GERD; Hiatal Hernia; Acid Reflux
This is a condition in which acid made in your stomach (and which normally remains in your stomach) flows back (or “refluxes”) into your esophagus (swallowing tube). It occurs due to an incompetent sphincter or pressure barrier that normally separates the esophagus and stomach and is only meant to open to allow the passage of ingested food unidirectionally downward. The main symptom of GERD is heartburn (a burning sensation behind the breastbone) though other symptoms can also result (trouble swallowing, cough, throat clearing, hoarseness). Sometimes the incompetent sphincter is associated with a HIATAL HERNIA, which simply means that a small part of the upper stomach ”herniates” upwards through the gap (or” hiatal”) created by a weak sphincter, making it easier for acid to flow backwards into the esophagus.
The cornerstone of treatment of GERD is to decrease the volume of acid produced by the stomach, so that the refluxed material is less damaging to the esophagus. Nowadays, the class of medications known as proton pump inhibitors (Nexium, Prilosec, Prevacid, Aciphex, etc.) is our most effective means of achieving this goal. In the rare cases when medication is not effective, a hiatal hernia (if present) can be repaired surgically by a relatively simple laparoscopic procedure.