Services & Treatments for GERD and Foregut Disorders?

Also known as EGD (esophagogastroduodenoscopy), an Upper Endoscopy is a procedure used to view the esophagus, stomach, and upper part of the small bowel. This examination looks for signs of reflux, peptic ulcer disease, or tumors.

EGD is more accurate than x-rays for identifying inflammation, detecting abnormal growths such as ulcers, tumors, or cancer, and for examining the inside of the upper digestive system. If your gastroenterologist detects potential abnormalities in the lining of the esophagus, a biopsy can be taken for further examination.

With this procedure, a liquid barium solution is swallowed while several x-rays are taken to examine the upper digestive tract. The liquid barium temporarily coats the lining of the esophagus, stomach, and intestine, making the outline of these organs visible on the x-ray film. The x-rays show how the solution is traveling from the mouth to the esophagus and into the stomach and is performed to visualize the presence of reflux, hiatal hernia, or obstruction.

For many cases of GERD and esophageal disorders, simple changes to daily life are all that is needed to treat the disease.

For this reason, your doctor may recommend:

• Reducing or eliminating smoking and alcohol consumption
• Dietary changes such as avoiding spicy, acidic, or fatty foods and coffee or carbonated beverages
• Weight loss
• Elevating your head while you sleep
• Eating smaller meals throughout the day
• Wearing loose fitting clothes

Medication therapy is often the next step if lifestyle changes are not effective. Over-the-counter antacids and other medications can neutralize stomach acids and help reduce acid production. Prescription medications may be effective in promoting healing and relieving symptoms.

The most common medications include:

• Antacids - Over-the-counter antacids are best for intermittent and relatively infrequent symptoms of reflux, but may actually worsen the problem if used too often.
• H2 blockers – Histamine blockers decrease acid production, providing short-term or on-demand relief for many people with GERD symptoms.
• Proton pump inhibitors - PPIs lower the amount of acid your stomach makes and are typically more effective than H2 blockers. They can heal the esophageal lining in most people with GERD, even those with severe esophageal damage, and are often prescribed for long-term GERD treatment.
• Prokinetics – Prescription medication that helps strengthen the lower esophageal sphincter and cause the contents of the stomach to empty faster. This allows less time for acid reflux to occur

The Center for GERD and Foregut Disorders uses the latest procedures performed by the most experienced physicians to treat certain esophageal disorders.

We aim for minimally invasive options which may include:

• Botox Treatment – A short-term treatment option in which medication is injected into muscles of the esophagus to treat problems like muscle spasms and achalasia.
• Endoscopic Mucosal Resection (EMR) – a procedure in which the top layer of esophageal tissue, called the mucosal layer, is removed by an endoscope. In time, another layer of tissue will grow back in its place. This procedure is often used in precancerous conditions, such as Barrett's Esophagus, and even some very early stage esophageal cancers.
• Esophageal Dilation – a procedure which uses a balloon to widen a narrowed section of your esophagus.
• Radiofrequency Ablation – an endoscopic treatment which uses heat energy - similar to microwave energy – in a precise and highly-controlled manner to destroy cells and diseased tissue, that result from Barrett’s Esophagus, without damaging normal underlying structures or healthy tissue. 
• Peroral endoscopic myotomy (POEM) – an innovative treatment for achalasia, this procedure uses upper endoscopy rather than conventional surgery to help permanently relax tight esophageal muscles and open up areas of the esophagus that have narrowed.

This step is usually reserved for those whose symptoms are not effectively treated by either lifestyle changes, medication, or non-surgical procedures. Sometimes this may be the first option if there is a physiological defect such as a hiatal hernia. Surgical treatment is usually minimally-invasive with quick recovery.

Surgeries performed may include:

• Laparoscopic Fundoplication – This minimally-invasive procedure is the most common surgical treatment for severe heartburn, or GERD. In this procedure, the surgeon wraps the upper part of the stomach (the fundus) around the lower portion of the esophagus, reinforcing the lower esophageal sphincter so food won’t reflux back into the esophagus.
• Laparoscopic Heller Myotomy – A minimally-invasive procedure that uses small incisions in the abdomen to open the tight lower esophageal sphincter (the valve between the esophagus and the stomach) to relieve the dysphagia (difficulty swallowing). 
• LINX Implant – LINX is a treatment intended for patients diagnosed with GERD who continue to have symptoms even while taking medication. This laparoscopic procedure uses a ring of flexible magnets placed around the esophagus which opens to allow food and liquids in the stomach and closes to prevent acid from going back up the esophagus. No alteration of the stomach is necessary.