Published on May. 29, 2026
MemorialCare Digestive Care Center has a new treatment, called cTIF, to help patients suffering from chronic acid reflux — specifically gastroesophageal reflex disease, or GERD — caused or significantly contributed to by a hiatal (stomach) hernia. cTIF is an advanced, hybrid procedure that combines surgery and endoscopy to treat both the underlying anatomy and reflux in a single procedure.
This emerging procedure is a significant advancement in reflux care because it addresses the underlying mechanical cause of GERD — not just the acidity of stomach contents.
“GERD is pretty common, it affects nearly 20% of the population,” said Jose Luis Aranez, M.D., gastroenterologist and medical director, Advanced Endoscopy, MemorialCare Digestive Care Center.
Most are treated with medicine to manage the symptoms, which can include chronic heartburn, regurgitating food or liquid from the stomach, bloating, abdominal swelling, nausea and even sudden and extreme chest or abdominal pain that can mimic a heart attack.
“Medicine can help, but we need to consider reflux as a spectrum of anatomical dysfunction,” said Dr. Aranez. “As patients develop a hernia, which is when a part of the stomach pushes through the opening of the diaphragm in the chest, management with medicine might be ineffective.”
Traditional hernia surgery involves wrapping the top of the stomach around the bottom of the esophagus. This reinforces the lower esophageal sphincter to keep stomach acid in place.
“The traditional option of a surgical fundoplication could be too tight which could lead to discomfort with difficulty swallowing or bloating,” said Dr. Aranez. “If the fundoplication is partial, it may not adequately control the reflux symptoms.”
Dr. Aranez, in collaboration with surgeon Atif Iqbal, M.D., medical director, MemorialCare Digestive Care Center — who specializes in bariatric and digestive disorders — have teamed up for the new cTIF hybrid procedure. Providing many patients, particularly younger adults facing long-term medication dependence, cTIF represents a shift from ongoing symptom management to targeted structural correction designed to improve long-term quality of life.
The endoscope is fitted with a device that manipulates the stomach tissue and implants permanent fasteners to bind the stomach and esophagus.
Post-procedure, patients are restricted to an all-liquid diet for two weeks and a pureed and soft food diet for four weeks before they can return to eating normally. Most can stop taking their acid reflux medicines completely.
“It really is a game changer. For the first time, we’re able to treat reflux at its source by restoring the body’s natural barrier, instead of relying on long-term medication to manage symptoms. For many patients, that means not only lasting relief, but the ability to come off daily medications and get back to living normally — sleeping through the night, eating without fear, and not planning their day around reflux. One of our first patients came in just two weeks after the procedure already sleeping through the night and feeling like they had their quality of life back.”
- Dr. Aranez
The procedure is ideal for otherwise healthy individuals, with chronic GERD, a small hiatal hernia and ongoing symptoms despite medication. Older patients who are medically fit can qualify for the treatment. However, candidates for the procedure must have a Body Mass Index (BMI) of under 35.
“This is a wonderful new option for patients who previously had limited choices,” said Dr. Aranez.