Acid Reflux Disorders/GERD
Acid is normally produced in the stomach to aid in digestion. When this acid refluxes up into the esophagus and causes symptoms, a condition called gastroesophageal reflux disease (GERD) occurs. GERD, which affects approximately 20 percent of the US population, is associated with a weak lower esophageal sphincter (the valve that prevents food from climbing up the esophagus from the stomach) and/or a laxity in the diaphragmatic opening separating the chest from the abdomen. Symptoms of GERD can include heartburn, chest pain, hoarseness, chronic cough, asthma, and pneumonia. Complications of prolonged acid exposure include ulcers in the esophagus, esophageal strictures, Barrett’s metaplasia (cells in the esophagus change to more stomach-like cells), and esophageal cancer.
Acid Reflux/GERD Treatments
Medical therapy is the first line treatment for GERD, and consists of medications that decrease acid production, typically proton-pump inhibitors. Medications are generally effective in controlling GERD. Lifestyle changes – such as weight loss, avoiding caffeine and alcohol, and staying upright after meals – can also help improve symptoms as well. Most routine GERD cases are treated by gastroenterologists. However, those suffering from a severe or complex case and who are not responding to medications may be referred to a thoracic surgeon.
Surgical therapy is performed when medical therapy fails and is directed towards reinforcing the lower esophageal sphincter by wrapping a portion of the stomach around the area of the sphincter and tightening the diaphragmatic opening. At Mount Sinai, our experienced thoracic surgeons employ a minimally invasive surgery called laparoscopic Nissen fundoplication (LNF). This operation is accomplished by making small incisions in the abdomen and, with the use of a camera, wrapping the top of the stomach around the lower part of the esophagus. Patients are usually discharged home the next day. The small incisions are barely visible within several weeks of the operation.
Dr. Dong-Seok Lee