GERD AND Hiatal Hernia Treatment

 

 

What is GERD?

Gastroesophageal reflux disease (GERD) is a disease in which stomach acid backs up the tube connecting your mouth and stomach (esophagus) which can cause heartburn and regurgitation. This backflow is called acid reflux.  If GERD is untreated, it can lead to inflammation and serious problems of the esophagus (such as a precancerous condition called Barrett’s esophagus with dysplasia.)  GERD can also create symptoms such as cough, shortness of breath, worsening asthma and aspiration pneumonia (when stomach acid comes up the esophagus and spills over into the lungs.) 

What causes GERD?

GERD can be caused by problems with the muscle at the bottom of your esophagus that keeps stomach acid from coming up into the esophagus.  That muscle is called the lower esophageal sphincter.  GERD can also be caused by a hiatal hernia.  A hiatal hernia occurs when your stomach slips up through your diaphragm into your chest. 

Ways to diagnose GERD and hiatal hernias:

  • pH/Impedence Testing: During this test, a tiny tube/probe is passed down your nostril and kept in place for 24 hours.  This probe senses every time stomach acid comes up into your esophagus, and it is how GERD is diagnosed. You must be off all antacid medications for 7 days for this test to be accurate.
  • Upper Endoscopy (EGD): During this test, your doctor will put you partially to sleep and will pass an endoscope (a flexible tube with a camera on the end) down your esophagus and examine your esophagus, stomach, and first portion of your small intestine.  This can help diagnose esophagus or stomach irritation, look for hiatal hernias, and examine for bacterial infections.  During an endoscopy, small tissue samples (biopsies) are often taken.
  • Upper GI Barium Swallow:  This is an X-ray that is taken while you swallow liquid contrast.  It is painless and helps look for hernias and narrowing of the esophagus.
  • Manometry: This test is used to determine if there is a problem with the muscle function of your esophagus.  It involves passing a small tube down your nose and swallowing liquid.  The small tube has sensors that measure how your esophagus squeezes.
  • Gastric Emptying Study: This study examines how well your stomach empties.  You eat radiolabelled food, and then the radiologist watches your stomach empty over the course of 4 hours.

How are GERD and hiatal hernias treated?

There are many treatment options for GERD and hiatal hernias. 

Medications

  • Antacid medications are often used to treat the symptoms of heartburn but don’t reliably prevent stomach fluid coming up into your esophagus.  Additionally, due to some concerns with using certain antacid medications (including esophageal cancer, bone loss, kidney problems, and colon infections), surgery is sometimes recommended to correct GERD. 

·Surgery

  • The traditional surgery used to treat GERD is fundoplication.  During this surgery, the surgeon wraps the stomach around the esophagus to reinforce the weak lower esophageal sphincter.  If there is a hiatal hernia, it is also repaired. 
  • Newer surgeries, such as LINX can also be used to treat GERD.  LINX is a magnetic augmentation device that is used to reinforce the defective lower esophageal sphincter.  In some instances it may have fewer side effects than the traditional fundoplication surgery, although both are excellent options to cure acid reflux.   During this procedure, hiatal hernias are also always repaired.

If you think you may have GERD or have been told you have a hiatal hernia, please schedule an appointment with the fellowship-trained anti-reflux surgeons at Downtown Surgery Specialists to discuss how we may help you.