Gastroesophageal Reflux Disease (GERD) Treatment
Patients at Johns Hopkins benefit from our unique multidisciplinary center, specializing in GERD and other reflux disorders. Specialists from different fields, including surgery, gastroenterology and ear, nose and throat, meet to talk about challenging reflux cases. We discuss the cases and create individualized treatment plans.
Our high volume and advanced technology combined with expert specialists means you are getting the superior care you deserve.
Treatment Approaches for GERD at Johns Hopkins
There are four approaches for GERD treatment, including medication and surgery. Often, patients respond well to a combination of lifestyle changes and a medication regimen.
Some patients do not find satisfactory relief from those methods and require surgical intervention. Other patients may choose surgery as an alternative to a lifetime of taking medication.
Treatment for GERD includes:
- Lifestyle and dietary changes
- Endoscopic therapy
Dietary and lifestyle changes are the first step in treating GERD. Certain foods make the reflux worse. Suggestions to help alleviate symptoms include:
- Lose weight if you are overweight — of all of the lifestyle changes you can make, this one is the most effective.
- Avoid foods that increase the level of acid in your stomach, including caffeinated beverages.
- Avoid foods that decrease the pressure in the lower esophagus, such as fatty foods, alcohol and peppermint.
- Avoid foods that affect peristalsis (the muscle movements in your digestive tract), such as coffee, alcohol and acidic liquids.
- Avoid foods that slow gastric emptying, including fatty foods.
- Avoid large meals.
- Quit smoking.
- Do not lie down immediately after a meal.
- Elevate the level of your head when you lie down.
If lifestyle and dietary changes do not work, your doctor may prescribe certain medications. There are two categories of medicines for reflux. One decreases the level of acid in your stomach, and one increases the level of motility (movement) in the upper gastrointestinal tract.
Over-the-counter antacids are best for intermittent and relatively infrequent symptoms of reflux. When taken frequently, antacids may worsen the problem. They leave the stomach quickly, and your stomach actually increases acid production as a result.
Histamine 2 (H2) blockers are drugs that help lower acid secretion. H2 blockers heal esophageal erosions in about 50 percent of patients.
Proton pump inhibitors
Proton pump inhibitors (PPIs) are drugs that block the three major pathways for acid production. PPIs suppress acid production much more effectively than H2 blockers. PPIs heal erosive esophagitis in many patients, even those with severe esophageal damage.
Prokinetic agents are drugs that enhance the activity of the smooth muscle of your gastrointestinal tract. These drugs are somewhat less effective than PPIs. Your doctor may prescribe them in combination with an acid-suppressing drug.
Transoral incisionless fundoplication (TIF) is an option to address GERD. TIF can mean a shorter treatment time, less pain and faster recovery compared to laparoscopic surgery. The procedure involves using a special TIF device to create a passageway for a flexible, tube-like imaging instrument called an endoscope. The procedure allows the physician to use preloaded tweezers and fasteners to repair or recreate the valve that serves as a natural barrier to reflux.
Currently, there are clinical trials testing the efficacy of endoscopic therapy for GERD. One form of therapy uses an endoscopic sewing machine to place sutures in the stomach and increase the anti-reflux barrier.
If your symptoms did not improve with lifestyle changes or drug therapy, you may be a candidate for surgery. Some patients prefer a surgical approach as an alternative to a lifetime of taking medications. The goal of surgery for reflux disease is to strengthen the anti-reflux barrier.
During a procedure known as a Nissen fundoplication, your surgeon wraps the upper part of your stomach around the lower esophagus. This enhances the anti-reflux barrier and can provide permanent relief from reflux. Your surgeon may perform this surgery laparoscopically, which means a less invasive procedure with a shorter recovery time.
Reflux may affect more than just the esophagus. Reflux can lead to inflammation of the pharynx (part of the throat right behind the mouth) and larynx (voice box). It may also cause bronchitis, asthma or pneumonia. If there are no obvious causes for the inflammation, your doctor may suspect reflux. The goal of treatment is to improve the symptoms through medication.