Dr. Pradeep K. Dewan

What is GERD?

Food passes from the mouth tothe stomach through esophagus (food pipe). This food cannot go back into the food pipe due to an intervening valve (the lower esophageal sphincter LES).

Weakening or abnormal frequent relaxation (opening) of the LES causes gastroesophageal reflux of GERD. (Causes reflux of acid from stomach to food pipe).

This condition may be associated with a hiatus hernia which occurs in 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 failure of the LES mechanism.

 

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. Untreated, gastroesophageal reflux can cause: ulcers, bleeding, narrowing of the esophageal lumen that can cause difficulty in swallowing. In some patients a condition called barretts esophagus occurs which may lead to cancer if left untreated for a long time.

 

How do I know if 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:

• Indigestion

• Painful burning in the upper chest or abdomen (heartburn)

• Regurgitation of food in mouth on lying down

• Difficulty in sleeping after eating

• Hoarseness of voice

• Chronic cough

• Sore throat – recurrent

• Chest complication due to acid going in the lungs

• Difficulty in swallowing

Some or all of these symptoms may occur several times a day, particularly at night, and may become chronic.

 

How is GERD diagnosed?

• Typical Symptoms.

• Upper GI  endoscopy: It will show reflux 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 oesphageal pressures.

Not all the tests are always required.

 

Treatment Options

• Lifestyle Changes to control heart burn:

Sleep with the head of the bed elevated 6 inches. Have smaller, more frequent meals.

Choose low- fat foods.

Wear loose-fitting clothing and loose-fitting belts around the waist.

 

• :

Eating large meals, especially before sleeping, spicy meals

Lying down for two to three hours after eating.

Eating chocolate or peppermints

Smoking cigarettes/chewing tobacco

Drinking alcohol

 

• Medicines

Medicines only relieve symptoms as long as patients continue to take them. They do not cure the condition.

 

• SURGICAL CORRECTION 

For patients with persistent symptoms requiring longterm medication, surgery is an option, which is also a curative mode of treatment. Surgery can reconstruct the valve (LES) as well as repair the hiatus hernia if present.

 

Surgical Options

 

• Laparoscopic Surgery

 

• Conventional Open Surgery

 

Aim of both the above procedure is the same: i.e. repair of LES and / hiatus hernia.

 

How is Laparoscopic Surgery for GERD different from open Surgery ?

Traditional open Surgery of GERD requires a large muscle cutting incision which results in a long lasting painful scar. Laparoscopic surgery requires four to five tiny  (5-10 mm) incision to perform the same procedure. The advantages of laparoscopic  surgery are minimal post operative pain, short hospital stay and excellent cosmetic result.

 

How successful is the surgery?

World wide 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 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 incision which usually disappears in 24 to 48 hours. They may also have a feeling of difficulty in swallowing due to a newly constructed sphincter which goes away with passage of time.