Gastro Esophageal Reflux Disease (GERD)

The esophagus carries food from the mouth to the stomach. The lower esophageal sphincter is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach.

Gastroesophageal reflux disease, or GERD, is a chronic disease that occurs when the lower esophageal sphincter does not close properly and stomach contents leak back, or reflux, into the esophagus.

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. 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.

Anyone, including infants, children, and pregnant women, can have GERD.

Symptoms

The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

The most frequent symptoms of GERD are so common that they may not be associated with a disease. Self-diagnosis can lead to mistreatment. Consultation with a physician is essential to proper diagnosis and treatment of GERD.

Causes

• Hiatal hernia- a hiatal 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
• Overweight
• Pregnancy
• Smoking

Also, certain food and drinks are associated with reflux.

Diagnoses

1. Medical history
2. Response to medication (Proton Pump Inhibitor)
3. Barium swallow radiograph
• Uses x rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus
4. Endoscopy
5. 24 Hr PH monitoring and esophageal manometry
• These studies are essential to confirm the diagnosis of GERD and to establish if one is a good candidate for surgery

Treatment

Conservative treatment

• Life style modification
• Medications including antacids, H2 receptor blockers or proton pump inhibitors

Surgical Treatment

Laparoscopic Nissen Fundoplication

This surgery is performed under general anesthesia.

If a combination of lifestyle changes and drug therapy does not remedy reflux symptoms, a Nissen Fundoplication can be a very effective surgical procedure to correct reflux. This procedure involves wrapping the upper portion of the stomach around the base of the esophagus to reinforce the strength of the lower esophageal sphincter. Until recently, the procedure required a large abdominal incision. A hospital stay of 3-5 days was usually required, and the time to full recovery and return to work was measured in weeks.

A Laparoscopic Nissen Fundoplication is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to perform the procedure through five tiny incisions, most of which are less than a half-centimeter in size. One advantage of this method is a brief hospitalization. Most of the time it will require an overnight stay. Other advantages include less pain (less of a need for pain medication), fewer and smaller scars, and a shorter recovery time.

Laparoscopic Nissen Fundoplication is a safe and effective treatment of GERD. However, in rare cases the laparoscopic approach is not possible because it becomes difficult to visualize or handle organs effectively. In such instances, the traditional incision may need to be made to safely complete the operation.