What is Gastroesophageal Reflux Disease (GERD)?

During normal ingestion, food travels from the mouth through the esophagus to the stomach, where it remains until it is advanced into the intestine. Muscles in the lower part of the esophagus just above the stomach, called the lower esophageal sphincter (LES), tighten to keep food and digestive acid in the stomach. In people with gastroesophageal reflux disease, these muscles loosen and allow acid to escape (reflux) into the esophagus, the sensitive lining of which is then damaged or burned.

Prolonged acid reflux, known as gastroesophageal reflux disease (GERD), reduces the LES' ability to contract, causing acid to remain in the esophagus longer and leading to extended burning. This in turn causes scarring, nerve damage, tightening of the esophagus, the formation of ulcers, and bleeding.

What are the symptoms of GERD?

The most common symptom is heartburn, the burning sensation felt in the center of the chest when acid and partially digested food move from the stomach to the esophagus. Other signs that you may have GERD include:

• Belching
• Regurgitation of food
• Nausea and vomiting
• Vomiting blood
• Hoarseness or change in voice
• Sore throat
• Difficulty swallowing
• Cough or wheezing

When is heartburn worrisome?

Heartburn affects almost everyone at some point in their lives. Heartburn that is experienced several times in a 24-hour period, that occurs many times a month, or that causes hoarseness, coughing, bleeding or swallowing difficulties, is not normal and should be examined.

How is GERD treated?

Often GERD symptoms can be treated medically, but when medical treatment fails, surgery is often indicted. The surgical treatment prevents reflux by creating a 'flap' or 'one-way' valve. This surgery is performed laparoscopically in the majority of cases. The procedure is very similar to that for a paraesophageal hernia.

A paraesophageal hernia is a type of hiatal hernia that occurs when part of the stomach squeezes through the hiatus, an opening in the diaphragm, and ends up next to the esophagus while the rest of the stomach and the esophagus remain in place.

Patients with a paraesophageal hernia may experience:

• Severe chest pain
• Stomach pain
• Difficulty swallowing
• Nausea
• Vomiting
• Indigestion

The specific cause of this condition is not known, although they can occur after an injury in the affected area or from increased pressure in the abdomen after excessive coughing, pregnancy or weight gain. This condition occurs most commonly in patients who are over the age of 50, overweight and smokers.

A paraesophageal hernia can be diagnosed through a specialized X-ray exam called a barium swallow, which allows your doctor to clearly identify abnormalities of the esophagus.

Although less common than other types of hernias, a paraesophageal hernia can lead to serious complications such as incarceration and strangulation. If signs of these complications begin to occur, immediate surgery may be required to treat the condition and prevent permanent damage.

Surgery for a paraesophageal hernia can usually be performed laparoscopically, and involves repositioning the stomach and reinforcing the hiatus. During this procedure, several tiny incisions are made in the abdomen, where the laparoscope and small surgical instruments are inserted to repair the hernia.

Some patients do not experience any symptoms from a paraesophageal hernia, and therefore may not require any treatment for this condition. However, it is important to regularly monitor this condition and seek medical attention at the first signs of incarceration or strangulation.