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Straight answers to the questions patients ask most, with links to the full explanation. Start with a search, or browse by topic.
61 questions
Reflux, heartburn & GERD
- What is the difference between heartburn, reflux, and GERD?Reflux is stomach contents moving up into the esophagus, heartburn is one symptom it can cause, and GERD is the diagnosis used when reflux causes troublesome symptoms or damage.Read the full answer
- Why might reflux symptoms persist despite medication?Common reasons include medication timing, reflux that is not mainly acid, a weakened reflux barrier such as a hiatal hernia — or symptoms that are not caused by reflux at all.Read the full answer
- Is it safe to take a PPI long term?Not without trade-offs. PPIs work well, but long-term use has been linked to a number of complications — including bone fractures, C. difficile infection, and low magnesium and vitamin B12 levels — so they are best used at the lowest effective dose, reviewed regularly, and not assumed to be a lifelong answer.Read the full answer
- Which lifestyle changes actually help reflux?Weight loss has the strongest evidence; avoiding late meals and raising the head of the bed help night-time symptoms; food triggers are individual.Read the full answer
- When should heartburn be checked with an endoscopy?Endoscopy is recommended first when there are warning signs — trouble swallowing, bleeding, weight loss, or anemia — and when symptoms don’t respond to treatment or a procedure is being considered.Read the full answer
- Can reflux cause chest pain?Yes, but chest pain should be evaluated for heart causes first; call 911 for sudden, severe, or pressure-like chest pain.Read the full answer
- When is reflux surgery worth considering?When GERD has been confirmed by testing and medication isn’t controlling symptoms well, isn’t tolerated, or isn’t how you want to manage a long-term condition — and your swallowing function is suitable.Read the full answer
- Does being overweight change reflux treatment choices?Yes. Excess weight worsens reflux, and in people with significant obesity, gastric bypass may address reflux and weight together; a sleeve gastrectomy can make reflux worse.Read the full answer
- Are there stages of GERD?Not officially — GERD isn’t staged the way cancer is. Instead, doctors describe how severe it is, mainly by grading any inflammation seen on endoscopy (Los Angeles grades A through D) and by checking for complications such as a narrowing or Barrett’s esophagus.Read the full answer
- When should I see a GERD or acid reflux specialist?Consider a reflux specialist if heartburn or regurgitation continues despite medication, if you need daily medication and want a long-term alternative, if you have a hiatal hernia or Barrett’s esophagus, or if you have warning signs such as trouble swallowing, unintended weight loss, vomiting, or signs of bleeding.Read the full answer
Hiatal & paraesophageal hernias
- Does a hiatal hernia always need surgery?No. Small sliding hernias rarely need repair on their own, and paraesophageal hernias without symptoms can often be watched; symptomatic paraesophageal hernias are generally repaired.Read the full answer
- Can a large hiatal hernia cause shortness of breath or anemia?Yes. A large hernia can take up space in the chest and make breathing harder, and irritation of the stomach lining at the diaphragm can cause slow bleeding and iron-deficiency anemia.Read the full answer
- Is mesh used in hiatal hernia repair?Sometimes. Evidence is mixed, and the 2024 SAGES guideline made no recommendation for or against mesh, so the choice is individualized.Read the full answer
- Why is a fundoplication often added to hernia repair?Repairing a hernia disturbs the natural reflux barrier, and a fundoplication restores it; it can also help anchor the stomach below the diaphragm.Read the full answer
- What should patients understand about recovery and follow-up?Most minimally invasive repairs involve a short hospital stay, a few weeks on a soft diet while swelling settles, and follow-up to check swallowing, reflux, and the repair.Read the full answer
- What is considered a large hiatal hernia?There is no single official cutoff, but surgeons generally describe a hiatal hernia as large when several centimeters of stomach sit above the diaphragm, and as a large or “giant” paraesophageal hernia when roughly a third or more of the stomach has moved into the chest.Read the full answer
Recurrent reflux & revisional surgery
- What can cause symptoms after a previous fundoplication?Common causes include a recurrent hiatal hernia, a wrap that has loosened, slipped, or is too tight, a mismatch between the wrap and esophageal function, slow stomach emptying — or an original diagnosis that wasn’t reflux.Read the full answer
- How is a recurrent hiatal hernia evaluated?Usually with imaging to show the anatomy, endoscopy to examine the lining and wrap, manometry to assess swallowing function, and a review of your prior operative report.Read the full answer
- Does a recurrence seen on imaging always need another operation?No. Small recurrences are relatively common after large hernia repairs, and many cause few or no symptoms; treatment depends on symptoms and findings, not the image alone.Read the full answer
- What should I bring to a foregut second-opinion visit?Bring or send the operative report from any prior surgery, recent endoscopy and pathology reports, pH and manometry results (ideally the full reports), imaging reports with access to the images, and a current medication list.Read the full answer
- Are redo operations riskier than first operations?Yes. Scar tissue makes reoperation more complex, and published reviews show somewhat lower success and higher complication rates than first operations — though most patients who undergo reoperation are satisfied with the outcome.Read the full answer
Achalasia & swallowing disorders
- What causes food to feel stuck?Common causes include narrowing from reflux, rings, eosinophilic esophagitis, and motility disorders such as achalasia; less often, a tumor. Because causes range from simple to serious, persistent sticking should be evaluated.Read the full answer
- What is achalasia, and how is it diagnosed?Achalasia is a loss of nerves in the esophagus that keeps the lower valve from relaxing and stops the normal squeezing wave; it is diagnosed with high-resolution manometry, supported by a barium study and endoscopy.Read the full answer
- How do POEM and Heller myotomy compare?Both relieve achalasia symptoms very effectively. POEM — done through the mouth with no incisions — has become an increasingly common first choice at experienced centers because it matches Heller myotomy for symptom relief, allows a precisely tailored myotomy, and usually means a quicker recovery. Reflux after POEM is usually mild and manageable.Read the full answer
Zenker’s diverticulum
- What is a Zenker’s diverticulum?It is a pouch that forms where the throat meets the esophagus, above a muscle that doesn’t relax fully, and it traps food and liquid.Read the full answer
- What are the treatment options for Zenker’s diverticulum?Treatment divides the tight cricopharyngeus muscle — endoscopically through the mouth, with a flexible or rigid scope, or surgically through the neck — and is chosen based on the pouch’s size, your anatomy, and your overall health.Read the full answer
LPR & throat symptoms
- Can cough or hoarseness have causes other than reflux?Yes — often. Postnasal drip, asthma, ACE-inhibitor medicines, smoking, voice strain, vocal cord problems, and, rarely, laryngeal cancer are all common or important causes.Read the full answer
- Should I take reflux medication for hoarseness?Not on symptoms alone. Otolaryngology guidelines advise examining the larynx before prescribing reflux medication for isolated hoarseness, because many other conditions can cause it.Read the full answer
- How is reflux-related cough or throat irritation tested?By ruling out other causes first, then — especially when there’s no heartburn or regurgitation — using reflux monitoring, often off medication, rather than relying on a long trial of medication or on laryngoscopy findings alone.Read the full answer
Barrett’s esophagus
- Does Barrett’s esophagus mean I’ll get cancer?No. Barrett’s esophagus increases the risk of one type of esophageal cancer, but most people with Barrett’s never develop cancer, and surveillance is designed to catch precancerous change early.Read the full answer
- How often do I need an endoscopy if I have Barrett’s esophagus?It depends on the length of the Barrett’s segment and whether dysplasia has been found; people without dysplasia typically have surveillance every few years, and those with dysplasia or after treatment are checked more often.Read the full answer
- Can reflux surgery reverse Barrett’s esophagus?It may. Several studies have found that Barrett’s esophagus regresses after anti-reflux surgery in a meaningful share of patients — becoming shorter, losing low-grade dysplasia, or no longer showing up on biopsies — and some suggest regression is more likely after surgery than with medication alone. Results vary, so surveillance continues afterward.Read the full answer
Reflux after bariatric surgery
- Why can reflux develop after a sleeve gastrectomy?The narrow sleeve has higher internal pressure, the natural angle between the esophagus and stomach changes, and a hiatal hernia or narrowing of the sleeve can add to the problem.Read the full answer
- What are the options for reflux after a sleeve gastrectomy?Medication and lifestyle measures first; correcting problems such as a narrowed sleeve or a hiatal hernia when present; and, for reflux that doesn’t respond, conversion to a Roux-en-Y gastric bypass, which is the most established surgical option.Read the full answer
- Can reflux happen after a gastric bypass?It is less common, because gastric bypass is itself an anti-reflux operation, but reflux-like symptoms can occur from a hiatal hernia, a larger-than-intended pouch, an ulcer at the connection, or causes that aren’t reflux.Read the full answer
Gastroparesis
- What is gastroparesis, and how is it diagnosed?Gastroparesis is slow stomach emptying without a blockage; it’s diagnosed by ruling out obstruction with an endoscopy and measuring emptying, most often with a four-hour gastric emptying study.Read the full answer
- When is a procedure considered for gastroparesis?When symptoms remain severe despite diet changes, blood-sugar control, medication review, and medical therapy — and slow emptying has been confirmed.Read the full answer
Comparing treatment options
- How are Nissen, Toupet, LINX, and incisionless treatments different?Nissen and Toupet rebuild the valve with the patient’s own stomach (complete versus partial wrap); LINX reinforces it with a magnetic bead ring; incisionless treatments such as ARMA work from inside, through the mouth, and suit a narrower group of patients.Read the full answer
- How long do the results of reflux procedures last?Many people have lasting control for years, but no anti-reflux procedure is guaranteed to be permanent; some people eventually resume medication or, less often, need another procedure.Read the full answer
- Is robotic surgery better than laparoscopic surgery for reflux?Both are minimally invasive and SAGES considers either reasonable for fundoplication; the quality of the operation matters more than the platform.Read the full answer
Nissen & Toupet fundoplication
- What are the common side effects after fundoplication?Early swallowing tightness, bloating, and difficulty belching are the most common, and usually improve over weeks to months; a small number of people have longer-lasting problems.Read the full answer
- What is eating like after fundoplication?Most people move gradually from liquids to soft foods to a normal diet over several weeks, eating smaller meals slowly; your surgical team will give you specific instructions.Read the full answer
- What can I eat a year or more after a Nissen fundoplication?By a year after surgery, most people are back to a normal, varied diet. Many keep a few habits — eating more slowly, taking smaller bites, and going easy on carbonated drinks — and a few find that foods like dry bread or tough meat still need extra care.Read the full answer
LINX magnetic sphincter augmentation
- Who is a candidate for LINX?Generally, people with GERD confirmed by pH testing, adequate esophageal squeezing on manometry, and no allergy to titanium, stainless steel, nickel, or ferrous materials — particularly those whose regurgitation persists despite medication.Read the full answer
- Can I have an MRI with LINX?Yes, but only within limits that depend on the specific LINX model you have; always tell imaging staff about the device before any MRI.Read the full answer
Incisionless reflux treatment
- What is ARMA, and who may be a candidate?ARMA (anti-reflux mucosal ablation) is an incisionless, endoscopic procedure that tightens and reshapes the reflux valve through controlled healing of the lining at the top of the stomach. It may suit people with confirmed reflux and no hiatal hernia or only a small one.Read the full answer
- What is TIF, and what are its limitations?TIF (transoral incisionless fundoplication) builds a partial reflux valve from inside the stomach using a device passed through the mouth and a series of fasteners. It is limited to a narrow group of patients, and the valve is looser than a surgical fundoplication.Read the full answer
Reflux & esophageal testing
- What testing is needed before reflux surgery?At minimum, objective proof of GERD (from endoscopy or pH monitoring), esophageal manometry to check swallowing function, and an assessment of any hiatal hernia; other tests are added when symptoms call for them.Read the full answer
- How does swallowing function affect treatment decisions?Every anti-reflux procedure adds some resistance where the esophagus meets the stomach, so the esophagus must be able to push food through it; manometry shows whether it can, and helps choose the type of procedure.Read the full answer
- Do I need to stop my reflux medication before testing?It depends on the question the test is answering — tests to prove GERD are usually done off PPIs, while tests to explain persistent symptoms are sometimes done on them. Follow your testing team’s instructions.Read the full answer
- What does a normal pH study mean if I still have symptoms?It usually means abnormal acid reflux is not the main cause, which points toward other explanations — such as a sensitive esophagus, a motility disorder, or a non-esophageal cause — and makes anti-reflux surgery unlikely to help.Read the full answer
Upper endoscopy (EGD)
Bravo wireless pH monitoring
24-hour impedance-pH testing
High-resolution esophageal manometry
Appointments, location & referrals
- Do I need a referral to see Dr. Speer?That depends on your health plan. Some plans require a referral from a primary care clinician before a specialist visit; the scheduling team and your insurer can tell you what yours requires.Read the full answer
- What should I expect at a first visit with a foregut surgeon?A detailed conversation about your symptoms and history, a review of any tests you’ve already had, an examination, and a discussion of which additional tests — if any — are needed before treatment options can be weighed.Read the full answer
- How do I request an appointment?Call the scheduling line at 303-265-5260 — new-patient appointments with Dr. Speer are scheduled by phone. Referring clinicians can also send a referral by fax.Read the full answer
- How much does reflux surgery cost, and does insurance cover it?There isn’t one price — what you pay depends on your insurance plan, the procedure, and where it is done. Health plans, including Medicare, generally cover anti-reflux and hiatal hernia surgery when testing shows it is medically necessary, though many require prior authorization and you may owe a deductible, copay, or coinsurance.Read the full answer
Traveling from elsewhere in Colorado
- How can I make a trip from elsewhere in Colorado more efficient?Send your records ahead of time, ask whether visits and tests can be scheduled on the same or consecutive days, and plan for sedation-related driving restrictions and seasonal road conditions.Read the full answer
- Can tests done closer to home be used?Often, yes. Recent, complete results from other facilities can usually be reviewed; sometimes a test needs to be repeated because it is outdated, incomplete, or was done in a way that doesn’t answer the current question.Read the full answer
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