The majority of people who suffer from gastroesophageal reflux disease (GERD) benefit from medications such as proton pump inhibitors (PPIs). However, in up to 20 percent of cases, medications alone aren't enough to prevent damaging acid reflux.
Severest consequences of GERD include: erosive esophagitis, strictures, or Barrett's esophagus (which can lead to esophageal cancer). For some, surgery is often the only option. The most common surgery for GERD is a laparoscopic procedure known as a Nissen fundoplication.
Hiatal Hernia and GERD
Twenty-five percent of people over the age of 50 have a hiatal hernia. This increases their risk for developing GERD. A hiatal hernia is a common condition and usually produces no symptoms. It occurs when a small portion of the stomach and the lower esophageal sphincter (LES) slip through an opening in the diaphragm (known as the hiatus) into the chest cavity.
The result is a weakened LES, the muscle responsible for preventing stomach contents like acids from backing up into the esophagus. A hiatal hernia may be either congenital or it can develop later in life. A Nissen fundoplication can be especially helpful for those whose GERD is caused by a hiatal hernia.
Obesity and Hiatal Hernia
Being overweight is one of the biggest risk factors for the development of a hiatal hernia. Two 2006 studies found a strong link between obesity and GERD. Researchers believe that extra fat in the abdomen may put pressure on the stomach, causing the LES to relax and allowing digestive acids to enter the esophagus. Fat may also release chemicals that slow the clearance of acids from the esophagus.
People who were overweight were 50 percent more likely than those who were normal weight to develop GERD, according to the research. Those who were obese were twice as likely to have the condition.
One of the studies, published in The New England Journal of Medicine, found that women who decreased their body mass index by more than 3.5 points (a loss of 20 or more pounds) decreased their risk of experiencing GERD-related symptoms.
A surgeon wraps the part of the stomach known as the gastric fundus around the lower esophagus (including the LES) in a Nissen fundoplication. This helps to strengthen the barrier and prevent the back flow of acids into the esophagus.
Although it can be performed as a traditional open surgery, the Nissen fundoplication is most often performed laparoscopically. This is a technique in which a small fiber-optic video camera is inserted through the abdominal wall.
The Nissen fundoplication is less invasive than open surgery, but it does have side effects. Success rates are between 90 and 95 percent for patients with typical symptoms of GERD—like heartburn and regurgitation—and 70 to 80 percent in those who suffer atypical symptoms, such as chronic cough.
Diet After Nissen Fundoplication Surgery
Patients must make dietary and lifestyle adjustments for about six weeks following Nissen fundoplication surgery. Three days following surgery, most patients are on a clear liquid diet, which may include:
- apple juice
- beef broth
- chicken broth
- cranberry juice
- decaffeinated tea
- grape juice
After the clear liquid diet, most patients are put on a full liquid diet for an additional three days. This diet consists of anything on the clear liquid diet plus the following:
- Carnation instant breakfast (not chocolate)
- creamed soups (strained, no broccoli or tomato)
- cream of wheat (or cream of rice)
- ice cream (vanilla or strawberry)
- milk (no chocolate milk)
- yogurt (plain, blended, or custard with fruit or seeds)
Seven days after surgery, most patients are able to tolerate a soft food diet. However, to heal properly, patients must keep their stomach from stretching. This will require them to eat small, frequent meals six to eight times per day.
In addition, patients are advised to take the following steps following surgery:
- Avoid alcohol, caffeine, carbonated drinks, chocolate, citrus fruits (and juices), and tomato-based foods such as pizza or spaghetti sauce.
- Avoid foods that cause gas or stomach distention including beans, broccoli, cabbage, cauliflower, corn, lentils, onions, and peas.
- Avoid drinking through a straw and chewing gum or tobacco (as these can lead to swallowing air and cause gas).
- Avoid foods that are hard to swallow, such as bananas or soft breads.
- Save sweet foods until the end of a meal, as they digest more quickly.
- Sit upright at meals and for 30 minutes after each meal and at least two hours after the last meal of the day.