GERDOften, the culprit is a condition called gastroesophageal reflux disease, or GERD. Gastroesophageal refers to the stomach and the esophagus, the tube that carries food from the throat to the stomach. GERD causes acid in the stomach to go back up into the esophagus. Symptoms can range from an acid taste in the mouth to a burning sensation in the chest to severe pain, coughing, vomiting and difficulty breathing.
Many patients find relief by avoiding certain foods and beverages, losing weight or taking antacids or prescription medication. But for those with a severe form of the disease who are not helped by medicine, a minimally invasive surgical procedure called fundoplication may be the answer. It was for Bob Hirsch of Manhattan. He says he suffered for more than 20 years until he had the procedure done.
"I can't begin to tell you how much my life has changed since the operation," Hirsch says. "Before the surgery, I would wake up in the middle of the night feeling like I was choking." Now, several years after the operation, Hirsch not only gets a good night's sleep, but can also eat and drink whatever he wants.
GERD is caused by a defect in the lower esophageal sphincter — or LES — which functions as a valve at the lower end of the esophagus. When the LES is doing its job properly, it opens when we eat to allow food into the stomach, and then closes afterward. When the valve becomes acid from the stomach can flow back up into the esophagus.
"It's important for people with chronic GERD, that is, those who've had it for 10 to 20 years along with severe symptoms, to see a doctor," says Dr. Barry Salky of Mount Sinai Medical Center, who performed the surgery for Hirsch at the Laparoscopic Surgical Center of New York.
Sometimes GERD can result in serious complications, such as bleeding in the esophagus or, in a small number of cases, cancer, according to Salky.
Before any operation takes place, the correct diagnosis is critical, says Dr. Mark Reiner, of the Laparoscopic Surgical Center. In the procedure, surgeons make five tiny incisions and insert a laparoscope, a type of fiberoptic telescope connected to a high-resolution video camera. "In essence, we create a new valve by wrapping the top part of the stomach around the lower end of the esophagus to stop the reflux," Reiner explains. Doctors report that 95% of patients will be able to lead normal lives after the operation.
Thirty percent of patients with GERD also have a hiatal hernia, an opening in the diaphragm that allows part of the stomach to shift into the chest. If this is the case, doctors repair the hiatal hernia laparoscopically, too.
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Original Publication Date: 02/20/2000