Dr. Williams has Performed Thousands of GERD Procedures

I have been assisting Dr. Williams in surgery since 2006. He is one of the most competent general surgeons I have ever worked with. I wholeheartedly recommend him to anyone needing surgery. He is kind and compassionate and has a care for his patients that I don't see in other doctors. He is a great person and does a great job!

- Chelsea Brennan - CST

Gastroesophageal Reflux Disease (GERD) Treatment in Boise

GERD Is A Common Problem

Do you often have heartburn or sour-tasting fluid in your throat? If so, you may have gastroesophageal reflux disease (GERD). This is a common problem that affects many adults. If not controlled, GERD can damage the esophagus. It can also lead to other serious problems. Our website will help you learn more about GERD and what can be done to treat it.

Causes of GERD

GERD is the flow of acid from the stomach into the esophagus. The acid can travel back (reflux) as far as the throat. Certain things can make GERD more likely. These include:

  • Being overweight
  • Having a hiatal hernia
  • Being pregnant
  • Having certain foods or drinks
  • Taking certain medications
  • Smoking

Symptoms of GERD

The symptoms of GERD can include:

  • A burning feeling in the chest (heartburn)
  • A bitter or sour taste in the back of the mouth
  • Worsening of the above symptoms after eating or lying down
  • Frequent burping
  • Pain in the upper abdomen
  • Sensation of food being stuck in the throat
  • Trouble swallowing
  • Hoarseness
  • Chronic coughing or wheezing

GERD Treatment Can Help

Ask Dr. Williams to form a treatment plan that best meets your needs. In some cases, GERD can be managed with simple lifestyle changes and medications. In others, surgery may offer more lasting relief. Your doctor will discuss all of your treatment options with you and outline their benefits and risks. Be sure to ask questions you have and get the answers you need.

If you have chest pain:

Chest pain caused by GERD may feel similar to that caused by heart problems. Be sure to have chest pain evaluated by a doctor.

How GERD Occurs

When you eat, food travels from your mouth down to a tube called the esophagus to your stomach. Along the way, food passes through a one-way valve called the lower esophageal sphincter (LES). Problems with the LES can lead to GERD.

The Role of LES

The LES is located between the esophagus and the stomach. Normally, the LES opens when you swallow. It allows food to enter the stomach, then closes quickly.

When You Have GERD

With GERD, the LES does not work well enough to hold food and fluids in the stomach. Escaping stomach contents irritate the esophagus, causing heartburn and other symptoms. Sometimes, the top of the stomach slides through an enlarged hiatus (hiatal hernia). This can make GERD worse.

Complications of GERD

Left untreated, GERD can become more severe and lead to serious problems over time. Severe GERD can cause pain, bleeding, or trouble swallowing. It can also increase the risk of cancer of the esophagus.

Diagnosing GERD

To confirm that you have GERD, your doctor will evaluate you. He or she may also order tests. Based on the results, you and your doctor can then plan your treatment.

Health History and Exam

Describe your symptoms and any health problems you have. You may also be asked about your eating, sleeping, smoking, and drinking habits. During the physical exam, your doctor may examine your throat. He or she may also listen to your stomach with a stethoscope and feel your abdomen.

Tests For GERD

Tests can help your doctor diagnose GERD and check for other problems. Possible tests include:

  • Endoscopy. A thin, lighted tube called an endoscopy is passed through the mouth, and down the throat and esophagus into the stomach. The scope has a camera that sends live images of the inside of the stomach to a monitor.
  • pH monitoring. A thin probe is placed in the esophagus for 24 hours. The probe records how much acid flows back from the stomach into the esophagus.
  • Barium swallow. For this test, you drink a chalky liquid called barium contrast (dye). X-rays are taken as the dye travels from the mouth to the stomach.

Planning the Treatment of GERD

Treatment for GERD is intended to control symptoms and prevent further damage to the esophagus. Below is a summary of the main treatments that you and your doctor may include in your plan. These will be covered in detail in the following pages. If tests show that you have complications of GERD, other treatments may be needed as well. These are described briefly below.

Treatment of GERD

Your treatment plan will likely include one or more of the following:

  • Lifestyle changes, such as diet, activity, and bedtime changes
  • Medications to control how much acid the stomach makes
  • Surgery to strengthen the lower esophageal sphincter (LES)

Treatment for Complications

Complications of GERD include ulcers, inflammation, strictures, and Barrett’s esophagus (see page 5). Each of these problems can usually be treated with the same lifestyle changes and medications that are used for GERD. The following problems may require more treatments.

  • If you have a stricture, your doctor may advise a procedure called dilation. This is done to stretch or widen the esophagus. This procedure can help improve problems with swallowing.
  • If you have Barrett’s esophagus, your doctor may advise routine endoscopy tests. Procedures to remove or destroy abnormal tissue in the esophagus may also be done. In severe cases, surgery may be needed.

GERD Treatment with Lifestyle Changes

When treating GERD, lifestyle changes are often tried first. These are things you can do yourself to help improve symptoms. Work with your doctor to determine what changes you should start with.

Watch What You Eat

Certain foods and drinks may trigger GERD symptoms. These may be different for each person. Keep a food log to track what you eat. Note whether any foods trigger your symptoms or make them worse. Then limit or avoid these foods. You list may include the following:

  • Alcohol
  • Chocolate
  • Caffeine (coffee, tea)
  • Carbonated beverages
  • Mint (peppermint, spearmint)
  • Citrus and tomato-based foods
  • Spicy foods
  • Fried and fatty foods
  • Onions

Watch How and When You Eat

Your eating habits can also have an effect on your symptoms. To help prevent reflux:

  • Eat your food slowly
  • Avoid eating large meals. Stop eating before you get full
  • Avoid lying down at least 2 to 3 hours after eating.
  • Don’t snack after dinner, especially not before bed.

Lose Extra Weight

Too much weight can put pressure on your abdomen and lead to reflux. To get rid of extra pounds, talk with your doctor about a weight-loss plan. Here are a few tips to help you get started:

  • Set realistic weight-loss goals. For most people, losing 1 to 2 pounds a week is a safe amount.
  • Manage the amount of calories you eat. You and your doctor can discuss what your target calorie range should be each day to achieve a health weight loss.
  • Be more active. Burning more calories than you eat can help you lose weight. Regular exercise is the best way to burn calories. Talk with your doctor about the type of activities you can do to help you lose weight.

Bedtime Changes

Reflux is more likely when lying down. To help control symptoms while you sleep, try these tips:

  • Raise the head of your bed 6 to 8 inches. Place a wedge under the head of the mattress. Or, slide blocks or books under the legs at the head of the bed. Don’t try just sleeping on several pillows. This can increase pressure on your LES and make symptoms worse.
  • Avoid lying flat. Try to lie on your left side whenever you can.

GERD Treatment and Recovery

Treatment with Medications

GERD can be treated with medications. These may be over the counter or prescription. Some medications work right away. Others take more time before you find relief. Your doctor will work with you to find the best medications for your symptoms.

Types of Medications

Medications for GERD work in different ways. Based on the severity of your symptoms, you may be advised to take one or more of the following:

  • Antacids. These help neutralize stomach acid. They work quickly, but are only useful for mild reflux.
  • H2 blockers. These cause the stomach to make less acid.
  • Proton pump inhibitors (PPIs). These also cause the stomach to make less acid, but they are stronger than H2 blockers.
  • Prokinetics. These strengthen the squeezing action of the esophagus and tighten the LES. They are often used along with H2 blockers. Some of these medications also make the stomach empty faster.

Medications Can Have Side Effects

Both over-the-counter and prescription medications for GERD can have side effects. Talk with your doctor or pharmacist about the possible side effects of any medication you take. For your safety, let your doctor or pharmacist know if you’re taking any other medications or have any known health problems.

If Surgery Is Needed

If other types of treatments fail to relieve your symptoms, surgery may be recommended. Your doctor will discuss benefits and risks of surgery with you. You will be told how to prepare for surgery. Follow all instructions carefully.

Tests Done Before Surgery

To check your health before surgery, your doctor may order certain tests. These can include blood tests, an ECG (electrocardiogram), and a chest x-ray to check your heart and lungs. You may also have a test called esophageal manometry. This test is used to measure the muscle tone of the LES and to tailor the surgery to your needs. The test also shows how well the esophagus moves food along.

Preparing for Surgery

  • Tell your doctor about all medications you take. This includes over-the-counter medications, herbs, and supplements. If you take medications to prevent blood clots, be sure to mention them. You may need to stop taking some or all of these before surgery.
  • Stop smoking. Smoking increases surgery risks and slows healing.
  • Stop eating and drinking as directed before the surgery. If you have been told to take medications, take them with small sips of water.
  • Arrange for help after the surgery. You’ll want to take it easy right after surgery, so arrange for help at home. Also, plan to have someone drive you to the hospital and pick you up afterward.

Risks and Complications

Risks of surgery for GERD include:

  • Injury to the liver, spleen, esophagus, or stomach
  • Bleeding
  • Infection
  • Increased gas or bloating
  • Inability to vomit
  • Trouble swallowing
  • Failure to relieve symptoms
  • Risks of anesthesia
  • Need to convert to an open procedure

Treatment with Surgery

Surgery for GERD is called fundoplication. During surgery, the LES is strengthened by wrapping the very top of the stomach around the lower part of the esophagus. The surgery typically takes 2 to 4 hours.

The Day of Surgery

Arrive at the hospital or surgery center on time. As you’re readied for surgery, you may be asked more than once to provide your name and what procedure you’re having. This is for your safety. You’ll be given an IV (intravenous) line to supply fluids and medication. You’ll also be told about the anesthesia that keeps your free from pain during the surgery. You may be drowsy but awake. Or, you may be in a state like deep sleep through the surgery.

During Surgery

Surgery is most often done using laparoscopy. This approach uses a thin, lighted tube called a laparoscope (scope).

  • The surgeon makes several small incisions in the abdomen.
  • The scope is inserted through one incision. Surgical tools are placed through the other incisions. The scope has a camera attached, which sends live images to a monitor.
  • The abdomen is filled with carbon dioxide (CO2) gas. This provides more space for the surgeon to see and work.
  • The CO2 gas and all surgical tools are removed after surgery.
  • The incisions are closed with stitches or strips of surgical tape.

If Open Surgery is Needed

During surgery, the surgeon may switch from laparoscopy to open surgery (also called open fundoplication). This does NOT mean something has gone wrong. Instead, a larger incision is needed to complete the procedure safely. Having open surgery means a longer hospital stay and recovery.

How the Surgery is Done

Repairing a Hiatal Hernia

If the opening of the hiatus is too large (hiatal hernia), the surgeon may tighten it with a few stitches. This repairs the hiatal hernia. Nothing is opened, removed, or rerouted during the procedure.

Strengthening the LES

To add support, the surgeon wraps the top of the stomach around the outside of the esophagus. This helps prevent reflux. To make sure the wrap is not too tight, a flexible rubber tube (bougie) may be temporarily inserted into the esophagus. The wrap is permanently stitched in place. If needed, the esophagus is widened (dilated) during surgery.

Full or Partial Wrap

Two Wraps may be used for the surgery. A full wrap goes all the way around the LES. A partial wrap goes only part of the way around. The surgeon will choose the wrap that is best for your case.

Recovering from Surgery

Most people go home 1 to 3 days after surgery. Follow your doctor’s instructions on how to care for yourself during recovery. You may be able to start on a liquid diet soon after surgery. Once you’re fully recovered, you’ll be able to eat without the pain and discomfort of GERD.

In the Hospital

After surgery, you’ll move to the recovery area, where you’ll be closely watched. Once you wake up, you’ll be taken to your hospital room. You’ll receive pain medications as needed. Soon, you’ll be out of bed and walking around. A nurse or therapist will teach you coughing and breathing exercises to help prevent lung problems. Within a day or so after surgery, you’ll start a liquid diet. Your doctor will determine when you can begin eating soft foods. These are foods that are moist and easy to swallow and digest. Solid foods will be added back to your diet as you can tolerate them. How long this takes varies for each person.

Back at Home

Take it easy when you return home. Don’t do any heavy lifting or vigorous activities. Follow your doctor’s advice about showering, driving, and returning to work. To help speed your recovery along, walk as often as you feel able. Also, continue the coughing and deep breathing exercises that you learned in the hospital for as long as directed.

Caring for Your Incisions

Your incisions will be covered with bandages. These may be removed a day or two after surgery. If strips of surgical tape were used to close your incisions, don’t pull them off. Let them fall off on their own. Once you’re allowed to get the incisions wet, gently clean the area with warm water and soap. Don’t use oils, powders, or lotions on your incisions.

Eating and Drinking

At first, swallowing may be hard. This will gradually improve as you recover. You’ll be given specific guidelines about what to eat and drink after surgery. These tips may help:

  • Eat smaller meals more often. Also, take small bites and chew your food well. These actions may help prevent gas buildup and ease swallowing.
  • Sit straight up while eating.
  • Avoid drinking alcohol until your doctor says it’s okay.

Follow Up with Your Doctor

See your doctor for follow-up visits as directed. These allow your doctor to check your progress and make sure you’re healing well. During follow-up visits, tell your doctor if you have any new symptoms or any reflux. Also be sure to ask questions you have.

When to Call the Doctor

Once at home, call your doctor if you develop any of these signs of symptoms:

  • Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher
  • Increased redness, bleeding, swelling, pain, or drainage around any incisions
  • Abdomen becomes tender or feels hard
  • Nausea or vomiting
  • Chest pain or shortness of breath
  • Trouble swallowing that continues to worsen
  • Bloody vomit or black, tarry stools

Work with Your Doctor

GERD can be uncomfortable, but it can be managed. Work with your doctor to find the treatment options that are right for you. With treatment and help from your doctor, you can get relief from pain and burning so you can feel good again.

Change for Your Health

Make long-term changes that will help control GERD and improve your overall health. To feel your best:

  • Maintain a healthy weight.
  • Get regular exercise.
  • Make healthy food choices.
  • Quit smoking.
  • Limit alcohol.

GERD & Acid Reflux Treatment Options
Straight from Dr. Williams