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Diseases & Conditions

GERD Hiatal Hernia & Heartburn

What is gastroesophageal reflux?

Gastroesophageal reflux or GERD, is the presence of stomach contents in the esophagus. A weakened valve between the esophagus and stomach allows gastric contents to irritate the esophagus.

GERD affects many people, and usually presents itself as heartburn. In most cases, heartburn can be relieved through diet and lifestyle changes.

Tips to control heartburn
  1. Avoid foods and beverages that irritate the esophagus and might further weaken the muscular valve. These include fried and fatty foods, peppermint, chocolate, alcohol, coffee, citrus fruits and juices, and tomato products.
  2. Lose weight if you are overweight.
  3. Stop smoking.
  4. Elevate your head 6 inches when lying on your back.
  5. Avoid lying down two to three hours after eating.
  6. Take an over-the-counter antacid.

Decreasing your portion sizes at mealtime might also improve symptoms. Eating meals at least two to three hours before bedtime might lessen reflux by allowing the acid in the stomach to decrease and the stomach to partially empty.

What is the role of hiatal hernia as a cause of reflux?

Heartburn occurs when the lower esophageal sphincter (LES) is not as strong as normal. This allows stomach acid to escape back into the esophagus and create discomfort.

Hiatal hernia is diagnosed when the stomach moves up into the chest through the opening in the diaphragm. (The diaphragm is the boundary that separates the abdominal contents from the chest cavity.) The opening in the diaphragm acts as an additional sphincter around the stomach and creates an area where stomach acid is held.

Hiatal hernia might not require treatment unless it is in danger of strangulation or complicated by GERD.

What are the goals of therapy?

  • Eliminate the patient's symptoms
  • Heal esophageal injury
  • Manage or prevent relapse
  • Prevent complications

What diagnostic tests are associated with reflux-associated problems?

  • Barium meal U.G.I.
  • Upper endoscopy
  • 24-hour ph monitoring
  • Esophageal manometry
  • Gastric emptying studies

Does GERD and hiatal hernia require surgery?

A small number of patients might need surgery because of poor response to medical therapy.

Although these conditions can limit daily activities, with an understanding of the causes and proper treatment most people will find relief.

Can surgery help stop GERD?

A laparoscopic repair of hiatal hernia and reflux called Nissen fundoplication can be very effective; 90 percent effective in most patient populations. It requires general anesthesia and a one-day stay in the hospital. Post-operatively, patients no longer require long-term therapy with Prilosec or other antacid medications.


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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 2/1/2012…#7018