons can perform a paraesophageal hernia repair with a combination of laparoscopic and robotic technology in order to fix the diaphragmatic defect. The anti-reflux procedure is determined by the intraoperative need to displace the gastroesophageal junction during reduction of the hernia as well as preoperative studies. An allograft mesh is typically used to repair (depending on the size) the defect. Patients may need to stay in the hospital for one or two days and then return home on a soft diet for two weeks.

  This procedure is performed under general anesthesia and may require overnight stays in the hospital. Please direct any specific questions to your surgeon.

• Hiatal Hernia Repair

  A hiatal hernia occurs when part of the stomach pushes upward through the diaphragm. The diaphragm normally has a small opening (hiatus) through which the food tube (esophagus) passes on its way to connect to the stomach. The stomach can push up through this opening and cause a Paraesophageal or hiatal hernia.

  In most cases, a small hiatal hernia doesn't cause problems, and you may never know you have one unless your doctor discovers it when checking for another condition.

  A large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn. Self-care measures or medications can usually relieve these symptoms, although a very large hiatal hernia sometimes requires surgery.

  To reduce the hernia and put it back where it belongs hiatal hernia surgery is generally performed as a laparoscopic, or "minimally invasive," procedure. During this type of surgery, a few small (5 to 10 millimeter) incisions are made in the abdomen. Surgical instruments are inserted through these incisions.

  The advantages of laparoscopic surgery include smaller incisions, less risk of infection, less pain and scarring, and a more rapid recovery. Many patients are able to walk around the same day after hernia surgery. Generally, the patient can resume his or her regular activities within a week. Complete recovery can take 2-4 weeks. Hard labor and heavy lifting should be avoided until your surgeon clears you after surgery.

  This procedure is performed under general anesthesia and may require overnight stays in the hospital. Please direct any specific questions to your surgeon.

• Nissen Fundoplication

  Nissen Fundoplication, also known as Laparoscopic Fundoplication, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernias. It is usually performed when medical therapy has failed.

  In a Fundoplication, the upper part of the stomach is wrapped around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter. The esophageal or hiatus hernia is repaired at the same time.

  With Nissen Fundoplication, patients are restricted to a liquid diet that is slowly advanced over weeks to normal food.

  This procedure is performed under general anesthesia and may require overnight stays in the hospital. Please direct any specific questions to your surgeon.

• LINX^® System

  The LINX^® Reflux Management System is used for treating GERD or Reflux when medication no longer provides adequate symptom control. LINX^® is a bracelet shaped system of flexible magnetic titanium beads that, when placed around the esophagus, supports a weak or malfunctioning lower esophageal sphincter (LES) (the muscle that opens and closes to allow food to enter and stay in the stomach) which may be causing acid reflux. Implanting the LINX^® system restores the body's barrier to reflux. The magnetic attraction of the titanium beads allows it to open and close to let food down or come back up if it needs to.

  The LINX^® placement is a less invasive surgery performed laparoscopically under general anesthesia and does not involve alterations to the anatomy that may limit future treatment options. The LINX^® System can be removed if needed with a procedure similar to the placement. Removal of the device leaves the esophagus the same as it was before the implant. Unlike other procedures that treat reflux, LINX^® requires no alteration to the stomach. Patients usually go home the same or next day and are able to eat a normal diet after surgery.

  LINX^® starts working as soon as the device is implanted and will continue to work for the long haul. Since it's made from titanium magnets, LINX^® is designed to have you reflux-free for a lifetime. It's a small device with big results. Not to mention, LINX^® won't affect trips through airport security and the device will still allow you to safely undergo a wide range of diagnostic imaging tests, including X-Ray, ultrasound, PET scans, CT scans or MRI's.

  This procedure is performed under general anesthesia and may require overnight stays in the hospital. Please direct any specific questions to your surgeon.

• Roux-en-Y Reconstruction

  If test results show that some, or all, of the patient's stomach must be removed, the surgeon must create a new way to allow food to travel from the mouth to the intestines. The most common method of creating a way for food is called a Roux-en-Y in which a small pouch is created from a part of the stomach and is connected to the small intestine and another connection is made between the intestines lower down.

  This procedure is performed under general anesthesia and may require overnight stays in the hospital. Please direct any specific questions to your surgeon.

• Gastric Bypass (GBP)

  Gastric Bypass Surgery refers to a surgical procedure in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both. GBP leads to a marked reduction in the functional volume of the stomach, accompanied by a resolution of refluxing of stomach acids to the esophagus. The stomach acids are redirected down the digestive system. The operation is also prescribed to treat morbid obesity.

  This procedure is performed under general anesthesia and may require overnight stays in the hospital. Please direct any specific questions to your surgeon.