Treatment for acid reflux and hiatus hernia in Otago and Southland
Do you experience burning in your chest after eating, regurgitation, or reflux at night?
These symptoms may be caused by gastro-oesophageal reflux disease (GORD), commonly known as acid reflux.
Many people manage reflux with medication and lifestyle changes. However, when symptoms persist despite treatment, anti-reflux surgery can provide long-term relief.
Mark Grant is an Upper Gastrointestinal and Bariatric Surgeon based in Dunedin, providing reflux and hiatus hernia surgery for patients throughout Otago, Southland, Queenstown, Wanaka and Invercargill.
What is gastro-oesophageal reflux disease (GORD)?
GORD occurs when stomach acid flows backwards into the oesophagus.
This usually happens when the valve between the stomach and oesophagus, the lower oesophageal sphincter, becomes weak.
When acid repeatedly enters the oesophagus it causes irritation and inflammation.
Many patients experience a burning discomfort behind the breastbone, commonly referred to as heartburn.
Common symptoms of reflux
Symptoms of reflux disease can include:
- Burning sensation in the chest after eating
- Acid or food regurgitation
- An unpleasant taste in the mouth
- Difficulty swallowing
- Chronic cough or wheezing
- Hoarseness or throat irritation
Some patients also experience night reflux, waking suddenly with acid in the throat.
What causes reflux disease?
Reflux disease is usually caused by weakness of the lower oesophageal sphincter, the valve that prevents stomach contents from travelling back into the oesophagus.
Several factors may contribute to reflux, including:
- Obesity
- Smoking
- Alcohol
- Fatty or spicy foods
- Pregnancy
- Hiatus hernia
What is a hiatus hernia?
A hiatus hernia occurs when part of the stomach moves upward through the diaphragm into the chest.
This weakens the natural barrier preventing reflux and can worsen acid reflux symptoms.
Many patients with reflux disease also have a hiatus hernia.
Treatment options for reflux
Treatment for reflux usually begins with non-surgical management.
Lifestyle changes
Lifestyle modifications may reduce reflux symptoms:
- weight loss
- reducing alcohol intake
- stopping smoking
- avoiding trigger foods
- changing eating and sleeping habits
Medication
Medications can reduce acid production and relieve symptoms.
Common treatments include:
- antacids such as Famotidine
- proton pump inhibitors (such as Omeprazole)
For many patients these treatments are effective.
However, some patients continue to experience symptoms despite medication.
When is reflux surgery recommended?
Surgery may be considered when:
- reflux symptoms persist despite medication
- medication is required long-term
- significant regurgitation occurs
- a large hiatus hernia is present
- reflux causes complications in the oesophagus
For suitable patients, anti-reflux surgery can provide long-term symptom control.
Laparoscopic anti-reflux surgery
Anti-reflux surgery is most commonly performed using laparoscopic (keyhole) surgery.
This technique allows surgery to be performed through small incisions in the abdomen.
During surgery:
- the stomach is returned to the abdomen
- the hiatus hernia is repaired
- the upper stomach is wrapped around the oesophagus (fundoplication)
This strengthens the natural anti-reflux valve.
Because this is minimally invasive surgery, patients usually experience:
- smaller incisions
- shorter hospital stay
- faster recovery
Recovery after reflux surgery
Most patients stay in hospital one night after surgery.
Typical recovery includes:
- gradual return to normal diet
- mild swallowing difficulty during early healing
- return to work within 2 weeks
- avoiding heavy lifting for 4 weeks
Diet is gradually advanced from pureed foods to normal diet over several weeks.
Expected results after reflux surgery
Anti-reflux surgery has been performed for many years and has well-established outcomes.
Clinical studies show:
- most patients experience significant improvement in reflux symptoms
- many patients no longer require reflux medication
- approximately 80% of patients remain symptom-free 10 years after surgery
A small percentage of patients may develop recurrence of a hiatus hernia over time.
Possible side effects
Side effects after anti-reflux surgery are uncommon but may include:
- temporary difficulty swallowing
- gas bloating
- reduced ability to belch
These symptoms usually improve during recovery.
Long-term complications are uncommon.
Reflux surgery for patients across Otago and Southland
Patients frequently travel to Dunedin for specialist Upper GI surgery.
Mark Grant provides reflux and hiatus hernia surgery for patients from:
- Dunedin
- Queenstown
- Wanaka
- Invercargill
- Oamaru
- Central Otago
Referrals are usually made by your GP or specialist.
Consultation for reflux surgery
If reflux symptoms are affecting your quality of life, specialist assessment may help determine whether surgery is appropriate.
A consultation includes review of symptoms, investigations and discussion of treatment options.
FAQs
Who is a candidate for reflux disease surgery?
Surgery is typically considered for patients with GERD whose symptoms don’t improve with lifestyle changes and medications. It may also be an option for people who prefer not to take medication long-term or experience side effects from them.
What are the different types of reflux disease surgery?
Laparoscopic fundoplication, particularly laparoscopic Nissen fundoplication, is the most common type of surgery for GERD. This minimally invasive procedure involves wrapping the upper part of the stomach around the lower esophagus to strengthen the anti-reflux valve.
What are the potential risks of reflux disease surgery?
As with any surgery, there are risks involved. These can include infection, bleeding, and complications from anesthesia. Specific to reflux surgery, there is a possibility of difficulty swallowing (dysphagia) or developing gas bloat. It’s important to discuss these risks with your doctor.
Can reflux disease come back after surgery?
Surgery is generally very effective for treating GERD, with most people no longer needing medication after the procedure. However, there is a small chance that symptoms may recur in some patients over time.
Are there any dietary restrictions after reflux disease surgery?
You will likely be on a clear liquid diet for a short time after surgery, followed by a gradual introduction of soft foods. Your doctor will provide specific instructions on what to eat and drink during recovery.