What types of doctors treat GERD. How to recognize symptoms requiring specialist care. What diagnostic tests do GERD specialists perform. When should you consult a gastroenterologist for acid reflux.

Understanding GERD: More Than Just Heartburn

Gastroesophageal reflux disease (GERD) is a chronic condition characterized by frequent acid reflux, occurring at least several times a week. While occasional heartburn is common, GERD’s persistent nature can significantly impact daily life and sleep quality. But what exactly sets GERD apart from ordinary heartburn?

GERD occurs when stomach contents flow back up through the esophagus into the chest, causing a burning sensation. The key difference lies in the frequency and, often, the severity of symptoms. GERD is not just a minor inconvenience; it’s a medical condition that may require specialist intervention.

Common GERD Symptoms Requiring Specialist Attention

• Heartburn occurring more than twice weekly
• Persistent heartburn unresponsive to antacids
• Nighttime acid reflux disrupting sleep
• Regurgitation of stomach contents
• Chest pain
• Chronic sore throat
• Difficulty swallowing
• Sensation of a lump in the throat
• Hoarseness
• Persistent bad breath

Can lifestyle changes alleviate GERD symptoms? In many cases, yes. Simple adjustments like maintaining a healthy weight, quitting smoking, reducing caffeine and alcohol intake, eating smaller meals, and avoiding late-night eating can provide relief. However, when these changes fail to resolve symptoms, it’s time to consider consulting a GERD specialist.

The Role of Primary Care in GERD Management

Your journey to managing GERD often begins with your general practitioner (GP) or pediatrician. These primary care providers play a crucial role in initial assessment and treatment. They can prescribe medications to reduce symptoms and offer valuable guidance on next steps.

When should you move beyond primary care for GERD? If your symptoms persist despite initial treatment or if your doctor suspects complications, they may recommend seeing a specialist. This referral is typically to a gastroenterologist, but in some cases, other specialists may be involved.

Gastroenterologists: The GERD Experts

Gastroenterologists are the primary specialists for diagnosing and treating GERD. These board-certified physicians undergo extensive training focused on the gastrointestinal tract and liver. But what makes them uniquely qualified to handle GERD cases?

Gastroenterologists possess in-depth knowledge of the digestive system’s intricacies. They are skilled in performing and interpreting various diagnostic tests specific to GERD and other gastrointestinal conditions. Their expertise allows them to differentiate GERD from other conditions with similar symptoms and develop comprehensive treatment plans.

When to See a Gastroenterologist for GERD

• Symptoms persist despite lifestyle changes and over-the-counter medications
• You experience difficulty swallowing or pain when swallowing
• You have unexplained weight loss
• Your primary care doctor recommends further evaluation
• You have a family history of Barrett’s esophagus or esophageal cancer

Otolaryngologists: Addressing GERD’s Impact on ENT Health

While gastroenterologists are the primary GERD specialists, otolaryngologists (ENTs) play a crucial role in certain cases. When might your GP refer you to an ENT instead of, or in addition to, a gastroenterologist?

If you experience symptoms primarily affecting your throat, voice box, or respiratory system, an ENT may be the appropriate specialist. These doctors are particularly adept at diagnosing and treating laryngopharyngeal reflux (LPR), a condition often associated with GERD that affects the throat and voice box.

Signs You May Need to See an ENT for GERD-Related Issues

• Chronic hoarseness or voice changes
• Persistent sore throat or cough
• Frequent throat clearing
• Difficulty swallowing (dysphagia)
• Sensation of a lump in the throat (globus sensation)

The Role of Nutritionists and Dietitians in GERD Management

While not primary GERD specialists, nutritionists and registered dietitians can be valuable allies in managing the condition. How can these professionals contribute to your GERD treatment plan?

Nutritional specialists offer personalized guidance on dietary modifications to reduce GERD symptoms. They can help you identify trigger foods, develop meal plans that minimize acid reflux, and provide strategies for maintaining a healthy weight – a key factor in GERD management.

Benefits of Consulting a Nutritionist for GERD

• Customized dietary recommendations
• Assistance with weight management
• Education on GERD-friendly eating habits
• Guidance on nutritional supplements that may help manage symptoms
• Support in making sustainable lifestyle changes

It’s important to note that while nutritionists and dietitians provide valuable support, they do not replace the need for medical evaluation by a gastroenterologist or ENT. Their role is complementary, focusing on lifestyle and dietary aspects of GERD management.

Diagnostic Procedures: How GERD Specialists Uncover the Truth

GERD specialists employ a variety of diagnostic tests to accurately assess your condition. These procedures not only confirm the presence of GERD but also help rule out other conditions that may mimic its symptoms. What are the most common diagnostic tests used by GERD doctors?

Key Diagnostic Tests for GERD

1. Upper Endoscopy: A flexible tube with a camera is inserted into the esophagus under light anesthesia. This allows direct visualization of the esophagus and stomach, and enables tissue sampling if necessary.
2. Esophageal pH Monitoring: A small monitor is placed in the esophagus to measure acid levels over several days, providing insight into the frequency and severity of acid reflux.
3. Esophageal Manometry: This test measures the strength and coordination of esophageal muscles, helping identify any abnormalities in esophageal function.
4. Esophagram (Barium Swallow): After drinking a barium solution, X-rays are taken of your upper digestive tract, revealing structural abnormalities or issues with swallowing.
5. Ambulatory 24-hour pH Probe: Similar to pH monitoring, this test uses a tube placed through the nose into the esophagus to measure acid levels continuously for 24 hours.

Why are these tests crucial? They provide objective data about your condition, helping specialists differentiate GERD from other conditions with similar symptoms. This precision in diagnosis leads to more effective, targeted treatment plans.

Beyond GERD: Conditions That Mimic Acid Reflux

One of the key reasons for seeing a GERD specialist is their ability to differentiate GERD from other conditions with similar symptoms. What conditions might be mistaken for GERD, and why is accurate diagnosis so important?

Conditions Often Confused with GERD

• Gastritis
• Helicobacter pylori (H. pylori) infection
• Gallstones
• Stomach ulcers
• Esophagitis
• Esophageal cancer
• Hiatal hernia
• Angina

Each of these conditions requires a different treatment approach. Misdiagnosing them as GERD could lead to ineffective treatment and potentially allow serious conditions to progress unchecked. GERD specialists have the expertise to conduct thorough evaluations and order appropriate tests to ensure an accurate diagnosis.

Treatment Approaches: From Medication to Lifestyle Changes

Once a GERD diagnosis is confirmed, what treatment options do specialists typically recommend? The approach often involves a combination of medication, lifestyle modifications, and in some cases, surgical intervention.

Common GERD Treatment Strategies

1. Medications: These may include over-the-counter antacids, H2 blockers, or prescription proton pump inhibitors (PPIs) to reduce stomach acid production.
2. Dietary Modifications: Avoiding trigger foods, eating smaller meals, and not lying down soon after eating can significantly reduce symptoms.
3. Lifestyle Changes: Weight loss, smoking cessation, and elevating the head of the bed can alleviate GERD symptoms.
4. Surgical Options: In severe cases or when other treatments fail, procedures like fundoplication may be recommended to strengthen the lower esophageal sphincter.

How do specialists determine the best treatment plan? They consider factors such as symptom severity, test results, overall health, and your personal preferences. Treatment is often a process of trial and adjustment to find the most effective approach for each individual.

The Importance of Follow-Up Care

Why is ongoing monitoring crucial in GERD management? Regular follow-ups allow specialists to assess treatment effectiveness, make necessary adjustments, and monitor for potential complications. This proactive approach ensures that your GERD remains well-controlled over time.

GERD specialists play a crucial role in diagnosing, treating, and managing this chronic condition. Their expertise goes beyond simply prescribing medication; they offer comprehensive care that addresses all aspects of GERD and its impact on your life. By understanding when to seek specialist care and what to expect from these experts, you can take a proactive approach to managing your GERD and improving your quality of life.

Types of Specialists & When to See Them

Gastroesophageal reflux disease (GERD) is a common condition that causes acid reflux (heartburn) at least several times a week. GERD symptoms can get in the way of daily activities or getting a good night’s sleep.

If heartburn is a daily or almost-daily part of your life, it may be time to see a GERD doctor.

In this article, we’ll go over the types of specialists who treat GERD. We’ll also clarify the symptoms that might indicate you need a specialist.

When you eat or drink, food is transported from your mouth to your stomach through a tube called the esophagus. GERD symptoms occur when stomach contents flow back up through the esophagus into the chest. This causes the burning sensation most associated with GERD.

Anyone can get an occasional bout of heartburn. GERD differs from ordinary heartburn in frequency and, in some instances, severity.

These common symptoms of GERD may require consultation with a specialist:

• heartburn that occurs more than twice weekly
• heartburn that doesn’t get better with antacid use
• acid reflux that wakes you up at night
• regurgitation of sour liquid or food particles from the stomach into the throat and mouth
• chest pain
• sore throat
• difficulty swallowing
• feeling like you have a lump in your throat
• hoarseness
• bad breath

Lifestyle changes that may help GERD symptoms

GERD symptoms may lessen with lifestyle changes, such as:

• maintaining a moderate weight
• trying to quit smoking, if you smoke
• eliminating or reducing consumption of coffee, alcohol, and carbonated beverages
• eating smaller meals, especially at night
• not eating late at night
• not lying down for at least 3 hours after eating
• eliminating spicy, fatty, and acidic foods from your diet

If lifestyle changes don’t eliminate these symptoms, seeing a GERD specialist may help. A GERD doctor can do medical testing that uncovers the underlying cause of your symptoms. They can also provide advice on how to handle GERD.

Babies, children, and adults can have GERD. Talking with your general healthcare practitioner (GP) or with your child’s pediatrician is a good first step for GERD treatment. They may prescribe medications that reduce symptoms, plus they can provide insight about next steps.

In many instances, your regular physician will recommend seeing a gastroenterologist or other type of specialist for testing and treatment.

Gastroenterologist

Gastroenterologists are board certified physicians who receive specialized training to treat conditions of the gastrointestinal tract and liver. Gastroenterologists are the type of specialists usually seen for diagnosis and treatment of GERD.

Otolaryngologist

Based on your symptoms, your GP may instead recommend you see an otolaryngologist. They are also known as an ENT, or ear, nose, and throat specialist. If you have stomach acid that spills into your throat or voice box, you may have laryngopharyngeal reflux (LPR) instead of, or in addition to, GERD. Otolaryngologists have experience diagnosing and treating both conditions.

Nutritionist or dietitian

Coaching from a nutritionist or registered dietitian may also be beneficial for helping you maintain a moderate weight. Nutritional specialists can also recommend lists of foods to eat or avoid for GERD management. These types of specialists don’t take the place of gastroenterologists or ENTs. They can, however, help with lifestyle choices and symptom management.

GERD doctors, such as gastroenterologists, receive extensive training to perform endoscopic procedures and interpret their results. GERD specialists are equipped to do diagnostic tests that uncover underlying causes and conditions that mimic GERD.

Conditions that may seem like GERD include:

• gastritis
• Helicobacter pylori (H. pylori)
• gallstones
• stomach ulcers
• esophagitis
• esophageal cancer
• hiatal hernia
• angina

Diagnostic tests that a GERD specialist may do include:

• Upper endoscopy. This procedure is done under light anesthesia. A flexible tube fitted with a small camera is placed into the esophagus to examine it. Your doctor may remove a tiny piece of esophageal tissue for biopsy during an upper endoscopy.
• Esophageal pH monitoring. For this test, a small monitor is placed into your esophagus to analyze how your gastrointestinal system manages and regulates the flow of stomach acid over the course of several days.
• Esophageal manometry. During this test, a tube is placed into the esophagus through the nose to measure the strength of the esophageal muscles.
• Esophogram. For this test, you will first drink a barium solution and then have an X-ray of your upper digestive tract.
• Ambulatory 24-hour pH probe. During this test, a tube is placed into the esophagus through your nose and left in place for 24 hours. A pH sensor in the tube measures acid levels in the esophagus.

After testing and diagnosis, you may be placed on medication and monitored. In some instances, a specialist will recommend that you continue to see them for monitoring and treatment. In other cases, they may instead recommend you see your GP regularly for monitoring.

If your symptoms don’t improve, a GERD specialist may recommend other treatments, such as surgery or a Transoral Incisionless Fundoplication (TIF). Though not as widely used as surgery, a TIF procedure is starting to be used more often in clinical practices. This minimally invasive, nonsurgical procedure repairs the anti-reflux barrier inside the stomach.

In some instances, diagnostic testing may show that a hiatal hernia is causing GERD symptoms. Hiatal hernias are often treated with an outpatient laparoscopy procedure, such as a Nissen fundoplication.

Surgery for GERD and its underlying causes can only be done by a GERD specialist.

Your GP may be able to recommend a GERD specialist to you. If you have health insurance, your insurer may also be able to provide a list of specialists practicing in your area. You may also wish to research patient recommendations online.

GERD specialists

GERD specialists can also be found here:

• You can find a gastroenterologist through the American College of Gastroenterology.
• You can find an otolaryngologist through the American Academy of Otolaryngology — Head and Neck Surgery.
• You can find a nutrition expert through the Academy of Nutrition and Dietetics.

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What to consider when choosing a specialist

When choosing a specialist, take these considerations into account:

• How many years have they been practicing their specialty?
• How experienced are they in treating your condition?
• Have any complaints been logged against them in the Federation of State Medical Boards’ DocInfo database?
• If surgery is required, how many times a week do they perform the procedure you need?
• Do they accept your insurance?
• How comfortable do they make you feel?
• Are they patient enough to answer all your questions without rushing you through the appointment?
• Does their office follow local COVID-19 safety guidelines?

Gastroesophageal reflux disease (GERD) involves excessive or extreme bouts of heartburn.

A GERD doctor such as a gastroenterologist is usually the best choice for diagnosing and treating this condition. In some instances, an ENT specialist may also be used to diagnose and treat GERD.

Gastroesophageal Reflux Disease (GERD) | Johns Hopkins Medicine

Gastroesophageal reflux disease (GERD) is a common condition in which the stomach contents move up into the esophagus. Reflux becomes a disease when it causes frequent or severe symptoms or injury. Reflux may damage the esophagus, pharynx or respiratory tract.

Symptoms of GERD

The main symptom of GERD is heartburn, often described as a fiery feeling in one’s chest, and regurgitating sour or bitter liquid to the throat or mouth. The combination of heartburn and regurgitation is such a common characteristic of GERD that formal testing may be unnecessary.

Other symptoms of GERD include:

• Non-burning chest pain, which is usually located in the middle of the chest and radiates to the back
• Difficulty swallowing (dysphagia)
• Atypical reflux symptoms relating to the throat, larynx or lungs:
  • Sore throat
  • Coughing
  • Increased salivation
  • Shortness of breath

GERD Diagnosis

A diagnosis of GERD starts with a thorough physical examination, during which you describe your symptoms and medical history. If the typical symptoms of reflux disease are present, including heartburn and regurgitation, your doctor may begin treatment without performing specific diagnostic tests.

However, tests may be performed if:

• Your symptoms are atypical
• The severity of the reflux raises concerns about esophageal damage
• Symptoms do not respond to initial treatment
• Your doctor is considering anti-reflux surgery

Diagnostic procedures for GERD include:

• Upper endoscopy
• Reflux testing (wireless pH/pH impedance)
• Esophageal manometry
• Barium esophagram

Upper Endoscopy

Upper endoscopy allows your doctor to examine the lining of your esophagus, stomach and first part of the small intestine. It is the best test for evaluating reflux-induced esophageal injury and diagnosing esophagitis and Barrett’s esophagus. It can also help diagnose an esophageal stricture (narrowing).

Although only 10 percent to 20 percent of people with reflux will have abnormal findings during an endoscopy, the procedure is necessary to evaluate the potential for complications. Your doctor also will want to rule out other, more serious conditions that mimic GERD.

During an upper endoscopy:

• You receive an anesthetic to help relax your gag reflex. You may also receive pain medication and a sedative.
• You lie on your left side, referred to as the left lateral position.
• Your doctor inserts the endoscope through your mouth and pharynx into the esophagus.
• The endoscope transmits an image of the esophagus, stomach and duodenum to a monitor that your physician is watching.

Reflux Testing

Wireless pH testing allows your doctor to evaluate your reflux activity over a 48-hour period while you continue your normal activities. To perform wireless pH testing.

The two methods are:

Wireless pH Testing

Wireless pH testing allows your doctor to evaluate your reflux activity over a 48-hour period while you continue your normal activities. To perform wireless pH testing:

• Your doctor performs an endoscopy and places a small chip in your lower esophagus
• The chip records the acid level in your esophagus for 48 hours.
• The chip transmits your acid level to a wireless recording device that you wear around your belt.
• The data from the recording device can gauge your reflux severity.

24-Hour pH Impedance

Your doctor may order this procedure to evaluate your reflux. This procedure monitors your pH level (level of acidity) for a prolonged period. During pH impedance:

• Your doctor places a thin, flexible catheter with an acid-sensitive tip through your nose into your esophagus. The catheter is placed in separate recording spots to evaluate the flow of liquid from your stomach into your esophagus.
• The catheter stays in your nose for a period of 24 hours.

Your doctor is able to evaluate whether you have GERD, the severity of your reflux, the presence of non-acid reflux and the correlation between your reflux and symptoms. This procedure helps in the design of a course of treatment for you.

Esophageal Manometry

Esophageal manometry — or esophageal motility (movement) studies — cannot diagnose GERD, but doctors use it to rule out other conditions that mimic GERD. This is especially important if your doctor is considering an anti-reflux surgery.

During an esophageal manometry:

• Your doctor places a pressure-sensitive catheter into the esophagus. (This may be performed right before esophageal pH impedance studies, as it determines where your doctor should place the catheter.)
• The catheter evaluates the strength and coordination of your muscle contractions. It also tests the strength and relaxation function of the lower esophageal sphincter.

An esophageal manometry is an essential part of the assessment process prior to anti-reflux surgery.

Barium Esophagram

Barium contrast radiography, or a barium esophagram, is an X-ray study. It is one of the most common procedures to test for GERD.

During barium contrast radiography:

• You swallow a contrast solution called barium.
• The barium coats your esophagus and gastrointestinal tract, making it easier for the doctor to detect abnormalities.
• An X-ray is taken.
• During the X-ray, your doctor looks for a narrowing in the esophagus called a stricture.

A barium esophagram also evaluates the coordination of your esophageal motor function. While it does not test for the presence of reflux, it is useful for evaluating injury to your esophagus.

Gastroesophageal Reflux Disease (GERD) | FAQ with Dr. Gina Adrales

Johns Hopkins minimally invasive surgeon Gina Adrales answers important questions about gastroesophageal reflux disease (GERD) including the most common symptoms and the recovery process.

GERD Complications

Patients with severe reflux may suffer from further complications, including:

• Esophagitis
• Esophageal strictures
• Barrett’s esophagus

Treatment

GERD Treatment

There are four approaches to treating GERD, including medication and surgery. Most patients can effectively use a combination of lifestyle changes and drug therapy to treat their GERD.

Learn more about GERD treatment.

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