Gastroesophageal Reflux: Treatment Options and Insights

Gastroesophageal reflux disease (GERD)

Hello Doctor: I have been troubled by gastroesophageal reflux disease (GERD).
Two months ago, I underwent an endoscopy, which revealed a sliding hiatal hernia and mild inflammation at the pylorus.
A biopsy was performed, and the results showed no Helicobacter pylori or abnormal tissue present.
I have been on medication for two months, specifically RICH 30mg "N.k." and DOMPERAN 10mg "SWIS." Although the burning sensation and feeling of a foreign body have decreased, I still experience discomfort after taking the medication.
In particular, after drinking water, I occasionally feel like there is water remaining in my throat, and I tend to burp after eating or drinking.
I would like to ask the doctor, since I only started experiencing symptoms during the Lunar New Year this year and have never had such issues before, if surgical treatment would allow for a complete return to normal? Is medication effective for this condition? Also, what exactly is a sliding hiatal hernia? Thank you, Doctor.

Nick, 20~29 year old female. Ask Date: 2008/08/19

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, sliding hiatal hernia refers to a condition where a portion of the stomach slides up into the thoracic cavity at the esophagogastric junction, often accompanied by gastroesophageal reflux disease (GERD), which exacerbates acid reflux symptoms.
The prevention and treatment of GERD (and reflux esophagitis) primarily focus on dietary and lifestyle modifications.
It is advisable to avoid smoking, alcohol, tea, coffee, spicy foods, glutinous rice products, chocolate, mustard, overly sweet or sour foods, cola, and cold drinks such as milk tea.
Additionally, it is recommended not to eat anything three hours before bedtime and to elevate the head while sleeping.
Consuming liquids in moderation is also beneficial in alleviating symptoms.

In terms of treatment, proton pump inhibitors and prokinetic agents are commonly used in combination.
First-line and second-line treatments are typically administered for four months, while third-line and fourth-line treatments may require a year of therapy.
Surgical intervention, primarily through fundoplication, is considered only in severe cases with recurrent episodes or esophageal stricture.
However, surgical procedures can also pose risks of being too tight or too loose.

Wishing you good health,
Dr.
Chi-Feng Chen, Taoyuan Hospital, Department of Health

Reply Date: 2008/08/19

More Info

Gastroesophageal reflux disease (GERD) is a common condition that affects many individuals, leading to symptoms such as heartburn, regurgitation, and discomfort in the chest and throat. Your experience with sliding hiatal hernia and the associated symptoms, including the sensation of food or water lingering in the throat and persistent discomfort, is not uncommon among those with GERD.

Understanding Sliding Hiatal Hernia
A sliding hiatal hernia occurs when a portion of the stomach pushes upward through the diaphragm into the chest cavity. This anatomical change can disrupt the normal function of the lower esophageal sphincter (LES), the muscle that prevents stomach contents from flowing back into the esophagus. When the LES is compromised, it can lead to increased acid reflux, which may explain your symptoms.

Treatment Options for GERD
1. Medications: The first line of treatment for GERD typically involves medications that reduce stomach acid. Proton pump inhibitors (PPIs) like RICH (30mg) and H2 blockers can help alleviate symptoms by decreasing acid production. Domperidone (DOMPERAN 10mg) is often used to enhance gastric motility, which can help reduce the sensation of fullness and improve gastric emptying. While these medications can be effective, they may not completely eliminate symptoms for everyone, as you've experienced.

2. Lifestyle Modifications: Alongside medication, lifestyle changes can significantly impact GERD symptoms. These include:
- Eating smaller, more frequent meals rather than large meals.

- Avoiding trigger foods such as spicy foods, citrus, chocolate, and fatty foods.

- Elevating the head of your bed to prevent nighttime reflux.

- Maintaining a healthy weight, as excess weight can increase abdominal pressure and exacerbate reflux.

3. Surgical Options: If conservative measures and medications do not provide adequate relief, surgical intervention may be considered. The most common surgical procedure for GERD is fundoplication, where the top of the stomach is wrapped around the lower esophagus to strengthen the LES. This surgery can provide long-term relief from GERD symptoms and is often effective in patients with a hiatal hernia. However, like any surgery, it carries risks and potential complications, so a thorough discussion with a gastroenterologist or surgeon is essential.

Prognosis and Recovery
Regarding your question about whether surgery can lead to a complete recovery, many patients experience significant improvement in their symptoms post-surgery. However, individual outcomes can vary, and some may still experience occasional reflux. It’s important to have realistic expectations and understand that while surgery can be very effective, it may not guarantee a complete resolution of symptoms.

Conclusion
In summary, GERD is a manageable condition with various treatment options available. Medications can help control symptoms, and lifestyle changes can further enhance treatment efficacy. If your symptoms persist despite these measures, discussing surgical options with your healthcare provider may be beneficial. Understanding your condition, including the implications of a sliding hiatal hernia, is crucial in making informed decisions about your treatment plan. Always consult with your healthcare provider for personalized advice tailored to your specific situation.

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