GERD, Hiatal Hernia & Heartburn

What is gastroesophageal reflux disease (GERD)?

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.

Six tips to control heartburn

• Avoid foods and beverages that irritate the esophagus and might further weaken the muscular valve. These include fried and fatty foods, peppermint, chocolate, alcohol, coffee, citrus fruits and juices, and tomato products
• Lose weight if you are overweight
• Stop smoking
• Elevate your head 15 cm (6 inches) by elevating the head of your bed on blocks or books
• Avoid lying down two to three hours after eating
• Take an over-the-counter antacid

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.

What is the role of hiatal hernia as a cause of reflux?

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.

Hiatal hernia might not require treatment unless it is in danger of strangulation or complicated by GERD.

What are the goals of treating reflux?

• Eliminate the patient's symptoms
• Heal esophageal injury
• Manage or prevent the return of reflux
• Prevent complications

What tests are used to diagnose reflux-associated problems?

• 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

Does GERD and hiatal hernia require surgery?

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.

Can surgery help stop GERD?

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.