Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) is a common digestive disorder with symptoms of heartburn in which stomach contents regurgitate (reflux) into the esophagus often causing inflammation and damage to the esophagus and occasionally to the lungs and vocal cords. While there are several causes of this disorder, surgery is most effective for those patients whose GERD is caused by a defective lower esophageal sphincter (LES), the muscle connecting the esophagus with the stomach. In general, more than 90% of patients who undergo surgery have no reflux after surgery.

Patients can benefit from a procedure called fundoplication to strengthen the lower esophageal sphincter and prevent acid reflux. Patients who undergo the procedure no longer need long-term medication to control GERD.

Pre-Operative Tests

Before surgery can be considered, it is important that the diagnosis and particular cause of the GERD is confirmed. Therefore, a history of signs and symptoms is evaluated and various tests are performed.

One of the tests which is performed is manometry, which involves passing a small flexible tube through the nose into the esophagus and stomach in order to measure pressures and function of the esophagus. Another test is the pH probe, which measures the amount of acid refluxed into the esophagus over 24 hours.

An upper endoscopy may also be necessary to look for possible areas of stricture. Endoscopy involves passing a flexible tube with a small visualization device into the mouth and down through the stomach. Biopsies (small tissue samples) can also be obtained from an endoscopy to confirm the diagnosis of esophageal inflammation and to exclude Barrett's esophagus, the transformation of esophageal cells into stomach lining cells after years of reflux.

Other tests which may be necessary include an upper GI series or a barium swallow x-ray, which can show the acid reflux and inflammation of the esophagus as well as the presence of hiatal hernia, which occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm, often causing LES dysfunction.