Houston UT MIST bariatric surgeon Erik B. Wilson MD discusses the options available for patients suffering from GERD and acid reflux caused by a hiatal hernia. For patients who cannot obtain relief from lifestyle modification or who prefer to avoid the risks of long-term medication therapy, minimally invasive laparoscopy surgery or non-invasive, incision-free surgical options can provide permanent relief from painful, disruptive gastric reflux.
Hiatal hernia treatment options depend on the size of the hernia and the severity of the symptoms. A hiatal hernia develops when a portion of the stomach protrudes through the hiatus, or opening in the wall of the diaphragm muscle, and into a person’s chest. Common among people over fifty, a hiatal hernia typically causes gastroesophageal reflux disease (GERD) because stomach acids that are forced back into the esophagus create a burning sensation commonly known as acid reflux or heartburn.
Individuals who suffer from GERD should seek treatment as soon as possible, especially if symptoms have been present for many years. Chronic acid reflux can lead to a condition called Barrett’s esophagus, a thickening of the lining of the esophagus in response to repeated exposure to harsh stomach acid. Over time, the cellular changes that cause this condition can lead to esophageal cancer. At Houston’s UT MIST Center for Bariatric and Metabolic Surgery, we employ a three-pronged approach to treating hiatal hernia and associated symptoms: control pain and discomfort, prevent GERD-related complications, and heal the damaged esophageal tissue.
At UT MIST, we have successfully treated thousands of patients suffering from unrelieved symptoms related to hiatal hernia. Treatment options are customized for each patient, based on the size of the hernia and the duration and severity of symptoms. Common options include lifestyle changes, pharmaceutical intervention, and minimally invasive hiatal hernia surgery.
Hiatal Hernia Causes and Risk Factors
Pinpointing the exact cause of a hiatal hernia can prove difficult, and in all likelihood, a combination of factors leads to its development. Potential causes may include one or more of the following: congenital abnormality, injury to the diaphragm, heavy lifting, or excessive pressure on surrounding muscles due to persistent coughing, straining during daily bowel movements, or frequent vomiting.
Obese patients with a BMI of 35 or greater have a higher likelihood of developing a hiatal hernia, and as many as 50 percent of these patients have asymptomatic hiatal hernias. The condition is also more common in patients over 50 simply because our muscles, including our diaphragm, weaken with age.
For patients with mild acid reflux related to their hiatal hernia, we typically begin by recommending lifestyle modifications to control symptoms. These include losing weight, eating the last meal of the day two or three hours prior to bedtime, consuming many small meals instead of a few large ones throughout the day, eliminating trigger foods and beverages (e.g., spicy or high-fat foods, tomatoes, citrus, onions, carbonated drinks, and alcohol), and elevating the head of the bed six to eight inches. We also recommend that patients stop smoking.
When lifestyle modification alone does not relieve GERD symptoms related to a hiatal hernia, medications often provide relief. These might include over-the-counter antacids, H-2-receptor blockers (H2RAs), or proton-pump inhibitors (PPIs) that block acid production and enable the damaged esophageal tissue to heal. Some patients may require prescription-strength H2RAs or PPIs.
According to a January 29, 2016, article in the New York Times, occasional use of proton-pump inhibitors to treat acid reflux appears to be safe; however, daily, long-term use may accelerate vascular aging, leading to serious side effects such as dementia, heart disease, and kidney disease. For this reason, patients with chronic, long-term heartburn should seek professional medical guidance if they have been self-medicating to control symptoms.
Hiatal Hernia Surgery
When lifestyle and pharmaceutical therapy fail, hiatal hernia surgery may be indicated to relieve chronic acid reflux and GERD. At Houston’s UT MIST Center for Bariatric and Metabolic Surgery, the most common procedure we perform is fundoplication. Unlike pharmaceutical therapy, the aim of this procedure is not to suppress acid, but rather to restore anatomical structures to prevent abnormal acid exposure to the esophagus. During fundoplication, the upper part of the stomach, or fundus, is plicated, or wrapped, around the esophagus and secured with stitches into position. Our surgeons typically perform this procedure via a minimally invasive or completely non-invasive approach, although it can be performed as an open procedure if needed. Following surgery, 85 to 90 percent of patients experience a reduction in symptoms, and most are able to discontinue acid-reflux medications altogether.
Minimally invasive hiatal hernia surgery is performed laparoscopically through minute incisions in a patient’s abdomen. A laparoscope, which contains a small camera on the end, is inserted through one of the incisions to enable the surgeon to visualize on a monitor the surgical field. Small surgical instruments are inserted through the other incisions to perform the procedure. Compared to traditional open surgery, laparoscopic surgery decreases the risk of infection and scarring, while increasing the rate of recovery.
A small hiatal hernia can also be repaired through an incisionless approach, called the Transoral Incisionless Fundoplication (TIF®). This innovative, evidence-based surgical procedure is performed through the mouth, with no abdominal incisions. Most patients are able to return to work in less than a week, and clinical studies show fewer long-term complications associated with TIF than with laparoscopic or open surgery.
For more information about hiatal hernia treatment options or to schedule an appointment at the Houston UT MIST Center for Bariatric and Metabolic Surgery, visit our website.
The seven board-certified surgeons led by Dr. Erik Wilson at UT MIST Center for Bariatric and Metabolic Surgery in Houston, Texas, perform thousands of surgeries each year. The practice specializes in minimally invasive endoscopic, laparoscopic, and robotic surgeries, and offers primary surgery, revisional surgery, medical surgery, and surgery for low BMI. The doctors also perform endoluminal surgery and endoscopic, incisionless bariatric surgery, as well as other gastrointestinal surgeries, including endoscopic gastric reflux surgery, hernia repair, robotic colon surgery, and robotic solid organ surgery. A medical weight-loss component is available, too. Given the university setting, the surgeons routinely teach other surgeons and medical students how to do operations. For more information, visit uthoustonweightloss.com or call 713-892-5500.