Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Fundoplication is the standard surgical method for
treating gastro-esophageal reflux disease (GERD). GERD
causes inflammation, pain (heartburn), and other serious complications (such as scarring
and stricture) of the esophagus. GERD results when acid refluxes
(regurgitates, or backwashes) from the stomach back up into the esophagus. Under
normal conditions, there is a barrier to reflux of acid. One part of this barrier
is the lower-most muscle of the esophagus (called the lower esophageal sphincter). Most
of the time, this muscle is contracted (constricted, or tight), which closes off
the esophagus from the stomach. In patients with GERD, the sphincter does not
function normally. The muscle is either weak or relaxes inappropriately.
Fundoplication is a surgical technique that strengthens the barrier to acid
reflux when the sphincter does not function normally.
What happens during fundoplication?
During
the fundoplication procedure, the part of the stomach that is closest to the
entry of the esophagus (the fundus of the stomach) is gathered, wrapped, and
sutured (sewn) around the lower end of the esophagus and the lower esophageal
sphincter. (The gathering and suturing of one tissue to another is
called plication.) This procedure increases the pressure at the lower end of the
esophagus and thereby reduces acid reflux.
Also, during fundoplication, other surgical steps
frequently are taken that also may reduce acid reflux. For instance, if the
patient has a hiatal hernia (which occurs in 80%
of patients with GERD), the hernial sac may be pulled down from the chest and
sutured so that it remains within the abdomen. Additionally, the opening in the diaphragm through which the
esophagus passes from the chest into the abdomen also may be tightened.
Fundoplication may be done using a large incision (laparotomy
in the abdomen or thoracotomy
in the chest) or
a laparoscope, which requires only several small punctures in the abdomen. The
advantage of the laparoscopic method is a speedier recovery and less
post-operative pain.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Causes of hiatal hernia are a larger than normal esophageal hiatus. There are two types of hiatal hernias, sliding, or para-esophageal. When symptoms of hiatal hernia appear, they are similar to GERD symptoms. Hiatal hernia treatment is generally surgery.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease (GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn.
Achalasia is a disease of the esophagus that mainly affects young adults. Abnormal function of nerves and muscles of the esophagus causes difficulty swallowing and sometimes chest pain.
Schatzki (Schatzki's) ring, is a narrow ring of tissue located just above the junction of the esophagus and stomach. The cause of Schatzki ring is not clearly known, however, some doctors believe they are caused by long term acid reflux. The symptoms of a Schatzki ring is primarily poorly chewed food that stays in chunks becoming stuck in the esophagus. Diagnosis of Schatzki's ring is barium x-ray or endoscopy. Treatment is generally a procedure to stretch or fracture the rings.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication, prescription medication, and surgery.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Acid backing up into the larynx (voice box), it causes reflux laryngitis. Irritation of the lining of the esophagus, larynx, and throat can lead to esophagitis, sinusitis, strictures, hoarseness, throat clearing, swallowing problems, asthma, chronic cough, and more. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with OTC medication, prescription medication, and lifestyle changes.
Reflux is caused by weakness in the muscle at the junction of the
esophagus with the stomach. Normally, this
muscular valve, or sphincter,
functions to keep food and stomach acid from moving upward from the stomach to
the esophagus and larynx. This valve opens to allow food into the stomach and
closes to keep the stomach's contents from coming back up. The backward movement
of stomach contents (gastric contents) up into the esophagus is referred to as
gastroesophageal reflux.
Additionally, any increase in abdominal pressure (such as obesity),
which can push acid back from the stomach up the esophagus, or a patient with
a hiatal hernia, will have an increased risk for reflux. When it causes
symptoms, it is referred to as gastroesophageal reflux disease (or GERD).
When the acid backs up into the voice box (larynx), the condition is referred to
as reflux laryngitis.
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