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Heartburn Have Your Attention?

November 2nd, 2016

It might be something more serious. If you suffer from frequent heartburn, you’re not alone. More than 60 million American adults report heartburn symptoms at least once a month. More than 15 million deal with it every day. But what’s the cause? And is there a solution? 

Gastroesophageal Reflux Disease or GERD, is a digestive disorder affecting the lower esophageal sphincter (LES), the ring of muscle between the stomach and esophagus. GERD causes symptoms like heart burn or indigestion and sometimes people develop GERD due to hiatal hernia. Hiatal hernia occurs when the stomach bulges up into the chest through the opening in the wall of muscle that separates the chest from the abdomen. 

“GERD occurs when the communication between the esophagus and the stomach is abnormal, and gastric acid refluxes up in to the esophagus,” says Heath Giles, M.D., board certified general surgeon with University Surgical Associates. “It leads to heartburn and indigestion initially, and then eventually leads to other symptoms like clearing of the voice, coughing, and difficulty swallowing. When left untreated, the condition will continue to progress to constant coughing and hoarseness through the day and night, and damage to the esophagus itself.” 

Lifestyle Changes, Medications, Surgery 

In many cases the first line of treatment for GERD is lifestyle and medical management. Losing weight, avoiding foods that contain acid like caffeine and chocolate and elevating the head of the bed are good places to start. Recent advances in medication are also changing the nature of treatment for GERD. In fact, many people get symptom relief with a combination of medicine and lifestyle changes – and never need to see a surgeon. 

“For people who have not seen relief with those treatments or are having complications – like changes in the esophagus that could be pre-cancerous, having issues with pulmonary problems like asthma and bronchitis, complications with a hiatal hernia, difficulty swallowing, compression of the stomach – an evaluation for anti-reflux surgery is appropriate,” Dr. Giles says. 

“If anti-reflux surgery is necessary, it’s important that each individual receives the right procedure. That decision is based on a range of tests that give the surgeon information about how a person’s body would likely respond,” Dr. Giles explains. “When people come to see us for this surgery, they are understandably interested in moving quickly to schedule the procedure. But in order to ensure we are offering the right option for every person, we need a large body of information to make the most informed and best decision that leads to a good outcome.”

The Process of Diagnosis 

According to Dr. Giles, several types of tests are used to rule out other potential causes of GERD and help ensure the highest likelihood of success with surgery. 

  • Upper endoscopy is a procedure that looks inside the digestive tract (esophagus, stomach and upper part of the small intestine) and is used to identify inflammation, ulcers, and rule out the potential for other malignancies (or presence of tumors). It also helps confirm whether acid reflux has resulted in changes within the esophagus that are consistent with the condition. 

  • An esophageal motility study (EMS) assesses the function of the upper and lower esophageal sphincter to determine if there is an appropriate level of esophageal motility. This is important because during the anti-reflux procedure, the stomach is wrapped around the base of the esophagus to tighten the communication between the two organs. This naturally creates a partial obstruction, and it’s important to understand how that will affect other parts of the digestion process. 

  • A barium swallow test can be used to determine the cause of painful swallowing, difficulty swallowing, or to rule out any structural problems in the esophagus. During this painless test, x-rays of the esophagus are taken after swallowing a solution of barium. 

Armed with Information 

When it comes to your health and decision making, information is a great tool. Once your surgeon has determined that anti-reflux surgery is appropriate, minimally invasive laparoscopic or robotic surgery is available. 

During robotic-assisted anti-reflux surgery, the surgeon operates through a several small incisions instead of a large open incision. He or she has a 3D view inside your body, and use instruments that bend and rotate – even farther than the human hand can bend! The instruments are guided by the surgeon (who sits at a console nearby). For more general information about robotic surgery capabilities, click here. [insert link to robotic surgery article]. 

If a hiatal hernia is shown to be causing symptoms of GERD, this is repaired first. The surgeon then wraps the upper curve of your stomach around the esophagus and stitches it into place, strengthening the connection between the stomach and esophagus and stopping acid from rising into the esophagus as easily. 

Just like any surgery, there are risks with robotic-assisted anti-acid reflux procedures, including tears in the stomach lining, small intestine or esophagus, a narrowing or tightening of the esophagus, collapsed lung, difficulty swallowing, bloating and uncomfortable gas buildup, or hiatal hernia. Your surgeon will discuss all these risks and how they relate to your individual medical history. 


“Recovery from anti-reflux surgery generally involves an overnight hospital stay, with the majority of patients going home the next day. Dietary modifications, including a complete liquid diet for two weeks and a progressive advancement of soft foods over the next month, are necessary for proper healing,” Dr. Giles says. “This slower paced recovery is directly related to how the procedure changes a person’s eating patterns. Many people learn to eat more slowly – leading to healthier eating and ultimately weight loss.” 

Are you interested in learning more about anti-reflux surgery? Talk with your primary care physician or schedule a consultation with Dr. Giles by calling (423) 267-0466. 

Posted by University Surgical | Topic: New Procedures  | Category: Robotic Surgery

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