Thoracic Surgery Menu Thoracic & Foregut Surgery Meet Your Thoracic Doctors Lung Conditions Lung Cancer Lung Cancer Screenings Mesothelioma Lung Cancer in Kentucky Esophageal Conditions Achalasia Esophageal Cancer Esophageal Diverticulum Esophageal Perforation GERD Leiomyoma Motility Disorders Paraesophageal/Hiatal Hernias Other Chest Conditions Patient Success Stories The White Ribbon Project Is Severe Acid Reflux Affecting Your Life? Gastroesophageal reflux disease (GERD) is a condition in which your stomach contents and gastric acid back up into your esophagus, causing a burning sensation in your throat and chest. Most cases of GERD can be treated effectively with medication and lifestyle changes. The goal of drug therapy is to reduce the level of acid in your stomach to relieve the symptoms of heartburn. Lifestyle changes like quitting smoking, weight loss and avoiding foods that cause symptoms may also offer relief of GERD symptoms. About 20-30% of patients will still have persistent symptoms despite medical management or may require escalating doses of acid medications. In these cases, surgery may be considered. If you have heartburn or GERD or take medication for those conditions, please complete the questionnaire to determine if surgery is a good treatment option for you. Scale: 0 = No Symptoms 1 = Symptoms noticeable, but not bothersome 2 = Symptoms noticeable and bothersome, but not every day 3 = Symptoms bothersome every day 4 = Symptoms affect daily activities 5 = Symptoms are incapacitating, unable to do daily activities Questions: 1. How bad is your heartburn? * 012345 2. Do you have difficulty swallowing? * 012345 3. Do you have pain with swallowing? * 012345 4. Do you have bloating or gassy feelings? * 012345 5. Do your symptoms change your diet? * YesNo 6. Do your symptoms wake you from sleep? * YesNo 7. How satisfied are you with your current condition? * SatisfiedNeutralDissatisfied 8. Do you experience regurgitation (contents refluxing when laying down or bending over)? * YesNo 9. Are you currently taking any medications for heartburn? * YesNo 10. If so, what medications are you currently taking? Click to add (?) 11. How long have you been taking these medications? Click to add (?) 12. Are you concerned with the warning regarding long-term heartburn medication use? * YesNo 13. Are you interested in considering surgical treatment for GERD to either improve your symptoms or eliminate your heartburn medications? * YesNo 14. Do you want to be contacted about treatment options? * YesNo Please provide us with your name and phone number so we can contact you if a consultation or appointment is indicated. First Name * Click to add (?) Last Name * Click to add (?) Email * Click to add (?) Phone Number * Click to add (?) Contact Review Click to add (?) Click to add (?) By clicking submit, I am agreeing to receive phone communications from St. Elizabeth Healthcare and St. Elizabeth Physicians. I confirm I am at least 18 years old and know that I may opt-out of these communications at any time. Click to review our Privacy Policies.