GERD, LPR, and Hiatal Hernia
Gastroesophageal reflux disease, also known as GERD, is a common disease caused by a weakened lower esophageal sphincter (LES). The hallmark complaint of GERD is heartburn, although there are other associated symptoms. Overtime, reflux can cause changes in the esophageal tissue that may lead to other, more serious medical conditions. GERD is usually managed by a patient’s PCP or gastroenterologist, who may initially recommend medical management (medication) for reflux control. If medication does not alleviate reflux symptoms, there are surgical options.
Laryngopharyngeal reflux (LPR) occurs when there is movement of gastric contents into the laryngopharynx. This is thought to mainly be due to an upper esophageal sphincter issue. Many times this is diagnosed by an Ear, Nose and Throat (ENT) specialist via an in office laryngoscopy.
A hiatal hernia is a condition where part of the stomach moves into the chest cavity through the opening in the diaphragm where the esophagus passes. The diaphragm is a muscle that separates the organs in the chest from the organs in the abdomen and when the stomach slides through the opening, the patient may or may not have the symptoms described below.
GERD is possible with or without hiatal hernia involvement. Hiatal hernia rarely occurs without signs and symptoms of GERD.
Signs and symptoms GERD and LPR with or without a Hiatal Hernia may include:
- Difficulty or painful swallowing
- Heartburn
- Reflux
- Chest pain
- Abdominal pain
- Hoarse voice/voice changes
- Sore throat
- Cough
- Throat clearing (mainly with LPR)
Interventions:
Our service offers a robust foregut program where we offer multiple diagnostic and surgical interventions for patients with GERD, LPR and/or Hiatal Hernia. Our endoscopy suite is fully equipped to perform various diagnostic testing for evaluation of esophageal function.
Diagnostic Interventions:
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Upper endoscopy (EGD) with or without biopsy
This is a procedure where the surgeon uses an endoscope to visualize the structures of the upper GI tract. When the area of concern is seen, a biopsy may be taken and sent for pathology.
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Bravo reflux capsule (pH testing)
Via upper endoscopy, our surgeons will attach a miniature pH capsule (aka the Bravo reflux capsule) into your esophagus to allow for ongoing monitoring of the pH of your esophagus over a 48-96 hour period.
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High resolution Manometry
This test is performed in the endoscopy suite with specially trained nurses who insert a special catheter via the nose that will assess esophageal pressures, movement (peristalsis) and food movement down the esophagus with a series of swallows.
Surgical Interventions:
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LINX
The LINX is a device made of small magnets that is surgically placed around the lower esophageal sphincter (LES) in order to help reinforce the weakened LES. It is designed to remain permanently around the LES. It is placed via a minimally invasive surgery.
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Fundoplication
Fundoplication is a surgical procedure where the upper part of the stomach is wrapped around the lower esophagus. This is usually performed during a minimally invasive surgery. Traditionally, there are 3 different kinds of fundoplications that can be performed: Nissen, Toupet, Dor.
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Hiatal Hernia Repair
Repair of the hiatal hernia involves making a few, small incisions in the abdomen (laparoscopy) and bringing down the part of the stomach that has moved/”herniated” through the diaphragm. The surgery is often times combined with a “reflux” surgery, such as LINX placement or fundoplication.
The LINX is a device made of small magnets that is surgically placed around the lower esophageal sphincter (LES) in order to help reinforce the weakened LES. It is designed to remain permanently around the LES. It is placed via a minimally invasive surgery.Fundoplication is a surgical procedure where the upper part of the stomach is wrapped around the lower esophagus. This is usually performed during a minimally invasive surgery. Traditionally, there are 3 different kinds of fundoplications that can be performed: Nissen, Toupet, Dor.