"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,
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
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.