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Thoracic Surgery

GERD, Heartburn and Esophageal Motility Program

If you have been diagnosed with GERD (gastroesophageal reflux disease), heartburn or an esophageal motility issue like achalasia (trouble swallowing), you are all too familiar with the irritation and pain these conditions can cause.

If medications have failed to control the symptoms, or if you want a more permanent solution, surgery may be the best alternative. The GERD, Heartburn and Esophageal Motility Program in the Division of Thoracic Surgery at Tufts Medical Center in Boston offers minimally invasive surgical procedures that are performed by experienced thoracic surgeons, Drs. Brinckerhoff and Lassaletta.

When heartburn becomes a serious health concern

GERD occurs when a ring of muscles known as the lower esophageal sphincter, or LES, weakens and becomes ineffective. Normally when we eat this ring of muscles acts as a one-way valve allowing food to move from your esophagus into your stomach.

It is not unusual for the LES to malfunction and allow stomach acid into esophagus. This refulx can happen when you eat too much and may cause the painful sensation known as heartburn.. When this happens often, however, it is an indication that the LES is no longer working properly. If the result is damage to the esophagus, throat or respiratory tract, it is labeled as GERD, which affects 20% of the population in the United States.

Esophageal motility and swallowing difficulty

The esophagus is a muscular tube that carries food through the chest from the throat into the stomach though a series of coordinated contractions called peristalsis.

Esophageal motility disorders encompass a broad class of diseases that are manifest by abnormal contractions of the esophageal body, as well as abnormal functioning of the upper and lower esophageal sphincters (muscular valves at either end of the esophagus).

To determine the cause of your symptoms, our team may recommend an esophageal motility study.

Diagnosing GERD

In many cases, GERD can be effectively treated with medication that neutralizes the stomach acids. For those who have found that the medication is ineffective or who do not want to continue taking it daily, surgery may provide a solution.

After an initial diagnosis of GERD, several tests may be done to confirm the diagnosis and exclude other disorders. These tests include:

  • An Upper GI Series: a series of x-rays of the upper digestive system are taken after the patient drinks a barium solution
  • 24-hour pH Monitoring: a probe is placed in the esophagus to track the level of acidity in the lower esophagus.
  • Manometry: a measurement of muscle pressure in the lower esophagus.
  • Endoscopy: a thin, lighted tube with a tiny camera attached is passed down the throat to examine the esophagus and stomach.

Diagnosing esophageal motility issues

Motility disorders of the esophagus can range from weak or ineffective swallows, spastic contractions of the esophagus, or result in complete loss of peristalsis, as in achalasia.  

The procedures used to diagnose esophageal motility issues, including achalasia, are similar to those used for GERD:  

  • a video swallow study – may show a distinctive narrowing of the lower esophagus.
  • an upper endoscopy – to visualize the inside of the esophagus.
  • high-resolution manometry – a specialized swallow study to measure the pressures generated by the esophagus.

Once your physician has determined that you have achalasia, the goal of treatment is to disrupt non-functioning muscle fibers to improve esophageal emptying and relieve symptoms.

Surgical options for GERD

To help reduce GERD symptoms, the surgeons at Tufts Medical Center use a minimally invasive technique called laparoscopy. Small incisions are made that allow us to insert instruments and cameras to guide them.

During the 2-hour procedure, called a Nissen fundoplication, we wrap a part of the stomach around both sides of the esophagus and suture it in place. This restores normal pressure to the LES. Patients generally remain in the hospital for just one night. After a few weeks on a liquid diet, patients are able to eat normally without the pain or discomfort of GERD.

At Tufts Medical Center, you will be cared for by nurses and doctors who specialize in GERD and who understand how disruptive this disease can be. We will quickly schedule your first appointment, often within days, so we can begin testing and set up a treatment plan.

Surgical treatments for esophageal motility

There are several treatment options for achalasia. Endoscopic therapies such as pneumatic dilation or injection of Botox can improve symptoms. The effects of Botox, however, are temporary (months), and pneumatic dilation often requires multiple treatments to be effective. Minimally invasive surgery through small incisions in the abdomen (Laparoscopic Heller myotomy) can offer permanent relief of symptoms, and unlike endoscopic therapies, gastric reflux can be addressed during the same procedure (fundoplication)

Although GERD is not life-threatening, it can cause intense pain, interfere with eating, inflame the esophagus or cause scarring of the esophagus. Common symptoms include:

  • Recurring heartburn, especially after meals
  • Hoarseness or sore throat
  • Laryngitis
  • Chronic dry cough, especially at night
  • A feeling of a lump in your throat
  • Bad breath
  • Chest pain or discomfort

It is possible, however, to have GERD without noticeable symptoms.

Harmony Allison, MD
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Harmony Allison, MD

Title(s): Gastroenterologist; Clinical and Research Instructor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-1480

Gastrointestinal motility, inflammatory bowel disease, general GI and endoscopy, diarrhea, constipation, celiac sprue and limited LFT abnormalities

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Laurence H. Brinckerhoff, MD

Laurence H. Brinckerhoff, MD

Title(s): Chief, Thoracic Surgery; Surgeon; Associate Professor, Tufts University School of Medicine
Department(s): Surgery, General Surgery, Thoracic Surgery
Appt. Phone: 617-636-5589
Fax #: 617-636-9095

Thoracic surgical oncology, minimally invasive surgery, clinical trials, tumor immunology

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Antonio D. Lassaletta, MD

Antonio D. Lassaletta, MD

Title(s): Thoracic Surgeon; Assistant Professor, Tufts University School of Medicine
Department(s): Surgery, Thoracic Surgery
Appt. Phone: 617-636-5589
Fax #: 617-636-9095

General thoracic and foregut surgery, minimally invasive thoracic surgery, surgical robotics

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At Tufts Medical Center’s GERD Program, we work closely with referring physicians to ensure a strong level of continuity for patients. We will work with you to obtain their records and send our results and recommendations.

We are able to set up appointments to see patients quickly, often within days of the referral. We also set up treatment as soon as possible after obtaining a diagnosis.

This program focuses on permanent and long-term solutions for disorders of the esophagus utilizing minimally invasive techniques through the smallest incisions possible. After surgical procedures such as a laparoscopic Nissen fundoplication for gastro esophageal reflux disease (GERD), or laparoscopic Heller myotomy and fundoplication for achalasia, patients often go home the next day and complete their recovery in their own homes.

To make an appointment, please call 617-636-5589.


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