Gastro-oesophageal reflux disease

 

What Is Gastro-oesophageal Reflux Disease (GORD)?

Gastro-oesophageal reflux disease (GORD) occurs when the natural protective mechanism in the lower oesophagus starts to deteriorate.  Often this is because the Lower Oesophageal Sphincter (LOS) fails to work and allows stomach acid to leak back up into the oesophagus, known as acid reflux. The oesophagus is the tube that runs from your throat to your stomach and when it becomes very inflamed it can cause a painful condition, known as Oesophagitis.

GORD is a very common condition and it is estimated that 10-20% of the population suffer with this problem at least once a week.

What Are The Symptoms Of Gastro-Oesophageal Disease?

Heartburn is the most common symptom, which is a burning feeling rising from the stomach through the chest and up towards the neck. These symptom can be made worse by consuming heavy meals, lying down or stooping and straining after meals.

The other common symptom is indigestion, combined with an unpleasant sour tasting acid in the throat and mouth

Who Is At Risk From Developing Gastro-Oesophageal Disease?

You are at risk from GORD if you:-

  • Have a pre-existing condition eg: cardiac sphincter failure or a Hiatus Hernia
  • Smoke
  • Consume large quantities of alcohol
  • Consume large portions or have a high fat diet
  • Have a high caffeine consumption
  • Are pregnant
  • Are obese
  • Wear excessively tight clothes
  • Suffer with a previous history of cardiac surgery
  • Have a hiatus hernia
  • Take medications such as: Tricyclics, Anticholinergics, Nitrates, Calcium-channel blockers and Benzodiazepines

There Are Serious Complications Caused By Acid Reflux, they are:-

Oesophageal Ulcers

The excessive acid produced by gastro-oesophageal reflux disease can damage the lining of your oesophagus and if left untreated can eventually lead to the formation of ulcers. Ulcers can very painful, bleed and make swallowing difficult.

Oesophageal Stricture

Repeated damage to the lining of your oesophagus can lead to the formation of scar tissue. If the scar tissue is allowed to build up, it can lead to a narrowing of your oesophagus. This narrowing is known as an oesophageal stricture and can make swallowing food both difficult and painful.

Strictures can be treated by inserting a deflated balloon and then inflating it to re-stretch the oesophagus. This procedure is usually carried out under local anaesthetic, with the help of an image-guided microscope. This technique allows the Consultant to carefully view and position the balloon down the narrowed Oesophagus without the need for an incision or surgery.

Barrett’s Oesophagus

Repeated episodes of GORD can lead to changes in the cells of the lining of the lower oesophagus; a condition known as Barrett’s Oesophagus.

These cell changes are not cancerous, but there is a small increased risk that they can become so. Every year, 0.5% of people who have Barrett’s Oesophagus will go on to develop cancer of the oesophagus.

If you have Barrett’s Oesophagus, you will be advised to have regular endoscopy checks (a microscopic camera inserted down the oesophagus) in order to monitor your condition. Please click here to read more detailed information on Endoscopy Procedures 

How Is Anti-Reflux Surgery Carried Out?

Until recently, traditional anti-reflux surgery involved a large abdominal incision and complex procedure and a painful and lengthy recovery period.

However, modern techniques utilising minimally invasive and key hole surgical techniques have revolutionised the treatment available to sufferers.

Laparoscopic anti-reflux surgery (also referred to as Laparoscopic Nissen Fundoplication) is performed to surgically reinforce the “valve” between the oesophagus and the stomach, by wrapping the upper portion of the stomach around the lowest portion of the oesophagus.

In a laparoscopic procedure, a small incision (5 to 10mm) is used to enter the abdomen with a canula (a narrow tube-like instrument). Another instrument called a laparoscope, is then inserted through the small incision (key hole surgery) and connected to a camera, giving the surgeon a clear and magnified view of the patient’s internal organs. The procedure to reinforce the valve is then performed from “inside” the abdomen through a key hole incison after expanding the available space by pumping carbon dioxide gas into the abdominal cavity.

What Are The Expected Results After Anti-Reflux Surgery?

Studies have shown that the vast majority of patients who undergo this procedure are symptom-free or have significant improvement in their symptoms.

The advantage of using such an up-to-date laparoscopic approach as previously described, is that this method usually provides:

  • A reduced postoperative pain
  • A shorter hospital stay
  • A faster return to work
  • An improved cosmetic result

What Is The Recovery Like After Anti-reflux Surgery?

The post-operative pain following this procedure is generally mild, although some patients may require pain medication.  It is not usual for further anti-reflux medication to be required after surgery.

Patients are encouraged to engage in light activity soon after surgery and discharge home within 1-3 days after their procedure.

There may be some modification of diet required initially after surgery, beginning with the introduction of very liquid like food, followed by gradually introducing soft and then more solid food.

Normal activities can be resumed within a short amount of time and recovering patients should expect to be back at work and driving within 2 weeks of surgery.

Are There Any Risks Associated With Laparoscopic Anti-Reflux Surgery?

All surgery involves an element of risk from developing complications. Risks such as bleeding, delayed healing, scarring, infection, nausea and vomiting or injury to the oesophagus, stomach or spleen will all be discussed openly at consultation, as well as the scrupulous efforts taken to manage and minimise these risks to their lowest possible potential.

Smoking will adversely affect wound healing and smokers may be precluded from having this type of surgery.

Although Laparoscopic Anti-Reflux Surgery is regularly performed without any complications, all surgery, no mater how expertly or carefully it is performed, carries risks and the importance of a full evaluation and consultation with your surgeon to discuss your understanding and expectations in relation to these risks cannot be over emphasised.

How Do You Find Out If I Am A Suitable Candidate For Surgery?

If you wish to find out if you are a suitable candidate for Gastro-Oesophageal surgery, our Consultants will carry out a full evaluation of your individual needs and circumstances and provide you with a comprehensive verbal and written explanation of any recommended treatment or surgery.

At East Midlands Bariatric Unit we understand the importance of the surgery you are contemplating and throughout your consultation you will be encouraged to ask as many questions as you wish and to take your time in making a decision to proceed with any treatment or not.

How Do You Make A Consultation Appointment?

At consultation you will be given both detailed information about the treatment options you are suitable for and encouraged to ask as many questions as you would like. If after careful consideration you decide to have anti-reflux surgery, then you will be treated swiftly at a time schedule to suit your personal needs and obligations.

If you would like to find out more about anti-reflux surgery and discover if you are a suitable candidate for this procedure, please telephone or email the Easy Midlands Bariatric Unit to organise a consultation appointment.

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