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Preventing and treating GERD - Lecture recap with Dr. Lisa Balduf

Gastroesophageal Reflux Disease (GERD) is a common condition that affects an estimated one in five Americans. In a recent BCH lecture, Lisa Balduf, MD, FACS, a board-certified general surgeon with Boulder Valley Surgical Associates, shared expert insights on identifying, preventing and treating this common ailment.

"You may be wondering why a general surgeon is talking about gastroesophageal reflux disease," Dr. Balduf said. "It is a disease process that we do offer surgery for. But luckily, most patients who have gastroesophageal reflux disease don't need surgery".

Left untreated, GERD can lead to complications such as erosions, ulcers, and increased esophageal cancer risk.

Understanding the anatomy of GERD 

"Even [healthy] individuals will have a little bit of heartburn from time to time," Dr. Balduf noted. But GERD is different. It is a more frequent and severe form of reflux in which symptoms happen regularly and can begin to interfere with daily life. GERD occurs when stomach contents, including digestive acids and sometimes food, repeatedly flow back into the esophagus, causing a sour or bitter taste and a burning sensation in the chest or throat.

Technically speaking, GERD is the abnormal exposure of the esophagus to acid, pepsin and bile from the stomach. Normally, a "valve" system involving the lower esophageal sphincter (LES) and the diaphragm keeps stomach contents in place. Dr. Balduf described the esophagus's movement as a "snake-like motion" called peristalsis that pushes food down to the stomach. When these mechanical components work abnormally, reflux can occur more often and may develop into GERD.

Dr. Balduf explained that this sometimes involves a hiatal hernia, which occurs when the "hole" in the diaphragm is too large, allowing a portion of the stomach to migrate upward into the chest cavity.

Recognizing the symptoms

According to Dr. Balduf, typical symptoms that may indicate you are suffering from GERD include:

  • Heartburn
  • Regurgitation: Liquid material coming back up into the throat or mouth.
  • Retrosternal chest pain: Typically described as burning or pressure that can radiate to the back or arms. 
  • Difficulty swallowing: Feeling as though food is getting stuck on the way down.

When to see a doctor: Dr. Balduf emphasized the importance of seeking medical evaluation for "alarm symptoms," such as vomiting blood, unintended weight loss or if food consistently gets stuck.

Because chest pain is a primary symptom, it is vital to distinguish GERD from heart disease with your provider. Other conditions can also mimic reflux, such as eosinophilic esophagitis or achalasia.

Investigating persistent symptoms

There are several tests that can be used to investigate the root cause of GERD symptoms.

  • Upper endoscopy (EGD): An inspection of the esophageal lining.
  • Esophageal acid testing: Using a wireless capsule to correlate symptoms with acid reflux over several days.
  • Esophageal manometry: A test to evaluate the motility and pressure of the esophagus.

Treatment options

Lifestyle changes

Many patients can manage their symptoms through lifestyle changes. Dr. Balduf recommended the following:

  • Dietary adjustments: Eat smaller, more frequent meals and avoid triggers like coffee, chocolate, alcohol and spicy foods.
  • Nighttime habits: "Try finishing your evening meal at least four hours before you go to lie down," Dr. Balduf suggested.
  • Sleep positioning: Use a bed wedge to elevate your head or sleep on your left side.
  • Lifestyle factors: Smoking cessation, weight loss and managing stress/anxiety are also key. "About a third of diagnosed GERD patients also have an anxiety disorder," Dr. Balduf shared, suggesting diaphragmatic breathing exercises as one helpful tool.

Over-the-counter (OTC) and prescription medications

There are many medications available by prescription and over-the-counter for GERD relief.

  • Antacids: These neutralize stomach acid for immediate relief.
  • Alginates: These form a "raft-like" gel barrier at the top of the stomach. Dr. Balduf noted these are particularly effective for nighttime or pregnancy-related symptoms.
  • H2 receptor antagonists: These reduce the amount of acid the stomach produces.
  • Proton pump inhibitors (PPIs): These are highly effective at preventing acid production but should only be taken on an empty stomach.

Procedures and surgery

For patients who do not find relief from medication or have mechanical issues like a hiatal hernia, there are surgical options to "re-establish a valve between the esophagus and stomach". 

  • Laparoscopic Fundoplication: A procedure that reinforces the valve.
  • TIF (Transoral Incisionless Fundoplication): An endoscopic, incision-free option for qualified candidates.
  • LINX™ Procedure: The placement of a small collar of magnets to create a mechanical barrier against reflux.
  • Bariatric surgery: For patients with a BMI over 35, Dr. Balduf identified the Laparoscopic Roux-en-Y gastric bypass as the preferred treatment.

Next steps

“One of the reassuring things I would say — since this is a surgeon giving this talk — is the vast majority of patients are well treated with medications alone," Dr. Balduf concluded.

If you have persistent symptoms, she recommends starting with your primary care provider or requesting a consultation with a gastroenterologist.

To schedule an appointment with one of BCH's primary care providers, call 303-415-4015. New and existing patients may also schedule an appointment through our new Provider Finder.

For more information on preventing and treating GERD, watch the full lecture recording below.