What is Gastroesophageal Reflux Disease (GERD)

Although heartburn is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastroesophageal reflux disease.

In this condition, stomach acids reflux or back up from the stomach into the esophagus. Heartburn is described as a harsh, burning sensation in the area in between your ribs or just below your neck. Other symptoms may also include vomiting or regurgitation, difficulty swallowing and chronic coughing or wheezing.

What is the cause of reflux?
Esophagus is a organ that transmits foods to the stomach. At the lower end of the esophagus is a small ring of muscle called the lower esophageal sphincter (LES). The LES acts like a one-way valve, allowing food to pass through into the stomach. Normally, the LES closes immediately after swallowing to prevent back-up of stomach juices, which have a high acid content, into the esophagus. GERD occurs when the LES does not function properly allowing acid to flow back and burn the lower esophagus. This irritates and inflames the esophagus, causing heartburn and eventually may damage the esophagus.

What are the risks of developing GERD?

Some people have naturally weak LES. For others fatty and spicy foods, some medications, tight clothing, smoking, drinking alcohol, vigorous exercise or changes in body position may cause reflux.

 

How to treat GERD?

Treatment of GERD follows a three-step protocol.

Life style changes: Change in diet can reduce symptoms. Losing weight, reducing or eliminating smoking and alcohol consumption, and altering eating and sleeping patterns can also help.

Drug treatment: If complaints do not improve despite lifestyle changes, drug therapy may be required. Antacids neutralize stomach acids and the amount of stomach acid produced. Both may be effective in relieving symptoms. Prescription drugs may be more effective in healing irritation of the esophagus and relieving symptoms.

Surgical procedure: Patients who made life changes and used drug but still need help, may consider surgical procedure. Surgery is very effective and the most commonly performed by endoscopy.

 

How is laparoscopic surgery performed?

The aim of laparoscopic antireflux surgery is to reconstruct the valve system between the stomach and esophagus. The operation is performed by winding the upper part of the stomach around the lower part of the esophagus. Carbon dioxide gas is used to expand the abdomen. The laparoscope, which is connected to a tiny video camera, is inserted through the small incision, giving the surgeon a magnified view of the patient’s internal organs on a television screen.

 

What are the advantages of laparoscopic method?

  • Reduced postoperative pain
  • Shorter hospital stay
  • A faster return to work
  • Improved cosmetic result

 

Necessary preparations

  • After your surgeon reviews with you the risks and benefits of the operation, you will need to give him a permission.
  • Blood tests, lung film and ECG are requested.
  • It is recommended that you shower the night before or morning of the operation.
  • The night before the operation, you should not eat or drink anything except your medications.
  • Tell your surgeon if you are taking medications such as blood thinners, vitamin E and painkillers. You may need to stop taking them a week before the surgery..
  • Diet medication is requested to be stopped 2 weeks before surgery.
  • Quit smoking and arrange for any help you may need at home

 

The day of the surgery

  • A qualified medical staff member will help place a small needle/catheter in your vein to deliver medication during surgery.
  • You will be under general anesthesia during the operation
  • Following the operation you will be sent to the recovery room until you are fully awake.
  • Most patients stay in the hospital the night of surgery and may require additional days in the hospital.

 

What happens if laparoscopic surgery cannot be performed?

In a small number of patients the laparoscopic method is not allowed because of the inability to visualize or handle the organs effectively. Your doctor may decide to perform a open surgery because of a history of prior abdominal surgery causing dense scar tissue or bleeding problems during the operation. It is decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather a surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.

 

What to expect after the surgery?

  • Patients are encouraged to engage in light activity while at home after surgery,
  • Post operative pain is generally mild although some patients may require prescription pain medication for a short period of time.
  • Anti-reflux medication is usually not required after surgery.
  • Most surgeons temporarily modify patient’s diet after surgery beginning with liquids followed by gradual advance to solid foods.
  • You will probably be able to get back to your normal activities within a short amount of time.
  • Call and schedule a follow-up appointment within 2 weeks after your operation.

 

What are the side effects of the operation?

  • Some patients develop temporary difficulty swallowing immediately after the operation. This usually resolves within one to three months after surgery.
  • Occasionally, patients may require a procedure to stretch the esophagus (endoscopic dilation) or rarely re-operation.
  • The ability to belch and or vomit may be limited following this procedure.
  • The failure of the operation has been reported very rarely.

 

Which complications may occur?

GERD is a safe procedure but complications may develop such as:

  • Adverse reaction to general anesthesia
  • Bleeding
  • injury to the esophagus, spleen, liver, stomach or internal organs
  • Infection of the wound, abdomen or blood.
  • Other less common complications may also occur.

 

When to call your doctor?

  • Persistent fever over 39 C
  • Bleeding
  • Increasing abdominal swelling
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • Chills
  • Persistent cough or shortness of breath
  • Purulent drainage from any incision
  • Redness surrounding your incisions that is worsening or getting bigger
  • Unable to eat or drink liquids

 

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