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Got GERD? Research Aims To Improve Outcomes After Anti-Reflux Surgery

Dec. 4, 2020

This post is by Yousef Nofal, a third-year medical student at Dell Medical School.

Up to 50% of people over the age of 60 may have a hiatal hernia, a condition in which the upper part of the stomach pushes into the chest through an opening in the diaphragm, the muscle that separates the abdomen from the chest. These hernias are often why people develop gastroesophageal reflux disease. Patients with GERD have frequent acid reflux, where stomach acid fluid flows backwards into the esophagus, often resulting in severe heartburn.

At the UT Health Austin Heartburn and Esophageal Disorders clinic, our team studies ways to improve care for patients with GERD. The surgical director for digestive health, Tripp Buckley, M.D., leads a research team that includes surgical residents and medical students such as myself.

Surgery is the only definitive treatment for hiatal hernias. To prevent these hernias from reoccurring, we use a piece of mesh to provide extra support to the diaphragm after hernia repair. Currently, it’s unclear which type of mesh is most effective in preventing hernias.

Researchers at the Heartburn and Esophageal Disorders clinic are on the cutting-edge of research. We were the first center in the U.S. to enroll patients into a clinical trial using a new, Food and Drug Administration-approved bio-absorbable mesh. Called DuraSorb, this mesh is used in hiatal hernia repairs and anti-reflux surgery.

Our team keeps a database of all patients who have received different types of mesh. This database allows us to keep track of our patients’ outcomes years after surgery. With this information and the results of our ongoing DuraSorb trial, we hope to discover which mesh is best for our patients.

However, understanding a technical surgery tool like mesh is only one aspect of improving patient outcomes. Our team is also interested in taking a more holistic look at improving the lives of patients with acid reflux.

In a recent study, we looked at how anxiety and hypervigilance — a state of being extremely sensitive to your symptoms — can affect quality of life. We reviewed the records of 102 patients who had anti-reflux surgery at Dell Seton Medical Center at The University of Texas from 2019 to 2020. Prior to surgery, patients with higher levels of anxiety and hypervigilance had worse quality of life and more intense symptoms of reflux.

Six months after surgery, these patients saw drastic improvement. After surgery, their quality of life was similar to that of patients who did not have high levels of anxiety or hypervigilance before surgery. We also found that the type of anti-reflux surgery performed did not play a role in the degree of improvement in anxiety, hypervigilance or quality of life.

These results challenge the traditional view that patients with worse mental and emotional health benefit less from surgery. As we continue to study the intersection of mental health and GERD, we believe these findings can help both providers and patients map out the best surgical plan for combating pesky acid reflux.