Gastroesophageal Reflux Disease (GERD) is a highly prevalent digestive disorder resulting from the backflow of stomach contents into the oesophagus. It significantly impairs quality of life and can lead to more serious complications if not correctly diagnosed and treated.
What is GERD?
GERD is the condition where stomach acid, and sometimes bile, flows back into the oesophagus. Because the oesophageal lining is not as acid-resistant as the stomach, this reflux causes irritation (oesophagitis) and characteristic symptoms. Physiological reflux occurs occasionally in everyone, while pathological reflux is defined by its frequency, severity and the damage it causes.
Common and Atypical Symptoms
Classic (Typical) Symptoms:
- Heartburn: The most common symptom; a burning sensation spreading from behind the breastbone towards the throat.
- Regurgitation: Bitter or sour stomach contents returning to the mouth.
- Belching, bloating, abdominal pain.
- Dysphagia: Difficulty swallowing solid foods.
Atypical (Extraoesophageal) Symptoms:
- Chronic cough, wheezing, shortness of breath.
- Hoarseness, voice changes, constant throat clearing.
- Globus sensation (lump in the throat), painful swallowing.
- Dental enamel erosion, bad breath.
- Chest pain — can be confused with cardiac pain.
Can GERD Affect the Lungs?
Yes. Reflux-related microaspiration (small amounts of stomach contents entering the airways) or vagal nerve reflexes can cause various respiratory symptoms:
- Persistent dry cough
- Recurrent bronchitis
- Asthma-like symptoms (shortness of breath, wheezing)
- Pneumonia
These patients are often managed with a diagnosis of asthma or chronic bronchitis. However, unless the underlying reflux is controlled, respiratory symptoms may not fully resolve. GERD should therefore always be considered in unexplained chronic cough.
Hiatal Hernia and its Relationship with GERD
Hiatal hernia is the upward protrusion of the upper stomach through the diaphragmatic opening (hiatus) into the chest cavity. This anatomical defect impairs the valve mechanism between stomach and oesophagus (the lower oesophageal sphincter), predisposing to reflux.
Symptoms of Hiatal Hernia:
- GERD-like symptoms (heartburn, regurgitation)
- Difficulty and pain on swallowing
- Early satiety
- Chest pain, palpitations, shortness of breath (especially with large hernias)
- Gastric volvulus: The stomach twisting on itself; a serious complication with severe pain, nausea and vomiting requiring emergency surgery.
Important Note: Not every GERD patient has a hiatal hernia. However, the two often coexist, particularly in older patients with severe reflux. Diagnosis is made via upper gastrointestinal endoscopy and, where needed, barium studies.
Treatment
1. Lifestyle Modification and Medical Therapy
This is first-line treatment: weight loss, elevating the head of the bed, avoiding lying down immediately after meals, avoiding smoking and alcohol, and limiting spicy, fatty and acidic foods. Proton pump inhibitors (PPIs) suppress acid secretion, relieving symptoms and allowing oesophageal damage to heal.
2. Surgical Treatment: Laparoscopic Antireflux Surgery
When should surgery be considered?
- Persistent symptoms despite long-term, high-dose medication
- Immediate return of symptoms when medication is stopped
- Medication side effects or intolerance
- A large or complicated hiatal hernia
- Serious extraoesophageal complications such as airway involvement
What is Laparoscopic Antireflux Surgery?
It is the current gold standard. Performed through small abdominal incisions using a camera and specialised instruments, its aim is to strengthen the weakened lower oesophageal sphincter and repair the hiatal hernia. The most commonly used technique is Nissen fundoplication, in which the upper stomach is wrapped around the oesophagus to create a new valve mechanism.
Advantages of the Laparoscopic Approach:
- Less pain and better cosmetic results
- Shorter hospital stay (typically 1-2 days)
- Faster recovery and return to normal life
- Lower risk of infection and incisional hernia
Why the Surgeon's Experience Matters
Laparoscopic antireflux surgery is technically demanding. The surgeon's experience directly affects long-term outcomes and complication rates. A well-planned, technically sound operation can markedly improve quality of life by removing the need for lifelong medication. The surgeon should also be equipped to perform revision surgery should late problems arise (dysphagia, gas-bloat syndrome, recurrence).
Conclusion
GERD is not merely heartburn but a complex condition affecting multiple systems, closely linked with hiatal hernia. Where lifestyle changes and medication fail to control symptoms, impair quality of life or lead to complications, laparoscopic antireflux and hernia repair surgery is an effective option. With proper patient selection and an experienced team, it offers a lasting solution.
This article is for informational purposes only. For diagnosis and treatment, please consult a general surgery specialist.