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What is GERD?


Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the esophagus and stomach.

Gastroesophageal refers to the stomach and esophagus. Reflux means to flow back or return. Therefore, gastroesophageal reflux is the return of the stomach’s contents back up into the esophagus.

In normal digestion, the lower esophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the LES is weak or relaxes inappropriately, allowing the stomach’s contents to flow up into the esophagus.

Loose or Incompetent Valve Allows for Reflux

Loose or Incompetent Valve Allows for Reflux


Hiatal hernias occur when the stomach and esophagus slide up through the diaphragm into the chest.  It is not a hernia in the abdominal wall just below the sternum as many patients presume. Sometimes pain is experienced in that area but it is not where the defect occurs. typical symptoms are heartburn or Gastroesophageal Reflux Disease (GERD).

Paraesophageal hernias are more complicated defects that occur when part of the stomach is squeezed up into the chest beside the esophagus. The stomach can be strangulated, restricting blood supply to the related tissues.

Treatment Options

These types of hernias are very complex and require expert evaluation and repair. Please see the HEARTBURN section of this site for details. There are  some similarities between these defects and abdominal wall defects.  In both situations the repair may be enhances and strengthened with the use of a mesh.  The biologic ( absorbable) and permanent meshes  can be used for a tension-free repair technique to repair esophageal hiatal defects during laparoscopic fundoplications and parasophageal hernia repairs. Fundoplication is a technique where part of the stomach is wrapped around the esophagus and sewn into place.  The patch/mesh can also be used to reinforce or buttress the hiatal hernia that has been closed primarily with sutures. This adds strength to the repair. Like any surgery, there is always a chance for complications, like infection or hernia recurrence. Your physician will discuss these with you prior to surgery. See our HIATAL and HEARTBURN VIDEOS for examples