Hiatus Hernia

Is There Surgery for Acid Reflux?

Yes. While many people suffer from acid reflux, not all of them have true acid reflux. It is true that there is a small group of patients who will truly benefit from acid reflux surgery. In this group of patients, surgery can be lifesaving.

What are the Symptoms of Acidity?

I see many patients who come with self-diagnosis of acidity and self-medication. Most of them feel surprised when I tell them they are actually not suffering from acidity. The fact is self-medication is not only harmful but also counter productive.

What is acidity?
Acidity is burning sensation just below the chest bone in the center either before or after food. If the acid is coming up to the chest, then the burning sensation is in the chest (heart burn) (hiatus hernia / LAX LES will be discussed in separate blog) . Sometimes, it is so severe that you can confuse this with heart attack.

Other symptoms such as pins and needle sensation / burning sensation in chest/abdomen alone is probably not acidity. Pain moving around different parts of the abdomen alone and back pain alone is probably not acidity. These might be somatization of acidity if associated with symptoms discussed in the first paragraph. These symptoms alone are probably not diagnostic of acidity / GERD.

What symptoms are not acidity?
• Feeling bloated
• Sounds in the abdomen
• Rigid abdomen
• Pain in different parts of abdomen at different times
• Altered toiletry habits
• Feel full after eating little food.
• Pricking sensation all over the abdomen

All these symptoms are not related to acidity at all. In fact, acidity medicines can make these symptoms worse. These are symptoms of irritable bowel syndrome (IBS). These symptoms might also be caused due to medicines, some diabetic medicines being the most common cause. Poor control of diabetes aggravates these symptoms. Some people suffer from these symptoms after they have had food poisoning (gastroenteritis). This is usually self-limiting. Some experience these symptoms after taking antibiotics for different conditions, and again, this is also self-limiting.

What are the home remedies for IBS?
• Drinking at least 3 litres of water
• Eating more fiber (all fruits, vegetables and greens)
• Eating less sweets
• Exercise (walking or any form of physical activity)

While the above lifestyle changes bring around life-long relief of symptoms, medicines (anti spasmodic / pre and pro biotics) will help initially to overcome these symptoms. If you are suffering from the symptoms described above, you do not need medicines for acidity. In fact, these medicines can make the symptoms worse.

What food to avoid in acidity?
As such, there is no prescribed diet for acidity. There is no absolute need to avoid any food.
Food habits lead to acidity, not food items.
Spices also do not cause acidity when consumed in limited quantity.
If you put together the foods that lead to acidity that are listed by 100 people, then there will be no items left to eat. So, we should be able to eat all items. If there is any particular food that increases the symptoms, avoid it.

Which group of Patients will benefit from Surgery?

Symptoms are caused by acid/food coming into the oesophagus (food pipe)or upto the throat. Surgery should be a treatment of choice in people who suffer from this condition. It is a burning sensation between the ribs or at the back of the throat. In some people, it can lead to recurrent throat infection or change of voice. If symptoms are severe, then it might feel like a heart attack at times. Some or all of these symptoms are made worse by bending down or when in the lying position.

Why do these Symptoms Occur?

It happens if there is disruption in the defense mechanisms preventing the food/acid coming upto the chest.

1. Weak Lower Oesophageal Sphincter (LOS): LOS is a one-way valve at the lower end of the oesophagus. It is meant to allow food to go from the oesophagus to the stomach but not the other way around. When it is weak, it leads to acid reflux and burning of the oesophagus (oesophagitis).
2. Hiatus hernia: This is a condition when part of the stomach is in the chest through the weakness of the diaphragm muscle. This might give a sensation of food being stuck in the chest.

Are there other factors that contribute to Acid Reflux?

Yes. They are:
1. Smoking
2. Alcohol
3. Tight Dress
4. Body posture—bending down/lying flat
5. Too much of spicy and fatty/oily food
6. Food Habits
7. Certain Medications

Is Surgery the first choice in all Patients?


What are the Steps before Surgery?

Lifestyle Changes
Drug Therapy

When Should one Consider Surgery?

One should consider surgery in one of the following situations:
1. Medicines are not giving complete cure and some symptoms are persisting inspite of taking medicines.
2. Symptoms are suppressed when one is on medicines but return as soon as one discontinues medicines.
3. One does not wish to take medicines life long and risk serious nutritional deficiencies.

How is Surgery Performed and what are the Benefits?

Now a days, surgery is performed as keyhole (laparoscopic). The surgery may not be complicated and has the following benefits:

1. One is in the hospital only for 2/3 days.
2. One can return to work within a week or so.
3. Scars are barely visible after few weeks.
4. There will be minimal post op pain, which will require simple pain killer medicines.

How is Surgery Performed?

It recreates the lost anatomical defence mechanism. In general, the stomach in the chest is returned to the normal abdominal position and the valve that is weak is strengthened. Part of the stomach (fundus) is wrapped around the lower end of the oesophagus to add extra strength to the valve.