Acid reflux is usually diagnosed based upon symptoms and response to treatment. Lifestyle changes such as weight loss, raising the head of bed 6 inches when sleeping, avoid acid producing food, quit smoking, avoid late and large meals, chew gum, and avoid tight clothing. Medications may also be used to help but some people may require surgery. Medications include proton pump inhibitors (Prevacid, Prilosec, Nexium), H2 blockers (Zantac, Pepcid, Tagamet, Axid), or Antacids (Tums, Maalox, Mylanta).
Testing involves an EGD, which is a procedure where the esophagus, stomach, and doudenum are viewed. Tests such as the Esophageal PH and Manometry search for the cause of acid reflux, heartburn, chest pain, or swallowing difficulty. PH measures the acid content and Manometry measures the strength and pattern of the muscle contractions in the esophagus. Often a CT scan and/or barium swallow is performed to look at the anatomy of the stomach to determine if someone may have a hiatal hernia.
There are a variety of treatments that are successful in treating GERD including: Medication, please advise your doctor with any side effects you may experience with any medication, Hiatal Hernia repair, TIF (Transoral Incisionless Fundoplication), Nissen or variant (wrap the stomach).
Hiatal Hernia Repair
The surgery is performed on an outpatient basis, either laparascopically or through very small incisions. The stomach is reduced into the abdomen in normal position and then the hernia or hole in the diaphragm is repaired either using sutures and/or mesh. Once the procedure is completed, the stomach will remain in it's anatomical position and the symptoms of GERD or reflux will reduce or resolve. In addition a TIF, Nissen or variant procedure may be needed to help with the valve of the GE junction if that becomes the reason for the reflux. One of the key parts of the procedure is the post-operative plan, you remain on a liquid diet for a few weeks to allow the repair to heal in order to maintain success of the treatment.
TIF or Transoral Incisionless Fundoplication
The TIF procedure is performed by orally inserting a flexible tube with a camera attached to reconstruct the valve entrance from the esophagus to the stomach. If a patient has reflux and no/small hiatal hernia then this is a safe and effective treatment. The EsophyX device is introduced into the mouth (similar to EGD), not through an incision. The TIF procedure reconstructs an antireflux valve at the gastroesophageal junction and reduces hiatal hernia, restoring natural anatomy.
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