Recent physiological experiments have demonstrated the presence of a zone of specialized function in the lowest four inches of the esophagus. This area has been referred to as a physiological sphincter because it is at higher resting pressure than the stomach. This serves to prevent the reflux of caustic acid into the esophagus during the digestion of food and is a protective barrier. When this sphincter is not functioning properly, inflammation and ulceration can develop in the esophagus from the reflux of acid. This can lead to a stricture, or narrowing of the esophagus, bleeding and the development of cancer.

Treatment for hiatal hernia is important in order to prevent the very serious complications of this disorder. Sophisticated diagnostic modalities such as pH testing and manometry are utilized to confirm the diagnosis. Treatment is primarily non-operative and utilizes the latest in H2 receptor blockers. Modification of the diet and weight control are other measures incorporated in the treatment plan.

 While most patients respond favorably to medical management, those that continue to experience symptoms are best treated by surgical intervention. Additionally, patients who are reluctant to be on medication for the rest of their lives and wish to have a more permanent solution are excellent candidates for surgery.

The Nissen Fundoplication is the procedure of choice in correcting the lower esophageal sphincter dysfunction. A portion of the upper stomach is wrapped around the lower esophagus completely encircling it. This creates a unidirectional valve like flow in the esophagus essentially recreating the "physiologic sphincter". The procedure takes less than an hour and patients can be discharged the next morning. Results have been dramatic with complete resolution of symptoms.