Metro Bariatrics - Amir Moazzez MD, FACS
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Fair Oaks Professional Bldg.
3620 Joseph Siewick Dr. Suite 200
Fairfax, VA 22033
703.620.3211 Phone
703.620.3215 Fax
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2280 Opitz Blvd. Suite 320
Woodbridge, VA 22191
703.878.7610 Phone
703.878.7614 Fax
Stafford
125 Hospital Center Blvd Suite 207
Stafford, VA 22554
540.318.6135 Phone
540.318.6144 Fax
Schedule a Consultation: 703.620.3211
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Gastroesophageal Reflux Disease (GERD)
General: GERD or reflux or heartburn is the condition when acid and/or bile juices from the GI tract backwash into the esophagus causing the burning sensation. The acidic juices are secreted in the stomach. These juices do not harm the stomach because of the thick muscular lining. However, when these juices reflux back onto the esophagus, patients have a burning sensation in the middle of the chest because the esophageal lining is very thin and sensitive. The junction between the esophagus and stomach (GE junction) serves as a “ball valve.” This allows food/liquids to pass from the esophagus to the stomach, and not allow stomach contents to reflux back into the esophagus. Patients who complain of heartburn have a problem with this anatomical location.
Signs and Symptoms: Heartburn or reflux begins between the lower aspect of the breast bone. This may feel like burning or knowing pain. The pain may travel up the chest to the back of the throat with a sour taste. The fluid may even irritate the windpipe and vocal cords causing hoarseness or asthma attacks.
Diagnosis: History and Physical
- EGD: This is a scope procedure that specifically looks at the lining of the esophagus, stomach, and duodenum. The endoscopist may take sample of tissue (biopsy) or pictures. If there is reflux then one may see inflammation or the presence of a hiatal hernia.
- Upper GI series: This is performed by the radiologist at the X-ray suite. Patients will drink barium and a series of pictures and videos are obtained looking for anatomical abnormalities—masses, ulcers, hernias, and a lesser extent reflux.
- pH probe or BRAVO probe: These are catheters or monitors which are placed at the GE junction to directly measure the extent and amount of acid exposure along with symptoms. If the diagnosis of GERD or the extent of disease is uncertain, then this test will accurately measure for reflux.
- Gastric emptying study: This test measures the amount and efficiency of the stomach emptying after eating a meal. If there is poor emptying, then this could contribute to heartburn/reflux.
- Esophageal Manometry study: To test the strength and coordination of the esophagus to propel food into the stomach. This test is necessary to complete prior to surgery to assist with heartburn.
Treatment:
- reduce amount of caffeine, tobacco, alcohol (acid stimulators)
- eat smaller meals and avoid eating prior to sleeping
- weight loss
- Anti-acid medications
If all these fail to manage your heartburn symptoms then you should consider consultation for anti-reflux surgery.
Surgical Option: Laparoscopic Nissen Fundoplication
This surgery reconstructions the “ball-valve” of the GE junction to prevent acid juices from refluxing into the esophagus from the stomach and allowing normal swallowing of food. The surgery consists of using 5 small 1cm incisions of the upper abdomen. We perform a 360 degree wrap of stomach around the lower esophagus. If there is a hiatal hernia, this will be reduced and repaired.
Post-operatively: Patients have minimal pain and are started on a liquid to soft diet on the following day. Discharge is usually the next day as tolerated. Patients go home on a soft diet and liquid pain medications. Activity levels are increased and encouraged as tolerated (avoid heavy lifting). Our patients follow up with us in the office after surgery, and are encouraged to call us at any time with questions.
