GERD & Acid Reflux Treatment in Dallas, TX

What Is GERD?

Gastroesophageal reflux disease (GERD) is a chronic digestive condition in which stomach acid, and sometimes bile, flows backward from the stomach into the esophagus on a regular basis. This backwash of acid — known as acid reflux — irritates and inflames the delicate lining of the esophagus, producing the hallmark burning sensation most people know as heartburn. While nearly everyone experiences occasional acid reflux, GERD is diagnosed when reflux occurs frequently (typically two or more times per week), persists over time, and causes troublesome symptoms or tissue damage.

GERD is one of the most prevalent gastrointestinal conditions in the United States. According to the American College of Gastroenterology (ACG), approximately 20% of American adults experience GERD symptoms on a weekly basis, and the condition accounts for roughly 9 million office visits each year. Despite its prevalence, GERD is often undertreated or self-managed with over-the-counter antacids, which may mask symptoms without addressing the underlying cause or preventing long-term complications.

At Texas Gut Health in Sachse, TX, Dr. Jaison John provides expert evaluation and individualized treatment plans for patients living with GERD and chronic acid reflux throughout the Dallas-Fort Worth area. Dr. John completed his gastroenterology fellowship at UT Medical Branch, where he served as Chief Fellow, and his internal medicine residency at UT Austin Dell Medical School, where he served as Chief Resident. He holds dual board certifications from the American Board of Internal Medicine in both internal medicine and gastroenterology, ensuring that every patient receives care grounded in the latest evidence-based guidelines.

Acid Reflux vs. GERD: Understanding the Difference

The terms "acid reflux" and "GERD" are often used interchangeably, but they describe different points on the same spectrum. Acid reflux refers to the physical event of stomach contents flowing backward through the lower esophageal sphincter (LES) into the esophagus. This happens to virtually everyone from time to time — after a large meal, when bending over, or when lying down shortly after eating. Occasional acid reflux is considered normal and is not a cause for concern.

GERD, on the other hand, is the chronic disease that develops when acid reflux becomes frequent, persistent, and clinically significant. The ACG defines GERD as a condition in which the reflux of stomach contents causes troublesome symptoms (such as heartburn or regurgitation at least twice per week) and/or complications (such as esophagitis, stricture, or Barrett's esophagus). In other words, GERD is what happens when acid reflux crosses the line from an occasional nuisance into a medical condition that requires diagnosis and management.

Understanding this distinction matters because patients who dismiss chronic reflux as "just heartburn" may delay seeking care until complications have already developed. If your acid reflux symptoms are frequent, worsening, or interfering with your quality of life, it is time to see a gastroenterologist.

Symptoms of GERD

GERD can produce a wide range of symptoms, some of which are well known and others that may be surprising. Symptoms are generally divided into two categories: typical (esophageal) symptoms and atypical (extraesophageal) symptoms.

Typical Symptoms

• Heartburn — A burning sensation or discomfort in the chest, usually behind the breastbone, that often worsens after eating, when lying down, or when bending over. Heartburn is the most common symptom of GERD and affects the majority of patients.
• Regurgitation — The sensation of stomach acid or partially digested food rising into the throat or mouth, often accompanied by a sour or bitter taste. Regurgitation is the second most common symptom and can be particularly bothersome at night.
• Difficulty swallowing (dysphagia) — A feeling that food is getting stuck in the throat or chest during swallowing. Dysphagia may indicate esophageal inflammation, narrowing (stricture), or another complication that warrants further evaluation with upper endoscopy.
• Chest pain — Non-cardiac chest pain is a well-recognized symptom of GERD. The pain can mimic the symptoms of a heart attack, making it essential to rule out cardiac causes first. Once heart disease is excluded, GERD is the most common esophageal cause of chest pain.
• Pain when swallowing (odynophagia) — Sharp or burning pain during swallowing may indicate erosive esophagitis or ulceration of the esophageal lining caused by chronic acid exposure.

Atypical Symptoms

• Chronic cough — A persistent dry cough, particularly at night or after meals, that does not respond to typical cough treatments. GERD is one of the top three causes of chronic cough in adults.
• Hoarseness and voice changes — Acid that reaches the throat and voice box (larynx) can cause laryngeal irritation, leading to a hoarse, raspy, or strained voice, especially in the morning.
• Sore throat — Recurring sore throat without an obvious infection may be caused by acid irritation of the throat tissues, a condition sometimes called laryngopharyngeal reflux (LPR).
• Globus sensation — The feeling of a lump or tightness in the throat, even when nothing is there, is a common atypical presentation of GERD.
• Worsening asthma — GERD can trigger or aggravate asthma symptoms, particularly at night. Acid reflux may cause bronchospasm or aspiration of small amounts of acid into the airways.
• Dental erosion — Chronic exposure of the teeth to stomach acid can erode tooth enamel, leading to increased sensitivity, cavities, and dental damage, especially on the back surfaces of the upper teeth.
• Sleep disruption — Nighttime reflux can significantly impair sleep quality, causing frequent awakenings, difficulty falling asleep, and daytime fatigue.

Causes & Risk Factors

GERD develops when the normal anti-reflux barrier between the stomach and esophagus fails to function properly. The primary component of this barrier is the lower esophageal sphincter (LES), a ring of muscle at the junction of the esophagus and stomach that acts as a one-way valve. Under normal conditions, the LES opens to allow food and liquid to pass into the stomach and then closes tightly to prevent stomach contents from flowing back up. When the LES weakens or relaxes at inappropriate times, acid reflux occurs.

Several factors can contribute to LES dysfunction and the development of GERD:

Anatomical and Physiological Causes

• Weakened or dysfunctional LES — The most fundamental cause of GERD is a lower esophageal sphincter that does not close tightly enough or relaxes too frequently (a phenomenon called transient lower esophageal sphincter relaxation, or TLESR). This allows stomach acid to flow freely into the esophagus.
• Hiatal hernia — A hiatal hernia occurs when the upper part of the stomach pushes through the diaphragm into the chest cavity. This anatomical displacement can weaken the LES and impair the natural anti-reflux barrier, making reflux significantly more likely. Hiatal hernias are found in a large proportion of patients with moderate to severe GERD.
• Impaired esophageal clearance — The esophagus normally clears refluxed acid through rhythmic muscular contractions (peristalsis) and by neutralizing acid with swallowed saliva. When esophageal motility is impaired, acid remains in contact with the esophageal lining for longer periods, increasing the risk of tissue damage.
• Delayed gastric emptying — When the stomach empties more slowly than normal (a condition called gastroparesis), increased gastric pressure and prolonged retention of food and acid can promote reflux.

Lifestyle and Environmental Risk Factors

• Obesity — Excess body weight, particularly abdominal obesity, is one of the strongest risk factors for GERD. Increased abdominal pressure pushes stomach contents upward through the LES. Studies show that even moderate weight gain can increase the frequency and severity of reflux symptoms, and weight loss often produces meaningful improvement.
• Smoking — Tobacco use reduces LES pressure, decreases saliva production (which normally helps neutralize acid), and impairs esophageal motility. Smokers have a significantly higher risk of GERD and its complications compared to non-smokers.
• Dietary triggers — Certain foods and beverages are known to relax the LES or stimulate acid production, including fatty or fried foods, chocolate, mint, coffee, alcohol, carbonated drinks, citrus fruits, tomato-based products, and spicy foods. Eating large meals or eating within 2 to 3 hours of bedtime also increases reflux risk.
• Pregnancy — Hormonal changes during pregnancy (particularly elevated progesterone) relax the LES, and the growing uterus increases abdominal pressure. As a result, GERD is extremely common during pregnancy, affecting up to 80% of pregnant women in the third trimester. Symptoms usually resolve after delivery.
• Certain medications — Several common medications can worsen GERD by relaxing the LES or irritating the esophageal lining, including NSAIDs (ibuprofen, naproxen), aspirin, calcium channel blockers, certain sedatives, and some antibiotics. Always inform your gastroenterologist about all medications you take.
• Connective tissue disorders — Conditions such as scleroderma can affect the smooth muscle of the esophagus and LES, significantly increasing the risk of GERD.

How GERD Is Diagnosed

In many cases, GERD can be diagnosed based on a careful review of your symptoms and medical history. If you describe classic symptoms of heartburn and regurgitation that improve with acid-suppressing medication, your gastroenterologist may make a clinical diagnosis of GERD without requiring additional testing. However, when symptoms are severe, persistent, atypical, or do not respond adequately to initial therapy, further evaluation is recommended to confirm the diagnosis, assess the severity of esophageal damage, and rule out other conditions.

At Texas Gut Health, Dr. John uses the following diagnostic approaches:

Upper Endoscopy (EGD)

An upper endoscopy (also called an esophagogastroduodenoscopy, or EGD) is the most direct way to evaluate the esophagus in patients with GERD. During this procedure, Dr. John passes a thin, flexible scope with a camera through the mouth and into the esophagus, stomach, and upper small intestine. This allows him to visually inspect the esophageal lining for signs of inflammation (esophagitis), erosions, ulcers, strictures (narrowing), and changes consistent with Barrett's esophagus. Tissue biopsies can be taken during the same procedure for microscopic analysis. The ACG recommends upper endoscopy for patients with alarm symptoms (difficulty swallowing, unintentional weight loss, anemia, or vomiting), patients who do not respond to standard PPI therapy, and patients with long-standing GERD who are being screened for Barrett's esophagus.

Ambulatory Esophageal pH Monitoring

Ambulatory pH monitoring is the gold standard for objectively measuring acid exposure in the esophagus. A small probe is placed in the esophagus (either attached to a thin catheter inserted through the nose or as a wireless capsule attached to the esophageal wall during endoscopy) and continuously records pH levels over a 24- to 48-hour period while you go about your normal daily activities. This test is particularly valuable for patients whose symptoms persist despite PPI therapy, for patients with atypical symptoms (chronic cough, hoarseness), and when the diagnosis of GERD is uncertain.

Esophageal Manometry

Esophageal manometry measures the pressure and coordination of muscular contractions in the esophagus and the resting pressure of the LES. A thin catheter is passed through the nose into the esophagus, and you are asked to swallow small sips of water while pressure readings are recorded. This test is useful for evaluating dysphagia, assessing LES function, and ruling out motility disorders such as achalasia that can mimic GERD. Manometry is also routinely performed before anti-reflux surgery to ensure that the esophagus has adequate motility to tolerate the procedure.

Barium Swallow (Upper GI Series)

A barium swallow involves drinking a chalky liquid containing barium while X-rays are taken as the liquid travels through the esophagus and stomach. This test can reveal structural abnormalities such as hiatal hernias, esophageal strictures, and large esophageal ulcers. While it is less sensitive than endoscopy for detecting mucosal changes, a barium swallow can provide useful anatomical information, particularly when planning surgical intervention.

Dr. John will determine the most appropriate diagnostic approach based on your individual symptoms, duration of illness, response to treatment, and risk factors. The goal of evaluation is not just to confirm the diagnosis but to understand the severity and mechanism of your reflux so that treatment can be tailored to your specific needs.

Treatment Options

GERD treatment follows a stepwise approach that begins with lifestyle modifications and progresses to medications and, when necessary, procedural or surgical interventions. The ACG recommends tailoring treatment to the severity of symptoms, the degree of esophageal damage, and each patient's individual response to therapy.

Lifestyle Modifications

Lifestyle changes are the foundation of GERD management and should be incorporated at every stage of treatment, regardless of whether medications are also being used. Evidence-based modifications include:

• Weight loss — For patients who are overweight or obese, losing even a modest amount of weight (5% to 10% of body weight) has been shown to significantly reduce GERD symptoms and acid exposure. Weight loss is one of the most effective non-pharmacological interventions for GERD.
• Elevating the head of the bed — Raising the head of the bed by 6 to 8 inches (using bed risers or a wedge pillow, not extra pillows) reduces nocturnal acid exposure by using gravity to keep stomach acid from flowing into the esophagus while you sleep.
• Avoiding late-night eating — Eating your last meal at least 2 to 3 hours before lying down gives your stomach time to empty and reduces the likelihood of nighttime reflux.
• Identifying and avoiding dietary triggers — While trigger foods vary by individual, common culprits include fatty foods, spicy foods, chocolate, coffee, alcohol, citrus, tomatoes, mint, and carbonated beverages. A food diary can help identify your personal triggers.
• Eating smaller meals — Large meals distend the stomach and increase pressure on the LES. Eating smaller, more frequent meals can reduce reflux episodes.
• Smoking cessation — Quitting smoking improves LES function, enhances esophageal clearance, and reduces the overall burden of acid reflux.
• Avoiding tight-fitting clothing — Clothing that constricts the abdomen can increase intra-abdominal pressure and worsen reflux.

Medications

When lifestyle modifications alone are not sufficient to control symptoms, medications play a central role in GERD management. The three main categories of acid-suppressing medications are:

• Proton pump inhibitors (PPIs) — PPIs (such as omeprazole, esomeprazole, lansoprazole, and pantoprazole) are the most effective medications for reducing stomach acid production and healing esophageal inflammation. They work by irreversibly blocking the hydrogen-potassium ATPase enzyme system (the "proton pump") in the stomach's acid-producing cells. The ACG recommends PPIs as first-line therapy for patients with erosive esophagitis and for patients with moderate to severe GERD symptoms. PPIs are most effective when taken 30 to 60 minutes before the first meal of the day.
• H2 receptor blockers (H2RAs) — H2 blockers (such as famotidine) reduce acid production by blocking histamine receptors on acid-secreting cells in the stomach. While less potent than PPIs, H2 blockers can be effective for mild GERD symptoms, for on-demand or nighttime symptom relief, and as add-on therapy for patients with persistent nighttime symptoms despite PPI use.
• Antacids — Over-the-counter antacids (such as calcium carbonate and aluminum/magnesium hydroxide) neutralize existing stomach acid and provide rapid but short-lived symptom relief. Antacids are appropriate for occasional, mild symptoms but are not effective for healing esophageal damage or controlling frequent GERD symptoms.

Dr. John works with each patient to find the right medication, dose, and duration of therapy. For patients on long-term PPI therapy, he follows ACG guidelines for periodic reassessment to ensure that the lowest effective dose is being used and that ongoing treatment remains appropriate.

Surgical and Procedural Options

For patients whose GERD is not adequately controlled with lifestyle changes and medications, or for patients who prefer not to take lifelong medication, surgical and endoscopic treatments may be appropriate. These options aim to restore the natural anti-reflux barrier and reduce or eliminate dependence on acid-suppressing drugs.

• Fundoplication (Nissen or partial) — Fundoplication is the most well-established surgical treatment for GERD. During this laparoscopic procedure, the upper part of the stomach (the fundus) is wrapped around the lower esophagus to reinforce the LES and create a mechanical barrier against reflux. A Nissen fundoplication involves a complete 360-degree wrap, while partial fundoplications (such as the Toupet procedure) use a partial wrap. Fundoplication has high long-term success rates and is typically recommended for patients with objectively confirmed GERD who have a good response to PPIs but wish to discontinue medication.
• LINX Magnetic Sphincter Augmentation — The LINX device is a small ring of magnetic titanium beads that is placed around the LES during a minimally invasive procedure. The magnetic attraction between the beads helps keep the LES closed to prevent reflux while still allowing food and liquid to pass through during swallowing. LINX is an option for patients with documented GERD who respond to PPIs and do not have a large hiatal hernia.
• Transoral incisionless fundoplication (TIF) — TIF is an endoscopic (non-surgical) procedure that reconstructs the anti-reflux barrier at the junction of the esophagus and stomach using a device inserted through the mouth. TIF may be appropriate for patients with partial-response GERD who wish to reduce or eliminate PPI use.
• Esophageal dilation — For patients who have developed an esophageal stricture (narrowing) as a complication of chronic GERD, esophageal dilation can be performed during an upper endoscopy to gently stretch the narrowed area and restore comfortable swallowing.

Dr. John will discuss all available treatment options with you and, when surgical evaluation is appropriate, will coordinate with trusted surgical colleagues in the Dallas-Fort Worth area to ensure seamless, comprehensive care.

Living with GERD

GERD is a chronic condition, but with the right combination of lifestyle adjustments, medical therapy, and ongoing monitoring, the vast majority of patients can achieve excellent symptom control and prevent complications. Here are practical strategies for managing GERD over the long term.

Dietary Tips for Managing GERD

• Keep a food diary to identify your personal trigger foods rather than following a one-size-fits-all restrictive diet.
• Eat slowly and chew your food thoroughly. Rushed eating promotes swallowing air and overeating, both of which can worsen reflux.
• Choose lean proteins (chicken, fish, turkey) and incorporate non-citrus fruits, vegetables, whole grains, and healthy fats (olive oil, avocado) into your meals.
• Limit carbonated beverages, caffeine, and alcohol, which can relax the LES and stimulate acid production.
• Avoid lying down for at least 2 to 3 hours after eating. If you enjoy an after-dinner walk, even a gentle 15-minute stroll can promote gastric emptying and reduce reflux.

Sleep and Nighttime Reflux

Nighttime GERD can be particularly disruptive and is associated with more severe esophageal damage because acid clearance is slower during sleep. To minimize nocturnal reflux:

• Elevate the head of your bed by 6 to 8 inches. Wedge pillows designed for reflux can be an effective alternative to bed risers.
• Sleep on your left side. Studies have shown that left-side sleeping reduces reflux episodes compared to sleeping on the right side or on the back, because of the anatomical position of the stomach.
• Finish eating at least 3 hours before bedtime.
• Avoid heavy or fatty meals in the evening.

When to Follow Up

Even when symptoms are well controlled, ongoing follow-up with your gastroenterologist is an important part of GERD management. Dr. John recommends regular follow-up visits to:

• Reassess symptom control and medication effectiveness.
• Evaluate whether PPI dose can be reduced or stepped down to an H2 blocker or on-demand therapy.
• Screen for complications, including Barrett's esophagus, in patients with long-standing GERD and risk factors such as male sex, age over 50, obesity, smoking history, and Caucasian race.
• Address any new or changing symptoms promptly.

Patients in the Sachse, Murphy, Wylie, Plano, Garland, Rowlett, Richardson, and greater Dallas-Fort Worth area can schedule follow-up appointments at Texas Gut Health by calling (214) 624-6596.

Complications of Untreated GERD

When GERD is left untreated or undertreated over a prolonged period, chronic acid exposure can lead to several serious complications. Understanding these risks underscores the importance of seeking professional evaluation and maintaining an effective treatment plan.

• Erosive esophagitis — Persistent acid exposure can cause inflammation, redness, and erosions (shallow ulcers) in the esophageal lining. Erosive esophagitis affects approximately one-third of patients with GERD and, if left untreated, can lead to deeper ulceration, bleeding, and pain with swallowing.
• Esophageal stricture — Chronic inflammation and scarring can cause the esophagus to narrow over time, creating a stricture that makes swallowing progressively more difficult. Patients may feel food "getting stuck" in the chest. Strictures can be treated with esophageal dilation during an upper endoscopy, but preventing further stricture formation requires effective acid suppression.
• Barrett's esophagus — In some patients with chronic GERD, the normal squamous cell lining of the lower esophagus is replaced by a type of tissue resembling the intestinal lining (intestinal metaplasia). This change, known as Barrett's esophagus, is considered a precancerous condition. Barrett's esophagus is estimated to occur in 5% to 15% of patients with chronic GERD symptoms. Patients diagnosed with Barrett's esophagus require regular endoscopic surveillance to monitor for dysplasia (precancerous cellular changes).
• Esophageal adenocarcinoma — Barrett's esophagus is the primary risk factor for esophageal adenocarcinoma, a type of esophageal cancer whose incidence has risen sharply over the past four decades. While the absolute risk of progression from Barrett's esophagus to cancer is low (approximately 0.5% per year), early detection through surveillance endoscopy allows precancerous changes to be identified and treated before cancer develops. This is one of the most compelling reasons not to ignore chronic GERD symptoms.
• Respiratory complications — Chronic aspiration of refluxed acid into the airways can contribute to recurrent pneumonia, worsening asthma, pulmonary fibrosis, and chronic bronchitis.
• Dental erosion — Long-term exposure of the teeth to stomach acid can cause irreversible enamel erosion, increased cavity risk, and tooth sensitivity.

The best way to prevent these complications is to seek evaluation from a gastroenterologist when GERD symptoms are frequent or worsening, and to follow your individualized treatment plan consistently. Dr. John and the team at Texas Gut Health are committed to helping patients in the Dallas-Fort Worth area manage GERD effectively and avoid long-term esophageal damage.

Frequently Asked Questions