|
Gastroesophageal
Reflux Disease (GERD)
|
| |
|
|
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 weakened or relaxes too frequently,
allowing acid 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 I 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) |
| :: |
Indigestion
|
| :: |
Regurgitation
of food in mouth on lying down |
| :: |
Difficulty
sleeping after eating |
| :: |
Hoarseness
|
| :: |
Chronic
Cough |
| :: |
Sore
Throat |
| :: |
Asthma
|
| :: |
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? |
| |
| :: |
Symptomatology
|
| :: |
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?
Lifestyle
Changes...
DO:
| :: |
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 |
AVOID:
| :: |
Eating
large meals, especially before sleep |
| :: |
Lying
down for two to three hours after eating |
| :: |
Eating
chocolate or peppermints |
| :: |
Smoking
cigarettes |
| :: |
Drinking
alcohol |
Medicines
Medicines
will give relief to symptoms till the time you take them
regularly. Few patients may also get long term relief but
may recur again. Moreover, many medicines have side effects.
Surgical
Correction
For
patients with persistent symptoms requiring chronic 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.
Surgical
Options
| :: |
Conventional
open surgery |
| :: |
Laparoscopic
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.
|
|
OPEN
|
LAPAROSCOPIC
|
|
Post
operative pain
|
Significant
|
Minimal
|
|
Hospital
stay
|
5-6
days
|
1-2
days
|
|
Symptom relief
|
Good
|
Good
|
|
Cosmesis
|
Poor
|
Excellent
|
|
| |
|
|
|
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.
|
