GastroEsophageal Reflux Disease (GERD) and Hiatus hernia

Gastroesophageal reflux (GER) happens when your stomach contents come back up into your esophagus causing heartburn (also called acid reflux). Normally the valve at the junction between stomach and esophagus (food pipe) is a one way valve and does not allow acid contents to come up to the esophagus. If the valve is weak or incompetent, there will be recurrent and troublesome acid reflux causing heartburns. Gastroesophageal reflux disease (GERD) is a long-lasting and more serious form of recurrent acid reflux.

The most common symptom of gastroesophageal reflux disease (GERD) is persistent heartburn, also called acid reflux with or without food contents. The diagnosis of GERD is clinical, however; and upper GI endoscopy is essential for confirmation and to rule out complications of GERD.

A hiatus hernia is a condition in which the upper part of your stomach bulges through an opening in your diaphragm. Diaphragm is the thin muscle that separates your chest from your abdomen. When there is constant acid exposure to the esophagus, it shortens and pulls stomach through the diaphragmatic hiatus.  When you have a hiatal hernia, it’s easier for the acid to come up.

There are two types of hiatus hernia. A sliding hernia is a condition in which your stomach can periodically slide above the diaphragm due to a wide opening in the diaphragm or weakness of the diaphragmatic muscle. In a Paraesophageal Hernia the stomach goes through an enlarged opening in the diaphragm and stomach sits next to the esophagus.

In patients with hiatus hernia apart from heartburns and acid reflux, they may experience additional symptoms like indigestion, regurgitation, belching, hiccups, nausea and vomiting. In advanced cases they may develop change in voice and recurrent lung infection.

Treatment:

Most symptoms of a hiatal hernia can be treated conservatively with medications, lifestyle adjustments, and self-care strategies. Medications include antacids, H2 receptor blockers, proton pump inhibitors and prokinetic agents. Lifestyle changes which could help those with GERD include Quitting cigarettes, Avoiding alcohol and caffeine, which promote reflux and avoiding spicy food. Eating a low fat-high fiber diet, reducing body weight and finishing an early dinner about 2 hours before bed are useful llife style changes in hiatus hernia patients.

Surgery for GERD and Hiatus Hernia:

Those with intractable symptoms, young patients ( as they may need long term medications with potential long term side effects), those with response to medications and those with complications of GERD and Hiatus hernia gets good benefit by the surgery laparoscopic fundoplication. Commonly done operation is Laparoscopic Nissen Fundoplication where is hiatus hernia is corrected, abdominal esophagus is placed back to normal position and a loose wrap with fundus is created to create a valve like mechanism to prevent reflux. Laparoscopic fundoplication requires 2-3 days in the hospital and generally a safe operation. Laparoscopic fundoplication provides long lasting cure from the GERD, excellent quality of life and helps the patients to avoid unnecessary medications.