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What is
gastroesophageal reflux?
Gastroesophageal
reflux 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.
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 6 inches when lying on your
back.
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 sphincter around the stomach and creates an area where stomach
acid is held.
Hiatal hernia might not require treatment unless it is in danger of
strangulation or complicated by GERD.
What are the goals of therapy?
- Eliminate the patient's symptoms
- Heal esophageal injury
- Manage or prevent relapse
- Prevent complications
What diagnostic tests are associated with reflux-associated problems?
- Barium meal U.G.I.
- Upper endoscopy
- 24-hour ph monitoring
- Esophageal manometry
- Gastric emptying studies
Does GERD and hiatal hernia require surgery?
A small number of patients might need surgery because of poor response to
medical therapy.
Although these conditions can limit daily activities, with an understanding
of the causes and proper treatment most people will find relief.
Can surgery help stop GERD?
A laparoscopic repair of hiatal hernia and reflux called Nissen
fundoplication can be very effective; 90 percent effective in most patient populations.
It requires general anesthesia and a one-day stay in the hospital.
Post-operatively, patients no longer require long-term therapy with Prilosec or
other antacid medications.
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