Gastroesophageal (GE) reflux is the condition when the stomach contents are able to “reflux” back through an incompetent lower esophageal sphincter (LES) into the esophagus.

Gastroesophageal reflux Disease (GERD) is a clinical condition caused by long-standing reflux that results in microscopic and visible changes to the inner lining of the esophagus and esophageal mucosa.

GERD is nondescript as to the cause of the condition. It only states that the stomach contents have been irritating the lining of the esophagus on a chronic basis. This can be caused by an anatomical abnormality of the GE junction (hiatal hernia) or may be related to dysfunction of the LES. Other possible causes of GERD may be infection (H. Pylori), environmental (stress), and dietary (nicotine, alcohol, caffeine, spicy food) in origin.

So far, we have not clarified the chemical nature of the refluxed content.

In Acid Reflux, the relative acid overproduction of acidic secretion and the exposure of the esophageal mucosa need to be addressed. This is accomplished by acid suppression medications, anti-histamine (H2 blockers), and Proton pump inhibitors (PPIs).  The physiology and the mechanism involving this condition are well understood. As a surgeon, however, I do see patients who should have had surgical intervention. The initial mode of therapy for a patient with documented acid reflux and or symptomatic hiatal hernia is placing them on medication. These patients are then recommended to have a related upper endoscopy. Patients who do not improve or where deterioration of the esophageal mucosa and the presence of precancerous cells are referred for surgical intervention.

Bile Reflux, contrary to acid reflux, may have tiny, if anything, to do with the LES. The symptoms experienced by the patient may be as after related to the excessive bile in the stomach, which is seen frequently

after cholecystectomy, or in those patients with a dysfunctional gallbladder (low EF on HIDA scan).

The treatment of Bile reflux is Duodenal Switch without the associated sleeve gastrectomy component in addition to repair of hiatal hernia if present. Ann Surg. 2007 Feb; 245(2): 247–253.