Gastroesophageal Reflux Disease (GERD) Symptoms Diagnosis and Treatment

Gastroesophageal reflux disease, referred to as GERD, is a chronic, often life-long, condition in which the stomach’s liquid contents back up into the esophagus causing inflammation or damage to the esophagus lining. Some GERD, or acid reflux, occurs in most people. However, in people diagnosed with GERD, the refluxed liquid has more acid content and remains in the esophagus for a longer period of time.

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 include:

Heartburn

Regurgitation

Trouble swallowing

Nausea

Chronic cough

Reflux induced asthma

GERD can be diagnosed using different treatments such as an endoscopy, chromoendoscopy, biopsies, X-rays in conjunction with a Barium swallow test, examination of the throat and larynx, and Bravo wireless pH testing.

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