The most common problem with the esophagus is gastroesophageal reflux disease (GERD).
Gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter, which acts as a valve between the esophagus and stomach, becomes weak or relaxes, causing stomach contents to rise up. The most common problem with the esophagus is GERD, which can cause damage to the esophagus over time.
Anyone, including infants and children, can have GERD. If not treated, it can lead to more serious health problems, including the risk of developing cancer of the esophagus. If you have had symptoms of GERD and have been using antacids or other over-the-counter reflux medications for more than two weeks, see your healthcare provider.
Patients with GERD need a full evaluation of their esophageal anatomy and function. The work-up for GERD typically begins with an upper endoscopy, in which the lining of the esophagus can be evaluated and biopsied to determine if any premalignant changes have occurred (Barrett’s esophagus). A hiatal hernia may also be detected during this procedure. Hiatal hernias and other structural variations may be further evaluated by an upper GI barium swallow exam, which will allow the esophagus and stomach to be visualized on an X-ray. The function of the esophageal muscles should also be evaluated by a manometry test, which measures the pressures in the esophagus during swallowing.
The diagnosis and severity of GERD is finally confirmed with a 24-hour pH test. This is accomplished either by placing a small tube into the esophagus which protrudes from the nose or an implantable device that eventually passes out through the GI tract. Information regarding acid exposure to the lower esophagus is recorded and may be analyzed to generate a score (DeMeester score) that describes the severity of GERD.
GERD is initially managed medically using H2 blockers or proton pump inhibitors, as well as lifestyle modifications. Many people can improve their symptoms by:
- Avoiding alcohol and spicy, fatty or acidic foods that trigger heartburn
- Eating smaller meals
- Not eating close to bedtime
- Losing weight if needed
- Wearing loose-fitting clothes
Both H2 blockers and proton pump inhibitors (PPIs) relieve symptoms of acid reflux or gastroesophageal reflux disease (GERD). H2 blockers include:
- Famotidine (Pepcid AC, Pepcid Oral)
- Cimetidine (Tagamet, Tagamet HB)
- Ranitidine (Zantac, Zantac 75, Zantac Efferdose, Zantac injection, and Zantac Syrup)
- Nizatidine Capsules (Axid AR, Axid Capsules, Nizatidine Capsules)
Proton pump inhibitors (PPIs) are:
- Omeprazole (Prilosec), also available over-the-counter (without a prescription)
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Rabeprazole (AcipHex)
- Pantoprazole (Protonix)
- Dexlansoprazole (Kapidex)
When a person cannot manage severe GERD symptoms through medication or lifestyle changes or if tests show premalignant damage to the esophagus (Barrett’s esophagus), your doctor will likely recommend surgery.
Surgical Options for GERD
LINX Reflux Management System
The LINX System is a small flexible band of interlinked titanium beads with magnetic cores. The magnetic attraction between the beads helps the lower esophageal sphincter (LES) resist opening to gastric pressures, preventing reflux from the stomach into the esophagus. LINX is designed so that swallowing forces temporarily break the magnetic bond, allowing food and liquid to pass normally into the stomach. Magnetic attraction of the device is designed to close the LES immediately after swallowing, restoring the body’s natural barrier to reflux.
The LINX system is placed around the esophagus just above the stomach using a common, minimally invasive surgical technique called laparoscopy. Patients are placed under general anesthesia during the procedure, which generally lasts less than an hour. The LINX System does not require any anatomic alteration of the stomach. Most patients go home the day after surgery and resume a normal diet.
Other surgical treatments for GERD involve a procedure known as a fundoplication. The surgeon first tightens the opening in the diaphragm through which the esophagus enters the abdomen from the chest and then wraps part of the stomach partially or completely around the lower esophagus. If a hiatal hernia is present it is repaired as well. Traditionally fundoplications were performed through an incision in the abdomen. The Ohio State University Wexner Medical Center offers two far less invasive options: The laparoscopic Nissen Fundoplication and the EsophyX fundoplication, which is performed completely endoscopically, without external incisions.
Laparoscopic Nissen Using Single Multiport
This minimally invasive approach utilizes specialized video equipment and instruments that allow a surgeon to perform the fundoplication through several tiny incisions, most of which are less than a half-centimeter in size. Advantages include shorter hospitalization, less pain, fewer and smaller scars and a faster recovery. Laparoscopic fundoplication is safe and effective. However, in the presence of adhesions or variations in anatomy, this method may become dangerous and your surgeon may need to continue by making the traditional incision to safely complete the operation.
Incisionless Fundoplication (EsophyX)
Endoluminal tissue fusion, a relatively new type of fundoplication is performed using the EsophyX device. The EsophyX is passed into the stomach through the mouth with the guidance of an endoscope, or small flexible camera. Once the device is passed through the mouth and into the stomach, the surgeon places small plastic fasteners that fold the upper stomach unto itself and recreate the lower esophageal sphincter (LES). Re-creation of the LES stops the stomach acid from backing up into the esophagus, thus providing relief from the sensation of heartburn. This approach does not require any skin incisions and is therefore associated with fewer complications, less pain, and a faster recovery than other surgical options. While the procedure often requires an overnight hospital stay, it provides prompt improvement in symptoms, with a rapid recovery.
Complications, although rare, include bleeding and infection. Rare postoperative complications may involve difficulty with swallowing or the fundoplication slipping into the chest.
Why Choose Ohio State
Why seek treatment at The Ohio State University Wexner Medical Center?
At The Ohio State University Wexner Medical Center, we offer a variety of advanced procedures and personalized treatment. We are leaders in the field of endoluminal, incisionless fundoplication and have performed over 500 laproscopic antireflux operations; laparoscopic repair has been the standard here for fifteen years. We were the first center in the U.S. to perform the Esophyx and thus have the longest experience of any American center for this type of treatment for GERD.
Also, in accordance with the American College of Physicians (ACP), American Gastroenterological Association (AGA) and American Association for the Study of Liver Disease (AASLD) we have developed a “fast-track” methodology to coordinate care for patients with gastroesophageal reflux disease, chronic diarrhea, rectal bleeding, abdominal pain, Hepatitis C and abnormal liver function tests.
In 2014, Ohio State's Wexner Medical Center received the "2014 Gastrointestinal Care Excellence Award" from Healthgrades, the leading online resource for information about physicians and hospitals. The award recognizes hospitals for superior outcomes in bowel obstruction treatment, colorectal surgeries, gallbladder removal, esophageal/stomach surgeries, treatment of gastrointestinal bleeds, treatment for pancreatitis, and small intestine surgeries. Patients who have these treatments or surgeries at these nationally recognized hospitals have a lower risk of dying or experiencing a complication during their hospital stay.