GERD and HIATAL HERNIA

GERD and Hiatal Hernia Surgery

What is GERD?

GERD (GastroEsophageal Reflux Disease) is commonly known as acid reflux. This condition occurs when acid from the stomach flows back up into the esophagus. In a healthy patient, anatomic and physiologic factors create a valve at the junction of the esophagus and stomach, preventing reflux. When that valve becomes incompetent, reflux occurs, and patients become symptomatic.

GERD Valve

Healthy Valve

Typical Symptoms

  • Heartburn (burning sensation in the chest, upper abdomen, or throat)
  • Reflux (regurgitation of food or sour liquid into the esophagus, throat, or mouth)

Atypical Symptoms

  • Chronic cough
  • Laryngitis/hoarseness
  • Sensation of lump in throat
  • Asthma
  • Chest pain

Diagnosis

GERD can often be diagnosed with classic endoscopic findings in conjunction with typical clinical symptoms. In some cases, and particularly prior to surgery, additional studies are performed to further characterize the disease. These additional studies may include:

  • pH test – A small probe is placed that measures the acid content refluxing into the esophagus
  • Esophagram and Upper GI series – Commonly known as a “barium swallow,” this is an X-ray study that takes live motion pictures while a patient drinks contrast.  It helps characterize the function of the esophagus, as well as identify the presence of a hiatal hernia
  • Esophageal Manometry – This study evaluates the muscle pressures in different regions of the esophagus and helps identify physiologic dysfunction contributing to symptoms

Treatment

Diet and Lifestyle Modifications

  • Weight loss
  • Avoiding spicy and acidic foods
  • Avoiding alcohol and caffeine
  • Abstaining from smoking
  • Avoiding carbonated beverage
  • Avoiding meals and beverage less than 2 hours before bed or laying down

Medication

PPI (Proton-pump inhibitors)

  • Gold standard medical therapy for GERD
  • Blocks the stomach’s acid production

H2 Blockers

  • Also commonly used, but need to be taken twice daily
  • Blocks acid production, but less so than PPI

Tums

  • Often used to help with immediate symptom relief
  • Does not address acid production

Anti-reflux surgery

Indications for surgery to treat GERD include any of the following:

  • Patient does not want to continue taking medications long-term
  • Medications fail to control symptoms
  • Development of complications from chronic GERD, such as strictures in the esophagus
  • Extra-esophageal/atypical symptoms
  •  
Minimally invasive surgery (laparoscopy or robotic surgery) is typically performed to treat GERD. Four small incisions are used to perform the surgery. The main components to the procedure include (1) mobilizing the lower part of the esophagus into the abdomen, (2) repairing any hiatal hernia that may be present, and (3) wrapping the top part of the stomach around the esophagus to recreate the valve function that has been lost. The stomach wrapped around esophagus is referred to as “fundoplication.”

Recently, an “incisionless” endoscopic technique has be used in select patients to successfully treat GERD. This new procedure is called Transoral Incisionless Fundoplication, or TIF. If you would like to learn more about this procedure and see if you are a candidate, CLICK HERE to visit our page on TIF.

Hiatal Hernia Repair

Hiatal hernias are not located on the abdominal wall, but rather on the inside of the abdomen where the esophagus meets the stomach. The “hiatus” refers to the opening in the diaphragm where the esophagus passes through from the chest into the abdomen and empties into the stomach. When this opening becomes larger than normal and the stomach slides up into the chest, a hiatal hernia is present. Symptoms often include heartburn, reflux, regurgitation, and a feeling that food gets stuck in the lower part of the chest or upper abdomen and does not pass through easily. Patients with GERD often have hiatal hernias.

What is a Hiatal Hernia?

Hiatal hernias are treated with surgery. During surgery, the portion of the stomach that has migrated above the diaphragm into the chest is pulled back down into the abdomen and the enlarged opening in the diaphragm muscle is closed down to its original size with sutures. To minimize reflux symptoms and help prevent recurrence, a fundoplication is performed. In some cases, a hiatal hernia repair can be combined with the TIF procedure.

Get Your GERD Examined Today​

Dr. Anthony Pozzessere is a Bergen County, New Jersey-based practitioner who has had many years of experience performing robot-assisted surgery, which has resulted in less pain, quicker recovery, shorter stay, and patient satisfaction. His thorough knowledge of the body and about the use of robot-assisted surgery has allowed him to accomplish hundreds of surgeries to help his patients.