Gerd And Hiatal Hernia Treatment In Tampa, FL

• Esophageal pH monitoring is the gold-standard test for GERD. A wireless Bravo capsule or a thin catheter records reflux over 48 to 72 hours while you eat, sleep, and go about a normal day. It tells us whether reflux is real, how severe it is, and whether your symptoms actually line up with reflux events. The role of pH monitoring in confirming GERD is recognized by the National Institute of Diabetes and Digestive and Kidney Diseases.
• Esophageal manometry measures how well your esophagus contracts and coordinates each swallow. The strength of your esophagus decides which operation is safe for you. A patient with weak motility who receives a full wrap can end up unable to swallow comfortably. Manometry is how we prevent that.
• Barium swallow (esophagram) shows how your esophagus behaves in real time. We use it selectively, when you have trouble swallowing, when there is concern for a narrowing, or after a prior operation.

For silent reflux, our testing goes a step further than most. Standard reflux testing only measures acid above the lower esophageal sphincter. We use a customized 24-hour dual-channel pH-impedance probe that measures reflux above both the lower and the upper esophageal sphincter, and detects non-acid reflux like bile and pepsin, not just acid. That matters, because the throat and voice box react to a single reflux episode a day, while the esophagus tolerates 40 to 50. When silent-reflux patients are selected with this level of testing, symptom improvement rises to roughly 80%, compared with the 50% often quoted when patients are chosen without it. This testing is technically demanding and not widely performed, which is why so many silent reflux patients are told their tests are normal and nothing can be done.

There is no single best reflux operation. There is only the right operation for the right patient, and in many cases the right answer is no operation at all. We make that decision with a fixed sequence, not a guess:

1. Confirm reflux is real. Objective pH testing, plus whether the reflux is acid, non-acid, or bile. No proof, no surgery, regardless of symptoms.
2. Map the anatomy. The presence and size of a hiatal hernia, esophageal length, and the relationship between stomach, diaphragm, and esophagus.
3. Test esophageal function. Manometry decides whether a full wrap, a partial wrap, or a magnetic device is safe, or whether surgery should be avoided.
4. Match symptoms to physiology. We separate symptoms that are very likely reflux from those that are unlikely, so expectations are honest before anything is scheduled.
5. Weigh your priorities. Durability, coming off medication, keeping the ability to burp and vomit, reversibility. These refine the choice once an operation is medically appropriate.
6. Choose a procedure, or choose none. Because Dr. Grandhige performs every major option, the decision is driven by what fits your body, not by the one procedure a surgeon is comfortable doing.

As Dr. Grandhige puts it: the operation is the last step, the decision-making is the surgery.

Tampa Bay Reflux Institute is the only practice in the Tampa Bay area offering all four major anti-reflux procedures, with RefluxStop added in 2026. That breadth is the point. When a surgeon offers one operation, every patient tends to get that operation. When you offer four, you can match the procedure to the anatomy.

Here is how the choice usually breaks down:

Almost everyone with reflux has a hiatal hernia, even a small one an endoscopy misses. A hiatal hernia is a stretched or weakened opening in the diaphragm that lets the stomach slip up into the chest. That pulls the lower esophageal sphincter out of position and removes the diaphragm’s support, so the reflux barrier fails mechanically. A hiatal hernia is also recognized by the NIDDK as a factor that can cause or worsen GERD.

Think of the reflux barrier as a two-part door. One part is the sphincter. The other is the diaphragm. If either fails, reflux happens. If both fail, reflux is almost inevitable. Medication cannot fix either part.

Dr. Grandhige recommends repair once a hernia passes about 3 centimeters, because at that size it almost always drives reflux mechanically, it tends to keep growing, and it raises the risk of serious problems like the stomach twisting (gastric volvulus). Smaller hernias still warrant repair when they come with significant symptoms, especially regurgitation, or with complications such as severe esophagitis or Barrett’s esophagus.

The repair matters for one practical reason. A common cause of failed reflux treatment, medical or surgical, is skipping the diaphragm. An operation that does not repair the hernia treats only half the problem and is far more likely to leave you with recurring symptoms.