About Our Treatment for Gastroesophageal Reflux Disease (GERD)
We are committed to bringing new and advanced diagnostic tools, medical treatments and non- surgical options to the patients we serve. Many of our patients come to us after suffering from debilitating effects of gastroesophageal (acid) reflux disease or GERD.
GERD is a condition that develops when a person frequently experiences regurgitation of stomach contents into the esophagus. For those who suffer GERD symptoms daily there is a seven times increased probability of their having esophageal cancer due to continuously exposing the esophagus to harsh stomach acid. Pharmaceuticals are a front-line solution used for GERD treatment. While pharmaceuticals may offer some relief, long-term use of proton pump inhibitors (PPI) have proven to be unsafe. The FDA has issued a warning that chronic PPI users are 2.2 times more likely to suffer hip fractures (4.5 times more likely after seven years of chronic use). Data also show increased incidences of heart attacks, strokes, and dementia associated with PPI use.
While many patients have GERD symptoms, our Center for Complex Digestive Disease Motility Program has the technology and expertise to diagnose a symptom’s root cause. Comprehensive testing allows diagnosis of complex problems such as paraesophageal hernias, diffuse esophageal spasm or achalasia, and identifies candidates for endoscopic or laparoscopic repairs of these serious conditions. As a comprehensive foregut motility center, we offer the most advanced diagnostic and treatment options.
For many people who suffer from GERD or GERD-like symptoms, there are solutions other than the use of H2 blockers or PPI medications. While these types of medications have been extremely successful in suppressing stomach acid production, the suppression of acid in conjunction with lifestyle modifications and weight loss treats only the symptoms and not the cause of GERD. Furthermore, medications can be an expensive lifetime treatment option. Aside from the risks associated with the significant risks from medications, complications from GERD that go untreated can increase a patient’s chances for more serious problems including inflammation, ulcers, strictures, dysphagia, asthma or esophageal cancer. For many patients whose GERD does not respond to treatment or who reach a place where treatment no longer addresses their symptoms, a “surgical-like” endoscopic intervention is a real option available to bring relief from GERD.
In some cases, there is very good news! GERD-like symptoms can be eradicated by diagnosing and treating Helicobacter pylori (H. pylori) bacteria found present in many patients. Diagnosis is accomplished through biopsy of the inflamed tissue and treatment is completed through a course of antibiotics.
Diagnosing GERD is the first step in identifying the best treatment option for patients. Historically, the diagnosis was made using an upper GI or 24-hour pH test with a trans-nasal catheter. These tests can be uncomfortable and irritating to the throat and nasal passage; patients tended to avoid testing. The Motility Program offers an innovative diagnostic tool for patients with severe chronic reflux disease known as the Bravo pH test. With the Bravo pH test, a tiny transmitter, about the size of a vitamin, is endoscopically attached to the wall of the esophagus. The capsule sends pH level data to a pager-sized recording device worn by the patient who is able to continue his/her regular daily routine and consume a normal diet. After 2 or 3 days the transmitter capsule is naturally sloughed off and eliminated through a normal bowel movement. The patient then returns the recording device to the motility office and we later analyze the data for diagnostic evaluation.
Additional diagnostic tools include endoscopy and esophageal manometry. Using an endoscope, physicians are able to see the inside of the esophagus and stomach to biopsy and diagnose conditions like Barrett’s esophagus. Esophageal manometry measures the pressure and contractions of the lower esophageal sphincter (LES) muscle, identifying or ruling out LES muscle weakness as the cause of GERD.
Endoscopic treatments for GERD have emerged as alternatives to chronic medication treatment. Since the primary physiological cause of GERD is the physical barrier loss at the gastro-esophageal junction (GEJ), the goal is to “tighten” the LES valve, thereby reducing reflux.
Candidates for interventional procedures are patients with severe and chronic GERD, GERD accompanied by paraesophageal or hiatal hernias suffering from uncontrollable symptoms, patients failing to respond to H2 blocker and PPI medication therapy or patients wishing to end or minimize their reliance on medication therapy.
TIF stands for “Transoral Incisionless Fundoplication” and is performed with the EsophyX device. EsophyX TIF is a minimally invasive procedure and offers a new advancement in the treatment of chronic acid reflux and GERD by reconstructing the body’s own anti-reflux barrier.
The EsophyX device and an endoscope are introduced together through the patient’s mouth (transorally) and advanced into the esophagus. With an endoscope, the doctor uses the EsophyX device to reconstruct the anti-reflux valve by wrapping the stomach’s fundus around the distal esophagus and securing it with poly-propylene fasteners.
The EsophyX TIF procedure generally takes about 30-45 minutes, and most patients can go home the next day and return to work and most normal activities within a few days.
Patient Referral and Insurance Coverage
Patients will need a referral from their primary care provider or physician specialist prior to scheduling their diagnostic options, or interventional endoscopic or laparoscopic surgical evaluation with our medical group.
Treatment for GERD is a surgical option covered by Medicare, Medi-Cal, and many private insurance companies. In order to avoid unexpected medical expenses, it is always best for patients to contact their insurance company prior to treatment to confirm coverage for this service and obtain prior authorization. In some cases, if insurance coverage is not available there are self-pay options available to patients.