Gastric Reflux Surgery:
If you have heartburn or acid reflux or ‘acidity’ twice a week or more —you may have GERD (Gastro-Oesophageal Reflux Disease). While medications give symptomatic relief from the pain of acid reflux and heartburn, it doesn’t restore the natural anatomy and generally doesn’t stop the disease progression. Acid reflux and heartburn medications just mask the problem usually causing more and more medication to be needed with less relief.
There is no need to continue to suffer from heartburn and acid reflux. At CALOMS we specialise in treating acid reflux disease and GERD(Gastro-Oesophageal Reflux Disease) and is one of the best centers in Pune, India to be trained and providing the most recent treatment options for GERD.
At CALOMS we offer the best treatment options including scientifically approved surgical treatment – Nissens Fundoplication for chronic gastro-oesophageal reflux disease. Dr. Girish Bapat specialises in the laparoscopic treatment and offers most advanced treatment.
What Is Gastro Esophageal Reflux Disease (GERD)?
Oesophagus or food pipe carries food from our mouth to our stomach. At the lower end of oesophagus there is a valve which opens to allow the food to pass through. The valve will then close in order to prevent the stomach contents to leak back or reflux into the Oesophagus. Therefore it is supposed to maintain a ‘one way traffic’.
People who are suffering from Gastro-Oesophageal reflux disease, GERD or acid reflux disease have problems with this GE valve not closing properly causing acid to reflux or leak into the oesophagus.
The lining of oesophagus is very delicate, when refluxed stomach acid touches the lining of the oesophagus, it causes a burning sensation in the chest or throat called heartburn. This fluid might cause a sour taste in the back of the mouth, and this is called acid indigestion (acid reflux). Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.
Symptoms of Gastro Esophageal Reflux Disease (GERD)?
Though the majority of patients with GERD complain of persistent heartburn and/or acid regurgitation, patients may experience symptoms of GERD in a variety of ways. Symptoms of GERD may include:
• Excessive Burping
• Regurgitation of food
• Chest pain (rule out angina)
• Hoarseness of voice
• Recurrent Sore throat
• Difficulty in swallowing or a feeling like food is stuck in your throat
• Dry Cough
• Bad Breath
Causes of Gastro-Oesophageal Reflux Disease:
It’s thought that GERD is caused by a combination of factors, but the most common is the failure of the lower oesophageal sphincter (LOS) – a ring of muscle towards the bottom of the oesophagus which acts like a one-way valve. In GERD, this sphincter doesn’t close properly, allowing acid to leak up into the oesophagus.
• Hiatus hernia- hiatus hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest.
• Alcohol use
• Eating fast
• Eating large meals
• Eating late at night, erratic eating habits
• Spicy, oily and junk food
• Aerated drinks – Coke, Limca, Pepsi etc
Complications of Gastro Esophageal Reflux Disease:
Apart from the poor quality of life, chronic Gastric Reflux can lead to potentially serious complications:
• Oesophagitis (Inflammation, irritation, or swelling of the esophagus)
• Stricture (Narrowing of the esophagus)
• Barrett’s Oesophagus can potentially become cancer.
Your doctor may be able to diagnose GERD based on frequent heartburn and other symptoms. Further testing for GERD is usually only required if:
• you have pain when swallowing (odynophagia)
• you have difficulty swallowing (dysphagia)
• your symptoms don’t improve despite taking medication
Further testing aims to confirm or disprove the diagnosis of GERD, while checking for any other possible causes of your symptoms, such as functional dyspepsia (irritation of the stomach or food pipe) or irritable bowel syndrome (IBS).
Endoscopy demonstrates anatomy and identifies the possible presence and severity of complications of reflux disease (oesophagitis, Barrett oesophagus, strictures (narrowing)). Using the patient’s history and pathologic analysis of biopsy specimens obtained during endoscopy, the diagnosis of GERD can be made. Endoscopy also excludes the presence of other diseases like peptic ulcer and stomach cancer that can present similarly to GERD.
Manometry is used to assess how well your lower oesophageal sphincter (LOS) is working, by measuring pressure levels inside the sphincter muscle. Manometry isn’t essential for diagnosing GORD, but it can help exclude conditions with similar symptoms. It can also help ensure that the strength of gullet contractions are adequate if surgery is being considered.
An X-ray of your upper digestive system. Sometimes called a barium swallow or upper GI series, this procedure involves drinking a chalky liquid that coats and fills the inside lining of your digestive tract. Then X-rays are taken of your upper digestive tract. The coating allows your doctor to see images of your oesophagus, stomach and upper intestine (duodenum). It also helps to diagnose the presence of hiatus hernia.
24 hour- pH studies:
This test is done to monitor the amount of acid in your oesophagus. Ambulatory acid (pH) probe tests use a device to measure acid for 24 hours. The device identifies when, and for how long, stomach acid regurgitates into your oesophagus.
Treatment of Gastro- oesophageal reflux disease (GERD).
Treatment of gastroesophageal reflux disease (GERD) involves a stepwise approach. The goals are to control symptoms, to heal oesophagitis, and to prevent recurrent oesophagitis or other complications. The treatment is based on (1) lifestyle modification and (2) control of gastric acid secretion through medical therapy with antacids or PPIs or surgical treatment with corrective antireflux surgery.
If you have GORD, you may find the following self-care techniques useful:
• If you’re overweight, losing weight may reduce your symptoms, as it will reduce pressure on your stomach.
• Giving up smoking can help, as smoke irritates your digestive system and can make your symptoms worse.
• Eating smaller, more frequent meals, rather than three large meals a day can help. Make sure you have your evening meal three or four hours before bedtime.
• Alcohol, coffee, chocolate, tomatoes, or fatty or spicy food can trigger the symptoms of GORD. If you suspect that any of these make your symptoms worse, remove them from your diet to see whether your symptoms improve.
• Raise the head of your bed by around 20cm (8 inches) by placing a piece of wood or blocks under it. This may improve your symptoms. Don’t use extra pillows, because it may increase pressure on your abdomen.
A number of different medications can be used to treat GERD. These include:
• over-the-counter medications
• Acid inhibitors (PPIs)
Depending on how your symptoms respond, you may need medication either on a short- or long-term basis.
A number of over-the-counter medicines (Antacids) can be used to help relieve mild to moderate symptoms of GERD. Antacids neutralise the effects of stomach acid. However, they shouldn’t be taken at the same time as other medicines, because they can stop other medicines being properly absorbed into your body. They may also damage the special coating on some types of tablets. Alginates produce a protective coating that shields the lining of your stomach and oesophagus from the effects of stomach acid. They work best if taken just after finishing a meal.
Proton-pump inhibitors (PPIs)
If GERD fails to respond to the self-care techniques described above, we may prescribe a course of a PPI for you. PPIs work by reducing the amount of acid produced by your stomach.
Most people tolerate PPIs well, and side effects are uncommon. When side effects do occur, they’re usually mild and may include:
• abdominal pain
To minimise any side effects, we will prescribe the lowest possible dose of PPIs that they think will be effective in controlling your symptoms.
In some cases, PPIs may be needed on a long-term basis.
H2-receptor antagonists (H2RA)
If PPIs can’t control your GORD symptoms, another medicine known as an H2RA may be recommended to take in combination with PPIs on a short-term basis (two weeks), or as an alternative to them.
H2RAs block the effects of the chemical histamine, which is used by your body to produce stomach acid. H2RAs, therefore, help reduce the amount of acid in your stomach.
Anti-reflux surgery (Nissens Fundoplication) is an extremely effective treatment for acid reflux disease. Surgery may be required where medical treatment fails to 4 relieve symptoms, or if the medication satisfactorily relieves the symptoms recur. Anti-reflux surgery is performed via laparoscopic or keyhole surgery. It requires a general anaesthetic and the duration of the procedure is normally approximately one- two hours. A patient will stay in the hospital usually for two- three nights after surgery.
Nissen Fudoplication + Hiatus Hernia Repair
A hiatus hernia, if present, is firstly replaced into the abdomen. The hole in the diaphragm is tightened up with stitches firstly. The operation involves the wrapping of the floppy upper part of the stomach (fundus) around the weakened lower oesophagus sphincter valve. This causes a much more effective and strong sphincter to prevent acid refluxing from the stomach into the esophagus.
For the first six weeks after surgery, you should only eat soft food, such as mince, mashed potatoes or soup. Avoid hard food that could get stuck at the site of the surgery, such as toast, chicken or meat.
Common side effects of nissens fundoplication include:
How safe is surgery?
Anti-reflux surgery is as safe as most other types of routine surgery such as gallbladder removal or groin hernia repair. Any type of surgery, however, can involve some potential risks which in this procedure include bleeding, infection, damage to any of the organs in the region such as stomach or oesophagus.
These side effects should resolve over the course of a few months.