What is GERD & Why Does it Happen?
Gastroesophageal Reflux Disease (GERD) is a chronic condition where stomach acid frequently flows backwards into the oesophagus, causing irritation and inflammation. GERD occurs when the Lower Oesophageal Sphincter (LES) — the muscular valve between the oesophagus and stomach — becomes weak, damaged, or relaxes inappropriately.
While antacids and PPIs manage symptoms by reducing acid production, they do not address the underlying structural problem. Nearly 30% of GERD patients have inadequate or partial response to PPIs, and many are unwilling to take daily medication for life due to long-term side effects (kidney disease, bone density loss, magnesium deficiency).
Endoscopic anti-reflux procedures performed by Dr. Hardik Ahuja physically repair or strengthen the LES — treating the root cause of GERD rather than just managing symptoms with daily medication.
Signs You May Have GERD
GERD manifests as a wide range of symptoms. If you experience any of the following — especially if they recur frequently or interfere with your daily life — an evaluation by Dr. Ahuja is recommended:
Heartburn
Burning sensation in the chest, especially after meals or when lying down. Often worsens at night.
Acid Regurgitation
Sour or bitter-tasting liquid rising into the throat or mouth. Often associated with water brash.
Difficulty Swallowing (Dysphagia)
Food feels stuck in the throat or chest. May indicate oesophageal narrowing from chronic acid damage.
Chronic Cough & Hoarseness
Persistent dry cough, throat clearing, or hoarse voice — often misdiagnosed as asthma or sinus issues.
Disturbed Sleep
Waking up at night with coughing, choking, or a burning sensation. Nighttime reflux is a major warning sign.
Nausea & Bloating
Persistent nausea, early satiety, and upper abdominal bloating — particularly after meals.
Dental Erosion
Acid reflux erodes tooth enamel, causing sensitivity and cavities — a silent sign of chronic GERD.
Non-Cardiac Chest Pain
Chest pain resembling heart attack but caused by oesophageal spasm or severe acid reflux.
Red flag symptoms needing immediate evaluation: difficulty swallowing, unexplained weight loss, vomiting blood, or black stools. These may indicate Barrett's oesophagus or early oesophageal cancer.
The GERD Treatment Ladder
Dr. Ahuja follows a stepwise, evidence-based approach — escalating to endoscopic treatment when lifestyle changes and medications are insufficient:
Lifestyle Modifications
Weight loss, head elevation during sleep, avoiding trigger foods (spicy, fatty, alcohol, coffee), small frequent meals, not lying down within 3 hours of eating.
Medication — PPIs / H2 Blockers / Antacids
Proton pump inhibitors (omeprazole, pantoprazole, rabeprazole) reduce acid production. First-line therapy. Effective for most patients but require daily, long-term use.
🎯 Endoscopic Anti-Reflux Treatment (ARMS / TIF / Stretta)
For PPI-dependent or PPI-refractory GERD, or those wishing to stop long-term medication. Fixes the structural defect — the weak LES — without open surgery. Performed by Dr. Hardik Ahuja.
Surgical — Laparoscopic Nissen Fundoplication
Reserved for severe GERD with large hiatal hernia, failure of all other treatments, or complications. Involves wrapping the upper stomach around the LES under general anaesthesia.
Endoscopic Anti-Reflux Procedures We Offer
✂️ ARMS — Anti-Reflux Mucosectomy
ARMS removes a strip of the mucosal lining at the gastroesophageal junction using endoscopic mucosal resection (EMR) or ESD techniques. The resulting fibrosis during healing tightens and reconstructs the LES, creating a stronger anti-reflux barrier.
ARMS is particularly effective for refractory GERD and produces durable symptom relief in 70–85% of patients at 1 year.
🪡 TIF — Transoral Incisionless Fundoplication
TIF uses an endoscopic suturing device (EsophyX) to recreate the natural anti-reflux valve — the His angle — between the oesophagus and stomach. Multiple tissue folds are placed to reconstruct and reinforce the valve, mimicking surgical Nissen fundoplication.
Clinical trials show 59–70% of patients achieve complete symptom control without PPIs at 6 months.
⚡ Stretta — Radiofrequency Ablation of LES
Stretta delivers low-energy radiofrequency waves to the muscle of the LES through a specialised catheter. The thermal energy induces collagen remodelling and muscle hypertrophy, strengthening the LES muscle over 2–4 weeks post-procedure.
Stretta is the least invasive endoscopic option and benefits 70–80% of patients.
🔬 Pre-Procedure Workup
Before any endoscopic anti-reflux procedure, Dr. Ahuja performs Upper GI Endoscopy, 24-hour pH-impedance monitoring (to confirm abnormal acid reflux), High-Resolution Manometry (to assess LES pressure and oesophageal motility), and Barium swallow in select cases.
This workup ensures the correct procedure is chosen for the correct patient.
Your Journey — Step by Step
Evaluation & Diagnosis
Endoscopy, pH monitoring, and manometry confirm GERD severity and suitability for endoscopic treatment.
Sedation
Moderate sedation administered via IV. You will be comfortable and pain-free throughout the procedure.
Endoscopic Repair
ARMS mucosectomy, TIF plication, or Stretta radiofrequency applied at the LES — all through the mouth, no cuts.
Recovery & Follow-up
Discharged same day or next morning. Soft diet for 1–2 weeks. Follow-up at 4 and 12 weeks to assess response.
ARMS vs TIF vs Stretta vs Surgery
| Parameter | ARMS | TIF | Stretta | Lap. Fundoplication |
|---|---|---|---|---|
| Mechanism | LES tightening via fibrosis | Valve reconstruction | LES muscle strengthening | Surgical wrap |
| Invasiveness | Endoscopic | Endoscopic | Endoscopic | Surgical (5 incisions) |
| Anaesthesia | Sedation | Sedation | Sedation | General |
| Procedure Time | 30–45 min | 45–60 min | 45–60 min | 90–120 min |
| Hospital Stay | Same-day | 1 night | Same-day | 2–3 days |
| Recovery | 2–3 days | 3–5 days | 1–2 days | 2–4 weeks |
| Success Rate | 70–85% | 60–70% PPI-free | 70–80% | 85–90% |
| Hiatal Hernia | Small only | Small–medium | Small only | All sizes |
| Risk Profile | Very low | Very low | Very low | Moderate |
| Reversibility | Difficult | Partial | N/A | Irreversible |
Who is a Good Candidate?
✅ Ideal Candidates
- Confirmed GERD by endoscopy and/or pH monitoring
- PPI-dependent for 6+ months wishing to stop medication
- Incomplete response to PPIs (refractory GERD)
- PPI intolerance due to side effects
- Small to moderate hiatal hernia (less than 3 cm)
- No severe oesophageal motility disorder
- Medically unfit for laparoscopic surgery
❌ Not Suitable For
- Large hiatal hernia (greater than 3 cm) — needs surgery
- Severe oesophageal dysmotility or achalasia
- Barrett's oesophagus with high-grade dysplasia
- Oesophageal stricture or narrowing
- Active oesophageal ulceration
- Pregnancy or severe coagulation disorders
- Prior upper GI surgery near the GEJ
How to Prepare
- Continue PPIs until instructed — do not stop independently before the procedure
- Fasting for 8 hours before the procedure (clear liquids until 2 hours prior)
- Stop blood thinners (aspirin, clopidogrel, warfarin) 5–7 days prior as directed
- Bring all previous endoscopy reports, pH study, manometry results, and prescription records
- Arrange a responsible adult to accompany you and drive you home after sedation
- Plan 2–3 days off work for recovery
- Inform Dr. Ahuja of all current medications and allergies
Post-procedure diet: Clear liquids for 24 hours → Soft diet for 1–2 weeks → Gradual return to normal diet. Avoid carbonated drinks, alcohol, and spicy food for 4 weeks. PPIs are continued for 4–8 weeks then tapered based on symptom response.
How Safe is Endoscopic GERD Treatment?
Endoscopic anti-reflux procedures are very safe, with overall complication rates below 2%. Dr. Hardik Ahuja performs these procedures with meticulous technique. Risks are significantly lower than laparoscopic fundoplication.
Nausea / Sore Throat
Very common in the first 24–48 hours, especially after TIF. Managed effectively with anti-nausea medications.
Temporary Dysphagia
Difficulty swallowing for 1–2 weeks after ARMS or TIF due to swelling at the repair site. Resolves spontaneously.
Bleeding (Rare)
Minor mucosal bleeding may occur during ARMS. Serious bleeding requiring intervention is extremely rare (<1%).
Perforation (Extremely Rare)
A small tear in the oesophageal wall. Risk is <0.5% and the procedure is halted immediately if this occurs.