Diagnosis and Treatment Options
Prescription medications may be the next step, but often aren’t recommended for long periods due to potential side effects.
If your symptoms do not improve, you may need to undergo diagnostic tests, such as a barium swallow x-ray, upper endoscopy, esophageal function testing (manometry) or an ambulatory pH monitoring examination. For more information on these tests, visit our common diagnostic tests page.
Barium swallow before (A) and after (B) surgery
If GERD is diagnosed and medication and lifestyle changes do not work, antireflux surgery (Nissen fundoplication), performed by a cardiothoracic surgeon, may be a treatment option.
Nissen fundoplication may be considered for patients who do not want to take lifelong medications or are concerned about side effects like osteoporosis.
During Nissen fundoplication surgery, the upper part of the stomach (fundus) is wrapped around the esophagus to reinforce the valve between the esophagus and stomach, making acid less likely to back up into the esophagus. The procedure usually is done using a minimally invasive (laparoscopic) approach through small incisions in the abdomen.
Patients with reflux sometimes have a hiatal hernia (the stomach has pushed up through the diaphragm and into the chest), which can be repaired laparoscopically during the Nissen fundoplication, although a larger incision though the chest or abdomen may be recommended, especially if your hernia is larger, you are overweight, or your esophagus is relatively short due to scarring.
If the minimally invasive method is used, you likely will be in the hospital for 2 to 3 days and may be able to return to your normal routine in 2 to 3 weeks. With open surgery, patients stay in the hospital for 5 to 7 days with a 6- to 7-week recovery. With a hiatal hernia, it is important to avoid heavy lifting for at least 6 to 8 weeks to help prevent a recurrent hernia.
Eventually you can return to a more normal diet but should be sure to chew more thoroughly and eat more slowly.
Occasionally, patients can have diarrhea (dumping syndrome) after eating certain foods, such as sweets, which can be improved by changing your diet.
After a Nissen fundoplication, it is also important to avoid large pills and foods that cause gas, such as carbonated beverages, because the reinforced valve can make it more difficult to burp or vomit.
Reviewed by: Jules Lin, MD and Rishi Reddy, MD