PROCEDURES
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Definition
Gastroesophageal reflux disease (GERD) occurs when stomach acid rises up the oesophagus continuously.
Aetiology
Causes of GERD include the following:
- - Weakening of the oesophageal sphincter
- - Increased abdominal pressure
- - Unhealthy dietary habits (eating spicy food, drinking coffee excessively, etc.)
- - Presence of a hiatus hernia
Pathology
An upper endoscopy is a common diagnostic procedure to analyse the oesophageal lining, stomach and first part of the small intestine. In addition, an upper endoscopy can be used to diagnose strictures within the oesophagus.
Another diagnostic test, referred to as barium contrast radiography involves swallowing a barium solution to check for abnormalities within the oesophagus. While the liquid moves through the oesophagus, x-ray images are taken.
Risk factors
Chronic GERD can cause complications such as:
- - Inflammation of the oesophageal lining (esophagitis)
- - Barrett's oesophagus is a condition that increases the risk of oesophageal cancer due to an alteration in cells of the oesophageal lining.
- - Oesophageal strictures develop when the oesophageal lining becomes damaged or scarred.
Symptoms
- - Heartburn, which is a painful sensation in the chest
- - Acid reflux symptoms (coughing, scratchy throat, trouble breathing and an increase in saliva production)
- - Food flows back into the mouth from the oesophagus
- - Voice hoarseness
- - Sore throat
Treatment & Surgery
- Medical therapy: Proton pump inhibitors (PPIs) such as omeprazole, H2 receptor blockers, antacids and prokinetics are typically prescribed.
- Indications for surgery: Surgery is indicated for the following reasons:
- Failed medical therapy
- Risk of Barrett’s oesophagus
- A chronic condition such as asthma can worsen due to acid reflux
- Surgical options and description of procedures: Nissen fundoplication (laparoscopic anti-reflux surgery) entails the following:
- Laparoscopic anti-reflux surgery also known as Nissen fundoplication, is a less invasive procedure that involves the surgeon creating a new valve mechanism at the bottom of the oesophagus. The top portion of the stomach, called the fundus, will be wrapped around the lower portion of the oesophagus to reinforce the lower oesophagal sphincter so that food won't move back into the oesophagus.
- Toupet fundoplication: is a single treatment for GERD and a hiatus hernia. Surgery entails sealing the diaphragm using sutures. Afterwards, the upper part of the stomach is wrapped around the oesophagus.
- Dor fundoplication: involves covering a portion of the oesophagus with the stomach fundus to lower the risk of acid reflux.
FAQ
Laparoscopic Nissen Fundoplication shows better control of GERD in patients with Type I Hiatus hernia than PPI with the added benefit of control of BMI:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442091/
See list of long-term effects associated with PPIs:
https://www.iersurgery.com/content/why-choose-surgery-for-gerd-or-acid-reflux
Laparoscopic Fundoplication is a safe and effective method to control GERD with associated Hiatus hernia:
https://journals.scholarsportal.info/details/24557420/v07i0002/64_misfgrcswrol.xml