Gastroesophageal reflux disease (GERD) is a chronic condition that requires patients to monitor symptoms throughout the course of their lives. Symptoms may include heartburn, difficulty swallowing, or regurgitation gas and bloating. Here is a complete list of symptoms.

The severity of GERD varies from person to person. For this reason, different treatment options may be appropriate. The severity of GERD can also vary from day to day or over time. For some individuals, GERD treatment may be needed on a regular basis. The need for treatment can increase over time, especially if symptoms gradually worsen.

Having reflux from time to time is normal, but if it interrupts your daily life, you should seek help. If you suffer symptoms of reflux twice or more per week, you may have GERD. Take this GERD Questionnaire if you suspect a problem and bring the results to your appointment for a GERD evaluation.

GERD Treatment Options

The most important goals of any GERD treatment are:

  • Symptom control
  • Prevention of GERD-related complications
  • Healing of esophagitis

Non-Surgical Treatments:

Depending on the severity of symptoms, treatment options for GERD may include:

  • Diet and lifestyle changes
    • Avoid foods that can trigger symptoms, such as coffee, tea, carbonated beverages, fatty or spicy foods, citrus fruits, tomatoes, garlic, onions, peppermint, or chocolate
    • Eat small, frequent meals
    • Lose weight
    • Reduce pressure on the stomach with weight loss and loose-fitting clothes
    • Stop smoking
    • Avoid alcohol
    • Don’t recline within 3 hours after eating
    • Raise the head of your bed 6-8 inches to reduce nighttime reflux
  • Over-the-counter and prescribed medicines
  • Conventional anti-reflux surgery

Each of these treatment options will be discussed with you to make sure the best option is selected for your situation.


Surgical Treatments:

Transoral Incisionless Fundoplication (TIF)

TIF is a minimally invasive, outpatient procedure that is performed through the mouth to reconstruct the antireflux valve between the esophagus and the stomach. This valve opens and closes as food is swallowed and acts as a physical barrier to reflux. This procedure restores the body’s natural protection against reflux. It eliminates the acidic symptoms of reflux (heartburn and sore throat) and the non-acidic, atypical symptoms (asthma, chronic cough, and regurgitation).

TIF

Benefits of the Procedure:

  • No scars, due to incisionless approach
  • Reduced risk and discomfort
  • Faster recovery since there is no internal cutting of the natural anatomy
  • Fewer adverse events and complications than conventional surgery
  • Can be revised if required

Anticipated risks with the TIF procedure include temporary discomforts, such as sore throat, shoulder pain, difficulty swallowing, nausea, or vomiting. Here is more information about risks associated with this procedure.

TIF is an acronym:

  • Transoral – the procedure is performed in the GI tract through the mouth
  • Incisionless – there are no incisions
  • Fundoplication – the anti-reflux valve is reconstructed by wrapping the upper portion of the stomach (fundus) around the esophagus

What to Expect About TIF Surgery:

Before Surgery
Because this surgery is performed under general anesthesia, preparation is similar to other surgeries. Specifically, patients must refrain from eating and drinking for several hours prior to the procedure.

During Surgery
TIF generally takes less than an hour, depending on the anatomy of the patient.

Our surgeon will insert the EsophyX device and an endoscope through the mouth to the esophagus. The endoscope lets our surgeon see what he is doing. The EsophyX device is used to reconstruct the anti-reflux valve. This involves wrapping the upper portion of the stomach around the damaged lower portion of the esophagus and securing it with poly-propylene fasteners. The fasteners are left in place to secure the newly constructed valve while healing occurs.

After Surgery
Specific instructions will vary patient-to-patient and at our surgeon’s discretion. Most patients can return home the same or next day, and can resume work and most ordinary activities within a few days. However, you should expect to experience some minor discomfort in their stomach, chest, nose, and/or throat for up to three to seven days after the procedure.

It’s important you comply with our recommendations after the procedure for proper healing. Retching, vomiting or excessive physical activity within approximately four weeks after the procedure may adversely affect the surgical repair. We may also recommend following a modified diet during that time.

Learn More

Here are some frequently asked questions and educational videos about TIF to provide you more information about this procedure. You may also download this TIF informational brochure (English) or TIF informational brochure (Spanish).


Fundoplication

The most common anti-reflux surgery is known as a fundoplication (fundo means top of stomach and plication means to fold). During this surgery, our surgeon will wrap the upper portion of the stomach around the end of the esophagus and stitch it in place. This technique reinforces the anti-reflux barrier and the junction between the esophagus and the stomach. Traditional surgery has been performed for more than 50 years and has proven successful at treating GERD symptoms.

When to Consider Anti-reflux Surgery
Most people with mild GERD can successfully control symptoms through dietary and lifestyle changes or medication. For patients who experience inadequate relief and/or side effects from medication, surgical intervention may be appropriate.

In addition, surgery may be suitable for patients who have any of the following:

  • Concerns about the long-term side effects or costs associated with medication
  • Certain complications of GERD, such as Barrett’s Esophagus
  • Symptoms of GERD outside the esophagus, such as asthma, hoarseness, cough, chest pain, or aspiration

Goals of Antireflux Surgery
The goal of a fundoplication is to restore the normal functions of the junction between the esophagus and the stomach. Other goals include:

  • Reduction of a hiatal hernia (if present) by repairing the enlarged opening of the diaphragm and ensuring the stomach and esophagus are properly positioned below the diaphragm
  • Restoration of the angle where the esophagus enters the stomach
  • Increased pressure of the muscle that controls the valve between the stomach and the esophagus to recreate a one-way valve to prevent reflux

Types of Anti-reflux Surgery

Laparoscopic Surgery
Although fundoplication was first performed as open surgery, technological advances in the 1990s enabled a laparoscopic approach. A laparoscopic procedure involves accessing the abdomen via several small incisions. The patient is sedated for the procedure. Our surgeon repairs any hiatal hernia before performing the fundoplication. Laparoscopic fundoplication can be performed on patients with any size hiatal hernia. Patients typically return to work within 1-2 weeks.

It is important to remember that laparoscopic fundoplication is a surgical procedure with risks including bleeding, infection, and injury to internal organs.


Comparison of the TIF Procedure and Traditional Anti-reflux Surgery

Among the treatments available to people with severe GERD-related symptoms, the more advanced options are the TIF procedure and traditional anti-reflux surgery. Both procedures have the same goal.

Traditional, or conventional, anti-reflux surgery has been long considered an effective solution for treating GERD. The surgery involves several abdominal incisions and typically includes side effects such as difficulty swallowing (26%), bloating (36%), and increased flatulence (65%).

The TIF procedure for chronic acid reflux treats the underlying cause of GERD without incisions. This procedure rebuilds the anti-reflux valve and restores the body’s natural protection against reflux.  It follows the well-established principles of conventional anti-reflux surgery and delivers similar results in an innovative way.


References:

[1] Jobe, B.A., et. al. Endoscopic Appraisal of the Gastroesophageal Valve After Antireflux Surgery. Am J of Gastro 2004.

[2] Nissen R, The Treatment of Hiatal Hernia and Esophageal Reflux by Fundoplication. Hernia 1964;30:488-496.

[3] Adler, R.H., et. al. A valve mechanism to prevent gastroesophageal reflux and esophagitis. Surgery 1958;44:63-75.

[4] Little, A., et. al. Mechanisms of Action of Antireflux Surgery: Theory and Fact. World J of Surg. 1992;16:320-5.

[5] Varin, O., et al. Total vs Partial Fundoplication in the Treatment of Gastroesophageal Reflux Disease:A Meta-Analysis. Arch Surg. 2009; 144(3): 273-278.