Around 40% of people with GERD find partial or no relief from their symptoms with first-line treatments such as lifestyle, dietary changes, and medication. In these cases, there’s a need for alternative treatment options.

Both endoscopic and surgical procedures can help manage GERD. Treatment depends on the severity of your condition. Surgery isn’t always necessary to fix GERD, but it may be the best option in certain instances.

This article will discuss GERD and its treatment options. We’ll highlight endoscopic therapies, including the TIF and Stretta procedures. Keep reading to learn which GERD treatment is best for you.

What Is GERD?

GERD stands for gastroesophageal reflux disease. This condition causes repeated reflux of stomach acid or bile. If left untreated, GERD can damage the lining of the esophagus.

Acid reflux occurs when the valve between the esophagus and stomach relaxes, which allows stomach contents to flow backward into the esophagus. This valve is called the lower esophageal sphincter (LES). When acid reflux occurs frequently or causes symptoms, it becomes GERD.

Common GERD symptoms include:

  • Heartburn (burning chest pain)
  • Regurgitation of food
  • Upper abdominal pain
  • Trouble swallowing
  • Sensation of a lump in your throat
  • Cough
  • Sore throat and hoarse voice

GERD Treatment Options

There are four main GERD treatment options. Most people find relief from GERD with a combination of lifestyle and dietary changes and medication. Endoscopic therapy or surgery is the next step if your symptoms don’t respond to these treatment options.

Lifestyle and Dietary Changes

Lifestyle and dietary changes are the initial treatment recommendation for GERD. Eating smaller meals more frequently can prevent your stomach from overfilling. This can reduce pressure on the LES and lower the risk of acid reflux.
Avoiding eating 2-3 hours before bed can also reduce GERD symptoms. Laying down after eating can cause your stomach contents to press against the LES. This makes it more likely for acid reflux to occur. Staying upright for a few hours after eating can keep acid reflux at bay.

Making healthy changes, such as quitting smoking and losing weight, can treat GERD. Excess abdominal fat increases pressure on the LES, which can contribute to a leaky muscular valve. Smoking also weakens the LES.

Also, avoiding certain foods that trigger GERD can help alleviate symptoms. Common trigger foods for GERD include:

  • Fatty or fried foods
  • Tomato-based products
  • Alcohol
  • Chocolate
  • Peppermint
  • Garlic
  • Spicy foods
  • Carbonated beverages
  • Caffeine

Medication

The following medications can help manage GERD symptoms:

  • Antacids. This medication neutralizes stomach acid and temporarily relieves symptoms such as heartburn and indigestion.
  • Histamine (H2) blockers. This medication can treat infrequent acid reflux symptoms. It lessens the amount of acid that your stomach produces and can last up to 12 hours.
  • Proton pump inhibitors (PPI). This medication can treat chronic acid reflux symptoms. It’s effective for acid reflux which occurs more than twice a week. PPIs block stomach acid production and last longer than H2 blockers, which gives your esophagus time to heal.

Endoscopic Therapy

The two primary endoscopic therapies for GERD are the transoral incisionless fundoplication (TIF) and the Stretta procedure. Endoscopic therapy is more effective than medication and can reduce GERD symptoms for several years.

TIF Procedure

The TIF procedure strengthens the LES by reinforcing the muscular valve between the esophagus and stomach. The TIF procedure works for patients with hiatal hernias that are 0-3 cm in size. Hiatal hernias occur when the stomach pushes up through the opening in the diaphragm, where the esophagus passes through.

During the TIF procedure, the doctor uses an endoscopic device to fold and fasten the upper part of the stomach around the lower esophagus. During the same session, the opening in the diaphragm where the esophagus passes through to the stomach is usually tightened. This creates a tight valve that prevents stomach contents from flowing backward into the esophagus.

Stretta Procedure

The Stretta procedure treats GERD with radiofrequency energy. It works for patients with hiatal hernias that are 0-2 cm in size.

During the Stretta procedure, the doctor inserts a flexible tube down the patient’s throat that delivers radiofrequency energy to the LES. This thickens the muscle and creates a tighter junction between the esophagus and stomach. The Stretta procedure can reduce random LES relaxation and prevent acid reflux.
Surgery
Surgery may be necessary to treat GERD that occur in the setting of a large hiatal hernia. Generally, your doctor will recommend surgery for hiatal hernias larger than 3 cm. Surgery can repair a hiatal hernia and also reinforce the lower esophageal sphincter.

Other candidates for surgery include people who experience GERD complications such as ulcers or who don’t respond to alternative treatment options.

The most common surgical treatment options for GERD include:

  • Nissen fundoplication
  • Toupet fundoplication
  • Watson fundoplication
  • LINX procedure

Endoscopic Procedures vs. Surgery

Endoscopic procedures such as the TIF and Stretta are safe and effective alternatives to surgery. These minimally invasive procedures can alleviate GERD symptoms without making surgical incisions. This results in a quicker recovery and no overnight hospitalization.

The TIF and Stretta are outpatient procedures, which means you get to go home after the procedure. This reduces your exposure to potential infections compared to staying in a hospital. What’s more, endoscopic procedures are more cost-effective than surgery due to the lack of overnight care needed afterward.

Risks of GERD Procedures

While GERD procedures are generally safe, they do pose certain risks. Both endoscopic and surgical procedures share similar risks.

The risks of GERD procedures include:

  • Bleeding
  • Pain
  • Adverse reaction to anesthesia
  • Infection
  • Recurrence of symptoms
  • Delayed gastric emptying

Which GERD Treatment Is Best For You?

Both endoscopic and surgical procedures can reduce the symptoms of GERD. These treatment options may even eliminate GERD altogether.

The best treatment for GERD depends on individual factors such as the presence and size of a hiatal hernia and the severity of your symptoms. You need to be evaluated by a doctor to determine which GERD procedure is most appropriate for you.

Dr. Yepuri is one of the few doctors in the Dallas-Fort Worth area trained in these procedures. He received specialized mentored training to achieve certification to perform both the TIF and Stretta procedures.

If you want to learn more about endoscopic procedures for GERD, you can request an
appointment online or call our office at (817) 267-8470.