Reflux: Hiatal Hernia and Treatment
When dealing with a problem with the external sphincter, this is often where we see something known as a hiatal hernia. This means that the opening in the diaphragm that is defined by this external sphincter becomes wider and wider, larger and larger, allowing your stomach to protrude up from the positive pressure cavity of the stomach into the negative pressure cavity of your chest. When this occurs, that allows gastric contents to be held up high in the negative pressure area of your chest and it facilitates more reflux. When the hiatal hernia is three centimeters or larger, roughly a little bit larger than an inch in size, we know that unless we fix that defect in the diaphragm, the hiatus, and bring the stomach back down, fix it in place eliminating the hiatal hernia, and tighten up the external sphincter, then no matter what we do, you will continue to reflux and your disease will continue to advance.
A large hiatal hernia, larger than three centimeters, is often is actually best treated surgically with a Nissen fundoplication, to close that area back down and reestablish the normal anatomy. On the other hand, if the external sphincter is normal, as it is in the majority of people with reflux, we’re really dealing with chronic degeneration of the lower esophageal sphincter – internal portion. When that occurs, we have completely different modalities that we can begin to look at. In particular, there’s one modality, known as the Stretta procedure, which allows us to naturally stimulate that internal sphincter to grow, reestablishing the pressure gradient and then preventing the pressure from the stomach from creating a reflux event.