Some patients with reflux disease (GERD) suffer from long term acid reflux, heartburn, sour brush, or regurgitation. Others may have a dry cough, difficulty swallowing (dysphagia), a feeling of something stuck in the throat, hoarseness, asthma, sore throat, earaches, or even chest pain. GERD may also be associated with gas, burping, bloating, or a hiatal hernia. A Hiatal hernia is an enlargement of a natural whole in the diaphragm through which the esophagus traverses as it exits the chest and enters into the abdomen emptying into the stomach. The enlargement causes the junction where the esophagus and stomach meet to dislocate (herniate) from the abdomen into the chest. This may cause chest pain, difficulty swallowing (dysphagia), GERD symptoms, or no symptoms at all. If GERD is untreated, the consistent exposure of stomach acid to the esophagus can lead to severe inflammation (esophagitis), strictures, Barrett's esophagus, or cancer. The most common operation to fix GERD is called a a gastric fundoplication. To fix the hiatal hernia, the surgeon does a hiatal hernia repair. Since GERD is often associated with a hiatal hernia, both procedures are performed at the same time, and this is called a Nissen Fundoplication. The fundoplication can be done with endoscopy, but the hiatal hernia repair requires an abdominal surgical approach. See                                                   to learn more about this approach. Dr. Mimms will determine and discuss eligibility for endoscopic fundoplication described below. Dr. Mimms also performs therapeutic and diagnostic upper endoscopy, which is also discussed below.