Heartburn Healers
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What is a Hiatus Hernia?
About one out of every four people have one. A hiatus hernia causes malfunctioning of the calve mechanism that sits at the end of the food pipe (esophagus), which keeps the stomach content from backing up. It is more common with advancing age: as many as sixty percent of people over sixty have a hiatus hernia. It is caused by a variety of forces (muscle weakness, trauma, obesity) that stretch the opening in the diaphragm through which the esophagus reaches the stomach.
The stomach then gets pushed up into the opening. The valve mechanism now becomes a funnel, allowing acid and food to back up. This is known as reflux. Reflux occurs when pressure in the abdomen is raised, as when bending over, lying down, straining. The acid content of the stomach burns the lining of the esophagus, causing inflammation and pain, also known as esophagitis.
Ulcers may form when the burning is severe. Eventually, this may lead to narrowing of the esophagus (stricture) or cancer. (While still rare, cancer of the esophagus is the most rapidly increasing cancer of the gastrointestinal tract.) Sometimes, so much of the stomach gets pushed up into the chest
that this alone causes problems. It is common for people with a hiatus hernia
to have stomach acid to come up and get into the windpipe, causing cough, choking, asthma and pneumonia.
Most people who come to us have already tried all kinds of remedies such as antacids and acid-blockers like Zantac®, Tagamet®, and Pepcid® or "third generation drugs like Prilosec®. They have been advised to not eat two hours before going to sleep and to elevate the head of their bed.
When heartburn is a recurring problem, it is important to make an accurate diagnosis of its cause. In our office, we provide the most complete diagnostic equipment available in Central Oregon. Moreover, what makes us unique is that our specialization makes it possible for you to have your tests done without having to see a series of different doctors. We provide "One Stop Shopping".
After taking a history and physical, we would start with an upper gastrointestinal endoscope. With the help of a thin, flexible video scope the esophagus and stomach and upper small intestine are examined. Photographs and biopsies (tiny samples to rule out Helicobacter pylori infection, ulcers etc.) are taken when needed.
If the cause is found to be a hiatus hernia, appropriate medications are prescribed: usually, strong acid production inhibitors such as Prilosec® or Prevacid®, sometimes in combination with other drugs. Surgery is advisable when complications of the disease occur (ulcers, bleeding, stricture, cancer) or when the medications stop their effectiveness. Additionally, it is an option for people who don't want to take pills for the rest of their lives or who cannot afford the expense.
When is surgery the right choice?
When surgery is considered, further tests are necessary. The endoscope has given valuable information about the lining of the stomach and esophagus. With manometry we now assess the function. With the help of a tiny probe that is swallowed, and a powerful computer program, we record the muscle activity and strength of the various parts of the esophagus. In about 5% of patients with heartburn symptoms, the food pipe is too weak to have the valve repaired. It is important to identify these people because for them, surgery might make things worse.
The second part of the computer assisted test is a 24-hour pH measurement. A 2 mm size (like a spaghetti noodle) tube is passed into the esophagus and hooked up to a portable device, carried on your belt, that continuously records the acid level in the esophagus. It is important to continue normal activities and eating habits when this is done. After 24 hours, the tube is removed and the information retrieved. Occasionally, special X-rays are needed as well.
This gives us all the information needed to make a nearly 100% accurate diagnosis and can confidently predict that surgery will solve the problem.
What is involved with surgery?
We use five tiny incisions of the abdominal wall, all less than half an inch, for our instruments to gain access to the abdomen. Thus, while viewing our work on the video monitor, using a 20X magnifying scope, we operate. The opening in the diaphragm is reduced to normal size, the esophagus is "mobilized" and the adjacent stomach is folded around it "like a hot dog bun" which recreates the valve.
After surgery, people stay overnight in the hospital and take a liquid diet as soon as they are awake. Recovery to normal activities takes about four days to a week, and some difficulty swallowing may occur for several weeks. After the first day, regular pain medication usually is enough to control discomfort.
Why have surgery?
Heartburn can be an extremely vexing problem. It can lead to long term, serious complications if not properly treated. Many people are still told by their doctor that they "have to learn to live with it". Nothing is farther from the truth. Accurate diagnosis, optimal treatment with medication, careful selection of those who will benefit from surgery, the use of advanced laparoscopic techniques: it is this combination that allows us to make an accurate diagnosis and provide a patient friendly, minimally invasive cure.
Part of good medical science is to objectively review our work. We keep detailed records of our work and present it in national and international conferences. While no operation is without possible complications, we know that with our extensive experience, you are in good hands.
Recently, we asked 125 of our patients who had had this operation at least a year earlier, how they felt. They were 99% unanimous in their appreciation for having their heartburn healed. With an A+ approval rating, we feel we can confidently recommend surgery when needed.
Additional Resources
For more information regarding heartburn and hiatus hernia, please visit the following websites.
Help Heartburn
Heartburn Alliance
Medicine Net (hiatal hernia page)