Henrico Doctors’ Hospital offers innovative acid reflux procedure
Dr. Clifford Smith performs area’s first Linx case
Heartburn and Esophageal Center
At Henrico Doctors’ Hospital, our board-certified gastroenterologists and surgeons specialize in treating patients with chronic Gastroesophageal Reflux Disease, or GERD, a condition that results in acid reflux and heartburn when stomach acid is not properly contained in the stomach and rises into the esophagus. The symptoms of GERD can be very painful and, if left untreated, harmful to the digestive system.
What Sets our Program Apart?
For more than 20 years, the surgeons at Henrico Doctors’ Hospital have been performing minimally-invasive, laparoscopic anti-reflux surgery, helping thousands of patients live more comfortably. They have the experience needed to care for even the most complex cases of GERD successfully.
Henrico Doctors' Hospital was the first program to:
- perform daVinci robotic gastrointestinal surgery in the United States.
- perform laparoscopic surgery for GERD in the mid-Atlantic region.
- offer the LINX procedure for reflux management.
Our multidisciplinary team includes surgeons, GI specialists, nurses, a GI Nurse Navigator to guide patients through the program, manometry nurses for diagnostic testing, and registered dieticians.
What is GERD?
Gastroesophageal reflux (GERD) occurs when stomach contents flow backwards into the esophagus. GERD is caused by a weak muscle in your esophagus called the Lower Esophageal Sphincter that is your body’s reflux barrier. Normally the barrier acts as a one-way valve allowing food to pass into the stomach, but preventing stomach contents from flowing back into the esophagus. In people with reflux, the barrier allows acid and bile to flow back into the esophagus.
Risk factors and lifestyle conditions for GERD include being overweight, jobs that require stooping, bending, or heavy lifting, being over the age of 40, pregnancy, diabetes, smoking, and diet and lifestyle choices, including a diet of alcohol, citrus, caffeinated beverages, tomato-based foods, chocolate, spicy foods and peppermint.
Symptoms of GERD include, but are not limited to:
For the majority of people heartburn is an annoyance, but for some it can turn into a more serious problem. Serious cases of GERD can lead to esophagitis, Barrett's esophagus, esophageal stricture, and, in rare cases, esophageal cancer if left untreated:
Testing for GERD
The doctor may suspect GERD based on symptoms and medical history, like the frequency of heartburn symptoms. Some diagnostic tests for GERD include, but are not limited to:
Esophageal pH monitoring is the best way to confirm reflux. A 24-hour pH monitoring system uses a small tube that is passed through the nose or mouth, down the esophagus, and into the stomach. The tube remains in place for 24 hours and monitors the amount and frequency of stomach acid that backs into the esophagus. Your doctor will review the acid report and a food and activity diary to see what is exacerbating the reflux.
A barium swallow exam is a series of x-rays of the esophagus, stomach, and the first part of the small intestine called the duodenum. The x-rays are taken during and after drinking contrast material called barium . The barium solution is a thick, white, chalky, milkshake-like liquid. It coats the inside lining of your GI tract, making it more visible on the x-ray.
Endoscopy is a procedure that allows the doctor to closely examine the lining of the esophagus. A thin, lighted tube with a tiny camera is passed down the throat to the esophagus and stomach. The doctor will be able to see irritation or changes to the esophagus. An ultrasound is sometimes combined with this procedure in order to make a better assessment of your condition.
Esophageal manometry is a diagnostic procedure that can be done in your doctor's office. A specialized tube is passed through the mouth into the esophagus. The tube can measure the amount of pressure created by muscles throughout the esophagus.
Non-Invasive Treatment Options
The primary modes of treatment for GERD include lifestyle modifications like medication management (OTC or prescription medications including antacids that neutralize stomach acid), maintaining a healthy weight, not eating three hours prior to lying down, or elevating your head while lying down or sleeping. Other treatments include PPI (Proton Pump Inhibitors) which reduce the production of acid in the stomach and H2 blockers which block the action of histamine and inhibit the secretion of stomach acid.
Outpatient Procedural Treatment Options
BARRX is a treatment option for Barrett’s Esophagus, a condition that can often result from chronic heartburn or GERD. It is usually performed on an outpatient basis and does not require any incisions or surgery. BARRX can minimize one’s risk of developing esophageal cancer if suffering from Barrett’s Esophagus as a result of GERD. During the procedure the patient swallows a thin, flexible, lighted tube called an endoscope. The endoscope transmits an image of the inside of the esophagus allowing the physician to view the esophagus and measure the area that requires treatment. A BARRX ablation catheter is inserted into the esophagus to deliver energy to the abnormal tissue. The BARRX procedure can minimize or prevent abnormal cells from developing into a cancerous condition of the esophagus.
Stretta therapy is a minimally invasive procedure that reduces GERD symptoms. Stretta is an outpatient procedure performed in about an hour, allowing patients to return to normal activities the following day. Stretta doesn’t require any incisions, stitches or implants. The Stretta procedure delivers radiofrequency energy to the muscle between the stomach and esophagus, which improves the muscle tissue and results in improved barrier function and fewer reflux events. Stretta treats the underlying problem that may cause GERD without surgery.
The LINX® Reflux Management System is a minimally-invasive laparoscopic procedure that implants a series of interlinked titanium beads with magnetic cores around the esophagus just above the stomach. The magnetic attraction between the beads expands the existing esophageal sphincter’s barrier function to prevent reflux. The LINX procedure is reversible and allows patients to preserve normal physiological functions such as belching or vomiting.
Nissen fundoplication is a laparoscopic procedure in the abdomen that allows the doctor to directly see and operate on the stomach. This surgery can be done laparoscopically, using small incisions to pass surgical tools into the abdomen to complete the surgery. The surgeon will view the area on a screen with images from a small camera inserted into the abdomen. Recovery is generally shorter with the laparoscopic procedure than open surgeries but may not be appropriate for every situation.
Heller myotomy is a minimally-invasive surgical procedure used to treat achalasia in which the muscles of the lower esophageal sphincter (LES) are cut, allowing food and liquids to pass to the stomach.
Do You Have GERD?
If you answer yes to two or more of the following questions you may have GERD.
- Do you frequently have one or more of the following? An uncomfortable feeling behind the breastbone that seems to be moving upward from the stomach? A burning sensation in the back of your throat? A bitter acid taste in your mouth?
- Do you often experience these problems after meals?
- Do you experience heartburn or acid indigestion two or more times per week?
- Do you find that antacids only provide temporary relief from your symptoms?
- Are you taking prescription medication to treat heartburn, but still have symptoms?
GERD Action Plans
If you suffer from heartburn, nausea, and other symptoms of GERD, our partner ShareCare.com offers a few action plans that can help you get relief.4 Questions to Ask Your Doctor » Tests to Diagnose GERD » Food Triggers to Avoid » Sleeping Positions that Stop Reflux »
Meet Our Nurse Navigator
Susie Herndon, BSN, RN, OCN, has nearly 20 years of nursing experience. As part of her Nurse Navigator role, she can help you understand your symptoms and condition and will explain tests, treatments and surgery options to you and your family.
Susie received her Bachelor of Arts from the College of William and Mary. She then received her Bachelor of Science in Nursing at Johns Hopkins University School of Nursing. She is currently pursuing her Master of Science in Nursing at Duke University School of Nursing in the Adult-Gerontology Primary Care Nurse Practitioner program with an oncology concentration. She is an Oncology Certified Nurse and Clinical Research Coordinator. Her professional interests include patient advocacy, caregiver support, and pancreatic cancer.
Susie Herndon, BSN, RN,
GI Nurse Navigator
Henrico Doctors’ Hospital
1602 Skipwith Road
Richmond, Va 23229