GERD / Heartburn / Hiatal Hernia Treated by Top Doctors in Baltimore

Indigestion, acid reflux and heartburn are experienced by most of us occasionally as brief periods of discomfort. When these symptoms become chronic – last longer, are stronger and occur frequently – they may signal more serious conditions such as GERD or hiatal hernia.

What is GERD?

GERD is a chronic condition in which the stomach’s liquid contents back up into the esophagus (the tube connecting the mouth to the stomach). These stomach acids and bile salts can irritate and damage the delicate lining of the esophagus and cause heartburn and other symptoms of distress.

What is a Hiatal Hernia?

A hiatal hernia is an upward bulge of part of the stomach through the muscular wall of the diaphragm into the chest. This happens when the natural opening (hiatus) in the diaphragm is either weakened or too large. There are two types of hiatal hernia:

• Sliding: the bottom of the esophagus and the top of the stomach push up into the chest. This is the more common type.
• Paraesophageal: part of the stomach bulges up into the chest so that it is positioned next to the esophagus. This type is less common and more likely to lead to complications.

Hiatal hernias occur more often in women, people who are overweight and those who are more than 50 years old.

GERD symptoms may include:

• Heartburn, especially after eating, bending over or when lying down at night
• Regurgitation – partially digested food comes back up into the esophagus
• Chronic dry cough or hoarseness
• Burping or gas bubbles
• Bad breath sometimes
• Asthma symptoms possibly
• Symptoms may be worse if hiatal hernia is also present

One or more of the following tests may be used to diagnose GERD:

• Upper endoscopy (esophagus, stomach and upper part of  small intestine)
• Esophageal manometry (pressure study)
• Esophageal motility studies
• pH test to measure acid levels in esophagus

Hiatal Hernia symptoms may include:

Many people who have hiatal hernias don’t have any symptoms and may not even know that they have one. Symptoms can be similar to those of GERD.

• Heartburn
• Acid reflux
• Upper abdominal pain
• Chest pain – can be severe

 Tests used to diagnose hiatal hernia can include:

• Special X-ray (barium swallow)
• Esophageal manometry (pressure study)
• Upper endoscopy (esophagus, stomach and upper part of small intestine)
• pH test to measure acid levels in esophagus

If you have been diagnosed with a paraesophageal hiatal hernia, and you experience severe chest or abdominal pain and nausea and vomiting, call your doctor immediately. This may mean that the blood supply to the stomach tissue trapped by the hiatal hernia has been cut off.

GERD Treatment Options

Severe acid reflux and GERD can usually be controlled with a combination of medication and diet changes in consultation with your doctor. When symptoms are severe and don’t respond to medical treatment, surgery may be necessary. Surgery for GERD is called Nissen fundoplication. It may be complete or partial. The surgeon uses minimally invasive techniques to wrap the upper part of the stomach around the lower end of the esophagus and stitch it into place. This prevents stomach acid from moving back into the esophagus.

Hiatal Hernia Treatment Options

Most people can control the symptoms of hiatal hernia with medication and changes in diet to reduce symptoms. If symptoms worsen or the herniated area becomes squeezed, surgery may become necessary. Laparoscopic surgery is the treatment of choice for hiatal hernia repair. Using 4-6 small incisions, the surgeon will reduce the size of the opening (hiatus) in the diaphragm and pull the stomach completely back into the abdomen.

Sometimes people have both hiatal hernias and GERD. Both of these can be surgically treated during the same minimally invasive surgical procedure.

Laparoscopic Approaches

The laparoscopic approaches for GERD and for hiatal hernia are less invasive than traditional surgery and may offer several advantages:

• Small incisions and little scarring
• Less risk of infection
• Less pain
• Shorter hospital stay
• More rapid recovery

In many cases you will be able to reduce or eliminate medications and go back to eating some or all of the foods you once avoided.