Book a dedicated reflux consultation in Perth. We assess ongoing heartburn, regurgitation, hiatal hernia, reflux after bariatric surgery, and symptoms related to weight-loss medication, then build a treatment plan tailored to the real cause.
Choose the option that best fits your situation
Acid reflux, otherwise known as gastro-oesophageal reflux disease (GORD) is a condition where the natural defences within the body’s upper digestive system are impaired. These defences are in place to prevent the acidic contents of the stomach from entering the oesophagus causing a burning sensation that in laymen’s terms, we call heartburn.
One of the primary causes of this condition is a hiatal hernia, a condition where the stomach protrudes through the diaphragm into the chest cavity. The other is the damage to the anti-reflux defence mechanisms including the lower oesophageal sphincter (LOS).
Whether you’ve been managing heartburn for years, have had bariatric surgery, are on weight-loss medication, or have been told you have a hiatal hernia, this consultation is designed to assess the real cause and find the right path forward.
If you’ve had a sleeve gastrectomy, gastric band, gastric bypass, or revision procedure and are now experiencing heartburn, regurgitation, vomiting, or swallowing symptoms, your assessment needs to account for altered anatomy and possible post-surgical changes. Dr Gounder brings direct experience with these complex presentations.
Learn about post-bariatric refluxGLP-1 and dual GIP/GLP-1 medicines (Ozempic, Wegovy, Saxenda, Mounjaro) can slow gastric emptying. If reflux, nausea, fullness, or regurgitation started or worsened after beginning weight-loss injections, bring your medication list and current dosing details to your consultation.
Reflux and weight-loss medicationIf you’ve been told you have a hiatal hernia, or you have reflux with chest tightness, regurgitation, or swallowing difficulty, we assess whether the hernia is contributing to your symptoms and whether treatment should remain medical or move toward surgery. Not every hiatal hernia requires an operation.
UnderstandingIf you’ve relied on antacids or acid-suppression medication for years, still have symptoms despite treatment, or are worried about complications like Barrett’s oesophagus, it may be time for formal assessment and testing with a specialist who understands the full picture.
Is it time for specialist review?Reflux happens when stomach contents move back into the oesophagus. Common symptoms include:
Reflux occurring twice or more per week, or symptoms disrupting your quality of life, generally warrants specialist review.
Reflux can happen for more than one reason. Common contributors include weakness of the lower oesophageal sphincter, hiatal hernia, delayed gastric emptying, excess abdominal pressure, obesity, certain medicines, smoking, and alcohol. It can also occur after some bariatric procedures, particularly when anatomy or pressure dynamics have changed.
Symptoms alone are a useful starting point, but treatment planning is more precise when reflux is objectively confirmed. Depending on your history, one or more of the following tests may be recommended.
A camera examination of the oesophagus and stomach to assess inflammation, ulcers, Barrett’s oesophagus, hiatal hernia size, and other structural changes.
A small sensor measures acid exposure in the oesophagus over 24–48 hours, providing objective confirmation of pathological reflux and its frequency.
Assesses the pressure and function of the lower oesophageal sphincter and oesophageal motility, important information before any surgical planning.
X-ray imaging with contrast that can visualise swallowing function, hiatal hernia anatomy, and oesophageal structure.
Bring any prior test results to your appointment, gastroscopy, pH study, manometry, barium swallow, CT scan, or operation notes all help make the most of your consultation time.
Treatment depends on the cause and severity of your reflux. Most pathways start conservatively, with surgery reserved for carefully selected patients with objectively confirmed reflux.
Eating habits, meal timing, weight management, positional changes, and trigger identification. A meaningful first step for many people.
Ensuring the right medications are being used correctly, and understanding whether medication alone is a sustainable long-term solution.
Objective testing ensures that any surgical recommendation is based on confirmed reflux rather than symptoms alone.
Objective testing ensures that any surgical recommendation is based on confirmed reflux rather than symptoms alone.
For people who have had previous bariatric surgery, assessment accounts for prior anatomy, possible complications, and whether revision or alternative approaches are most appropriate.
GLP-1 and dual GIP/GLP-1 receptor agonists can delay gastric emptying. If you’re using weight-loss medication and experiencing new or worsening reflux, nausea, regurgitation, or difficulty eating comfortably, this needs proper assessment to distinguish between medication effects, reflux, or a structural cause like a hiatal hernia.
The TGA advises patients to disclose GLP-1 medication use to all treating clinicians, particularly before procedures involving sedation or anaesthesia, due to the risk of delayed gastric emptying and aspiration.
Please bring your medication name, dose, and the date of your last dose to your appointment.
Your symptoms, medical history, current medications, prior test results, and previous surgical history are reviewed together. If investigations are needed, a plan is made before discussing whether medical management, further testing, hiatal hernia repair, anti-reflux surgery, or another pathway is most appropriate for your situation.
FRACS, General and Upper GI Surgery
Dr Siva Gounder is the Head of Bariatric Surgery at Perth Weight Loss & Surgery and an accredited specialist in both bariatric and general upper GI surgery. His experience spans sleeve gastrectomy, gastric bypass, revision bariatric surgery, hiatal hernia repair, and anti-reflux procedures, including the complex intersection of obesity-related disease and reflux.
For patients with reflux that sits at the crossroads of bariatric surgery history, weight management, or structural causes, this dual expertise means your assessment considers the full clinical picture rather than treating reflux and weight in isolation.
No. Many people manage reflux well with lifestyle changes, dietary adjustments, and medication. Surgery is considered when reflux is objectively confirmed, symptoms remain troublesome despite appropriate treatment, complications develop (such as Barrett’s oesophagus), or long-term medication is not a suitable solution. A specialist consultation helps clarify which pathway is right for you.
Not necessarily. Small hiatal hernias that are not causing significant symptoms may need no intervention. Surgery becomes more relevant when a hernia is causing persistent reflux, difficulty swallowing, chest tightness, or regurgitation that isn’t adequately controlled by other means. The consultation will help clarify whether your hernia is contributing to your symptoms and what the appropriate response is.
Yes. Reflux can develop or worsen after sleeve gastrectomy or gastric band surgery and may also reflect post-surgical complications such as a hiatal hernia, band slippage, or changes in oesophageal function. Post-bariatric reflux is an increasingly recognised clinical area requiring specialist assessment, treatment options may include medication, hiatus hernia repair, band removal, or in some cases conversion to a different surgical configuration such as Roux-en-Y gastric bypass.
Yes, always. The TGA advises patients to inform all treating health professionals, including anaesthetists and gastroenterologists, if they are taking GLP-1 or dual GIP/GLP-1 receptor agonist medications. Delayed gastric emptying caused by these medicines may increase the risk of aspiration during procedures involving sedation or anaesthesia. Please bring your medication name, current dose, and the date of your last dose to your consultation.
A GP referral is recommended and helpful for Medicare billing purposes and to ensure your GP is kept informed of your care. If you do not yet have a referral, you can still contact us, our team can advise you on the best next step. Bring any existing test results, previous letters, or operation notes you have, as these help make the most of your consultation time.
Barrett’s oesophagus is a change in the lining of the lower oesophagus that can develop in people with long-standing acid reflux. It is diagnosed on gastroscopy and requires ongoing monitoring. It does not necessarily mean surgery is needed, but it is one of the recognised indications for more thorough specialist review and, in some cases, surgical consideration for long-term management of the underlying reflux.
The surgical procedure used is called Hiatal Hernia Repair with Fundoplication. This is done via keyhole (laparoscopic) surgery.
In this procedure, the lower end of the oesophagus and the upper part of the stomach is freed completely The hernia is reduced, thus bringing the gastro-oesophageal junction below the diaphragm.
Then, the opening on the diaphragm is narrowed, allowing a free passage of oesophagus without any external compression on the wall of the oesophagus. This narrowing is performed with sutures, and is called a diaphragmatic crural repair or cruroplasty.
To prevent recurrence of the hiatal hernia and reflux of gastric acid, the gastric fundus (upper part of the stomach) is wrapped around the lower part of the oesophagus.
The wrap could either be a complete 360-degree wrap, or a partial 270 degree or 180-degree wrap:
The procedure can be performed via open or laparoscopic approach, through the abdomen or through the chest.
Large diaphragm defects and presence of weak tissue may require placement of synthetic or biological mesh.
Long term studies show that ninety-one to ninety-three percent of patients reported a good overall outcome at late follow-up, with good reflux control maintained long-term in the majority of patients 80 % report no heartburn, 13 % mild occasional symptoms, and 7 % report significant reflux symptoms at late follow-up. Proton pump inhibitor (eg Nexium) use was seen in 27 % of patients at 10 years follow-up,
But compared to people who do not have surgery, people who do have surgery are less likely to need medicine every day and have less severe symptoms when they stop taking medicine. Also, people who have surgery for GORD seem to be happy with the results, even if their symptoms do come back and they have to take medicine again.
