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Persistent Reflux Disease

Dr. Brent Matthews treats patients at

Center for Advanced Medicine
GI Center
4921 Parkview Place, 8th Floor, Suite C
St. Louis, MO 63110

Phone:  314-454-8877     Fax: 314-454-5396
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Question:  My husband has gastric reflux disease. He has changed his diet and takes medication, but his heartburn and regurgitation remain. What are his options?

Answer:  Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disorder caused by repetitive acid or occasional bile exposure from the stomach to the esophagus. GERD is due to an incompetence or malfunctioning of the lower esophageal sphincter, impaired emptying of the esophagus or a hiatal hernia.

Patients with GERD complain of heartburn, regurgitation, dysphagia (difficulty swallowing) and/or chest pain. Occasionally, patients will experience hoarseness, cough, asthma, erosion of dental enamel or sinusitis.

Excessive acid exposure can lead to complications such as esophagitis or ulceration, stricture (narrowing of the esophagus), or Barrett’s esophagus. Barrett’s esophagus is a precancerous condition characterized by a cellular change (metaplasia) in the lining of the esophagus. Most patients with GERD respond to medication with diet modifications.

But people, like your husband, who do not respond to medical therapy, develop complications of GERD or have a hiatal hernia may require a more thorough evaluation and be candidates for minimally invasive surgery.

Initial diagnostic testing is typically an upper endoscopy, esophagogastroduodenoscopy (EGD), performed by a gastroenterologist to evaluate for esophagitis, stricture, Barrett’s esophagus, hiatal hernia or another cause of the patient’s symptoms and to perform biopsies as necessary. A 24-hour pH or impedance test is performed to objectively document the amount of acid or non-acid reflux.

Esophageal manometry is completed to evaluate esophageal emptying and to exclude a motility disorder of the esophagus.

The goal of surgical therapy is to strengthen the lower esophageal sphincter by wrapping the upper part of the stomach 360-degrees around the lower 1 ½ inches of the esophagus (Nissen fundoplication). This is approached laparoscopically by five very small incisions.

In a patient with a hiatal hernia, the hiatal hernia is repaired to restore normal abdominal anatomy. Frequently, the hiatal hernia is reinforced with a biologic mesh.

Most patients are discharged after an overnight hospitalization and can typically resume a regular diet, normal activity and discontinue GERD medications after a month. Long-term follow-up outcome studies have demonstrated an 80-85 percent effectiveness at controlling GERD symptoms at 10 years.

It is important to select a surgeon with extensive experience with minimally invasive abdominal/GI surgical experience.
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Copyright 2013 Washington University School of Medicine