Gastroesophageal reflux disease, or GERD, is the presence of stomach contents in the esophagus. A weakened valve between the esophagus and stomach allows gastric contents to irritate the esophagus.

GERD affects many people and usually presents itself as heartburn. In most cases, heartburn can be relieved through diet and lifestyle changes.

Decreasing your portion sizes at mealtime might also improve symptoms. Eating meals at least two to three hours before bedtime might lessen reflux by allowing the acid in the stomach to decrease and the stomach to partially empty.

Heartburn occurs when the lower esophageal sphincter (LES) is not as strong as normal. This allows stomach acid to escape back into the esophagus and create discomfort.

Hiatal hernia is diagnosed when the stomach moves up into the chest through the opening in the diaphragm. (The diaphragm is the boundary that separates the abdominal contents from the chest cavity.) The opening in the diaphragm acts as an additional barrier to acid reflux.

• Barium meal UGI (upper gastrointestinal barium exam)
• Upper endoscopy (flexible tube with light and camera to examine digestive tract)
• 24-hour ph monitoring (measures the amount of acid flowing into the esophagus from the stomach)
• High-resolution esophageal manometry (measures the function of the lower esophageal sphincter)
  
• Gastric emptying study

A small number of patients might need surgery because of poor response to medical therapy. Although GERD and hiatal hernia can limit daily activities, most people will find relief with an understanding of the causes and proper treatment.

A laparoscopic (minimally invasive) repair of hiatal hernia and reflux called Nissen fundoplication has been shown to be 90% effective in most patient populations. The surgery strengthens the lower esophageal sphincter. It requires general anesthesia and a one-day stay in the hospital. Postoperatively, patients no longer require long-term therapy with Prilosec® or other antacid medications.