Frequently Asked Questions
What Is Heartburn?
Heartburn is a caustic pain in the upper abdomen behind the breast bone, combined with a sour and bitter taste which rises in the esophagus along the neck.
Heartburn is caused by the reflux of stomach contents – a mixture of food and gastric acid. The esophagus, coated with a sensitive mucous membrane, is affected by the acid. The results are inflammations and lesions which can be extremely painful, and cause a burning sensation. Additional typical reflux symptoms are air regurgitation, swallowing disorders, regurgitation of food, and cramp-like pain in the upper abdomen or behind the breast bone, as well as nausea and vomiting. Night-time cough attacks or bouts of breathlessness may also be caused by stomach contents flowing back into the esophagus and entering the airway. In many cases patients are (mistakenly) treated for asthma over a period of years.
Typically a closing mechanism, at the end of the esophagus, prevents the reflux of stomach contents. The function of this seal may be disturbed by drugs, such as hypertension medication, or a rich meal, and by a fatty diet and alcohol. This kind of dysfunction is easily treated by avoiding the trigger substances.
Yet, if severe heartburn persists over several years, usually an anatomical disorder is the cause.
What Is Hiatal Hernia / Hiatus Hernia?
Most cases of severe and persisting heartburn are caused by an anatomic disorder. The esophagus runs through the diaphragm, which in turn is firmly clasped around the esophagus. If the passage point of the esophagus is dilated, the condition is called hiatal hernia. Yet, if the sphincter at the lower end of the esophagus is intact, the hiatal hernia usually does not cause any discomfort.
In cases of strong acid reflux, therapy is necessary. Firstly, for alleviating the pain, secondly, in order to prevent long-term damage to the esophagus, such as inflammations, scarring and tissue changes up to canceration.
Below mentioned measurements are known to have relieving effects. In mild cases even an effective treatment is possible:
- Weight reduction in cases of overweight
- Abdication of late meals
- Sleeping with an elevated bed-head
- Consumption of only small amounts of alcohol
- Avoiding coffee
- Avoiding chocolate
- Avoiding greasy foods
There is no medicine that prevents the reflux of stomach contents into the esophagus. Existing drugs merely make sure that there is no acid in the fluid. These drugs follow two basic approaches: binding the existing acid or reducing the production of acid.
If an esophagitis, an inflammation of the esophagus, has been diagnosed, a drug therapy is strongly advised.
Surgical reflux therapies have one major benefit: the cause of the disorders is eliminated. Minimally invasive surgery enables treatment with a minimal impact on the body. The surgery itself is divided into two steps: +
- Correction of the hiatal hernia
- Formation of a valve mechanism at the lower end of the esophagus that will eliminate further reflux.
The operation is carried out laparoscopically, which means that no abdominal incision is necessary. The surgical instruments are inserted into the surgical area through five cuts measuring in between 5 and 12 millimeters length, and steered via the monitor.
The minimally invasive reflux surgery requires a three-day stay in our clinic.
- Day 1: Check-in and surgery, preliminary talk, gastroscopy (if no gastroscopy has been done in the last six months), ECG, blood tests, optional thoracic x-ray, pre-operative talk with anesthesiologist, afternoon tea
- Day 2: X-ray control, gradual return to solid food, further post-operative nutritional buildup
- Day 3: Discharge
Since 1992 I performed surgery according to above described principles on approximately 800 patients. Within the framework of a doctorate thesis, 51 patients that were operated in 2002 underwent a thorough follow-up examination. In this paper 91 % of the patients rated the results of the surgery as “very good” or “good”, and 94 % of the patients would, if they had to choose, undergo this intervention again in order to improve their quality of life. More than 90 % do no longer feel any impediment to their quality of life. As a result of the surgery, many patients are able to relinquish the taking of acid blockers entirely or at least most of the time.