April 15, 2002 -- Surgery to relieve heartburn seems to have many satisfied customers. A study finds that up to five years after surgery, many patients still have symptoms -- yet nearly all felt their surgery was working well.
A physical exam for hiatal hernia is similar to that for heartburn, with two additions: X-rays may be ordered to show the hernia, and if anemia is a concern, a blood sample may be taken to check your red blood cell count.
A hiatal hernia can be diagnosed with a specialized X-ray study that allows visualization of the esophagus and stomach (barium swallow) or with endoscopy (a test that allows the doctor to view the hernia directly). An esophageal manometry test (pressure study) may also be performed...
Daily heartburn is medically known as gastroesophageal reflux disease, or GERD, and though excess acid can be tamed through lifelong medication, many people opt for surgery. The surgery corrects the underlying defect in the valve that normally keeps acid from flowing from the stomach back up into the esophagus. However, recent studies have cast doubt on the surgery's long-term effectiveness, since many patients still required medications to control their acid reflux.
The current study finds that although they still have symptoms -- and take action to control them -- "most believe their surgical treatment is working well," writes lead author Jean Y. Liu, MD, MS, researcher at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
The study appears in the April issue of Archives of Surgery.
In the study, Liu analyzed 247 patients, 197 of whom had the laparoscopic procedure -- the less invasive type in which several small holes are made in the abdomen instead of one large cut. After their surgery, 28% were bothered by typical reflux symptoms of heartburn, but only 5% were bothered "a lot" or "terribly" by it; 65% reported bloating, but only 19% were bothered a lot or terribly.
In fact, 80% said they were "delighted or pleased" with their current symptoms; 6% were neutral; and 14% felt unhappy or terrible. Overall, 90% believed their surgery was working well, and 50% reported that it was working "perfectly." When asked about their eating and sleeping habits, 86% reported they were able to "eat what they want, when they want" and 81% reported that their "sleeping habits were back to normal."
The researchers write that patients undergoing laparoscopic surgery for acid reflux should not expect surgery to cure their problem. Many will continue to experience some symptoms or need to take some action to control these symptoms. Most patients, however, will experience significant improvement in their heartburn symptoms.