Heartburn and Hiatal Hernia

Why does reflux occur:

  • Weak lower esophageal sphincter pressure.
  • Lack of intra-abdominal esophagus.
  • Presence of a hiatal hernia allowing the stomach to ride into the chest.

Assessment of GERD

48 Hour pH BRAVO Studies

A small capsule is attached to the lower esophagus. Its acid sensor measurements are sent to an outside receiver and the acid exposure to the esophagus is recorded. Depending on the amount of acid reflux and the correlation with symptoms, an objective assessment of acid reflux severity can be made.

High Resolution Manometry

A multisensored nasogastric tube is inserted and intraesophageal pressures are measured at multiple levels simultaneously. Complete assessment of esophageal function including presence of a hiatal hernia can be made with this outpatient test.

Treatment Options for Patients with GERD



Intermittent symptoms, minimal acid reflux on pH studies, no hiatal hernia.


Moderate GERD: 

Frequent symptoms, positive acid reflux on pH studies, none or small hiatal hernia.


Severe GERD +/- Hiatal Hernia:

Aspiration pneumonia/asthma, significant acid reflux on pH studies, large hiatal hernia.

medical therepyMedical Therapy:

Anti acids, proton pump inhibitors, behavioral changes. If the patient is young, consider endoscopic surgery.


Endoscopic Antireflux surgery:

Undergeneralanesthesia, endoscopic surgical tools are advanced into the stomach and an antireflux valve is constructed from within the stomach. No incisions are needed.

Laparoscopic Antlapaireflux surgery:

Under general anesthesia, laparoscopic surgical tools are advanced through the abdomen and the hiatal hernia is repaired and antireflux valve is constructed. Minimal incisions in the abdomen are needed.

Our Medicine and Surgery Department can assist in providing all assessment tests and offer the different medical and surgical options available to your patients.