Reflux and GORD
Reflux, Gastro-Oesophageal Reflux Disease (GORD) and Hiatus Hernia: Causes, Symptoms, and Surgical Treatment
Gastro-Oesophageal Reflux Disease (GORD), commonly known as acid reflux, is a chronic condition affecting 15-20% of the Australian population. It occurs when stomach acid repeatedly flows back into the oesophagus, leading to irritation, inflammation, and discomfort. While occasional heartburn is common, persistent and severe acid reflux can significantly impact quality of life.
Many individuals manage GORD with lifestyle changes and medications, such as proton pump inhibitors (PPIs), which reduce stomach acid production. However, in cases where symptoms persist despite medical therapy, or when reflux affects sleep, eating, and daily activities, surgical intervention such as laparoscopic fundoplication may provide long-term relief.
If a hiatus hernia is contributing to reflux, surgery to repair the hernia and restore normal anatomy may be necessary. Dr. Goutham not only investigates causes of abdominal pain such as GORD but can also provide minimally invasive techniques to treat GORD and hiatus hernias, helping patients regain control over their health.
What Causes Reflux?
GORD occurs when the body’s natural anti-reflux mechanisms become weakened, allowing stomach acid to move up into the oesophagus. The lower oesophageal sphincter (LOS), a muscular valve that normally prevents acid from rising, can lose function due to several factors, including:
- Hiatus Hernia: A common condition where part of the stomach slides into the chest through the diaphragm. This weakens the LOS, making reflux more likely.
- Oesophageal Dysmotility: A disorder where the oesophagus doesn’t contract properly, preventing acid from clearing effectively.
- Obesity and Excess Abdominal Pressure: Increased pressure on the stomach can force acid back into the oesophagus, increasing reflux symptoms and contributing to the development of a hiatus hernia.
- Dietary and Lifestyle Factors: Smoking, excessive alcohol intake, consuming fatty or spicy foods, and overeating can all worsen acid reflux. This is usually in the context of excessive acid production.
Symptoms of Reflux and Hiatus Hernia
GORD symptoms can vary from mild to severe and are classified as either typical or atypical.
Typical Symptoms:
- Heartburn – A burning sensation behind the breastbone, often worsening after meals or when lying down.
- Regurgitation – A sour or bitter taste in the mouth due to stomach contents refluxing into the throat.
- Dysphagia – Difficulty swallowing, often due to oesophageal irritation or narrowing from chronic acid exposure.
Atypical Symptoms:
- Chest Pain or Ear Pain – Often mistaken for heart-related issues.
- Chronic Throat Problems – Hoarseness, laryngitis, throat pain, or persistent throat clearing.
- Respiratory Symptoms – Chronic cough, asthma-like symptoms, recurrent chest infections, or sinus issues.
- Dental Problems – Acid erosion of tooth enamel, a metallic or burning taste in the mouth, or persistent bad breath.
If left untreated, GORD can lead to complications such as oesophagitis (inflammation of the oesophagus), Barrett’s oesophagus (a precancerous condition), or even oesophageal cancer. Early diagnosis and treatment are essential to preventing long-term damage.
Management of Reflux and Hiatus Hernia
Non-Surgical Management
For mild to moderate cases, initial treatment focuses on:
- Lifestyle Changes – Maintaining a healthy weight, avoiding large meals, reducing alcohol intake, quitting smoking, and elevating the head of the bed can help alleviate symptoms.
- Dietary Modifications – Limiting acidic, spicy, and fatty foods can reduce reflux episodes.
- Medications – Proton pump inhibitors (PPIs) help decrease acid production and provide symptom relief.
While these measures work for many, they do not address the underlying anatomical issues, such as a hiatus hernia or a weak LOS. Patients with persistent or severe symptoms despite conservative treatment may benefit from surgical intervention.
Surgical Treatment for Reflux and Hiatus Hernia
Laparoscopic Fundoplication: A Minimally Invasive Solution
For patients with severe GORD or a hiatus hernia contributing to reflux, laparoscopic fundoplication is a highly effective surgical option. This minimally invasive procedure involves:
- Repairing the Hiatus Hernia – If present, the stomach is repositioned below the diaphragm, and the opening in the diaphragm is tightened to prevent future herniation.
- Strengthening the Anti-Reflux Barrier – The upper portion of the stomach (fundus) is wrapped around the lower oesophagus, reinforcing the LOS to prevent acid reflux.
- Minimally Invasive Benefits – Small incisions, faster recovery, less post-operative pain, and a quicker return to daily activities compared to traditional open surgery.
Success Rates and Long-Term Outcomes
Laparoscopic fundoplication has a high success rate, with most patients experiencing significant relief from reflux symptoms. Many patients are also able to reduce or completely stop taking acid-suppressing medications.
Post-operative dietary guidelines
Following laparoscopic fundoplication, temporary difficulty swallowing solid foods is common due to post-surgical swelling at the gastro-oesophageal junction. To promote healing and ensure comfort, patients are advised to follow a gradual dietary progression:
✔ Phase 1: Liquid Diet (First Few Days) – Clear broths, juices, and smooth soups.
✔ Phase 2: Soft or Pureed Foods (Weeks 1-2) – Mashed vegetables, yogurt, and soft cereals.
✔ Phase 3: Gradual Reintroduction of Solid Foods (Weeks 3-6) – Chewing food thoroughly and eating smaller meals to prevent discomfort.
To prevent constipation and aid digestion, maintaining adequate hydration and fiber intake is essential. A food processor or blender can help create easily digestible meals during the early recovery period.
When to Seek Specialist Care for Reflux and Hiatus Hernia
If you experience:
- Severe reflux symptoms that persist despite medication
- Frequent regurgitation affecting sleep and daily activities
- Difficulty swallowing or chronic throat irritation
- Unexplained chest pain, persistent cough, or worsening asthma
It is essential to consult a specialist for further evaluation. Surgical intervention may offer a long-term solution, improving your quality of life and reducing the risk of complications.
Schedule a Consultation with Dr. Goutham
Dr. Goutham specialises in minimally invasive surgery for GORD and hiatus hernias, offering comprehensive assessments and tailored treatment plans. Whether through lifestyle modifications, medication, or laparoscopic surgery, Dr. Goutham provides expert care to help you achieve lasting relief from acid reflux.
