GERD Symptoms to Surgery (and What to Expect During Recovery)

If you have experienced the classic version of heartburn—a burning sensation in the throat area after eating—you could have gastroesophageal reflux disease (GERD). But heartburn is only one way GERD presents, according to Dr. Thomas Scarritt, board-certified and fellowship-trained gastrointestinal surgeon for EmergeOrtho—Triangle Region. There are other side effects of the condition that may be more or less pronounced depending on the diagnosis.

Regardless of whether GERD symptoms are mild or more severe, seeking the aid of a gastrointestinal specialist is crucial to preventing more significant problems from occurring.

“We know that long-term acid exposure in the lower esophagus is a risk factor for esophageal cancer,” Dr. Scarritt says.

Whether you suspect you may be experiencing side effects of GERD, or have already been diagnosed with the condition, Dr. Scarritt has the expertise to help you navigate treatment and recovery. As a highly skilled board-certified and fellowship-trained gastrointestinal surgeon, Dr. Scarritt takes pleasure in providing patient-centered care — including sharing everything you need to know about GERD surgical procedures and outcomes.

GERD Symptoms, Causes, and Diagnosis

While some patients with GERD exhibit the classic symptoms of heartburn, it can also cause:

• A feeling like you constantly need to clear your throat
• A feeling of a piece of food or object is stuck in your throat
• Bad breath
• Regurgitation of food (more common with the presence of a hiatal hernia)

Others, however, may have what Dr. Scarritt refers to as silent, non-acid reflux. “It does not cause pain,” he says, “but can lead to other complications from exposure to stomach contents. In rare cases, it can contribute to lung disease from chronic aspiration.”

GERD can often, although not always, be attributed to a hiatal hernia. A hiatal hernia means part of the stomach protrudes through the diaphragm into your chest. Pregnant women can also be at a higher risk of developing GERD because the expanding uterus pushes on the stomach, forcing stomach acid into the esophagus.

To reduce the risk of esophageal cancer and lung disease, and to confirm the potential cause of GERD, Dr. Scarritt stresses the importance of diagnostic and preoperative testing. To confirm a GERD diagnosis and rule out any other health conditions, Dr. Scarritt relies upon several diagnostic approaches, including:

1. Endoscopy. A gastroenterologist inserts a tiny camera into the esophagus to look for signs of damage in the esophagus and stomach, including signs of a hiatal hernia.
   “We know that long-term reflux can cause damage to the esophagus, and that is something that we want to rule out or detect early on in the process,” Scarritt says. “So that is the first test.”
2. Upper GI swallow study. After a patient drinks a liquid called a “contrast,” radiographic images are captured to detect evidence of acid reflux.
3. Esophageal Manometry. A probe is placed in the esophagus while the patient swallows water. While not always the most pleasant test, according to Dr. Scarritt, “It is also one of the most important for me as a surgeon when I am doing surgical planning. It tells me how well your esophagus functions, and the function of your esophagus can change the type of surgery that I do.”
   It can also change the diagnosis from GERD to esophageal dysmotility disorders that require an entirely different path of treatment.

Next Step: GERD Surgery Preoperative Planning

While some cases of GERD can be managed with medication, if symptoms persist or a diagnosis is severe, surgery is the most likely course of treatment. During preoperative planning, Dr. Scarritt considers factors such as:

• The presence or absence of a hiatal hernia.
• The size of the hiatal hernia.
• The extent of esophageal damage.
• The extent of long-term damage that has made the esophagus weak (or unable to squeeze well).
• The health of the patient’s heart and lungs.

“All these things either support our decision to do surgery or change the type of the procedure that we do for the patient,” Dr. Scarritt explains.

GERD Surgery

The main surgical approach to address GERD is called fundoplication.

“It is an antireflux operation where we essentially wrap the stomach around itself to act as a valve,” Dr. Scarritt says. “There are a couple of different kinds of fundoplications, which is where preoperative testing comes in, to narrow down which type is going to be best for you.”

If a patient happens to have a hiatal hernia, Dr. Scarritt repairs it at the same time as the fundoplication.

Depending on whether a patient has a hiatal hernia may also affect the duration of the surgical procedure. Typically, however, most fundoplications last around two to two and a half hours.

GERD Surgery Recovery

After surgery, patients usually stay in the hospital overnight. As part of their recovery, GERD surgery patients must follow a strict liquid diet for a period of time.

“For the diet— the whole progression should be about six to eight weeks,” Dr. Scarritt explains. “Usually, I prescribe liquid for a week, pureed foods for a week, then soft foods if everything is going well. Once tolerating a soft diet, patients can slowly add in foods and by about eight weeks are back to a mostly normal diet.”

Dr. Scarritt also encourages his patients to be active quickly following surgery.

“I generally say as far as light activity, as soon as you feel up to it; I want you walking and being active right away,” he says. “I encourage [patients] to stay away from heavy activity, lifting, and manual labor, usually for about six weeks, to let everything recover.”

If you would like to learn more about GERD surgery or Dr. Scarritt, request a consultation now. Or, please call us at (919) 281-1723 for any questions you may have.