Luciano Fiszer, MD, is a Fellow of the American College of Surgeons and a Miami-based board-certified general surgeon specializing in hernia surgery.
Gastroesophageal reflux disease, or GERD or acid reflux or heartburn as it is commonly known, is a disease that affects at least 20 percent of adults in the United States. GERD is characterized by a burning sensation in the middle of someone’s chest that is often accompanied by a sour taste in the mouth. These symptoms can also be accompanied by nausea and possible vomiting of previously ingested food. It is often triggered when people eat spicy or fatty foods or eat too quickly.
GERD involves two main parts of the gastrointestinal tract, as implied in the name: the esophagus and gastric acid. After food is chewed and swallowed, it travels down the esophagus through peristalsis. Peristalsis is the coordinated pushing of a ball of food (called a bolus) by the muscles within the esophagus. This bolus is pushed down systematically by the esophagus into the stomach, where the bolus is broken down by the acidic contents of the stomach, collectively known as gastric acid. This gastric acid is responsible for breaking down the bolus into smaller components that can be gradually absorbed throughout the small intestine; it is especially helpful in breaking down fatty foods. It is produced by proton pumps found within the cells that line the stomach. As the name implies, the protons that are being pumped into the stomach are hydrogen. Hydrogen is the main reason why the contents of the stomach are acidic.
There are several reasons why GERD can develop in a person. One of the most common etiologies of GERD involves a muscle known as the lower esophageal sphincter (LES). When functioning normally, this muscle protects the esophagus from any acid that may regurgitate up the esophagus. It does this by maintaining a high closing pressure during fasting periods and relaxing open during feeding periods. When this muscle relaxes too often, the acidic contents of the stomach can regurgitate upwards during fasting periods or shortly after someone eats. This regurgitation of gastric acid is the “reflux” component of GERD and is what is responsible for symptoms like the sour taste in the mouth and nausea one typically experiences with GERD.
Some of the more common remedies for acid reflux include over-the-counter medications or simple, nonpharmacologic methods. These simple methods may include staying away from spicy food, eating bland foods, eating small meals frequently, or having water after eating a large meal.
Over-the-counter medications typically include antacids, the most commonly advertised being Tums. When reflux symptoms cannot be controlled with these methods, it is possible to get a prescription for an antacid. The most commonly prescribed is omeprazole, otherwise known as Prilosec. Omeprazole is a proton pump inhibitor. This class of drugs is responsible for blocking the proton pumps responsible for making the stomach contents acidic. Therefore, after ingesting a meal, even if the LES is dysfunctional, the acid that is regurgitated through the sphincter is less acidic and less corrosive than normal, causing a decrease in symptoms.
Another possible reason why some people may develop GERD is due to the presence of a hiatal hernia. A hiatal hernia is an outpouching of the stomach through an opening of the diaphragm that extends into the chest. The development of these hernias is unknown, but it is believed to be caused by a weakening of the tissue surrounding these structures. Some risk factors for the development of hernias include obesity and smoking. Hiatal hernias have been linked to the development of GERD, primarily due to the shorter length between the LES and the stomach. Those with large hiatal hernias may have shorter and weaker lower esophageal sphincters, which makes the development of GERD more likely.
Those with hiatal hernias may require reflux surgery in order for symptoms to abate. The most common surgical procedure, and the gold standard for the treatment of GERD in patients with large hiatal hernias, is fundoplication. Fundoplication is a surgical procedure in which the upper part of the stomach is wrapped around the lower esophagus, creating reinforcement for the LES and making it less likely for gastric acid to reflux into the lower esophagus. The procedure can be done laparoscopically—meaning that a small incision will be made in order for probes and cameras to be inserted—or through an open manner, which would require a larger incision. The gold standard for fundoplication is to do it laparoscopically; this is known as the laparoscopic Nissen fundoplication.
The laparoscopic Nissen fundoplication utilizes a laparoscope, which is a small instrument that has a camera attachment, allowing the surgeon to see inside the body on a TV monitor without having to make a large incision. Prior to the procedure, patients are under anesthesia and sedated, so that they remain asleep during the entirety of the procedure. During the procedure, the surgeon uses the laparoscope to locate the surgical site and, through the use of equally small surgical instruments, wrap the upper stomach around the lower esophagus as described previously. Laparoscopic procedures are advantageous in that patients are able to leave the hospital sooner, have less post-operative pain, and can return to normal function faster than if an open procedure were done.
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At Elite Surgical Miami our mission is to first and foremast make sure our patients are educated and treated with the utmost respect.
Dr. Fiszer performs these procedures using the most advanced surgical technologies.
Dr. Fiszer has been in medical practice for over 10 years, providing expertise in minimally invasive laparoscopic and robotic-assisted surgery.
At Elite Surgical Miami we make sure that the patient gets the best care professionally and emotionally, a combination we pride ourselves on.
"I had the gastric sleeve with Dr. Fiszer a few weeks ago and it was the best experience I could have hoped for. He was caring and attentive to all my questions, offered information when there were things I didn't ask that I would need to know and the procedure itself was so so much better to recover from than I could have hoped for. I would (and will) highly recommend him to anyone and everyone that is looking for a surgeon. He also did an endoscopy on me a few months earlier and I had an equally good experience for that procedure. A+++ in my book!"
"Dr Fiszer and his staff are wonderful. He is a very knowledgeable, kind, caring, and concerned physician. He answered all of my questions and even answered questions I did not know I had. I was very hesitant about having any type of bariatric surgery. Dr. Fiszer helped me choose which procedure was best for me and when I decide on the gastric sleeve I felt well informed and comfortable with my decision. I would highly recommend him to anyone without reservation."
"Dr. Fiszer is an amazing doctor. His bedside manner is impeccable and his desire to make you feel safe is one of the main reason I will always seek him out for any future surgery. His medical expertise is next to none. Dr. Fiszer performed emergency surgery on my husband for an abscess last weekend and his treatment, compassion, love for his work and respect for his patients is the highest I’ve ever seen. I loved his treatment, courtesy and overall desire to help. God bless you Doc! You ROCK!!!"
Dr. Fiszer performs these procedures using the most advanced surgical technologies.
Dr. Luciano Fiszer, MD, is a board-certified general surgeon who specializes in bariatric /weight-loss surgery and surgical procedures of the digestive tract. Dr. Fiszer has been in medical practice for over 10 years, providing expertise in minimally invasive laparoscopic and robotic-assisted surgery.