What is gastroesophageal reflux disease (GERD). How can GERD be diagnosed. What are the treatment options for GERD. Where can I find a specialist for GERD.

Understanding GERD

Gastroesophageal reflux disease (GERD) is a chronic condition in which the contents of the stomach, including acid, flow back (reflux) into the esophagus. This can cause a range of symptoms, such as heartburn, belching, difficulty swallowing, and a sour taste in the mouth. GERD occurs when the valve at the lower end of the esophagus, known as the lower esophageal sphincter (LES), becomes weakened or relaxes inappropriately, allowing stomach contents to flow back into the esophagus.

Diagnosing GERD

To diagnose GERD, your gastroenterologist may recommend one or more of the following tests:

• Upper Endoscopy: A flexible tube with a camera is inserted through the mouth to examine the esophagus, stomach, and small intestine for any signs of damage or inflammation.
• EndoFLIP: During an endoscopy, a device is used to measure the pressure and movement within the esophagus, which can help assess the function of the esophageal sphincter.
• Esophageal Manometry: A thin, flexible tube is inserted through the nose and into the esophagus to measure the strength and pattern of the esophageal muscles.
• Esophageal Reflux Test: A catheter or probe is placed in the esophagus to monitor the presence and severity of acid reflux.
• Barium Swallow: A barium-containing liquid is swallowed, and X-ray images are taken to observe the movement of the barium through the esophagus, which can detect any structural abnormalities.

Treating GERD

The treatment for GERD typically starts with lifestyle changes and over-the-counter medications, followed by prescription medications if necessary. In some cases, if these non-surgical options are not effective, surgical treatment may be recommended.

Nonsurgical Treatments

Nonsurgical treatments for GERD may include:

• Dietary and lifestyle changes, such as avoiding trigger foods, maintaining a healthy weight, and avoiding lying down after meals
• Over-the-counter antacids or H2 blockers, which can provide relief from occasional heartburn
• Prescription medications, such as proton pump inhibitors, which can help reduce the production of stomach acid

Surgical Treatments

If nonsurgical treatments are not effective, your gastroenterologist may recommend a surgical procedure to treat GERD. These specialized procedures are typically performed by skilled surgeons with extensive experience in treating GERD and related conditions, such as hiatal hernias.

Some common surgical treatments for GERD include:

• Fundoplication: A surgical procedure that strengthens the lower esophageal sphincter by wrapping the upper part of the stomach around the lower esophagus.
• Hiatal Hernia Repair: A surgical procedure to repair a hiatal hernia, which can allow stomach contents to flow back into the esophagus and contribute to GERD symptoms.

Complications of Untreated GERD

If left untreated, chronic acid reflux can lead to a variety of complications, including:

• Esophagitis: Painful irritation and inflammation of the esophageal lining
• Barrett’s Esophagus: Precancerous changes in the lining of the esophagus that can potentially lead to esophageal cancer
• Esophageal Stricture: Narrowing of the esophagus, which can make it difficult to swallow
• Other Complications: Hoarseness, dental enamel damage, and respiratory problems

Finding a GERD Specialist

If you are experiencing persistent or severe GERD symptoms, it is important to seek care from a gastroenterologist or surgeon who specializes in the treatment of GERD and related conditions. These specialists can provide a comprehensive evaluation, diagnose the underlying cause of your GERD, and develop an individualized treatment plan to help you find relief.

To find a GERD specialist, you can search for “GERD specialist near me” or “gastroenterologist for GERD” on your preferred search engine. You can also check with your primary care provider for a referral to a gastroenterology practice or surgeon with expertise in treating GERD.

Conclusion

Gastroesophageal reflux disease (GERD) is a chronic condition that can have a significant impact on your quality of life. By understanding the causes, symptoms, and treatment options for GERD, you can take the first step towards finding relief and preventing complications. If you are experiencing persistent GERD symptoms, work with a gastroenterologist or surgeon who specializes in GERD to develop a personalized treatment plan that addresses the root cause of your condition.

Gastroesophageal Reflux Disease (GERD) and Hiatal Hernia

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Overview

When diet and medication no longer control chronic GERD (gastroesophageal reflux disease) symptoms, Duke gastroenterologists use endoscopic procedures to view the inside of your digestive tract to identify the reason for your discomfort. In some cases, a hiatal hernia (or a type of hiatal hernia called paraesophageal hernia) may be to blame.

Once the cause is diagnosed, your gastroenterologist may recommend a minimally invasive treatment to give you relief. These specialized procedures are performed by skilled surgeons with extensive experience treating GERD and related conditions.

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Understanding GERD

Content

GERD occurs when stomach contents move up into the esophagus. That may cause symptoms such as burning behind your breastbone, belching, an acid taste in your mouth, or difficulty swallowing.

Treatment Stages
Our gastroenterologists may recommend treating GERD in stages, starting with diet and lifestyle changes and over-the-counter acid reducers before recommending prescription medications, including proton pump inhibitors. If these nonsurgical options aren’t effective and your GERD is considered moderate to severe, your gastroenterologist may recommend surgical treatment.

Complications of Untreated GERD
Getting effective treatment for GERD is important because chronic acid reflux can cause painful irritation called esophagitis. It can also cause precancerous changes in the lining of the esophagus. This is called Barrett’s esophagus and may lead to the development of esophageal cancer. In some cases, severe reflux can cause hoarseness, dental enamel damage, and narrowing of the esophagus called stricture.

Acid Reflux Procedures Repair Hiatal Hernias
A hiatal hernia, or type of hiatal hernia called a paraesophageal hernia, occurs when the stomach and other abdominal organs enter the chest area through the hiatus, a naturally occurring hole in the diaphragm. The presence of a hiatal or paraesophageal hernia allows acid to flow freely into the esophagus and may cause additional symptoms including nausea, vomiting, chest pain, heartburn, and difficulty swallowing. A surgical procedure can repair these hernias and offer symptom relief.

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Duke Health offers locations throughout the Triangle. Find one near you.

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Tests

Tests Overview

One or more of the following tests may be recommended to determine the cause of your symptoms and which GERD treatment is best for you.

Upper Endoscopy

Description

Your doctor inserts a flexible tube into your mouth to view the inside of your esophagus, stomach, and small intestine.

EndoFLIP

Description

During endoscopy, your gastroenterologist uses a device to measure pressures inside your esophagus and assess the ability of your esophagus to contract. When the esophagus works as it should, coordinated contractions moves food and liquid down to your stomach

Esophageal Manometry

Description

A thin, flexible tube called a catheter is inserted through your nose and into your esophagus. It evaluates esophageal motility by monitoring strength and patterns of muscle function within the esophagus.

Esophageal Reflux Test

Description

A catheter or probe placed in the esophagus is used to determine the presence and severity of reflux.

Barium Swallow

Description

A barium liquid is swallowed and travels the length of your esophagus. X-ray images show how the barium moves through your esophagus. This test can detect problems with the structure of your esophagus.

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GERD Treatments

Treatments Overview

As a comprehensive center, we offer several procedures to treat GERD, hiatal hernia, and paraesophageal hernia.  

Surgical Fundoplication

Description

In this standard surgical treatment of GERD, your surgeon wraps part or all of the stomach around the lower esophagus to strengthen the muscle and stop the acid reflux. This surgery is typically performed through small incisions.

LINX® Reflux Management System

Description

During this minimally invasive procedure, your surgeon wraps a ring of magnetic titanium beads around the lower esophageal muscle to prevent the contents of your stomach from refluxing into your esophagus. It does not prevent food or liquids from traveling down the esophagus into your stomach. 

TIF (Transoral Incisionless Fundoplication)

Description

Small instruments are passed through an endoscope, which is inserted in your mouth to reach your stomach. No incisions are required. The surgeon wraps the upper part of your stomach around your lower esophagus and uses a special device to help the esophageal valve prevent stomach acid from refluxing into your esophagus.

Gastric Bypass Surgery

Description

If you experience GERD caused by obesity, gastric bypass surgery can bring relief by moving much of the acid-producing portion of the stomach away from the esophagus. 

Why Choose Duke

Content

Extensive Experience
Our gastroenterologists have completed specialized training and are highly skilled in the use of endoscopy to diagnose GERD and other esophageal disorders. Our board-certified surgeons have additional fellowship training in thoracic surgery. This includes specialized procedures in and around the esophagus.

More Complex Procedures
Robot-assisted surgery allows our surgeons to visualize the surgical site better. The precision of the robotic tools allows doctors to do more complex procedures in smaller areas and place sutures with greater accuracy.

Access to Clinical Trials
You may be eligible to participate in our ongoing clinical trials, which test new therapies and approaches to treating GERD and related conditions.

Leaders in Innovative Techniques
We were the first center in North Carolina to implant the LINX device and use the TIF device for GERD. We are constantly looking for newer, less invasive options to give people freedom from chronic reflux.

High Volume Referral Center
People are often referred to our gastroenterologists for the management of GERD and its symptoms. Patients frequently travel to us from nearby regions.

Best Hospital for Gastroenterology and GI Surgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our gastroenterology and GI surgery program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2022–2023.

This page was medically reviewed on 11/18/2021

Tips on Finding a Doctor

Whether your doctor is a family doctor or a specialist (like a gastroenterologist), there are certain qualities to look for to help you get the care you need for your gastroesophageal reflux disease (GERD). Use these tips to help you find a doctor that is right for you.

Here is a checklist of questions to consider:

• Is your doctor sympathetic? Does he or she listen carefully as you explain your symptoms? Does he or she understand the real impact of GERD on your life? If you feel your doctor thinks your symptoms are trivial or “all in your head,” it’s time to move on.
• Does your doctor spend the time needed to explain and discuss your GERD?
• Does your doctor order many tests, but fail to explain the reason for them and the meaning of their results?
• Does your doctor regularly order medicines or diets without explanation of their risks and benefits?
• Are you able to get an appointment within a reasonable time?
• Is your doctor usually available, or do you often see a stand-in who is unfamiliar with your case?
• Does your doctor seem knowledgeable about your illness, yet willing to seek a specialist’s advice for difficult issues?

Perhaps most importantly, does the doctor inspire your confidence? Are you able to establish a good relationship? GERD is a long-term condition that will likely take twists and turns over time. You will be best served by a doctor who is your partner through this.

No doctor is perfect, but the answers to the above questions should help you decide. Remember, you are not married to your doctor. It is your right to find a new one and have your complete medical record transferred. On the other hand, too many changes can work against you.

More Finding a Doctor Topics

• How to Talk to Your Doctor
• Doctor-Patient Communication 
• How to Help Your Doctor Help You
• Helpful Insights from a GI Doctor
• Changing Doctors

Looking for a Provider? Helpful links:

• Find a Registered Dietitian Nutritionist – Compiled and maintained by Academy of Nutrition and Dietetics
• AGA GI Locator Service – Compiled and maintained by American Gastroenterological Association (AGA)
• Find a Gastroenterologist – Compiled and maintained by American College of Gastroenterology (ACG)
• A Registry of GI Motility Laboratories for Patient Evaluation – Compiled and maintained by The American Neurogastroenterology and Motility Society (ANMS)
• Find a Pediatric Gastroenterologist – Compiled and maintained by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)

Adapted from IFFGD Publication: I Have a Gut Problem: Which Doctor Should I See? by W. Grant Thompson, MD, FRCP(C), Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada.

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Which doctor should I contact with herpes

Herpes is a disease of a viral nature, the main manifestation of which is a blistering rash on the skin and mucous membranes. Experts believe that the carrier of the virus is a large part of the population. Up to a certain point, it is in a dormant state, but after the action of adverse factors, it is activated and causes an exacerbation of a herpes infection.

Types of herpes and provoked diseases

Experts distinguish several types of herpes viruses:

• varicella zoster virus, which causes shingles and chickenpox;
• herpes simplex virus type 1, which causes the classic blistering rash on the lips;
• herpes simplex virus type 2 leads to the appearance of genital herpes and dangerous complications for the reproductive health of women and men;
• Epstein-Barr virus, which causes infectious mononucleosis;
• herpes virus causing cytomegalovirus infection.

The virus resides in the nerve cells of the trigeminal nerve until a situation occurs that provoked its reactivation. Infection usually occurs at an early age through the respiratory tract or close household contacts. Herpes simplex type 2 is characterized by oncogenic properties, can cause the development of cervical cancer and malignant lesions of other genital organs. After the first sexual intercourse and infection, clinical manifestations can be smoothed out, but the virus remains in the ganglia for the rest of life.

Provoking factors

The following factors contribute to the exacerbation of herpes infection:

• weakening of immunity, development of immunodeficiency states;
• lesions of the skin and mucous membranes;
• lack of vitamins, minerals;
• frequent SARS, hypothermia;
• severe physical overload;
• psycho-emotional shocks.

Herpes symptoms

Herpes simplex virus infects the skin of the lips, mucous membranes of the cheeks, gums, genitals. Bubble rash occurs against the background of limited hyperemia. The bubbles are arranged in groups, inside there is a transparent liquid, after opening, red erosions appear. If the rashes are not injured, then they gradually dry out, become covered with a yellow crust on top.

Additional symptoms of herpes:

• fever;
• body aches;
• weakness;
• headache;
• chills.

Herpetic stomatitis often develops in children against the background of an exacerbation of herpes. Rashes are localized in the oral cavity: in the cheeks, gums and tongue. Bubbles quickly open, forming erosive surfaces. With aphthous stomatitis, the mucous membrane is sharply swollen and red, aphthae are formed with a white central part and a bright rim. Salivation is increased, body temperature may be elevated. The mucous membrane is painful, the appetite is reduced.

Genital herpes is accompanied by the formation of blisters on the head of the penis and foreskin in men, in the anus, thighs and genitals in women. The state of health remains satisfactory. With weak immunity, signs of fever with intoxication may occur: headaches, muscle pain, decreased performance and appetite, chills. Urination may be painful. In men, herpes can cause urethritis and prostatitis.

An exacerbation of genital herpes is often provoked by a change in sexual partner, hypothermia of the legs, recurrence of genitourinary infections and kidney disease. In the cool season, the virus is most active.

Which specialist should I contact?

For cutaneous herpes and shingles, it is recommended to consult a dermatologist. A general practitioner or general practitioner can provide the necessary medical care. Genital herpes is treated by venereologists, urologists and gynecologists. Additionally, consultation with an immunologist is necessary, since a herpes infection is chronic, weakening the human immune system.

Principles of treatment

Comprehensive treatment of herpes infection includes the use of antiviral drugs in tablet form and in the form of topical preparations for the treatment of the skin and mucous membranes. The duration of drug therapy directly depends on the severity of the patient’s condition. Usually treatment with antiviral agents lasts 1-2 weeks. Preparations such as acyclovir are recommended to be combined with interferon. You can not use antiviral agents for long courses. Otherwise, viral resistance occurs and the effectiveness of therapy decreases. Antiviral drugs do not destroy the herpes virus, but only reduce its amount in the body. If desired, vaccination can be carried out, which often allows the disease to be transferred to the stage of long-term remission. Vaccination is done during the period of subsiding of acute signs of infection.

Treatment focuses on immunocorrection. Increasing the body’s natural defenses can reduce the number of recurrences of herpes infection per year and significantly improve the patient’s quality of life.

To prevent exacerbations, the following rules are recommended:

• avoid hypothermia and overheating, especially in women during menstruation, if they are prone to recurrences of genital herpes;
• use personal protective equipment during intimate contact;
• lead a healthy lifestyle, eat well;
• do not respond to stress and everyday provocations, keep calm;
• timely start treatment of acute respiratory infections, influenza;
• regularly take multivitamin preparations, according to the doctor’s indication – immunostimulating drugs;
• detect and treat sexually transmitted diseases in a timely manner;
• avoid injury to mucous membranes and skin.

By following these simple rules, paying attention to the prevention of exacerbations, you can significantly reduce the number of relapses and avoid complications. The patient works in tandem with a doctor or a team of specialists, but does not attempt to heal on his own using dubious methods.

Please note! The information on this page is provided for reference only. To prescribe treatment, you must consult a doctor.

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