Division of Gastroenterology, Hepatology & Nutrition
The Division of Gastroenterology, Hepatology, and Nutrition, part of the Department of Medicine, offers world-class patient care, research programs, and education and training opportunities.
Heartburn, GERD & Hiatal Hernia Care
Helping you feel better and prevent complications
Treatment To Relieve Your Symptoms & Protect Your Health
Many people occasionally experience acid reflux, also known as acid indigestion or heartburn. The uncomfortable feeling in your chest often comes after eating a large meal, or after drinking alcohol or beverages with caffeine. But if you’re experiencing heartburn multiple times each week, you could be living with gastroesophageal reflux disease, or GERD. And you could be at risk for other serious health problems as a result.
Through the Chest Disease Center at Beth Israel Deaconess Medical Center (BIDMC), you can get expert care for heartburn and GERD. Dietary and lifestyle changes and medication help many people. And if they don’t adequately relieve your symptoms, you might benefit from surgery.
Our team includes experts in minimally invasive procedures. These treatment strategies result in a quicker recovery than traditional surgery with a lower risk of complications. The procedures may help you feel better and lower your risk of future health problems.
More About GERD
Understanding Heartburn & GERD
Heartburn occurs when stomach acid flows into your esophagus, the tube that allows food and drink to move from your mouth to your stomach. This reflux creates a burning sensation.
Heartburn on a regular basis may signal GERD. This condition is a result of a weak sphincter muscle (valve) between your stomach and esophagus. When the lower esophageal sphincter (LES) is weak or opens abnormally, stomach contents splash back into your esophagus. In addition to heartburn, this may cause other symptoms, including:
- A bitter or sour taste in your mouth.
- Breathing difficulties.
- Nausea.
- Painful or difficult swallowing.
- Throat problems.
Untreated, GERD may potentially cause:
- Esophageal stricture, a narrowing of your esophagus.
- Esophageal ulcers, sores that develop in the lining of your esophagus.
- Barrett's esophagus, a condition in which precancerous cells are present in your esophagus.
- Esophageal cancer, which is the development of cancerous cells in your esophagus.
Diagnosing GERD
Often, we can diagnose GERD based on your symptoms and medical history. However, your doctor may order one or more tests to confirm the diagnosis, including:
- Upper endoscopy — A test that allows us to see inside your esophagus and remove tissue for a biopsy, if necessary.
- Swallow study – A test that allows us to assess the anatomy of your esophagus and stomach, swallowing and esophageal function, and the extent of acid reflux.
- Esophageal pH monitoring — Tests that measure acid and nonacid reflux in your esophagus.
- Manometry – A test that assesses how effectively your esophagus and lower esophageal sphincter are working.
Treatment Options
Treatment for GERD usually begins with dietary changes. Foods such as chocolate, coffee, onions and peppermint may cause your LES to relax and not close tightly. Other foods can irritate the esophagus once it’s affected by GERD. These include spicy foods, tomato products and citrus fruits. On a GERD diet, you avoid these foods and eat smaller meals than usual.
Doctors also may recommend that you take medication. Acid reducers, antacids or prescription medicines may help. Some people benefit from raising the head of their bed while sleeping, as well.
Surgical Treatments for GERD
If dietary and lifestyle changes don’t help your GERD, you may want to consider surgery.
Hiatal Hernia
Heartburn and GERD may be associated with a hiatal hernia. This type of hernia occurs when part of your stomach pushes through the opening in your diaphragm (the hiatus) that allows your esophagus to connect with your stomach. The diaphragm is a large muscle that separates your chest cavity (where your heart and lungs are located) from your abdominal cavity (where your stomach, liver and intestines are found). In some cases, more than half of the stomach can move into the chest.
Large hernias may cause a number of symptoms other than heartburn, including trouble swallowing, discomfort after eating, bleeding and difficulty breathing. Medications rarely help these symptoms, so surgery may play an important role in treatment.
Surgical Treatment for Heartburn and Hiatal Hernia
Surgery to provide heartburn relief involves three steps:
- Fixing the hiatal hernia (if present) by returning the stomach into the abdomen.
- Making the hiatus smaller.
- Creating a fundoplication and/or Gastropexy. Gastropexy is a surgical procedure where the stomach is attached to the abdominal wall.
To fix your hernia, we gently bring the part of your stomach that’s within your chest back below your diaphragm. Using stitches, we then make the hiatus opening smaller, so your stomach is less likely to slip through the space.
Finally for the fundoplication, we pass a small part of your stomach behind your esophagus.
Think of a fundoplication in terms of a belt for a pair of pants that are too loose. In the case of heartburn, the muscle that normally prevents acid reflux is too loose. We use fundoplication to make that muscle tighter to prevent heartburn.
A fundoplication doesn't make your stomach smaller and won't help you lose weight. However, you may notice that food sometimes goes down slowly after surgery. This is almost always temporary and is usually due to swelling at the fundoplication. As your swelling goes down, you should be able to eat normally. Usually, we recommend that you stay on a modified diet until the swelling subsides.
