Reflux Evaluation and Treatment

Reflux means stomach contents move back up into the esophagus, the tube that carries food from your throat to your stomach. Stomach acid belongs in the stomach. The esophagus is not built for it.

Heartburn is the symptom people expect. Many people never get it. Reflux also shows up as a cough that will not quit, a hoarse voice, a lump in the throat, chest pain, trouble swallowing, dental problems, disrupted sleep, or asthma that keeps flaring. That is part of why it gets missed for years.

Underneath the symptoms there is usually a mechanical reason. The valve between the esophagus and the stomach may not close properly. Part of the stomach may have moved up through the diaphragm, which is called a hiatal hernia. The esophagus may not be moving food along the way it should. These are different problems. They need different treatments. You cannot tell them apart by how the symptoms feel.

Here is where I differ from a lot of surgeons. Many go straight from symptoms to an operation, skipping the diagnostic workup entirely. That is how people end up with an operation that was never going to fix their problem. I do not operate on a guess. I test first, I read the results, and the results decide the treatment.

There is one more thing worth saying plainly. The link between reflux and metabolic health runs both directions. Metabolic disease can drive reflux. But an anatomic problem or untreated reflux can also drive metabolic change. When eating hurts, when swallowing is hard, when sleep is broken night after night, your eating, your energy, and your metabolism all shift. Treating the reflux can change the metabolic picture. That is why these two sides of the practice belong together.

People who have been on acid-reducing medication for a long time and still have symptoms, or who do not want to stay on it indefinitely.

People whose symptoms come back the moment they stop medication. That is information, not failure.

People with symptoms that were never connected to reflux. Chronic cough, hoarseness, throat clearing, chest pain that has been cleared by cardiology, trouble swallowing, or sleep that is wrecked by lying flat.

People with a known hiatal hernia, and people who have had reflux surgery before and are still having symptoms.

People being evaluated for metabolic surgery. Reflux changes which procedure is the right one, so it has to be understood first.

Reflux affects more men than women. I mention that because men are less likely to be evaluated for it and more likely to live with it for years, and because a lot of people assume this is not a problem that applies to them.

The conversation. We start with your history. What the symptoms are, when they started, what makes them worse, what you have taken and what it did. This part matters more than people expect.

The workup. Testing looks at three questions. What does the anatomy look like, how well does the esophagus move, and is acid actually coming up. Depending on your case that can include an endoscopy to look directly at the esophagus and stomach, a study of how the esophagus contracts, a study that measures acid over time, and imaging of the anatomy. I will explain which tests I am recommending for you and why. [CLINICAL REVIEW: confirm the exact reflux testing Dr. Good orders and offers in office, including naming conventions she prefers for manometry and pH testing.]

The plan. We sit down with the results and I tell you what they show in plain language. Treatment may be medical management, changes matched to what the testing found, an endoscopic treatment, or a surgical repair of the anatomy. If an operation is the right answer, I will explain exactly why the testing points there. [CLINICAL REVIEW: which reflux treatments and repairs does Dr. Good perform herself, and which does she refer out?]

After. We follow up to see whether the treatment did what it was supposed to do, and adjust if it did not.