Celebrate GERD Awareness Week: Understanding GERD and Treatment Options at Premier Surgical Associates

November is GERD Awareness Month, and this week at Premier Surgical Associates in Knoxville, TN, we’re highlighting the importance of recognizing and treating Gastroesophageal Reflux Disease (GERD). Affecting approximately 30-40% of American adults, GERD is a chronic condition that occurs when stomach acid frequently flows back into the esophagus. This backward flow, known as reflux, is caused by a malfunction in the lower esophageal sphincter (LES)—a valve between the esophagus and the stomach. For GERD sufferers, this valve does not close properly, allowing acid to irritate the lining of the esophagus and cause discomfort. 

The most common symptom of GERD is heartburn, but it’s not the only one. People with GERD may also experience a sore throat, frequent swallowing, chest pain, persistent coughing, and even dental erosion. If you experience acid reflux or heartburn twice a week or more, it could indicate GERD, and addressing it early can prevent complications. For some, dietary changes and medications may provide temporary relief. However, when these treatments are not effective or when symptoms persist, surgical intervention can be a powerful, long-lasting solution.

Surgical Solutions for GERD at Premier Surgical in East Tennessee

At Premier Surgical Associates in Knoxville, Cleveland, and Johnson CIty TN, we offer a range of advanced surgical treatments to help those with severe or persistent GERD symptoms. Our team specializes in procedures that can effectively restore function to the LES and provide relief from acid reflux. Here are some of the innovative options we offer:

1. Nissen Fundoplication: This procedure is designed to tighten the LES by wrapping the upper part of the stomach around the lower esophagus. It recreates the “valve” function to prevent acid from moving back into the esophagus. Our surgeons typically perform this procedure laparoscopically, using small incisions and a camera to guide the surgery. Laparoscopic surgery allows for quicker recovery, less pain, and a reduced risk of complications.
2. LINX Reflux Management System: The LINX device is another excellent, minimally invasive option for many patients. This small bracelet of magnetic beads is placed around the LES, allowing food to pass into the stomach while blocking acid from refluxing into the esophagus. The LINX procedure usually takes less than an hour and is performed as an outpatient procedure, allowing patients to return home the same day. 
3. Transoral Incisionless Fundoplication (TIF): The TIF procedure is a completely incisionless option that treats GERD by reinforcing the LES. Using a flexible device through the mouth, the surgeon reshapes the LES to prevent acid reflux. TIF is ideal for patients looking for an effective, minimally invasive solution without any incisions.
4. Hiatal Hernia Repair: For many GERD patients, a hiatal hernia can exacerbate symptoms. This condition occurs when the stomach pushes up through the diaphragm, making reflux more likely. Hiatal hernias are often repaired during anti-reflux surgery, providing additional relief from GERD symptoms.

Beyond GERD: Treatment for Gastroparesis

For patients suffering from gastroparesis, a related digestive condition, we offer Enterra Therapy. This treatment uses a small gastric electrical stimulation (GES) device to relieve nausea and vomiting associated with gastroparesis by encouraging the stomach to empty more effectively.

Get Relief from GERD with Premier Surgical

GERD Awareness Month is a reminder that chronic acid reflux doesn’t have to be a part of your life. At Premier Surgical Associates, we’re committed to providing compassionate, expert care to help you find lasting relief. If you’re experiencing persistent GERD symptoms, consult our team to explore treatment options tailored to your needs.

Schedule an appointment online with a Premier Surgical physician today and take the first step toward a life free from the discomfort of GERD.

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For Caitlin Peterson of Knoxville, 32, eating had become nearly impossible last year. She suffered from severe gastroesophageal reflux disease (GERD), and threw up every day.

Caitlin can now eat normally after Dr. Michael Antiporda treated her with robotic-assisted GERD surgery.

“I lost almost 90 pounds,” she said. “I was vomiting multiple times a day and my body was rejecting meat. I was pretty much eating pizza and ice cream and that was it,” said Peterson. “It was not an eating disorder. People could see I was physically trying to eat, and it would come back up.”

Peterson’s GERD was caused by a severe hiatal hernia. This occurs when the upper part of the stomach bulges through the opening (called the hiatus) in the diaphragm, a large muscle that separates the abdomen and chest cavities.

A small hiatal hernia isn’t usually a problem, but a large one can let food flow back up into the esophagus, leading to heartburn, reflux, vomiting and chest pain.

“I had the hernia and a lot of reflux for over 10 years, but it had always been smaller,” said Peterson. With time and the usual strains of life from coughing, having a bowel movement or vomiting, it had enlarged. “Also, I have always thrown up a lot. I learned at a young age how to deal with it. I always know where the bathrooms are,” she said.

Anxious for relief, in March 2023 Peterson went to see Premier Surgical general surgeon Michael Antiporda,  MD, who is fellowship-trained in minimally invasive esophageal and stomach surgery. He conducted several tests to confirm her diagnosis of hiatal hernia and GERD, and evaluate the overall function of her esophagus and stomach. The tests also helped him determine the best anti-reflux operation for her particular case.

Dr. Michael Antiporda, Foregut Surgeon

“I’m glad I went through the testing because it led to a different type of surgery,” Peterson said. “I had the TIF procedure. I’m an IT manager, so I love the idea of having a type of surgery that’s the latest and greatest in technology.”

Transoral Incisionless Fundoplication (TIF) is a reconstruction of the valve between the stomach and the esophagus using an endoscope and without extra incisions. The procedure is done through the mouth and esophagus. The top tissues of the stomach (the fundus) are used to re-create a valve by folding the tissue over and essentially wrapping it around the esophagus in a uniform and ideal fashion.

At Fort Sanders Regional Medical Center in Knoxville, Dr. Antiporda used a state-of the-art robotic surgical suite to perform Peterson’s surgery.

While viewing 3D, high-resolution images on a computer screen, Dr. Antiporda used micro-surgical instruments powered by robotic arm technology. “For Caitlin, we took advantage of the most technologically advanced procedures available,” he said. “We were able to conduct a minimally invasive procedure to construct an anti-reflux valve for her that is more uniform and better able to consistently stop her reflux.”

Peterson spent one night at the hospital and went back to her work-from home job as an IT project manager after just one day off work.

“My experience at Fort Sanders Regional was great,” she said. “Everyone was very nice. They want you to feel comfortable. My dad took me to the hospital, and he couldn’t believe how fast it all was.”

Recovery involved a month of liquid foods before Peterson could swallow well again. She also had a follow-up noninvasive procedure in July to adjust the tightness of her new valve, a step that is occasionally performed after definitive anti-reflux surgery.

“Ever since then everything’s been perfect,” she said. “I’ve gained 15 pounds back. I feel like I have more energy, and I’ve got a good sleep schedule now. It definitely has affected my life! I’m not afraid to go out to eat because I might get sick. I’m not afraid to do a long road trip.”

Dr. Antiporda stressed that persistent GERD should always be evaluated thoroughly. “The most important thing is to meet with a specialist with extensive experience treating conditions of the esophagus or stomach, either a gastroenterologist or a foregut surgeon, because treatment can be complex,” he said. (A foregut surgeon specializes in the anterior part of the digestive tract.)

“There are options besides pills that are extremely effective for treating GERD. If we don’t treat it, reflux can increase the chances of esophageal cancer. There are many options for such treatments at Fort Sanders Regional.”

Peterson said she would recommend Fort Sanders Regional and Dr. Antiporda to anyone who needs a similar surgery. “He spends time with you. He truly cares for his patients.

“I’m very “I’m very happy with everything Dr. Antiporda did for me, and everyone at Fort Sanders Regional was super nice. It was great care. Now I’m able to eat anything I want, as often as I want!”

For more information about surgical options for treating GERD, visit https://www.premiersurgical.com/specialties/acid-reflux-relief/ Dr. Michael Antiporda specializes in GERD and fore-gut surgery. He is located at the Premier Surgical at Fort Sanders Regional office in Knoxville.To request an appointment with Dr. Antiporda call (865) 524-3695 or visit: https://www.premiersurgical.com/fort-sanders-appointment-request/

The post No More Reflux: Knox Woman’s GERD Relieved by Robotic-assisted Surgery first appeared on Premier Surgical.

Understanding the Differences Between Gallbladder Disease and Acid Reflux

When it comes to abdominal discomfort, two terms often come to mind – gallbladder issues and acid reflux. At Premier Surgical Associates in Knoxville, Cleveland, and Johnson City, TN, we understand that distinguishing between these two can be tricky as they share similar symptoms. In our mission to educate and empower our patients, we’re diving deep into this subject to explain the differences between gallbladder problems and acid reflux.

What is Gallbladder Disease?

The gallbladder is a small organ located beneath your liver, responsible for storing bile, a digestive fluid produced by the liver. Gallbladder diseases are primarily characterized by gallstones, tiny hardened deposits that can cause blockages and inflammation.

Symptoms often include severe abdominal pain, nausea, vomiting, and occasionally fever or chills. This pain is usually felt in the upper right section of the abdomen and may radiate to the right shoulder or back.

What is Acid Reflux? 

Acid reflux, medically termed as gastroesophageal reflux disease (GERD), is a condition where stomach acid or bile irritates the food pipe lining. It’s marked by a burning discomfort, known as heartburn, typically felt behind the breastbone.

The symptoms often worsen after eating, bending over, or lying down. Other common symptoms include a sour or bitter taste at the back of your mouth, frequent belching, and sometimes chronic cough or laryngitis.

Key Differences Between Gallbladder and Acid Reflux

Although gallbladder disease and acid reflux may present with similar symptoms, especially upper abdominal pain, they have distinct differences.

Location of Discomfort: While gallbladder pain is typically concentrated in the upper right abdomen and may radiate to the back or right shoulder, acid reflux causes discomfort in the middle of the chest, often radiating up towards the throat.

Triggers: Gallbladder pain often occurs after a fatty meal and may wake you up at night. On the other hand, acid reflux symptoms are often aggravated by specific food and drinks such as citrus fruits, chocolate, coffee, spicy or fatty food, and alcohol.

Other Symptoms: Acid reflux may also cause a sour taste in the mouth, frequent belching, or even a chronic cough. These symptoms are less common with gallbladder disease.

Diagnosis and Treatment: Diagnosis of these conditions involves different methods. For gallbladder issues, an ultrasound or a HIDA scan is often employed, while acid reflux is usually diagnosed using an upper endoscopy or a 24-hour pH monitoring test. The treatment plans for these two conditions also differ significantly.

Get Expert Care at Premier

While gallbladder disease and acid reflux can cause significant discomfort, understanding their differences can assist you in seeking the right treatment. It’s always best to consult with healthcare professionals if you experience persistent symptoms of either condition. At Premier Surgical, our team of surgeons are experienced in the surgical treatment of gallbladder issues and acid reflux. Contact us today to request an appointment with one of our physicians.

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GERD Awareness Week

November 20th marks the beginning of GERD Awareness Week. Gastroesophageal reflux disease (GERD) affects up to 40 percent of American adults. Here’s what the physicians of Premier Surgical Associates would like you to know about this common condition.

What is GERD?

GERD is a condition where stomach acid consistently flows back into the tube that connects your mouth and stomach. This backflow irritates your esophagus’s lining and causes the symptoms associated with GERD.

Usually, when you swallow, there’s a valve between the esophagus and stomach that prevents the contents of your stomach from going back into the esophagus. However, in individuals with GERD, this valve doesn’t function properly.

What are the Symptoms of GERD?

There are several symptoms associated with GERD:

• Heartburn
• Pain or discomfort in the chest region
• Discomfort when you lie down to sleep
• Bloating
• Chronic cough
• Frequent swallowing and throat clearing
• Asthma-like symptoms
• The erosion of gums, teeth, and other oral structures

Treatments for GERD

Individuals with GERD have multiple treatment options to alleviate their symptoms and enhance their quality of life.

Lifestyle Changes

Changing your lifestyle can reduce or eliminate some cases of GERD. Limiting foods that trigger your reflux can alleviate the severity of your symptoms.

If you’re not sure what symptoms trigger your GERD, keep a food diary. Common culprits include:

• Chocolate
• Spicy food
• Carbonated beverages
• Fried foods
• Coffee
• Alcohol

Avoid lying down for two hours after you eat or drink, and use a pillow to keep your upper body elevated while you sleep.

Medication

There are prescription and non-prescription medications that are designed to reduce discomfort caused by GERD. Some medications focus on preventing symptoms; these medications are usually taken daily. Other medications aim to treat problematic symptoms caused by GERD and are taken as needed.

For people with long-term GERD, eventually medication may no longer help control your discomfort and symptoms. That’s when surgical treatment may be recommended.

Nissen Fundoplication

Nissen fundoplication is a surgical procedure where the top of the stomach is wrapped around the lower esophagus. This makes the lower esophageal sphincter stronger, preventing acid backup that causes GERD symptoms.

LINX Reflux Management System

The LINX Reflux Management System is a new, effective option for treating GERD. It uses a small bracelet made of magnetic titanium beads; this bracelet is placed around the lower esophageal sphincter so that it functions correctly.

Find relief at Premier Surgical Associates

At Premier Surgical Associates, our expert surgeons specialize in the surgical treatment of gastrointestinal conditions like GERD. We can evaluate your symptoms, identify the underlying cause, and recommend the most appropriate long term treatment for you.

Learn more about acid reflux treatments at Premier Surgical. Request an appointment at one of our East Tennessee offices by visiting this link.

The post GERD Awareness Week first appeared on Premier Surgical.

Gallbladder Problems or Acid Reflux?
You’re experiencing pain in the top portion of your stomach, along with other symptoms, like bloating and tenderness around the abdomen.

Acid reflux and gallbladder issues are two common causes of abdominal pain. The physicians at Premier Surgical share what you need to know about the symptoms and recommended treatment associated with these conditions.

Gallbladder Problems
Your gallbladder is a small sac in the upper right region of your stomach. It stores bile from your liver that assists with food digestion.

When the gallbladder is infected or blocked, this causes gallbladder problems. A gallbladder attack often occurs within a few hours after you have a heavy or greasy meal. Symptoms usually start to ease within an hour after they first appear.

Symptoms
Symptoms associated with gallbladder problems include:
· Pain that spreads from the upper right portion of the abdomen to the right shoulder
· Fever
· Vomiting
· Tenderness around the abdomen
· Jaundice
· Pain that worsens when you breathe
Treatment

A cholecystectomy is an operation that treats gallbladder problems by removing the gallbladder. Most of the time, you’re allowed to go home on the day of your surgery.

Your doctor may recommend a cholecystectomy to treat gallstones, gallbladder, inflammation, gallbladder polyps, or inflammation of the pancreas that’s caused by gallstones.

Acid Reflux
Acid reflux occurs when your esophageal sphincter doesn’t close properly and allows the contents of your stomach to travel up to the esophagus.

Unlike gallbladder pain, pain caused by acid reflux is usually felt in the center of your chest or below your ribs. Your stomach might feel uncomfortable, but you usually don’t experience excessive pain that spreads to the rest of your body.
Pain and symptoms caused by acid reflux often appear soon after a meal and worsen when you lie down or move around a lot.

Symptoms
Symptoms caused by acid reflux include:
· Burning in the chest
· Chest pain
· Regurgitating sour liquid or food
· Trouble swallowing
· The feeling that you have a lump in your throat

Treatment
Some people can manage their acid reflux by avoiding foods that trigger their symptoms, like spicy dishes, chocolate, tomatoes, and citrus. Medication can also alleviate acid reflux symptoms.

However, chronic or severe cases of acid reflux are treated with a surgical procedure known as fundoplication. During this operation, your fundus (the top part of your stomach) is folded and sewn around your esophageal sphincter.
This blocks acid so that it’s unable to travel into your esophagus and cause the symptoms associated with acid reflux.
Most patients need to stay in the hospital a day or two after their fundoplication surgery.

Schedule an Appointment with Premier Surgical Associates
Want to explore surgical options for your stomach discomfort? Contact Premier Surgical Associates to request an appointment with one of our physicians. Our board certified surgeons have years of experience in treating gallbladder disease and long term acid reflux issues.

The post Gallbladder Problems or Acid Reflux? first appeared on Premier Surgical.

Millions of Americans experience acid reflux every day. Most don’t know if it’s severe enough and lasts long enough, in the worst cases acid reflux can increase the risk of esophageal cancer.

When that happens, the symptoms usually become apparent as a slow but distinctive change in one’s usual reflux symptoms, or new difficulties with eating or swallowing.

William enjoys hiking again after esophageal cancer surgery with Dr. Michael Antiporda.

William Emert is one such patient who had years of reflux and found out the hard way. “I thought I was healthy,” Emert says. “I didn’t listen to my body.”

Since his cancer diagnosis in May 2021, cutting-edge treatment including robot-assisted surgery at Fort Sanders Regional Medical Center took Emert from a life-threatening illness to the restored quality of life he enjoys today.

Prolonged gastroesophageal reflux disease (GERD) can damage the lining of the esophagus, making it easier for abnormal cells to take over and possibly transform into a type of tissue called Barrett’s esophagus, a condition which raises the risk of esophageal cancer

“I was feeling run-down at work, just feeling bad, weak and tired all the time. I kept ignoring it and ignoring it,” Emert says.

Emert’s wife encouraged him to see a doctor, and when he finally did, he was shocked by the news that came from his blood work.

“The doctor said ‘We’ve got to send you to the emergency room immediately. You’ve got internal bleeding, and I think you might have cancer,’” Emert recalls. “It blows you away.”

A very large tumor had engulfed the lower third of Emert’s esophagus, draping down onto his  stomach. After the diagnosis of cancer was confirmed, he underwent preoperative chemotherapy and radiation to shrink the tumor. Surgery was planned to complete the treatment.

William’s tumor was about 12 cm long, involving 1/3 of his esophagus.

Michael A. Antiporda, MD, is a fellowship-trained foregut surgeon (specializing in procedures for the esophagus, stomach and upper small intestine) with Premier Surgical at Fort Sanders Regional Medical Center. He recommended robotic-assisted laparoscopic surgery to remove the tumor and reconstruct Emert’s GI tract in the most minimally invasive way possible.

“This is major surgery in potentially treacherous territory involving the chest, abdomen and neck,” Dr. Antiporda says. “It’s a highly complex operation that’s not done in high volume in many places, but at Fort Sanders Regional we’re able to do many complicated cancer surgeries like these with good outcomes.”

The Right Hospital

Fort Sanders Regional was the first hospital in East Tennessee with robotic-assisted surgery. The medical center has continually updated and added to its robotic program since then. This technology allows surgeons to offer the most advanced and minimally invasive procedures for a wide array of
indications.

“Mr. Emert underwent robotic transhiatal esophagectomy, which I performed using multiple very small abdominal incisions and one small left-neck incision. The robot is clutch for doing an operation like this because it permits a surgeon to use tiny incisions to operate comfortably and safely in what would otherwise be a very tight and limited space,” Dr. Antiporda says.

Dr. Michael Antiporda, Foregut Surgeon

“The alternative to this type of surgery would have been to make large painful incisions in the upper abdomen or between the ribs, which take significantly longer to recover from.”

The tumor was removed in August 2021. Although it was major surgery, Emert was able to go home in less than a week, fully realizing the advantage of faster recovery that is often seen with robotic surgery. He was pronounced “cancer-free” on August 14.

Lessons to Learn

Today Emert has a smaller stomach space that limits the amount of food he can eat in one sitting, but there are no restrictions on his diet. His quality of life has returned and he and his wife go on adventures from fishing to foraging mushrooms.

“I feel great. I had forgotten what it was to be healthy because I just got so used to feeling bad,” he says.

Through it all, Emert has learned some important life lessons. Among them are the importance of taking time to enjoy and appreciate life, along with the importance of self-awareness when it comes to good health.

“Listen to your body, because your body knows when something’s wrong. I learned the hard way,” Emert says. “I’m just glad to be here, and it wouldn’t have been possible without the doctors that I had. I don’t think I’ve met a better doctor – or person – in my whole life than Dr. Antiporda.”

Dr. Antiporda says uncontrolled GERD is the most common underlying cause of esophageal type of cancer and it’s important to see a doctor for ongoing reflux that causes pain or trouble swallowing. In the event that a cancer diagnosis does come as a result of GERD,

Dr. Michael Antiporda is a General Surgeon with Premier Surgical Associates at Fort Sanders Regional in Knoxville. To schedule a consultation with Dr. Antiporda, call (865) 524-3695.

The post Robot-assisted Esophageal Surgery Helps Doctors Restore Lives first appeared on Premier Surgical.

Written by Michael Antiporda, MD, Premier General Surgeon

Every year during the week of Thanksgiving, we recognize National GERD Awareness Week. GERD, or gastroesophageal reflux disease, occurs when the lower esophageal sphincter (LES) does not function correctly to keep stomach contents from refluxing up into the esophagus. Patients with GERD will then classically experience symptoms such as heartburn and regurgitation, but may also have less common symptoms such as difficulty swallowing, chest or upper abdominal pain, chronic cough, and hoarseness.

Many Americans experience GERD symptoms on a regular basis. In fact, anywhere from 20-40% of Americans experience heartburn on a weekly or monthly basis. In many cases, these symptoms are effectively controlled with dietary changes such as avoiding foods associated with GERD, such as acidic food and drinks, coffee, chocolate, and high fat meals. Beyond this, medications such as antacids like Tums or acid-suppressing medications like histamine blockers and proton pump inhibitors will control more severe symptoms.

But when dietary changes and/or medication are inadequate, then anti-reflux surgery may be an excellent option that can restore a patient’s quality of life and allow him or her to enjoy eating the foods they used to enjoy without suffering troublesome heartburn or regurgitation.

It is important to treat GERD effectively to prevent long-term damage to the esophagus. We recommend that patients talk to their primary care provider, gastroenterologist, or foregut surgeon if they have had troublesome reflux symptoms for many years, do not have adequate control of symptoms with medications, have had changes or worsening of symptoms, or have had symptoms bad enough to require medications more than twice per week.

References and Suggested Reading:

Gyawali CP, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout AJPM, Vaezi M, Sifrim D, Fox MR, Vela MF, Tutuian R, Tack J, Bredenoord AJ, Pandolfino J, Roman S. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018 Jul;67(7):1351-1362. doi: 10.1136/gutjnl-2017-314722. Epub 2018 Feb 3. PMID: 29437910; PMCID: PMC6031267.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031267/

Slater BJ, Dirks RC, McKinley SK, Ansari MT, Kohn GP, Thosani N, Qumseya B, Billmeier S, Daly S, Crawford C, P Ehlers A, Hollands C, Palazzo F, Rodriguez N, Train A, Wassenaar E, Walsh D, Pryor AD, Stefanidis D. SAGES guidelines for the surgical treatment of gastroesophageal reflux (GERD). Surg Endosc. 2021 Sep;35(9):4903-4917. doi: 10.1007/s00464-021-08625-5. Epub 2021 Jul 19. PMID: 34279710. https://www.sages.org/publications/guidelines/guidelines-for-the-surgical-treatment-of-gastroesophageal-reflux-gerd/

https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959

GERD Awareness Week

Dr. Michael Antiporda is a foregut surgeon with Premier Surgical Associates in Knoxville, TN. He is based at Fort Sanders Regional Medical Center. His expertise and training comprises medical and surgical treatment of both benign and malignant conditions of the stomach and esophagus. He has published multiple papers and presented at numerous national conferences on surgery for GERD and hiatal hernia. He is proud to have learned from and trained with some of the best known surgeons in his field. To request an appointment with Dr. Antiporda, call (865) 524-3695 or click the link below:

Dr. Antiporda Appointment Request

The post What You Should Know About GERD first appeared on Premier Surgical.

Kim Hagan has suffered from heartburn for as long as she can remember, and her pain and discomfort worsened over the past few years. No matter what she ate, the feeling of acid reflux remained constant.

Kim said goodbye to acid reflux thanks to a new minimally invasive procedure performed by Premier general surgeon Dr. Michael Antiporda at Fort Sanders Regional.

“I would refrain from eating after a certain hour, but it wouldn’t matter. I ended up sleeping propped up in the living room sleeper chair most nights,” she recalls. “It burned my throat to lay flat in the bed.”

Hagan recently underwent a newly available anti-reflux procedure called magnetic sphincter augmentation at Fort Sanders Regional Medical Center in Knoxville. She was the first person in the East Tennessee region to receive this minimally invasive surgery.

The retired nurse was referred to Premier Surgical Associates general surgeon Michael Antiporda, MD, at Fort Sanders Regional. He specializes in minimally invasive and robotic-assisted surgery for the stomach and esophagus. Dr. Antiporda has specialized training in diagnosis and medical management of gastrointestinal conditions such as reflux. He is skilled in helping his patients get the right diagnosis and navigate proper treatment.

“Reflux is a consequence of abnormal anatomy in the lower esophageal sphincter,” Dr. Antiporda explains.

“When this dysfunction occurs, the lower esophageal sphincter is no longer a one-way valve preventing the stomach contents from coming up the esophagus. When that happens, there are over-the-counter medications available that can suppress the acid, but they do not keep physical movement from acid coming up in severe cases.”

Dr. Antiporda underscored that for people suffering from reflux, surgery is not the first line of defense. Many people find relief with medication or lifestyle and diet changes. He says, “Discussion between a patient and doctor is important, and getting the right diagnosis is key. I like to set goals with my patients with their input to do what’s best for them.

He continues, “Ms. Hagan was an excellent candidate for this procedure because she had experienced years of severe reflux symptoms which medication was no longer helping. Her symptoms were impacting her quality of life, and based on comprehensive testing, we observed the physiology of her esophagus and saw the dysfunction and how this procedure would help solve the issue.”

Breakthrough Technology

Traditionally, patients would undergo acid reflux surgery called  fundoplication. During this operation, the surgeon wraps the upper part of the stomach around the lower part of the esophagus in order to tighten the lower esophageal sphincter, preventing stomach acid from coming up the esophagus and throat. This procedure is still used to treat severe reflux.

With magnetic sphincter augmentation, a small device made of metal beads called the LINX Reflux Management System is inserted around the esophagus with a tight enough grip to prevent reflux from coming back up. The beads move apart during swallowing to allow food to pass through.

Dr.Antiporda explains, “Having a device made of titanium will last a patient’s entire life — it won’t stretch, wear out or need replacing over time.” He says the operation has fewer complications than traditional anti-reflux surgery and offers a faster, more comfortable recovery time for patients, with immediate resolution of symptoms. Patients typically
discontinue reflux medication and can eat regular food right away.

“This Changed My Life”

“After several diagnostic tests, I met with Dr. Antiporda and found out about the procedure and said, ‘sign me up!’” Hagan says. “He is so knowledgeable. He was enthusiastic about helping me. He gave me plenty of reading material to take home, which I appreciated. He made sure we were on the same page.”

She received several small laparoscopic incisions and spent one night at Fort Sanders Regional. Hagan, who has had many surgeries, said her post-operative experience was “a breeze,” with no discomfort.

Post-op instructions included recommendations to take small bites and chew food thoroughly. After living with reflux for so long, Hagan feared the symptoms would continue, but she happily reports, “Two months later, I have had zero reflux or heartburn issues. This surgery has been a miracle,” she beams. “This has changed my life for the better.”

Looking Ahead

Dr. Antiporda says that Fort Sanders Regional is committed to offering the most up-to-date treatment for patients. “Medicine isn’t ‘one size fits all.’ Treatment is tailored to each individual patient based on where they are on the spectrum of disease,” he says. “We strive to be on the cutting edge of technology, and offering procedures like this means patients have more options.”

If you suffer from long term acid reflux and considering surgery, you can request an appointment with Dr. Antiporda by calling Premier Fort Sanders at (865) 524-3695 or vising https://www.premiersurgical.com/dr-antiporda-appointment-request/.

The post The Heart(burn) of the Matter first appeared on Premier Surgical.

Surgery is often a good option for GERD patients who have more severe symptoms or whose symptoms persist for years even with higher dosage of medication.

Surgical Options for GERD
There are different surgical options for GERD, including:

Laparoscopic Nissen Fundoplication
First performed in the early ‘90s, laparoscopic Nissen fundoplication is considered the gold standard in GERD surgery.

It’s a minimally invasive procedure that involves five keyhole incisions that wraps part of the upper stomach around the lower esophagus in order to create a one-way valve that prevents stomach contents from moving backward but still allows food or liquid to pass from the esophagus into the stomach.

Toupet Fundoplication
This is similar to the laparoscopic Nissen fundoplication, except that the stomach wrap is partial. It wraps around the esophagus for 270 degrees, rather than 360 degrees like the Nissen.

This is performed for patients who have a weaker esophageal function as a complete wrap in such cases would cause too much trouble with swallowing.

Magnetic Sphincter Augmentation with the LINX Device
This is another good, newer option for GERD, which shows very good data from randomized controlled trials, showing excellent reflux control with minimal side effects.

In this procedure, a small device (LINX) is implanted to tighten the opening of the lower esophageal sphincter. Sometimes the Nissen fundoplication can cause some bloat or difficulty trying to belch, but the LINX allows some venting because it can be opened with enough pressure from the stomach.

The physicians of Premier Surgical Associates of Knoxville and Cleveland, TN, surgically treat patients with acid reflux and GERD. To request an appointment with one of our experienced surgeons, visit https://www.premiersurgical.com/acid-reflux-appointment-request/

The post Types of Surgeries for Acid Reflux first appeared on Premier Surgical.

GERD or gastroesophageal reflux disease affects about 20 percent of the population.

We interviewed Dr. Michael Antiporda, a general surgeon with Premier Surgical Associates with fellowship training focused on esophagus and stomach surgery, to explain surgical options for GERD patients.

When should one consider surgery?

“When GERD is proven by testing and medicines do not adequately control symptoms, then surgery is an excellent option. Surgery is best for patients who have more severe symptoms or who have had symptoms for years that are worsening despite higher doses of medication. Surgery is very safe and effective when performed by surgeons who dedicate themselves to completely understanding the physiology and outcomes of esophageal and gastric surgery.”

The terms acid reflux, heartburn, and GERD are often used interchangeably.

Acid reflux occurs when the acid from the stomach moves backward into the esophagus. This typically occurs as a result of a weak or dysfunctional lower esophageal sphincter (LES) or when a hiatal hernia is present.

Heartburn, on the other hand, refers to the mild to severe pain in the chest caused by acid moving back into the esophagus. The lining of the esophagus is more delicate than the stomach lining so when acid moves back, you can feel a sharp, burning pain.

Finally, the term GERD refers to chronic acid reflux causing symptoms on a regular basis, typically weekly or more often.

Dr. Michael Antiporda, General Surgeon

What are the symptoms of GERD?

“The most common symptoms are heartburn and regurgitation, especially when happening after eating or when lying down or bending forward. Other associated symptoms may include chest, back, or upper abdominal pain, trouble swallowing solids or liquids, feeling full quickly, or bloating. Symptoms can also affect the airways and lungs and cause voice changes, hoarseness, or aspiration and lung infections.”

What are the surgical options for GERD patients?

“The gold standard is laparoscopic Nissen fundoplication. This was first performed in the early 90s and has undergone much evolution and refinement. Essentially, this is a minimally invasive procedure done under general anesthesia with five keyhole incisions that wraps part of the upper stomach around the lower esophagus in order to create a one-way valve that prevents stomach contents from moving backward but still allows food or liquid to pass from the esophagus into the stomach.

Another option is the Toupet fundoplication which is similar to the Nissen, but the stomach wrap is partial in that it wraps around the esophagus for 270 degrees, rather than 360 degrees like the Nissen. This is performed for patients who have a weaker esophageal function in which I would worry that a complete wrap would cause too much trouble with swallowing.

Magnetic sphincter augmentation with the LINX device is an option that has very good data from randomized controlled trials showing excellent reflux control with minimal side effects. Sometimes the Nissen fundoplication can cause some bloat or difficulty trying to belch, but the LINX allows some venting because it can be opened with enough pressure from the stomach.

What can patients expect after the surgery?

“After anti-reflux surgery, patients will no longer experience troublesome reflux symptoms like heartburn or regurgitation, and they will no longer need those medications they were reliant on before like antacids and proton pump inhibitors. There is a short period of time (a few weeks) right after surgery when swallowing may be slightly more difficult due to swelling caused by the surgery itself, but this always gets better with time and patients are able to eat all the foods they used to enjoy before they suffered from GERD. They will be able to lie flat at night and not worry about being woken up by acid reflux.”

Who are not candidates for the surgery?

“Anti-reflux surgery is not indicated when pre-operative testing shows that symptoms are caused by something other than GERD. Sometimes this is an esophageal motility disorder or even not something related to the stomach or esophagus. And, in some instances, GERD is early-stage or mild and we realize that it may be better to remain on medications rather than to go ahead with the surgery. It’s a mutual decision that is made after a lot of discussion and education between the patient and surgeon.”

Premier Surgical Associates of Knoxville and Cleveland, TN, surgically treats patients with acid reflux and GERD. To request an appointment with one of our experienced surgeons, visit https://www.premiersurgical.com/acid-reflux-appointment-request/.

References:
https://www.healthline.com/health/gerd/heartburn-vs-acid-reflux#gerd
https://www.memorialhermann.org/digestive/laparoscopic-nissen-fundoplication/

Toupet Fundoplication/Partial Wrap

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