Acid Reflux: Causes, Treatments, and Surgical Options

Gastroesophageal reflux disease (GERD)

Hello Doctor: I have been troubled by gastroesophageal reflux disease (GERD).
Two months ago, I underwent an upper gastrointestinal 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 as if water is lingering in my throat, and I tend to burp after eating or drinking.
I would like to ask the doctor: 1.
Since I only started experiencing symptoms during the Lunar New Year this year and have never had such issues before, if I opt for surgical treatment, can I fully recover to normal? 2.
Why did this condition suddenly occur? 3.
Is medication effective for this condition? 4.
What exactly is a sliding hiatal hernia? Is it congenital or acquired? Thank you, Doctor.

nick, 20~29 year old female. Ask Date: 2008/08/27

Dr. You Ligang reply Gastroenterology and Hepatology

Hello,
1.
Since I started experiencing symptoms during this year's Lunar New Year, and I have never had such issues before, I would like to know if surgical treatment can lead to a complete recovery.
Laparoscopic surgery is performed by a surgeon using a laparoscope to repair the hiatal hernia, which reduces reflux.
This procedure is an effective treatment.
For certain patients who require long-term medication, have complications, or exhibit columnar cell metaplasia in the esophageal mucosa, surgical treatment may be considered.
However, potential postoperative complications such as upper abdominal bloating, difficulty belching, and significant weight loss must also be taken into account.
2.
Why did this condition suddenly occur? Hiatal hernias are more common in individuals who are overweight, older adults, or women.
There are many causes of gastroesophageal reflux disease (GERD), and the true cause is often unknown for many patients.
Individuals with dry eye syndrome may have reduced saliva, making them more susceptible to this condition.
Patients with scleroderma have impaired esophageal motility, which can easily lead to reflux.
Older adults with hiatal hernias may have a compromised lower esophageal sphincter, making it easier for acid to reflux.
Additionally, patients with gastric emptying disorders due to various reasons may experience prolonged gastric acid retention, which can also lead to GERD.
Other factors such as lying down after eating, anxiety or insomnia, smoking, and obesity can trigger gastroesophageal reflux disease.
3.
Is medication effective for this condition? Medications are very effective for gastroesophageal reflux disease.
It is recommended to use the branded proton pump inhibitor NEXIUM 40 mg, as it tends to be more effective, along with lifestyle and dietary adjustments.
A small number of individuals may require high-dose treatment (twice a day) to achieve effectiveness.
4.
What is a sliding hiatal hernia, and is it congenital or acquired? Congenital hiatal hernias generally occur in newborns and are primarily due to a congenital defect in the diaphragm.
Acquired hiatal hernias are caused by factors such as aging, obesity, smoking, and heavy lifting.
Wishing you good health,
Dr.
You Li-Kuang, Taoyuan Hospital, Department of Health

Reply Date: 2008/08/27

More Info

Acid reflux, also known as gastroesophageal reflux disease (GERD), is a condition where stomach acid flows back into the esophagus, causing symptoms such as heartburn, regurgitation, and discomfort. Your situation, involving sliding hiatal hernia and mild inflammation at the pylorus, is quite common and can contribute to the symptoms you're experiencing. Let's address your questions one by one.

1. Can surgery completely restore normal function?
Surgical options for treating GERD, particularly when associated with a hiatal hernia, can be quite effective. The most common surgical procedure is called fundoplication, where the top of the stomach is wrapped around the lower esophagus to prevent acid reflux. Many patients experience significant relief from their symptoms post-surgery, and some may even achieve a complete resolution of their reflux symptoms. However, it's important to note that while surgery can greatly improve quality of life, it may not guarantee a complete return to normal function for everyone. Factors such as the severity of the condition, the presence of other gastrointestinal issues, and individual anatomy can influence outcomes.

2. Why did this condition suddenly appear?
The onset of GERD symptoms can be attributed to various factors. In your case, the development of a sliding hiatal hernia may have contributed to the sudden appearance of symptoms. A sliding hiatal hernia occurs when part of the stomach pushes through the diaphragm into the chest cavity. This can happen due to increased abdominal pressure from factors such as obesity, pregnancy, or even chronic coughing. Additionally, lifestyle changes, dietary habits, and stress can also play a role in the sudden onset of reflux symptoms. It's essential to evaluate these factors with your healthcare provider to identify potential triggers.

3. Is medication effective for this condition?
Medications such as proton pump inhibitors (PPIs) and H2 receptor antagonists are commonly prescribed to manage GERD symptoms. The medications you mentioned, RICH (likely a PPI) and DOMPERAN (which is a prokinetic agent), can help reduce stomach acid production and improve gastric emptying, respectively. While these medications can be effective in alleviating symptoms, they may not address the underlying anatomical issues, such as a hiatal hernia. Therefore, while you may experience symptom relief, it is crucial to discuss with your doctor whether long-term medication is the best approach for your specific situation.

4. What is a sliding hiatal hernia, and is it congenital or acquired?
A sliding hiatal hernia is characterized by the movement of the gastroesophageal junction and part of the stomach into the thoracic cavity through the diaphragm. This type of hernia is more common and can be either congenital (present at birth) or acquired over time. Factors that contribute to the development of a sliding hiatal hernia include age, obesity, pregnancy, and increased abdominal pressure. In many cases, it is acquired due to lifestyle factors and changes in the body's structure over time.

In conclusion, managing GERD often requires a multifaceted approach that includes lifestyle modifications, medication, and possibly surgical intervention. It is essential to maintain open communication with your healthcare provider to tailor a treatment plan that best suits your needs and addresses your symptoms effectively. If you continue to experience discomfort despite medication, further evaluation and discussion about surgical options may be warranted.

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