Many people have experienced acid reflux. Acid reflux is the backflow of stomach acids into the esophagus, and is a common digestive symptom that can occur after a heavy meal, bending over the waist or lying down immediately after eating, or during pregnancy. Most of are so used to this symptom that we don’t realize that it can be a sign of a serious problem.
Sometimes acid reflux can be a sign of hiatal hernia, a condition where a small portion of the stomach bulges through the hiatus, an opening in the diaphragm that allows the esophagus to pass through. Excessive pressure on the muscles surrounding the hiatus due to persistent vomiting, straining during bowel movements, coughing or lifting heavy objects can weaken these muscles allowing the stomach to get stuck in the hiatus. This also weakens the sphincter muscles at the end of the esophagus that act as a gate, allowing only the one-way flow of food towards the stomach. As a result, the contents of the stomach move up the esophagus, leading to acid reflux and a more severe form of the condition called gastroesophageal reflux disease (GERD).
Acid reflux, GERD and hiatal hernia usually have similar symptoms such as heartburn, frequent belching and abdominal pain. When acid reflux becomes severe, persistent, doesn’t resolve with lifestyle changes, diet and medication, or leads to swallowing difficulties, it’s time to visit your doctor for a close examination.
Your doctor will order a barium swallow X-ray (imaging test that requires you to swallow a substance that highlights the organs) and endoscopy (lighted tube with camera is inserted through your mouth to view the digestive tract). These tests help ascertain the cause of acid reflux to hiatal hernia. They also rule out pre-cancerous changes in the lining of the esophagus – referred to as Barrett’s esophagus – as a result of chronic acid exposure.
Once diagnosed, your doctor will suggest conservative treatments such as medication and diet to control the reflux. However, surgery may be suggested when these methods fail to relieve symptoms, and in case of the narrowing and inflammation of the esophagus due to severe reflux. During surgery, your surgeon will restore the stomach’s normal position, repair the hiatal hernia and create a fundoplication or wrap (using the stomach) to strengthen a weak sphincter.
Surgery is done laparascopically using a minimally invasive approach. Patients spend only one night in the hospital. It has a high success rate, and when performed by an experienced surgeon, you may not require long-term medication.