"Surgery is successful for most patients -- in fact, the patient who has done well with medications but doesn't want to take them long-term will do well with surgery," says Radhika Srinivasan, MD, a gastrointestinal specialist and assistant professor of medicine at the University of Pennsylvania in Philadelphia.
In fundoplication surgery, a "wrap" is created around the stomach to strengthen the lower esophageal sphincter -- the "flap" that controls acid from entering the esophagus. The procedure can be done laproscopically -- through a tiny slit in the abdomen, while the patient is under general anesthesia, which requires only a brief hospital stay.
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...
Some medical centers offer an endoscopic procedure, Srinivasan says. A tube is inserted into the esophagus, and stitches and a "drawstring" are created at the end of the esophagus.
"Radiofrequency ablation" is another cutting-edge procedure not available everywhere; in this procedure, the surgeon creates scar tissue at the end of the esophagus, to help block reflux.
The advantage of these procedures: They're done under conscious or "twilight" sedation -- in an outpatient surgical center or hospital GI unit -- and don't require a hospital stay.
But surgery may not solve all your heartburn problems, she says. "Not all patients can stay away from medications entirely, even after the surgery." Some must continue taking a protein pump inhibitor like Nexium. Also, if the wrap is too tight, the patient may develop a gas-bloating problem -- or may be unable to burp. A too-tight wrap can become ineffective, she adds.
So, scientists are studying other surgical options.
A study presented earlier this year at a meeting of gastroenterology doctors showed that nearly two-thirds of patients who underwent a new procedure called the Stretta procedure were off all acid-blocking drugs a year afterward.
With the patient conscious but under heavy sedation, a thin tube, or catheter, with a balloon at the end is guided through the mouth to the end of the esophagus just above the stomach. There the balloon is inflated, exposing four sharp probes on the outside of the balloon. The probes then discharge high-frequency radio waves into the muscle at the top of the stomach.
After several rounds of this process, the muscle -- which is too loose in GERD patients -- becomes much tighter. Tightening the muscle keeps stomach acid from splashing up into the esophagus.