Connecting the Dots: Gastroesophageal Reflux Disease and Hiatal Hernia

Commonly understood as Acid reflux, Gastroesophageal disease is one of India’s most common lifestyle diseases. Mostly, in the beginning, heartburns or acid refluxes are minor which are caused after overeating or eating spicy food or certain types of food like pizza, etc. These can be managed easily at home with medications prescribed by a physician however if these episodes of acid refluxes become persistent, one must seek a consultation with a gastroenterologist who may advise some investigations or endoscopic evaluation to rule out GERD i.e. Gastroesophageal Reflux Disease. In simple words, reflux becomes a disease when it causes frequent and severe symptoms like extreme burning sensation in the food pipe and undigested food moving up from the stomach into the food pipe.

Prolonged and untreated cases of GERD can lead to scarring of the tissue in the esophagus which leads to its narrowing. This is often referred to as an esophageal stricture. The inflammation caused due to this can lead to ulceration and even precancerous or cancerous changes in severe rare cases.

GERD associated with a Hiatal hernia is another common condition that can be completely cured with a minimally invasive hernia repair procedure. A Hiatus or Hiatal hernia develops when a hole in the diaphragm (hiatus) through which food and liquids pass from the esophagus into the stomach enlarges. This causes the stomach to slide upward into the chest in turn leading to acid reflux and movement of the undigested food back into the food pipe. Untreated cases can even lead to serious complications like obstruction or strangulation of the stomach which could be potentially life-threatening.

Hiatal hernia is usually caused due to weakened muscles of the diaphragm or structural abnormalities in the diaphragm. Other causes include obesity, pregnancy, and excess pressure due to constipation, coughing, sneezing. The most common symptoms of hiatus hernia are a burning sensation in the chest, usually after eating and worsens at night, chest pain, difficulty in swallowing, regurgitation of food, a sensation of a lump in the throat. The treatment is simple and is usually done as a daycare procedure. The surgeon enters laparoscopically or with the next generation robot, Versius from CMR Surgical, Cambridge, UK. The procedure is called Nissen Fundoplication in which the stomach is pulled back from the chest and the hole is repaired with mesh placement. Patients are up and about on the same day of the surgery, there is minimal pain or blood loss, and excellent cosmetic results. There are no diet restrictions or restrictions for the patient regarding physical activities.