Smart Tip
What is the LES?

On this page, we talk a lot about the LES, or lower esophageal sphincter. The LES is a group of muscles that open and close to control how substances—such as food and acid—pass from the esophagus to the stomach. If the LES does not close properly, reflux can occur.

In the News
Drs. Jonathan Aranow and Nadeem Hussain Take on GERD

In October 2019, Seasons Magazine published a story about the GERD program at Middlesex Health! 

Read the Article

Gastroesophageal Reflux Disease (GERD) can keep you from doing what you love. At Middlesex Health, we have the experts and technology to help.

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I want to...

Call us today at 833-END-GERD (833-363-4373).

When you call, you will speak with a trained nurse who will help guide you to the right providers. This nurse may also facilitate scheduling and can answer questions you may have about how to find care.

At Middlesex Health, we are fortunate to have two expert surgeons who specialize in the surgical treatmet of GERD.

  • Jonathan Aranow, MD: Dr. Aranow is one of Connecticut's leading esophageal/stomach surgeons, offering the widest range of minimally invasive procedures for GERD in the state.  He is a nationally recognized bariatric surgeon and advocate for patients with morbid obesity, and his approach to care supports positive lifestyle changes in addition to surgery.

    See Dr. Aranow's Profile
  • Grigoriy (Greg) Klimovich: Dr. Klimovich joined the Middlesex Health Surgical Alliance in 2019 after completing his fellowship in minimally invasive weight loss surgery at the Yale University School of Medicine. He has a special interest in bariatric surgery and abdominal wall surgery, and he performs certain procedures for GERD.

    See Dr. Klimovich's Profile

Middlesex Health has a team of expert gastroenterologists who can help you manage the symptoms of GERD. A gastroenterologist is the type of doctor that you will most likely see if you require daily medication for GERD or have a family history of stomach or esophageal cancer.

Meet Our Gastroenterologists

Click here to learn about the different types of surgery for GERD.

There are several reasons that Middlesex Health's GERD Program is unique—and they all center around providing seamless, cutting-edge care for you.

  • All-in-One Program: Our gastroenterologists (GIs) and surgeons collaborate on your care. This means that your workup and initial testing take place at one site, and any advanced testing is performed and coordinated by your GI and surgeon together.
  • Comprehensive Care: Dr. Aranow performs the widest range of GERD treatment procedures in the state of Connecticut.
  • Leaders in the State: Middlesex was the first in Connecticut to perform LINX and TIF procedures for GERD. 
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Information + Treatment Options

Patients can get relief from GERD with surgical treatment.

About GERD

Gastroesophageal Reflux Disease (GERD) occurs when stomach acid moves upwards into your esophagus, the muscular tube that connects your mouth and stomach. 

Stomach acid is not meant to be in the esophagus. The lower esophageal sphincter (LES) is a group of muscles that open to let food into the stomach and then quickly close to keep stomach acid and food from backing up into the esophagus. If the LES does not close properly, this backup, or acid reflux, can occur.

Chronic acid reflux can cause serious damage to the esophagus. This damage has been linked to an increased risk of developing esophageal cancer.

The most common symptom of GERD is heartburn.

Diagram: Healthy Stomach vs. GERD
In a healthy stomach, acid cannot escape into the esophagus, because the LES is working properly.

A healthy stomach vs. a stomach with GERD.

Symptoms of GERD include:

  • heartburn (a burning sensation in the chest)
    • this burning may be worse after eating and at night
  • chest pain or stomach pain
  • burning/acid taste in the throat
  • difficulty swallowing
  • regurgitation
  • feeling like you have a lump in your throat/sore throat
  • coughing (with no other explanation, like a cold or allergies)

These symptoms can be very uncomfortable and can even cause debilitating pain. 

Certain health conditions and parts of your lifestyle may increase your risk of GERD. These include:

  • obesity
  • older age
  • having a hiatal hernia 
  • having a weak lower esophageal sphincter (LES)
  • smoking
  • drinking alcohol
  • eating certain foods (citrus, chocolate, fatty foods, very spicy foods)
  • use of certain medications (aspirin, NSAIDs like ibuprofin or naproxen)

You and your doctor will work together to determine if you need to be tested for GERD. If you do, there are several approaches that your doctor may take to evaluate your symptoms and make a diagnosis.

pH Monitoring

pH monitoring allows your provider to determine if acid is flowing up from your stomach to your esophagus (reflux). 

  • 24-hour pH monitoring
    pH monitoring allows your provider to determine if—and how much—acid is flowing from your stomach to your esophagus over a 24-hour period. This is an outpatient test.
  • Bravo Esophageal pH Test
    During an outpatient procedure called an upper endoscopy, your doctor will place a small capsule in your esophagus. This will measure pH levels and transmit them to a receiver. You will be asked to record certain behaviors (eating, lying down) while the capsule is active.
Muscle Function Testing
  • Esophageal manometry (pronounced "muh-NOM-uh-tree")
    This test provides information about how the muscles in your esophagus and at the top of your stomach are working. Improper function of these muscles can contribute to GERD. You doctor may also refer to this as "motility testing."
    • The lower esophageal sphincter (LES) is a group of muscles that open to let food into the stomach and then quickly close to keep stomach acid and food from backing up into the esophagus. Your doctor can use manometry to make sure the LES is opening and closing properly.
    • The muscles in your esophagus move food from your mouth to your stomach. If these muscles aren't working well, you may experience chest pain or trouble swallowing.

If your doctor determines that one of these tests will be an important part of your care, your care team will explain the test in more detail and give you all of the information you need to prepare.

Upper Endoscopy

Upper endoscopy is an outpatient procedure. Your doctor will use this test to examine the upper part of your digestive tract using a tube with a very small camera on the end. This is a more general test than pH testing and manometry, and your doctor may use it to rule out conditions such as Barrett's esophagus and other erosive conditions, which have similar symptoms to GERD.

 

Help for GERD

There are many things you can do in your daily life to help improve your acid reflux. There are also certain medications meant to alleviate the symptoms of GERD. It is important to talk to your doctor about any changes you plan to make.

There are many things you can try at home to address your heartburn or other GERD symptoms. These include, but are not limited to: 

  • losing weight (if appropriate)
  • avoiding aggravating foods
  • limiting/stopping smoking or drinking alcohol
  • not lying down for ~three hours after you eat
  • raising up the head of your bed
    • place blocks under the legs of your bed or place a soft wedge under the top end of your mattress
    • six to eight inches should be enough to help

It is important to talk to your doctor before making any major changes to your lifestyle.

There are several medications that can help with GERD. Although they work in different ways, they all have one purpose: to reduce or block stomach acid.

The most common types of medications include:

  • antacids: short-term relief, available over-the-counter
  • histamine blockers: short term relief, available over-the-counter
  • proton pump inhibitors (PPIs): longer term relief, available over-the counter or by prescription

You should always talk to your doctor before taking a medication, especially if you have GERD symptoms on a regular basis.

It is also important to note that using medications for GERD for a long time does have risks. If you are using antacids, histamine blockers, or PPIs consistently for more than six weeks, you should find a PCP or gastroenterologist and discuss your symptoms.

Primary Care Providers
If you are experiencing symptoms of GERD, the best first step is to talk to your primary care provider (PCP). PCP's are most helpful if you have intermittent symptoms, or symptoms on an irregular basis.

If necessary, your PCP can refer you to the appropriate specialist. 

Gastroenterologist
You might be asked to see a gastroenterologist, or doctor who specializes in the digestive system and related organs, such as the liver and pancreas. Gastroenterologists are most helpful if you require daily medication or need to change the dose of your medication.

You should also see a gastroenterologist if you have a family history of stomach or esophageal cancer.

Surgeon
The gastroenterologist may refer you to a specialized surgeon who can perform one of multiple procedures to manage or cure GERD. Many of these are minimally invasive surgeries. You may wish to meet with a surgeon if:

  • you have family or personal history of Barrett's esophagus or esophageal adenocarcinoma (cancer)
  • proton pump inhibitors (PPIs) become less effective over time
  • increasing the dose of your PPI becomes necessary for controlling your symptoms
  • you start having GERD symptoms at night, even though you are on a PPI
  • you start having regurgitation or chronic hoarseness/cough, even though you are on a PPI
  • you develop esophagitis, even though you are on a PPI
  • you have inflammation or scarring in the esophagus that isn't healing, even though you are on a PPI
  • you are unable to tolerate the side effects of PPIs or other medications
  • you do not want to rely on medications to control your symptoms
  • you have a hiatal hernia, as well as GERD symptoms

Surgical Treatments for GERD

If lifestyle changes and medications don't improve your GERD symptoms, your doctor may want to discuss surgical options. At Middlesex Health, we offer several cutting-edge procedures that can offer relief.

The LINX Reflux Management System is an innovative method for the treatment of Gastroesophageal Reflux Disease (GERD).

What is the LINX Procedure? How does it work?

The LINX Procedure allows your surgeon to restore your body's natural ability to prevent reflux. The surgeon will place a tiny ring of magnetic titanium beads around the junction between your esophagus and stomach. The magnetic ring opens when you swallow, so that food can pass into your stomach normally. It then closes quickly and is strong enough to keep acid and bile from coming back up into your esophagus.

Is the procedure permanent? Is there a long recovery period?

The LINX Procedure is completely reversible, because your doctor does not make any changes to the anatomy of your throat or stomach. It is also minimally invasive, which has many benefits, including:

  • shorter surgical time—typically less than an hour
  • smaller incisions
  • quicker recovery—most patients go home the day after surgery and can eat a normal diet immediately
How do I know if LINX is right for me?

The LINX Reflux Management System may be appropriate for patients with reflux/GERD who have not had relief using over-the-counter or prescription medications. Your doctor can help determine if LINX may be a good option for you and your specific symptoms.

What is partial fundoplication?

In this procedure, which is performed laparoscopically* using the da Vinci® robotic surgical system, your surgeon builds a new lower esophageal sphincter (LES) by wrapping the upper portion of the stomach around the lowest point of the esophagus. The new LES prevents reflux of stomach acid into the esophagus.

What is the difference between partial and Nissen fundoplication?
  • In a Dor (anterior) partial fundoplication, the doctor will wrap the upper portion of the stomach half way (180°) around the esophagus.
  • In a Toupet (posterior) partial fundoplication, the doctor will wrap the upper portion of the stomach 3/4 of the way (270°) around the esophagus.
  • In a Nissen fundoplication, your doctor will wrap the upper portion of the stomach all the way (360°) around. 

The new LES created in the partial procedures is not quite as tight as the LES created during the Nissen procedure. Your doctor can help you understand which approach is most appropriate for your symptoms.

 
 
Is it difficult to recover from this surgery?

Advances in minimally invasive, robot-assisted surgery mean that patients recover much more quickly from surgery. Most patients are in the hospital for one night and can return to work within a week. Many experience only minimal discomfort and few side effects. This is much easier than recovery from traditional surgery, which required a 10 day hospital stay and approximately six weeks of recovery.

*Laparoscopy: A laparoscopy is a minimally invasive surgery used to examine or address issues in the abdomen.

 

What is Nissen fundoplication?

In this procedure, which is performed laparoscopically*, your surgeon builds a new lower esophageal sphincter (LES) by wrapping the upper portion of the stomach around the lowest point of the esophagus. The new LES prevents reflux of stomach acid into the esophagus.

At Middlesex, Nissen fundoplication is not performed as often as partial fundoplication. It is an older technique, and our surgeons find that they can achieve excellent results with partial fundoplication or other procedures.

Is it difficult to recover from this surgery?

Advances in minimally invasive, videoscopic surgery mean that patients recover much more quickly from surgery. Most patients are in the hospital for two to three days and can return to work within a week. This is much easier than recovery from traditional surgery, which required a 10 day hospital stay and approximately six weeks of recovery.

How effective is this surgery?

Studies have shown that more than 90% of patients who have a Nissen fundoplication are still symptom-free after 10 years.

*Laparoscopy: A laparoscopy is a minimally invasive surgery used to examine or address issues in the abdomen.

What is the TIF® Procedure?

The TIF® Procedure is also a type of fundoplication—but it doesn't require any incisions. The EsophyX® device, which was specially designed for this surgery, is used to reconstruct the anatomy of the lower esophageal sphincter (LES) so that your body once again has the natural ability to prevent reflux.

What does TIF stand for?

TIF stands for Transoral Incisionless Fundoplication:

  • Transoral: All of the tools used in this procedure are gently inserted through the mouth.
  • Incisionless: A transoral approach means no incisions in the abdomen—and no scars.
  • Fundoplication: Fundoplication is the rebuilding of the lower esophageal sphincter using the upper part of the stomach—just like in a Nissen or Toupet fundoplication.
Is it hard to recover from this procedure?

Most patients recover from the TIF® procedure more quickly than from conventional surgery, because there are no incisions that need to heal. In fact, many patients are back to work and normal activities in just a few days. 

The TIF® procedure has an excellent safety record, but it is still surgery. It is important to remember that all procedures have some risk and may lead to complications. Some patients experience sore throat, discomfort, and difficulty swallowing after the TIF® procedure. Your doctor will discuss possible side effects of the procedure with you.

How effective is the TIF® procedure?

According to studies by EndoGastric Solutions, 85% of patients who have had the TIF® procedure had relief from all GERD symptoms.

Note: This procedure is not appropriate for patients with a significant hiatal hernia.

What is a hiatal hernia?

A hiatal hernia occurs when a part of the stomach pushes up into the chest above the diaphragm.

The diaphragm is the muscle that keeps the organs in your chest separate from the organs in your abdomen. It has an opening that allows the esophagus to reach the stomach. When the stomach pushes up through this opening, it is called a hiatal hernia.

GERD, or acid reflux, can be a symptom of a hiatal hernia. 

How can surgery help? Is it the only treatment option?

Your doctor may recommend surgery to repair your diaphragm, so that the stomach cannot push through. This procedure is done with assistance from the da Vinci® robotic surgical system.

In most cases, hiatal hernias only cause mild symptoms—or even no symptoms at all. Surgery is usually used for patients with more severe symptoms, when lifestyle changes and medication do not help.

It is important to note that hiatal hernias can get bigger with time. If you have serious symptoms from a hiatal hernia, it is recommended that you consult a surgeon to determine if surgery is the right treatment.

Is it difficult to recover from this surgery?

Minimally invasive and robotic surgical techniques typically allow patients to recover much more quickly from surgery, compared to open surgical techniques.

Smart Tip

Learn More About Lifestyle Changes

Making changes to your lifestyle is key to successful weight loss, which can help improve GERD symptoms.

Visit our Online Learning Center for information about healthy eating, being active, and how to maintain weight loss achievements.

You can also get started with these articles:

 

Smart Tip
What is the LES?

On this page, we talk a lot about the LES, or lower esophageal sphincter. The LES is a group of muscles that open and close to control how substances—such as food and acid—pass from the esophagus to the stomach. If the LES does not close properly, reflux can occur.

In the News
Drs. Jonathan Aranow and Nadeem Hussain Take on GERD

In October 2019, Seasons Magazine published a story about the GERD program at Middlesex Health! 

Read the Article