Acid Reflux and Hernia Repair

Is It Acid Reflux…
Or Something Else?

Don Booth had been taking acid-suppressing medication to manage his symptoms of gastroesophageal reflux disease (GERD), more commonly known as acid reflux, for a couple of years when he started to become extremely tired and experience persistent bloating and relentless indigestion. “Even though it was getting worse, I just passed it off,” says the 57-year-old resident of Milford. Don assumed his symptoms were part of his acid reflux and that his lethargy somehow related to his work that requires him to constantly be on the move.

Fortunately, Don finally decided to see his primary care physician William Muller, MD, of Tri-River Family Health Center in Uxbridge, who determined that he had iron deficiency anemia, a condition in which the body doesn’t have enough healthy red blood cells. Dr. Muller referred him to gastroenterologist Albert Crimaldi, MD, PhD, FACG, who could better identify the cause of Don’s anemia. “Anytime there is iron deficiency anemia, you have to look for either the inability to absorb iron or the loss of iron,” explains Dr. Crimaldi. “The loss of iron clearly equates to loss of blood. The most prominent place for loss of blood is in the GI tract.”

A hernia—one potential cause of the anemia—can mimic, as well as exacerbate, the symptoms of GERD, says Dr. Crimaldi, adding that distinguishing between the two can obviously be confusing for patients. Many patients continue to self-medicate for acid reflux without knowing that a more serious underlying condition exists. That’s why it’s important for patients to see a gastroenterologist when symptoms persist, he adds.

Luckily for Don, he went to see Dr. Crimaldi who could then begin a series of diagnostic tests to determine what might be going on. First, Dr. Crimaldi performed a colonoscopy to look for sources of bleeding, including polyps, hemorrhoids, cancerous growths, or arteriovenous malformations (blood vessels that rise to the surface of the colon and can spontaneously bleed). Don’s colonoscopy came back negative; however, other tests showed evidence of a hernia—a hole in his diaphragm through which his stomach had moved, displacing it from his abdominal cavity into his chest cavity. One such test involved swallowing a PillCam,™ a video capsule that wirelessly transmits several thousand JPEG photos to a portable receiver as it moved through Don’s gastrointestinal tract.

In Don’s case, all tests pointed to the presence of a hernia that was causing ongoing and chronic blood loss. For this reason, Dr. Crimaldi referred Don to surgeon Patrick M. McEnaney, MD, of UMass Memorial General Surgery at Milford, for a hernia repair. Don says he chose Dr. McEnaney and Milford Regional for his surgery because Drs. Crimaldi and Muller highly recommended both. He also felt comfortable with Dr. McEnaney when meeting with him prior to the surgery. “When you have any type of surgery, you need to feel comfortable with the physician. I felt comfortable with him. He explained everything in great detail,” Don recalls.

During laparascopic surgery, Dr. McEnaney repaired Don’s hernia by moving his stomach back into his abdominal cavity and inserting a biologic patch to cover the area through which Don’s stomach had ruptured. The patch, into which the body grows naturally, also covered a portion of his normal diaphragmatic opening to try and prevent any future hernias.

Don says what he remembers most about his stay at Milford Regional is the sensitive nursing care he received while there. “I never felt like I was just a patient or that they were just there doing their jobs,” he recollects. “They seemed to be much more personally involved than that.”

Although he still takes acid-suppressing medications for his reflux, Don says his bloating, indigestion, and lethargy were gone almost immediately after the procedure. Looking back, Don is relieved that he didn’t self-diagnose his condition and left it to his physicians to diagnose and treat his illness. “The surgery took away the symptoms that were slowing me down and taking away my energy,” he says, enthusiastically. “Getting rid of that discomfort has been great!”

Read more about Albert Crimaldi, MD and Patrick McEnaney, MD