What is GERD? If you have heartburn or reflux twice a week or more, you may have GERD. Heartburn is the most common symptom, but you may also experience:

• Hoarseness or sore throat
• Frequent swallowing
• Asthma or asthma-like symptoms
• Pain or discomfort in the chest
• Sleep disruption (unable to sleep lying down)
• Bloating
• Excessive clearing of the throat
• Persistent cough
• Burning in the mouth or throat
• Intolerance of certain foods
• Dental erosions or therapy-resistant gum disease or inflammation

About 45% of the American population get acid reflux. About 10% have an acid reflux more than once a week and they experience variety of symptoms, including waking up at night with food or acid coming up in their mouth, waking up with coughing spells, day time food or acid reflux, food getting stuck in the esophagus while eating.

Why pharmaceuticals are not a long-term solution? GERD today is typically treated with medications such as histamine receptor antagonists (H2 blockers), such as Pepcid, Tagamet and Zantac, and proton pump inhibitors (PPIs), such as Nexium, Prilosec and Protonix. These medications can lose their effectiveness over time. They also don’t treat the underlying root causes of reflux, the deteriorated anatomy of the antireflux barrier, so life-long medication therapy is required. In addition, recent studies on the adverse effects of long-term use of PPIs indicate a significantly higher incidence of hip fractures, particularly among women.

Why are acid and food coming back up to the mouth? At the lower end of the esophagus there is a valve called lower esophageal sphincter (LES). When the LES becomes incompetent it fails to keep acid and food in the stomach, allowing them to come up when ever there is pressure on stomach.

What is the solution or management? The best solution is to repair the diaphgmatic hernia and create a new valve around the lower esophagus. Dr. Pandya does this laparoscopically and the procedure is called laparoscopic antireflux surgery. For more information click here.

There are many medications sold by various pharmaceutical companies like Nexium, Zantac, and many others. These medications work to temporarily reduce acid production in the stomach and provide short term relief. They do not provide any lasting benefit and certainly do not correct the basic defect in the LES. It may also cause harm to those who take the medication if taken for a long period of time.

TIF procedure

Now there is no good reason to take acid reducing pills every day. The defective esophageal valve can be reconstructed by Endoscopic Fundoplication or Videoscopic surgery.

I am very happy to announce that now I will be able to help GERD patients with Transoral Incisionless Fundoplication (TIF). TIF recreates the lower esophageal valve and helps eliminate gastroesophageal acid reflux by correcting anatomic root cause of GERD, eliminating need for daily dose of PPI medications and associated long term effects and complications including kidney damage.

Why Pharmaceuticals Are Not a Long-term Solution

GERD today is treated with medications such as H2 blockers, and PPIs. These medications lose their effectiveness over time. They also don’t treat the underlying root causes of reflux, the deteriorated anatomy of the antireflux barrier, requiring life-long use of these medications. In addition, recent studies on the adverse effects of long-term use of PPIs indicate a significantly higher incidence of hip fractures, particularly among women.

Tif Procedure

TIF is the latest treatment for safely and effectively treating chronic acid reflux disease in selected patients. TIF is performed endoscopically using the innovative surgical device. In clinical studies, 79% of patients remained off daily PPIs (proton pump inhibitors) and 93% experienced a total elimination of heartburn at two years after the TIF procedure

TIF was developed to emulate more invasive surgical techniques, but from within completely eliminating incisions and visible scars. Using the FDA-cleared EsophyX device, the procedure is performed through the mouth, rather than through an abdominal incision. Typically lasting no more than 50-60 minutes, the procedure is performed under general anesthesia and reconstructs the antireflux barrier to restore the competency of the gastroesophageal junction. Most patients can go home the next day and return to work within a few days.

Conventional Videoscopic Antireflux Surgical Treatment

For people who have larger hiatal hernia, Laparoscopic Videoscopic surgical intervention may be required. The conventional Laparoscopic Nissen Fundoplication procedure has been proven a very effective long-term solution to manage acid reflux. It includes a few small incisions for Videoscopic Surgery and patients remain in the hospital for up to 1-2 days. As shown at the image to the right, this procedure includes, Laparoscopic repair of Hiatal Hernia and also recreates the lower esophageal valve that stops the acid going back up and therefore there is no need to take expensive medications with serious side effects such as Nexium , Omeprazole, Protonix, Zantak, Pepcid among a few.