Acid Reflux, GERD, Upper GI Surgery

Our general surgeons at Wichita Surgical Specialists perform surgical procedures to treat a breadth of conditions affecting the gastrointestinal or upper digestive system (the upper GI). The upper digestive system includes the esophagus, stomach and the small intestine.

Conditions We Treat:

• Acid reflux/Gastroesophageal reflux disease (GERD)
• Crohn’s disease
• Colitis
• Diverticulitis
• Gallstones
• Hernias
• Swallowing disorders
• Ulcers
• Achalasia

Acid Reflux/GERD

Heartburn, acid reflux and GERD are terms that are often used interchangeably but they actually have different meanings.

Most people will experience the occasional heartburn, a slight discomfort or burning sensation in the chest, neck and/or throat. In fact, the American College of Gastroenterology states that more than 60 million Americans experience heartburn once a month.

Heartburn is actually a symptom, or result of, acid reflux, which is where too much stomach acid flows back up into the esophagus. Common causes are spicy, acidic, fatty or fried foods, or acidic drinks, and the symptoms can be worse when lying down or bending over.

Other factors that can cause acid reflux include alcohol consumption, smoking, obesity, pregnancy, or a type of hernia called a hiatal hernia.

If the occasional acid reflux progresses to become chronic and severe, it could be a more serious condition called gastroesophageal reflux disease (GERD). It may be time to consult with a physician if symptoms occur twice a week or more, and/or other factors are present, such as trouble swallowing, dry cough, blood or weight loss.

Symptoms of GERD include:

• Heartburn
• Chest pain
• Bad breath
• Dry cough
• Trouble swallowing
• Regurgitation
• Food sticking
• Damage to tooth enamel due to excess acid
• Vomiting

Symptoms of GERD can often be controlled with conservative treatments, including diet changes, weight loss, cessation of smoking and alcohol, and/or over-the-counter or prescription medication. Medications used to treat GERD include antacids, H2 blockers and proton pump inhibitors (PPIs).

However, medications only treat the symptoms and don’t correct the underlying anatomic issue. In addition, lifestyle changes aren’t always enough for some people. Therefore, further evaluation and treatments may be necessary.

Hiatal Hernia

People with a hiatal hernia are highly prone to acid reflux and GERD. A hiatal hernia (also referred to as a paraoesophageal hernia) is a condition in which the upper part of the stomach slips through a hole in the diaphragm, (the esophageal hiatus) causing that part of the stomach to protrude or bulge. The hernia is a result of weakened muscles of the diaphragm.

This muscle weakness can be caused by several factors, including the long-standing presence of stomach acids from GERD. Pressure on the stomach muscles can also increase the chances of developing a hiatal hernia. Some contributing factors may include:

• Frequent coughing
• Straining with constipation
• Lifting heavy objects
• Obesity
• Poor posture, slouching
• Pregnancy
• Heredity
• Smoking
• Trauma

If left untreated, a hiatal hernia can grow, leading to increased pain and complications. These complications may include chronic esophageal inflammation, leading to bleeding and/or perforation of the esophagus; scarring and narrowing of the lower esophagus, which can cause difficulty in swallowing; bowel obstruction; intestinal tissue strangulation; and an increased risk for esophageal cancer.

How to Diagnose GERD & Hiatal Hernias

GERD can often be determined by symptoms and a physical examination alone; however, diagnostic tests may be necessary for a complete diagnosis. These tests may include an ultrasound, upper endoscopy, or a biopsy. Additionally, an upper GI barium x-ray may be part of the diagnostic process for a hiatal hernia.

Endoscopy
An endoscopy is a minimally invasive exploratory procedure used in the diagnosis of acid reflux and other gastrointestinal conditions including hiatal hernias, ulcers, inflammation, tumors or bleeding. Often referred to as an upper gastrointestinal (UG) endoscopy or esophagogastroduodenoscopy (EGD), an endoscopy involves inserting a thin, flexible tube called an endoscope (scope) into the throat. The tube has a microscopic camera on the end to help the surgeon explore the lining of the upper GI tract, including the esophagus, stomach and small intestine (duodenum).

During the endoscopy procedure, the surgeon may also take a small tissue sample for further examination.

Surgical Treatment for GERD & Hiatal Hernias

When conservative treatments are not successful, when a patient experiences severe, chronic acid reflux, or when a patient has a hiatal hernia, surgical treatment may be necessary.

There are several surgical options that may help to relieve GERD symptoms as well as manage complications. Your surgeon will discuss with you the best options for your individual needs.

Laparoscopic Antireflux Surgery
Laparoscopic antireflux surgery, also referred to as Nissen fundoplication or partial fundoplication, is a minimally-invasive procedure performed by many of our surgeons (see below) to treat GERD and hiatal hernias. Whether the surgery will be performed with the conventional laparoscopic or robotic-assisted laparoscopic approach will be determined by your surgeon.

During the procedure, the surgeon wraps and stitches the upper portion of the stomach around the lower end of the esophagus. This tightens the opening of the diaphragm, preventing the stomach bulge as well as essentially creates a one-way “valve” to prevent stomach acid from flowing up from the stomach to the esophagus.

After a full diagnosis, your surgeon will discuss with you a recommended treatment plan for your specific condition. For additional information on gastrointestinal surgery at Wichita Surgical Specialists or to schedule an appointment, please call 316-263-0296, or toll-free 800-362-3130.