<< Back

Medicine or Surgery for Acid Reflux? A Fresh Look at Digestive Health Center

August 10, 2020

A coordinated approach by gastroenterologists and gastric surgeons and the most advanced diagnostics are leading to the best outcomes for care for patients dealing with acid reflux and swallowing issues.

As part of Hartford Hospital’s new Digestive Health Center (DHC), gastroenterologists and surgeons are coming together sooner within the timespan of a patient’s care, and seeing better outcomes.

In his role as Director of the Motility Lab at Hartford Hospital, Dr. Jeffrey Gelwan sees this firsthand. Up to five patients a day are seen in Hartford Hospital’s Motility Lab, coming in for testing related to acid reflux and swallowing issues. Dr. Edward Hannoush, a minimally invasive gastrointestinal surgeon, said his ability to order a range of tests to determine what the underlying causes of reflux are have made treatments much more effective.

“Historically, the management of reflux, gastrointestinal esophageal reflux disease (GERD) and difficulty swallowing has been siloed,” Hannoush said. “The gastroenterologist wants to manage with medication and the surgeon wants to do surgery. Coming together now to work collaboratively in the DHC, we develop a personalized plan for each patient.”

One in five people in the United States are diagnosed with acid reflux. For those people, one-third will have evidence of inflammation in their esophagus. Although many patients have classic reflux symptoms such as heartburn and regurgitation, a large number of patients have “atypical” symptoms such as chest pain, difficulty swallowing, cough, hoarseness and worsening asthma.

Although medicines to treat acid reflux are commonly prescribed, up to 40 percent of patients on these medications find partial to no relief. Drs. Gelwan and Hannoush also noted that those medicines only treat symptoms — they do not cure the problem. Patients can improve their situations through lifestyle changes like losing weight and eating smaller meals and taking their medications, but diagnostic testing is often needed to better assess patients who do not respond to traditional anti-reflux therapies.

Tests can identify the underlying cause of the reflux or difficulty swallowing, which can help optimize patients’ medical therapy and/or potentially be surgically corrected. Esophageal manometry assesses how the esophagus is functioning by measuring contractions, as well as the strength of the lower esophageal sphincter.

Several esophageal studies measure the pH in the esophagus and help determine how often the patient refluxes and if these reflux episodes are related to the patient’s symptoms. In one such test, doctors can place a sensor inside the esophagus and record 96 hours of data. This test, called BRAVO, is often done on patients with atypical symptoms of reflux.

Another relatively new test, EndoFLIP, is a minimally invasive procedure that inserts a balloon into the esophagus and measures the area and pressure inside the esophagus as well as across the lower esophageal sphincter. Hartford Hospital is in the process of becoming a national center to teach other doctors in the country how to do this procedure.

“With this group of testing, we can gather a lot of information about the patient and determine if the patient’s symptoms are caused by reflux or are secondary to a motility disorder,” Dr. Gelwan said. “We have seen that about 44 percent of the patients undergoing esophageal manometry have some abnormality in their esophageal motility. These tests have improved our diagnostic ability greatly.”

Hannoush added, “It is all really useful to understanding what is really going on.” Oftentimes, a patient with reflux can go on for years on medical treatment without undergoing testing to really know what is driving their symptoms. Testing allows us to come up with better treatment strategies to what the issue is in that particular patient.

Several surgical options can correct the problem. What makes surgery attractive is that, while medications to treat reflux work by reducing the acidity of the refluxed fluid, everything we do in surgery is aimed to actually prevent reflux from happening altogether and be able to hopefully come off or dramatically reduce the need for medications. These procedures are all performed minimally invasively and recovery is short.

In some cases, reflux is caused by a hiatal hernia, when the stomach migrates through the diaphragm muscle into the chest — which is repaired at the time of surgery. There are also interventions that prevent reflux by strengthening the valve at the lower esophageal junction to the stomach. The newest procedure is called LINX (magnetic sphincter augmentation) procedure, a minimally invasive laparoscopic implantation of a small device made of interlinked titanium beads with magnetic cores, which prevents reflux by augmenting the esophageal sphincter’s barrier function.

So when you swallow food, it will push its way through the magnets to allow for food to enter the stomach, which recloses after the food goes by. This prevents SSTOMacid from the stomach rising up into the esophagus.  Another option is called fundoplication, in which the surgeon will wrap the lower part of the esophagus with the floppy part of the stomach. After a meal, when the stomach becomes distended, the wrapped stomach will increase the pressure around the lower esophagus and therefore prevent reflux from occurring.

Lastly, although these procedures can be very effective, there is no such thing as “one size fits all” and they are not for everyone. Careful patient selection and most importantly, a coordinated multidisciplinary patient-centered approach is what delivers best results, which is the objective of the Digestive Health Center.

For more information on Hartford Hospital’s Digestive Health Center, click here.

Not feeling well? Call your healthcare provider for guidance and try to avoid going directly to an emergency department or urgent care center, as this could increase the chances of the disease spreading.

Click here to schedule a virtual visit with a Hartford HealthCare-GoHealth Urgent Care provider.

Stay with Hartford HealthCare for everything you need to know about the coronavirus threat. Click here for information updated daily.

Stay fit. Stay happy. Stay healthy. And keep on top of COVID-19 with Hartford HealthCare’s daily text alerts. Subscribe by texting MoreLife to 31996.