Treatment & Surgery for Gastroesophageal Reflux Disease (GERD)
If you need a Nissen fundoplication surgery in Huntsville, used to treat gastroesophageal reflux disease (GERD), hiatus hernia, and heartburn, make an appointment to see our expert team at Alabama Surgical Associates. Our board certified surgeons specialize in advanced laparoscopic surgical procedures.
GERD occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach.
The main symptoms are persistent acid regurgitation and heartburn, caused by refluxed stomach acid touching the lining of the esophagus. Heartburn that occurs more than twice a week may be considered GERD, and can eventually lead to more serious health problems.
It’s also possible to have GERD without heartburn. Some people experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.
When medicine and lifestyle changes do not alleviate your symptoms, Nissen fundoplication surgery is an option.
No one knows why people get GERD, though a hiatal hernia may contribute. A hiatal hernia, which occurs when the upper part of the stomach is above the diaphragm, makes it easier for the acid to come up. Like GERD, a hiatal hernia can happen in people of any age. Other factors that may contribute to GERD include alcohol use, excess weight, pregnancy, and smoking.
Nissen fundoplication is generally the last option for treating GERD. If you have had regular, persistent heartburn or other symptoms, you should first visit an internist, a doctor who specializes in internal medicine, or a gastroenterologist, a doctor who treats diseases of the stomach and intestines.
The first steps are to make lifestyle changes, such as giving up smoking, reducing or stopping alcohol intake, losing weight where necessary, and eating smaller meals. Your doctor may also recommend that you wear looser clothes, avoid lying down for three hours after a meal, and raise the head of your bed.
Your doctor is likely to recommend medication before suggesting a Nissen fundoplication. These medications include over-the-counter antacids such as Alka-Seltzer and Mylanta, and prescription medications which stop the acid production or help the muscles that empty your stomach.
If your heartburn does not improve with lifestyle changes or drugs, you may need additional tests.
- A barium swallow radiograph uses x rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus.
- Upper endoscopy allows the doctor to see the surface of the esophagus and search for abnormalities with a tiny camera. This test can confirm GERD if it shows injury to the esophagus and you have also had moderate to severe symptoms.
- In an ambulatory pH monitoring examination, a tiny tube measures when and how much acid comes up into your esophagus over a 24 hour period. This test is useful for people with GERD symptoms but no esophageal damage. It ca also detect whether respiratory symptoms, such as wheezing and coughing, are triggered by reflux.
Fundoplication, usually the specific variation called Nissen fundoplication, is the standard surgical treatment for GERD. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.
This procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. To perform the fundoplication, surgeons use small instruments that hold a tiny camera.
This procedure has been performed safely and effectively with a laparoscopic instrument on people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. What’s more, the healing time is much faster. People can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.
Surgery is one way to avoid the serious complications that can sometimes develop from GERD. Continued inflammation of the esophagus can lead to bleeding or ulcers, while scarred tissue can narrow the esophagus and make swallowing difficult. Some people develop Barrett’s esophagus, where cells in the esophageal lining take on an abnormal shape and color, which over time can lead to cancer.