Gastroesophageal Reflux Diseases
What is GERD ?
Normally after food passes through the esophagus (food pipe) into the stomach, a muscular valve called the lower esophageal sphincter (LES) closes, preventing the movement of food or acid upward.
Gastroesophageal reflux occurs when the LES is loose, allowing acid & food from the stomach to flow backward into the esophagus.
Some people may also suffer from a hiatus hernia, which is caused by an opening in the diaphragm, a flat muscle that separates the lungs from the abdomen. A hiatal hernia allows a portion of the stomach to protrude into the chest. This condition can then cause the LES to fail.
Why should GERD be treated?
Although most cases of gastroesophageal reflux are caused by a weakened valve, there might be other causes that should be assessed by your doctor. If left untreated, gastroesophageal reflux can cause: esophageal ulcers, esophageal bleeding, inflammation of the esophagus, chronic hoarseness, Barrett’s esophagus, and narrowing of the esophagus (peptic stricture) that can cause difficulty in swallowing. It can also cause cancer if left untreated for a long time.
How do know if I have GERD?
A physical examination and specific tests by your doctor can determine if you have GERD. This condition may however, produce the following symptoms:
- Painful burning in the upper chest or abdomen (heartburn)
- Regurgitation of food in mouth on lying down
- Difficulty sleeping after eating
- Chronic Cough
- Sore Throat
- Difficulty Swallowing
Some or all of these symptoms may occur several times a day, particularly at night, and may become chronic
How is GERD diagnosed?
- Upper GI endoscopy : Which will show refux and presence or absence of esophagitis.
- Barium swallow : It will show presence of reflux and associated hiatus hernia if present.
- 24 hour pH monitoring : Will document excessive presence of acid inside the esophagus
- Manometry : Will document oesophageal pressures.
- Not all the tests are always required.
- Treatment options
What Can I Do To Take Control Of My Heartburn?
- Sleep with the head of the bed elevated 6 inches
- Have smaller, more frequent meals
- Choose low-fat foods
- Wear looser-fitting clothing and looser-fitting belts around the waist
- Dont go to sleep immediately after food.
- Eating large meals, especially before sleep
- Lying down for two to three hours after eating
- Eating chocolate or peppermints
- Smoking cigarettes
- Drinking alcohol
Medicines is usually first line of treatment. Itwill give relief to symptoms till the time you take them regularly. Few patients may also get long term relief but may recur again.
For patients with persistent symptoms inspite of medication, surgery is an option, which is also a curative mode of treatment. Surgery can repair the valve (LES) as well as repair the hiatus hernia if present.
Conventional open surgery
AIM of both the above procedures is the same : i.e repair of LES and/ or hiatus hernia
How is Laparoscopic surgery for GERD different from open surgery?
Traditional open surgery for GERD requires a large 10-12 cm muscle cutting incision unlike laparoscopic surgery which requires four to five 5 mm tiny incision to perform the same procedure.laparoscopic repair is as good as open repair but it is painless with shorter hospital stay and excellent cosmesis.
How successful is the surgery?
Worldwide experience has shown that over 90% of patients are symptom free after laparoscopic surgical procedure for gastroesophageal reflux disease. Most dramatic change that occurs is in the improvement in quality of life.
What can a patient expect following surgery.
After laparoscopic surgery patients can expect mild pain in their abdomen at the site of small incisions, which usually disappears in 24 to 48 hours. They will also have a feeling of difficulty in swallowing due to a newly constructed sphincter which goes away by 4 weeks.
Patients are put on liquid diet immediately after surgery and are discharged next morning on a soft diet.