Conditions
Conditions We Treat
Reflux and foregut disease, metabolic disease, gallbladder disease, and hernia. Plain language explanations of what is happening and what can be done about it.
Metabolic Health
Conditions driven by metabolism and physiology, not willpower.
- Obesity as a Metabolic DiseaseObesity is a chronic metabolic disease. The body defends a set point through hormones that control hunger, fullness, and how energy is stored. That is physiology, not willpower, and it is treatable.
- Type 2 Diabetes and Metabolic SurgeryType 2 diabetes is a disease of insulin signaling. Metabolic procedures change gut hormone signaling directly, which is why they are studied as treatment for the diabetes itself and not only as a way to change body size.
- Metabolic SyndromeMetabolic syndrome is not one disease. It is a cluster of findings that tend to appear together because they share a root cause in insulin signaling and how the body stores energy.
- Obstructive Sleep Apnea and Metabolic HealthObstructive sleep apnea and metabolic disease feed each other. Fragmented sleep worsens insulin signaling and blood pressure, and metabolic change alters the airway. Treating one usually helps the other.
- Fatty Liver Disease (MASLD and MASH)Fatty liver disease is metabolic disease showing up in the liver. It is usually silent, it is detected on labs or imaging, and the stage of scarring matters far more than the amount of fat.
- PCOS and Metabolic HealthPolycystic ovary syndrome is a hormonal condition with a metabolic engine underneath it. Insulin resistance drives much of what patients experience, which is why metabolic treatment often improves the syndrome itself.
- High Blood Pressure and Metabolic HealthHigh blood pressure is usually a symptom of something upstream. When it appears alongside glucose and lipid changes, the shared driver is metabolic, and treating that driver moves more than one number.
- Joint Pain and Metabolic LoadJoint pain in metabolic disease has two sources: mechanical load across the joint and inflammatory signaling from metabolically active tissue. Both are treatable, and treating only one usually disappoints.
- BMI, Body Composition, and Surgical CandidacyBMI is a population screening tool. It does not distinguish muscle from fat, it says nothing about where energy is stored, and it does not decide who benefits from treatment. Candidacy is a clinical judgment, not a threshold.
Reflux and Foregut
Acid reflux and the swallowing and stomach conditions that travel with it.
- GERD, Chronic Acid RefluxAcid reflux becomes GERD when stomach contents move into the esophagus often enough to cause symptoms or damage. Heartburn is the symptom. The valve at the top of the stomach is usually the cause.
- Hiatal HerniaA hiatal hernia occurs when part of the stomach moves up through the opening in the diaphragm. It is one of the most common reasons the reflux barrier stops working, and it is frequently the missing piece in stubborn reflux.
- Barrett's EsophagusBarrett's esophagus is the lining of the lower esophagus changing to a type more like intestinal lining after years of acid exposure. It is an adaptation, it is usually silent, and it is the reason long standing reflux deserves a look rather than a refill.
- EsophagitisEsophagitis is inflammation of the esophageal lining. Reflux causes most of it, but medications, allergic disease, and infection cause the rest, and the treatments are not interchangeable.
- Dysphagia, Difficulty SwallowingDifficulty swallowing is a symptom, never a diagnosis, and it always deserves evaluation. Where in the swallow the trouble occurs points directly at which mechanism has failed.
- Silent Reflux and Laryngopharyngeal RefluxLaryngopharyngeal reflux affects the throat, voice box, and airway rather than the chest. Most people with it have no heartburn at all, which is why it is so often treated as allergy, asthma, or postnasal drip for years.
- RegurgitationRegurgitation is food or liquid returning to the mouth without nausea and without the forceful effort of vomiting. It usually signals a mechanical problem, and it responds poorly to acid medication because acid is not the issue.
- GastroparesisGastroparesis means the stomach empties too slowly even though nothing is blocking the outlet. Fullness after small amounts, nausea, and unpredictable meals are the daily reality, and diagnosis requires measuring emptying rather than assuming it.
General Surgery
Gallbladder, appendix, and hernia of all kinds.
- Gallstones and Gallbladder DiseaseGallstones form when bile becomes chemically unbalanced. Most cause no trouble. Symptoms begin when a stone blocks the outflow of bile, and that blockage is what drives both the pain and the risk.
- AppendicitisAppendicitis is inflammation of the appendix, usually from a blockage at its opening. It is one of the more common reasons for urgent abdominal surgery, and delay is the main thing that makes it worse.
- Inguinal HerniaAn inguinal hernia is a gap in the abdominal wall in the groin that lets tissue push through. It does not heal on its own, and the important judgment is whether and when to repair it rather than whether it will resolve.
- Umbilical HerniaAn umbilical hernia is a defect at the navel where tissue pushes through the abdominal wall. In adults it does not close on its own, and small defects can matter more than large ones.
- Ventral and Incisional HerniaA ventral hernia is a defect in the front abdominal wall. When it occurs at the site of a previous incision it is called incisional. These are the most variable hernias to plan for, and preparation changes the outcome more than in any other hernia type.