GERD is a chronic condition defined by the persistent backflow of stomach contents into the esophagus. This reflux occurs when the lower esophageal sphincter, a ring of muscle at the junction of the esophagus and stomach, does not close properly, allowing acid to escape. GERD is a common issue that requires professional medical guidance for accurate diagnosis and long-term management. Effective treatment often involves a coordinated approach, beginning with a general practitioner and escalating to specialists for complex or unresponsive cases.
The Starting Point: Primary Care Physicians
The initial point of contact for most individuals experiencing GERD symptoms is their Primary Care Physician (PCP), including family doctors or general internists. PCPs evaluate the patient’s medical history and current symptoms, such as frequent heartburn or regurgitation. In the absence of “alarm symptoms” like unexplained weight loss or difficulty swallowing, the PCP can often make a presumptive diagnosis.
Initial treatment involves lifestyle modifications and empiric medical therapy. PCPs advise changes such as elevating the head of the bed, avoiding trigger foods, and managing weight to reduce pressure on the lower esophageal sphincter. For medication, they usually prescribe acid-suppressing drugs, commonly starting with H2-blockers or Proton Pump Inhibitors (PPIs).
Most mild-to-moderate GERD cases respond well to this initial strategy. The PCP monitors the patient’s response to therapy, and if symptoms are controlled, the patient continues long-term management at this level.
When to See a Gastroenterologist
A referral to a Gastroenterologist is appropriate when a patient’s condition does not improve with initial PCP care. A Gastroenterologist specializes in the entire digestive system, including the esophagus, stomach, and intestines. Patients are typically referred if symptoms are severe, persistent despite high-dose PPI therapy, or if they present with concerning “alarm symptoms.”
Alarm symptoms requiring specialist consultation include:
- New-onset difficulty swallowing (dysphagia).
- Painful swallowing (odynophagia).
- Unexplained anemia.
- Gastrointestinal bleeding.
A specialist is also consulted if the diagnosis is uncertain or if the patient has atypical symptoms, such as chronic cough or hoarseness, which may indicate reflux affecting the throat or lungs. The gastroenterologist uses specialized diagnostic tools to confirm the diagnosis and assess for potential complications.
The most common diagnostic tool is an upper gastrointestinal endoscopy. This procedure uses a flexible tube with a camera to examine the lining of the esophagus and stomach, identifying complications like esophagitis, strictures, or Barrett’s esophagus.
Advanced Diagnostic Testing
The specialist may order ambulatory pH monitoring, which measures the frequency and duration of acid reflux events over 24 to 96 hours using a catheter or wireless capsule. Esophageal manometry may also be ordered, which measures the pressure and coordination of muscle contractions in the esophagus and the force of the lower esophageal sphincter. The results of these tests guide the specialist in refining the medical treatment plan or determining if more advanced interventions are necessary.
Specialized and Surgical Treatment Teams
A surgical team may be involved for patients whose GERD is refractory or who wish to avoid long-term medication. The primary specialist is a general surgeon or a foregut surgeon specializing in the upper digestive tract. They perform procedures designed to physically reinforce the barrier between the stomach and the esophagus.
Common surgical options include laparoscopic fundoplication (e.g., the Nissen procedure), which involves wrapping the upper part of the stomach around the lower esophagus to create a tighter valve. Another option is the placement of a LINX device, a ring of magnetic beads implanted around the lower esophageal sphincter. Advanced gastroenterologists may also perform minimally invasive endoscopic procedures, such as Transoral Incisionless Fundoplication (TIF), which tightens the sphincter without external incisions.
In cases with predominantly extraesophageal symptoms, such as chronic throat clearing or laryngitis, an Otolaryngologist (ENT specialist) may be consulted. The management of complex GERD is multidisciplinary, requiring the coordinated efforts of the PCP for ongoing care, the gastroenterologist for diagnostics, and specialized surgeons for definitive repair.