Foregut surgery · Denver area
Specialist care for reflux, hiatal hernia, and the esophagus.
Emily Speer, MD, is a fellowship-trained foregut and minimally invasive surgeon with Intermountain Health. Care begins with understanding exactly what is causing your symptoms — surgery is one of several options, not the starting point.
Referring a patient? Referral information
Start with your symptoms
Where would you like to begin?
- Heartburn or regurgitation that won’t settleReflux, heartburn & GERD
- A hiatal or paraesophageal hernia on a scanHiatal & paraesophageal hernias
- Symptoms that returned after reflux or hernia surgeryRecurrent reflux & revisional surgery
- Food sticking, or trouble swallowingAchalasia & swallowing disorders
- Cough, hoarseness, or constant throat clearingLPR & throat symptoms
- Reflux after a sleeve gastrectomy or bypassReflux after bariatric surgery
- A new diagnosis of Barrett’s esophagusBarrett’s esophagus
- Nausea, early fullness, or slow stomach emptyingGastroparesis
A careful evaluation
From symptoms to a clear plan
Heartburn, regurgitation, and swallowing trouble can come from several different conditions. A thorough foregut evaluation generally moves through four stages.
How testing worksListen and review
A detailed history of your symptoms, what has and hasn’t helped, and a careful look at prior tests and operative reports.
Define the problem
Testing fills the gaps — endoscopy, pH monitoring, manometry, or imaging — so the diagnosis rests on evidence, not guesswork.
Match the options
Lifestyle measures, medication, endoscopic procedures, or surgery, weighed against your findings, anatomy, and priorities.
Follow through
Clear expectations for recovery and follow-up, with attention to swallowing, reflux control, and quality of life.
Second opinions
When symptoms return after surgery
Reflux, swallowing difficulty, or hernia symptoms after a fundoplication or hernia repair have several possible causes. Working out which one applies — with your operative records, imaging, and physiology testing — comes before any decision about revisional surgery.
Recurrent reflux & revisional surgeryAcross Colorado
Traveling from farther away?
The clinic is in Wheat Ridge, on the west side of the Denver metro area. Sending records ahead and grouping tests can make each trip count.
Planning your visitTreatment options
A spectrum of options for reflux
Every procedure requires reflux to be confirmed and swallowing function to be checked first. The right choice depends on test results, anatomy, and what matters most to you.
- Lifestyle & medicationWhere most people start — and where many do well.
- Incisionless (TIF)An endoscopic valve for carefully selected patients.
- LINXA magnetic ring that reinforces the valve.
- FundoplicationNissen or Toupet — the established operation.
- Gastric bypassTreats reflux and weight together in obesity.
“Dr. Speer aims to provide patients with the education they need to make informed treatment decisions.”
Research & teaching
Surgeon, author, teacher
- Peer-reviewed research on esophageal stents, feeding tubes, and surgery for gastroparesis, published in Surgical Endoscopy and the Journal of Gastrointestinal Surgery.
- SAGES surgical education, including a “how I do it” talk on Nissen fundoplication in a SAGES Foregut livestream on hiatal surgery.
- Operative teaching videos on complex paraesophageal hernia repair in the SAGES video library.
Patient learning center
Questions patients often ask
- What is the difference between heartburn, reflux, and GERD?Reflux is stomach contents moving up into the esophagus, heartburn is one symptom it can cause, and GERD is the diagnosis used when reflux causes troublesome symptoms or damage.
- Why might reflux symptoms persist despite medication?Common reasons include medication timing, reflux that is not mainly acid, a weakened reflux barrier such as a hiatal hernia — or symptoms that are not caused by reflux at all.
- Does a hiatal hernia always need surgery?No. Small sliding hernias rarely need repair on their own, and paraesophageal hernias without symptoms can often be watched; symptomatic paraesophageal hernias are generally repaired.
- What testing is needed before reflux surgery?At minimum, objective proof of GERD (from endoscopy or pH monitoring), esophageal manometry to check swallowing function, and an assessment of any hiatal hernia; other tests are added when symptoms call for them.
- What can cause symptoms after a previous fundoplication?Common causes include a recurrent hiatal hernia, a wrap that has loosened, slipped, or is too tight, a mismatch between the wrap and esophageal function, slow stomach emptying — or an original diagnosis that wasn’t reflux.
Appointments
Talk with Dr. Speer about your symptoms and options.
Whether you are starting an evaluation, looking for a second opinion, or have had symptoms return after surgery, the first step is a conversation and a careful look at your history and tests.