Reflux

Reflux Diagnosis & Treatment

Reflux happens when stomach contents travel back into the oesophagus, throat or lungs.

It occurs when pressure in the stomach exceeds the closing pressure of the lower oesophageal valve.

Main drivers: hiatus hernia · weak lower oesophageal sphincter · oesophageal sensitivity · delayed gastric emptying (gastroparesis).

Reflux isn’t one-size-fits-all. Since starting NSW’s first high-definition oesophageal physiology lab in 2008, we’ve used detailed reflux and motility testing to identify the exact problem and match the right treatment, whether that’s optimised medication, endoscopic therapy or laparoscopic/robotic anti-reflux surgery.

Reflux Symptoms

Heartburn (burning behind the breastbone) · regurgitation · epigastric discomfort · chest pain/food “sticking” · cough/voice change · asthma-like breathlessness · belching/gas trapping · bitter taste. Because other conditions can mimic reflux, a clear diagnosis matters, especially if symptoms persist, you’re over 50, or swallowing is difficult.

When to Investigate

If a short trial of antacids or acid suppression doesn’t help, or red flags are present, testing is appropriate. No single test answers everything; A/Prof Talbot tailors the work-up to your symptoms and goals.

Reflux Testing

Endoscopy (gastroscopy): checks for oesophagitis, Barrett’s, ulcers, cancer and hiatus hernia.
Reflux monitoring:
- Catheter (24hr): thin nasal catheter; eat/drink normally; press a button when symptoms occur.
- Capsule (96hr): endoscopically placed, wirelessly records reflux; detaches naturally.
Oesophageal function (manometry): measures valve function and swallowing.
H. pylori testing and ultrasound/CT as needed to exclude other causes.

What To Expect

Most tests are day-only.

Laparoscopic surgery uses small incisions, typically a 1–2 night stay, and staged return to normal diet and activity. You’ll receive clear guidance on recovery and follow-up.

Risks & Considerations

All treatments carry risks. With reflux surgery, these can include bleeding, infection, bloating, dysphagia or (rarely) injury/leak.

Careful pre-operative testing helps select the option with the best benefit-to-risk profile for you.

The first step is to identify the problem, then offer a solution specific to that problem. Rather than saying everyone with reflux gets a tablet or surgery, we use the data to help you choose the therapy that’s right for you.

Reflux Treatment Options

Upper GI Surgery will match the therapy to the cause of the reflux (hernia, weak valve, sensitivity, gastric emptying) and your individual goals

Medications

Reduce acid strength, not the number of events

Antacids (quick relief).
PPIs (e.g., esomeprazole, pantoprazole) lower acid production.
H2 blockers (less potent; sometimes adjunctive).
Prokinetics (e.g., domperidone, metoclopramide) for slow gastric emptying.
Neuromodulators/diaphragmatic breathing for hypersensitivity, belching and gas trapping.

Endoscopic therapy (incisionless):

RAP (Resection and Plication) - tightens the gastro-oesophageal junction in selected patients without a significant hiatus hernia.

Laparoscopic anti-reflux surgery:

Hiatus hernia repair with or without fundoplication - restores normal anatomy and strengthens the valve.

Bariatric Considerations

in selected patients with obesity and severe reflux, hiatus hernia repair will often address reflux, and gastric bypass can address both reflux and weight problems.

In a high-volume tertiary practice, you’re more likely to find an individualised plan. If a clinician has only one or two options, that’s what you’ll get; we can offer several evidence-based treatments and choose the one that best suits you.

Why Choose Upper GI Surgery?

Precise diagnostics - NSW’s longest-established high-resolution oesophageal lab to correlate symptoms with reflux and motility.
Full spectrum care - optimised medical therapy, endoscopic options (where appropriate) and advanced laparoscopic surgery.
Hiatus hernia expertise - thousands of procedures performed including robotic surgery and modern materials to reduce recurrence rates.
Upper GI specialist - extensive experience with reflux, Barrett’s and complex oesophageal disorders.