Gastroenterology & GI Surgery

GERD and Hiatal Hernias: Combining Innovative Medical and Surgical Care for Complex Cases

Nov. 2, 2023 - Eden McCleskey

Houston Methodist physicians and surgeons cross multiple disciplines in the treatment of diseases and disorders related to gastroesophageal reflux (GERD). The team developed their own standards and guidelines — based on years of research — to ensure each patient's unique needs are met.

While reflux, GERD and hiatal hernias are common, Houston Methodist sees the most unusual and challenging presentations thanks to its high volume and subspecialty expertise. The program often receives referrals from pulmonologists, otolaryngologists and allergists for evaluation of atypical symptoms.

The Houston Methodist J.C. Walter Jr. Transplant Center is a leading lung transplant center in the U.S. and one of just a few in the nation to perform early transplantation for end-stage lung disease due to severe COVID pneumonia.

"One of the most devastating complications of lung transplant is gastroesophageal reflux causing aspiration, which then inflames lung tissue and triggers organ rejection," said Dr. Gulchin Ergun, a Houston Methodist gastroenterologist. "The pandemic gave us an opportunity to study this unique patient population to determine the importance of reflux testing before and after transplant, and to help ensure optimal outcomes for them."

Surgeons at the Underwood Center then use minimally invasive surgery techniques to provide a barrier to prevent reflux and resulting organ rejection.

Esophageal function testing via manometry, impedance-pH and BRAVO™ in the hospital's state-of-the-art diagnostic GI lab is performed to assess the contribution of reflux to symptoms and determine if surgery is needed.

Additionally, Underwood Center surgeons consistently adopt and evaluate the newest technologies and tools to provide patients with the least invasive options, providing faster recovery with less pain — including robotic-assisted fundoplication.

The team's multimodal pain regimen allows Houston Methodist patients to go home after surgical treatment of GERD and hiatal hernia with only over-the-counter pain medications. Narcotic use at the time of discharge has dropped from 87% to 9.6% over the last three years with good pain control, dramatically reducing complications after surgery.

"Through our comprehensive pain management protocol, we help patients better understand how to control their pain through education and the use of multiple non-narcotic pain medications after surgery," said Dr. Min Kim, a gastrointestinal surgeon with Houston Methodist.

Other clinical differentiators for the program include:

  • Comprehensive assessment and diagnostic capabilities, including pH impedance testing, BRAVO™ pH testing, high-resolution manometry and Endoflip™.
  • A full spectrum of treatment options from medical management to endoscopic, laparoscopic and robotic surgical approaches, including revision procedures for patients whose previous surgeries failed to produce desired results.
  • Clinical outcomes research on robotic-assisted procedures, new innovations and technologies and the impact of GERD on lung transplants in COVID-19 patients.
  • Intraoperative tools that provide real-time feedback on surgical success, monitor changes in sphincter pressure and measure motility, distensibility, diameter and cross-sectional area around the gastroesophageal junction.

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