Gastroesophageal Reflux Disease (GERD) and Hiatal Hernia

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When diet and medication no longer control chronic GERD (gastroesophageal reflux disease) symptoms, Duke gastroenterologists use endoscopic procedures to view the inside of your digestive tract to identify the reason for your discomfort. In some cases, a hiatal hernia (or a type of hiatal hernia called paraesophageal hernia) may be to blame.

Once the cause is diagnosed, your gastroenterologist may recommend a minimally invasive treatment to give you relief. These specialized procedures are performed by skilled surgeons with extensive experience treating GERD and related conditions.

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Understanding GERD

GERD occurs when stomach contents move up into the esophagus. That may cause symptoms such as burning behind your breastbone, belching, an acid taste in your mouth, or difficulty swallowing.

Treatment Stages
Our gastroenterologists may recommend treating GERD in stages, starting with diet and lifestyle changes and over-the-counter acid reducers before recommending prescription medications, including proton pump inhibitors. If these nonsurgical options aren't effective and your GERD is considered moderate to severe, your gastroenterologist may recommend surgical treatment.

Complications of Untreated GERD
Effective treatment for GERD is important because chronic acid reflux can cause painful irritation called esophagitis. It can also cause precancerous changes in the lining of the esophagus. This is called Barrett’s esophagus and may lead to the development of esophageal cancer. In some cases, severe reflux can cause hoarseness, dental enamel damage, and narrowing of the esophagus called stricture.

Acid Reflux Procedures Repair Hiatal Hernias
A hiatal hernia, or type of hiatal hernia called a paraesophageal hernia, occurs when the stomach and other abdominal organs enter the chest area through the hiatus, a naturally occurring hole in the diaphragm. The presence of a hiatal or paraesophageal hernia allows acid to flow freely into the esophagus and may cause additional symptoms including nausea, vomiting, chest pain, heartburn, and difficulty swallowing. A surgical procedure can repair these hernias and offer symptom relief.

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Duke Health offers locations throughout the Triangle. Find one near you.


One or more of the following tests may be recommended to determine the cause of your symptoms and which GERD treatment is best for you.

Upper Endoscopy

Your doctor inserts a flexible tube into your mouth to view the inside of your esophagus, stomach, and small intestine.


During endoscopy, your gastroenterologist uses a device to measure pressures inside your esophagus and assess the ability of your esophagus to contract. When the esophagus works as it should, coordinated contractions moves food and liquid down to your stomach

Esophageal Manometry

A thin, flexible tube called a catheter is inserted through your nose and into your esophagus. It evaluates esophageal motility by monitoring strength and patterns of muscle function within the esophagus.

Esophageal Reflux Test

A catheter or probe placed in the esophagus is used to determine the presence and severity of reflux.

Barium Swallow

A barium liquid is swallowed and travels the length of your esophagus. X-ray images show how the barium moves through your esophagus. This test can detect problems with the structure of your esophagus.

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GERD Treatments

As a comprehensive center, we offer several procedures to treat GERD, hiatal hernia, and paraesophageal hernia. 

Surgical Fundoplication

In this standard surgical treatment of GERD, your surgeon wraps part or all of the stomach around the lower esophagus to strengthen the muscle and stop the acid reflux. This surgery is typically performed through small incisions.

LINX® Reflux Management System

During this minimally invasive procedure, your surgeon wraps a ring of magnetic titanium beads around the lower esophageal muscle to prevent the contents of your stomach from refluxing into your esophagus. It does not prevent food or liquids from traveling down the esophagus into your stomach. 

TIF (Transoral Incisionless Fundoplication)

Small instruments are passed through an endoscope, which is inserted in your mouth to reach your stomach. No incisions are required. The surgeon wraps the upper part of your stomach around your lower esophagus and uses a special device to help the esophageal valve prevent stomach acid from refluxing into your esophagus.

Gastric Bypass Surgery

If you experience GERD caused by obesity, gastric bypass surgery can bring relief by moving much of the acid-producing portion of the stomach away from the esophagus. 

Why Choose Duke

Extensive Experience
Our gastroenterologists have completed specialized training and are highly skilled in the use of endoscopy to diagnose GERD and other esophageal disorders. Our board-certified surgeons have additional fellowship training in thoracic surgery. This includes specialized procedures in and around the esophagus.

More Complex Procedures
Robot-assisted surgery allows our surgeons to visualize the surgical site better. The precision of the robotic tools allows doctors to do more complex procedures in smaller areas and place sutures with greater accuracy.

Access to Clinical Trials
You may be eligible to participate in our ongoing clinical trials, which test new therapies and approaches to treating GERD and related conditions.

Leaders in Innovative Techniques
We were the first center in North Carolina to implant the LINX device and use the TIF device for GERD. We are constantly looking for newer, less invasive options to give people freedom from chronic reflux.

High Volume Referral Center
People are often referred to our gastroenterologists for the management of GERD and its symptoms. Patients frequently travel to us from nearby regions.

Best Hospital for Gastroenterology and GI Surgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our gastroenterology and GI surgery program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.

This page was medically reviewed on 11/18/2021