"We are fortunate to have these technologies available," says Damien Mallat, MD, a member of the medical staff at Baylor University Medical Center at Dallas. Baylor offers endoscopic surgery, which features a suture fed through an endoscope (a thin tube-like device) or a jaw-like device, to stitch and tighten a muscle known as the lower esophageal sphincter.

"In the U.S., only a few centers have these, and only a few physicians are doing these types of endoscopic surgery."

Up to 80 percent of Baylor patients have shown improvement of symptoms, and nearly 60 percent have stopped using medications, he says.

Common symptoms of GERD include heartburn and regurgitation, says Mallat. These symptoms usually are caused by a problem with the lower esophageal sphincter. When working properly, the sphincter lets food into the stomach and blocks stomach acids from entering the esophagus. When too much acid enters the esophagus, the lining is injured, resulting in chronic heartburn and regurgitation.

"People underestimate the impact of reflux on their daily quality of life," says Daniel DeMarco, MD, who treats reflux patients and is a member of the medical staff at Baylor Dallas. "Symptoms include a lack of a full night's sleep, hoarseness and recurring pneumonia, all of which affect their daily performance. Stopping the acid stops heartburn, but doesn't stop reflux."

Heartburn and non-cardiac chest discomfort also can be related to other conditions, Mallat adds, such as peptic ulcers, hiatal hernia, gallbladder and pancreatic problems or irritable bowel syndrome, complicating the diagnosis of GERD.

After a diagnosis of GERD is made, Mallat says the first treatment option is the medical management of symptoms. Initially, this may involve the use of antacids, Pepcid AC^® (known generically as famotidine), Nexium^® (esomeprazole) or Prevacid^® (lansoprazole), among others.

However, these medications are expensive and have to be taken for a long time because GERD is a chronic condition like hypertension. If patients wish not to take these medications, the standard surgical procedure has been Nissen funduplication, a procedure in which the upper part of the stomach is surgically wrapped around the esophagus to prevent acid from backing up.

The Nissen procedure has been performed with open surgery of the abdomen or laparoscopic surgery (which involves smaller incisions through the chest and abdomen). These surgeries have measurable complications and some risk of mortality. In addition, the procedures require a longer hospital stay and can involve a recovery time as long as three to six months.

Mallat notes that endoscopic surgery, on the other hand, is done on an outpatient basis, is less expensive and has a complication rate of less than 5 percent. "What we can do with endoscopic surgery is very exciting," Mallat says, "and I hope it opens eyes to the possibilities."  : :