Gastroesophageal reflux, achalasia of the esophagus

Hiatal hernia and gastroesophageal reflux

What is gastroesophageal reflux disease (GERD)?

A hiatal hernia is the weakness – bulging of the hole in the diaphragm (the muscle that separates the chest cavity from the abdominal cavity) through which the esophagus passes. It is classified into:

  • type I (sliding)
  • type II (paraesophageal in which the fundus of the stomach also bulges through the mediastinum) and
  • type III (a combination of the two above categories)

These hernias cause reflux of acidic gastric fluids from the stomach into the esophagus, causing pain, heartburn and over time erosion, damaging the esophagus to the point of dysplasia (Barrett’s esophagus) and eventually esophageal cancer.

In addition to the typical symptoms due to the “injury” of the esophagus, acid reflux causes symptoms in the upper and lower respiratory tract as well, such as chronic cough, laryngitis, chronic sinusitis or aspiration pneumonia, and asthma.


Symptoms and risk factors for GERD

A diagnosis of GERD is made if a patient suffers 2 – 3 episodes per week. The most common symptoms of the disease are heartburn and pressure in the chest. Other symptoms include a feeling of sour taste, persistent hoarseness of the voice, pain in the throat accompanied by coughing, chronic sinusitis and more.

Diet is a risk factor for GERD. Fried, fatty and richly spiced food, alcohol and coffee abuse contribute to the production of gastric acid.

Research has linked obesity, stress and smoking to more severe symptoms of the disease.


Treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease is a common condition that affects a lot of people. It is initially treated conservatively with medication and 90% of patients have a good response to that.

However, a significant percentage of patients relapse despite medication, while in recent years long-term medication has been blamed for damages to the liver and central nervous system.

For the majority of patients with reflux, the cause is a Type 1 hiatal hernia.

Hiatal hernia repair is carried out with laparoscopy or even better robotic surgery by reconstructing the normal “valve” of the gastroesophageal junction from the stomach wall. This “valve” prevents stomach contents from re-entering the esophagus.

 If the hiatal hernia opening is large, then the diaphragm may require mesh reinforcement.

Surgical repair is carried out with laparoscopy or robotic assistance using special tools through small incisions (5-10 mm).

Post-operative pain is minimal, the patient gets out of bed the same day and leaves the hospital in 24 to a maximum of 48 hours. The patients’ diet for 10 to 20 days after the surgery consists of liquids and creams-purées. After that time, the patient is free to eat all kinds of food no longer needs to take reflux medication.

With surgical treatment, the vast majority of patients are relieved of their symptoms.


Diet and Nutrition – Tailored advice to GOP

If you adopt some simple habits, then you will see a dramatic improvement in your symptoms.

To begin with, it is good to avoid large portions of food. Prefer small and frequent meals and try to eat slowly, chewing your food well. Very fatty and acidic meals make reflux worse.

Given that excess weight also worsens reflux, ask your doctor to recommend a diet adapted to your habits and taste preferences.

Finally, avoid lying down immediately after a meal.