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Originally published October 13, 2026
Last updated October 13, 2026
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Chronic GERD (gastroesophageal reflux disease) may seem like a simple medical condition: acid and food travel from the stomach into the esophagus. But it’s actually a complex disease that can have many possible symptoms and clinical manifestations.
“The causes of GERD revolve around a dysfunctional anti-reflux barrier,” says Luke R. Putnam, MD, MS, FACS, a gastrointestinal surgeon with the USC Upper GI and General Surgery Program, part of USC Surgery and the USC Digestive Health Institute of Keck Medicine of USC.
In the anti-reflux barrier, the lower esophageal sphincter, a ring-shaped muscle, lets food and liquid pass into the stomach, then stays shut to keep the stomach’s contents from getting into the esophagus.
This barrier works best when it’s in the same location as the diaphragm muscles, Putnam explains. But with GERD, the barrier often is weakened by a hiatal hernia, which develops when the top of the stomach pushes upward through the esophageal hiatus and the lower esophageal sphincter no longer aligns with the diaphragm muscles.
Typical symptoms of GERD include heartburn and regurgitation. But there are also several atypical symptoms — such as a cough, sore throat, hoarseness, dental problems, chest discomfort, a sensation of food or liquid getting stuck in the chest, or even waking up in the middle of the night and not knowing why.
Patients with GERD might undergo a progression of treatments that begin with lifestyle modification and then, if needed, move to medication and possibly surgery.
When patients first experience GERD, they can start making some lifestyle changes. For instance, patients can try avoiding certain foods that trigger their symptoms. If they experience symptoms when they eat close to bedtime, they can eat earlier. If the symptoms happen when they lie flat, they can sleep with an extra pillow. And if patients with GERD are overweight, they can try to lose weight to decrease intra-abdominal pressure and put less strain on the anti-reflux barrier.
Typically, patients should give any lifestyle modifications three to six months to see if they work. If their symptoms persist, patients receive a chronic GERD diagnosis. “Once we know from lifestyle modification that the GERD is not transient, we investigate further,” Putnam says.
Further investigation can involve endoscopy of the stomach, esophagus and lower esophageal sphincter; measurement of the amount of acid entering the esophagus; and manometry, a test that evaluates how well the esophagus pushes food and liquids forward and how well the sphincter squeezes and relaxes.
With a chronic GERD diagnosis, patients can try over-the-counter drugs such as antacids or alginates, or prescription medications such as histamine blockers or proton pump inhibitors. If the medications work well, then patients eventually, and gradually, will be weaned off the drugs.
If the meds don’t work or aren’t well tolerated, or if the patients prefer not to take them, then Putnam looks at correcting the problem surgically.
Most commonly, patients with chronic GERD have a hiatal hernia, so identifying that and repairing it is top priority. Additionally, to further strengthen the anti-reflux barrier, a fundoplication can be performed, which gently wraps the upper part of the stomach around the bottom of the esophagus in order to reinforce the lower esophageal sphincter. Other “newer” options for bolstering the lower esophageal sphincter include transoral (endoscopic) fundoplication (EsophyX®) or magnetic sphincter augmentation (LINX®), which implants a small device to tighten the sphincter. The latest procedure-based, anti-reflux technology to receive FDA approval is an implantable device (RefluxStop®).
For patients who are overweight and do not have success with medications, a gastric bypass can be offered to treat both the obesity and the reflux.
With so many possible symptoms and treatments, patients with chronic GERD should not be managed with a uniform approach. They benefit from seeing a medical team with a deep well of experience in evaluating the underlying causes of GERD and assessing the available treatment options for cases ranging from small hernias to very complex conditions.
“We’re fortunate at Keck Medicine to have a legacy in foregut pathology — several generations of internationally renowned surgeons,” Putnam says.
At a high-volume specialty care program like the USC Upper GI and General Surgery Program, gastroenterologists, gastrointestinal motility specialists and foregut surgeons all work together collaboratively to develop optimal treatment plans tailored to each patient. They also stay up to date with the latest technologies and advancements in their field, Putnam notes.
“We know how to personalize the treatment of GERD for each patient. It’s not a one-size-fits-all approach,” he says. “It truly is a hand-in-hand partnership that puts patient-centered care first.”
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