Gastroesophageal reflux disease is a common condition in the Western world and occurs when stomach contents back up into the esophagus, which is located in the chest. That is, liquids or even food that are inside the stomach rise up, while the normal thing would be to go down to the small intestine.

At the junction of the esophagus and the stomach there is an anatomical valve that normally prevents the return of stomach contents back into the esophagus. Reflux occurs when this valve is not working properly. However, we also have regression in the case of a hiatal hernia, in which the stomach has slipped up towards the chest, while its normal position is inside the abdomen. In a hiatal hernia, together with the stomach rises into the chest and the valve which clearly does not work and most of the food remains inside the chest.

Reflux or Hiatal Hernia?

“Regurgitation and hiatal hernia have similar symptoms. The most common is pain or burning in the chest because the liquids that return upwards are irritating”, explains Mr. Aristotelis Kechagias MD PHD FACS, General Surgeon, Endocrine Surgeon, specializing in Advanced Laparoscopic Surgery, Director of the Ith Surgical Clinic Metropolitan General.

“Many patients have the unpleasant feeling of liquids or food rising up, and the return of liquids causes difficulty in breathing, shortness of breath, rapid heart rate, hoarse voice and bad breath. Also, in large hiatal hernias, the patient feels the food “sticking” at the level of the chest, quite simply, because the stomach has shifted there. Anemia with low hematocrit is sometimes present. In the long term, chronic acid reflux causes inflammation in the esophagus – called esophagitis and Barrett’s esophagus – factors that increase the risk of esophageal cancer,” he points out.

Diagnosis and Treatment

Diagnosis is made clinically by the patient’s symptoms and by taking a detailed history. “Gastroscopy is needed to investigate whether the esophagus is inflamed or not. In cases where a large hiatal hernia is suspected, a chest x-ray should be taken. In some cases with ambiguous symptoms, specialized tests of the esophagus are needed, such as manometry and ph-metry.

In the early stages, reflux can be mild and occasional, but it generally gets worse over time, just like a hiatal hernia, and neither heals on its own.

In mild reflux, the patient must make changes in his daily life such as a careful diet, weight loss, and taking antacids or drugs that reduce the acidity of the stomach” recommends the specialist.

When is the treatment surgical?

“Surgery is necessary when reflux symptoms cannot be controlled with medication or when gastroscopy shows esophagitis or Barrett’s esophagus to prevent esophageal cancer. We operate on a hiatal hernia when the symptoms worsen despite medication, when it is large or when it shows a gradual increase in size,” he explains.

“Regurgitation and hiatal hernia are corrected with minimally invasive methods, i.e. laparoscopic or robotic. This is the Nissen vault surgery in which the stomach is returned to its normal position in the abdomen and a new valve is created by rotating the dome of the stomach around the lower esophagus. In Northern European countries, these operations are performed by surgeons with a separate specialty title, that of Gastrointestinal System Surgeon. In our center, the type of flexible domeplasty is chosen to eliminate the risk of dysphagia.

Minimally invasive toroplasty has immediate recovery. That is, the patient can eat and get up shortly after the operation and in 24 hours he returns home without special painkillers. In a few days he can return to work. We recommend to our patients a lighter diet for 2 weeks and avoidance of intense physical exercise for 3 months”, concludes Mr. Kehagias.