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. The
feeling may radiate through the chest and into the throat and
neck. Many adults in the experience this uncomfortable burning
sensation at least once a month. Other symptoms may also include
vomiting, difficulty swallowing and chronic coughing or wheezing.
What causes GERD?
When you eat, food travels from your mouth to your stomach through
a tube called the esophagus. 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 contributes to GERD?
Some people are born with a naturally weak sphincter (LES).
For others however, fatty and spicy foods, certain types of
medication, tight clothing, smoking, drinking alcohol, vigorous
exercise or changes in body position (bending over or lying
down) may cause the LES to relax, causing reflux. A hiatal hernia
(a common term for GERD) may be present in many patients who
suffer from GERD, but may not cause symptoms of heartburn.
How is GERD treated?
GERD is generally treated in three progressive steps:
- Life style changes:
In many cases, changing diet and taking over-the-counter antacids
can reduce how often and how harsh your symptoms are. Losing
weight, reducing or eliminating smoking and alcohol consumption,
and altering eating and sleeping patterns can also help.
- Drug Therapy:
If symptoms persist after these life style changes, drug therapy
may be required. Antacids neutralize stomach acids and over-the-counter
medications reduce 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. This therapy needs to be discussed
with your surgeon.
- Surgery:
Patients who do not respond well to lifestyle changes or medications
or those who continually require medications to control their
symptoms, will have to live with their condition or may undergo
a surgical procedure. Surgery is very effective in treating
GERD.
There are procedures being tried, known as Intraluminal Endoscopic
Procedures, which are alternatives to laparoscopic and open
surgery. You will need to discuss with your surgeon and physician
whether you are a candidate for any of these procedures.
What are the advantages of the Laparoscopic
method?
The advantage of the laparoscopic approach is that it usually
provides:
• Reduced postoperative pain
• Shorter hospital stay
• A faster return to work
• Improved cosmetic result
Are you a candiate for the Laparoscopic
method?
Although laparoscopic anti-reflux surgery has many benefits,
it may not be appropriate for some patients. Obtain a thorough
medical evaluation by a surgeon qualified in laparoscopic
anti-reflux surgery in consultation with your primary care
physician or Gastroenterologist to find out if the technique
is appropriate for you.
What to expect before Laparoscopic Anti-Reflux
Surgery:
• After your surgeon reviews with you the potential
risks and benefits of the operation, you will need to provide
written consent for surgery.
• Preoperative preparation includes blood work, medical
evaluation, chest x-ray and an electrocardiogram, depending
on your age and medical condition.
• Your surgeon may request that you completely empty
your colon and cleanse your intestines prior to surgery. You
may be requested to drink clear liquids, only, for one or
several days prior to surgery.
• It is recommended that you shower the night before
or morning of the operation.
• After midnight the night before the operation, you
should not eat or drink anything except medications that your
surgeon has told you are permissible to take with a sip of
water the morning of surgery.
• Drugs such as aspirin, blood thinners, anti-inflammatory
medications (arthritis medications) and Vitamin E will need
to be stopped temporarily for several days to a week prior
to surgery.
• Diet medication or St. John's Wort should not be used
for the two weeks prior to surgery.
• Stop smoking and arrange for any help you may need
at home.
What to expect the day of Surgery:
• You usually arrive at the hospital the morning of
the operation.
• A qualified medical staff member will place a small
needle/catheter in your vein to dispense medication during
surgery.
• Often pre-operative medications are necessary.
• You will be under general anesthesia - asleep during
the operation which may last several hours.
• 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.
How is Laparoscopic AntiReflux Surgery
performed?
Laparoscopic anti-reflux surgery (commonly referred to as
Laparoscopic Nissen Fundoplication) involves reinforcing the
"valve" between the esophagus and the stomach by
wrapping the upper portion of the stomach around the lowest
portion of the esophagus - much the way a bun wraps around
a hot dog.
In a laparoscopic procedure, surgeons use small incisions
(1/4 to 1/2 inch) to enter the abdomen through cannulas (narrow
tube-like instruments). 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.
The entire operation is performed "inside" after
the abdomen is expanded by inflating gas into it.
What happens if the operation cannot
be performed by the Laparoscopic method?
In a small number of patients the laparoscopic method is not
feasible because of the inability to visualize or handle the
organs effectively. Factors that may increase the possibility
of converting to the "open" procedure may include
obesity, a history of prior abdominal surgery causing dense
scar tissue, or bleeding problems during the operation. The
decision to perform the open procedure is a judgment 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 sound surgical judgment. The decision to convert to
an open procedure is strictly based on patient safety.
What should I expect after 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. Anti-reflux
medication is usually not required after surgery.
• Some surgeons modify patients diet after surgery beginning
with liquids followed by gradual advance to solid foods. You
should ask your surgeon about dietary restrictions immediately
after the operation. You will probably be able to get back
to your normal activities within a short amount of time. These
activities include showering, driving, walking up stairs,
lifting, working and engaging in sexual intercourse.
Are there side effects to this operation?
Studies have shown that the vast majority of patients who
undergo the procedure are either symptom-free or have significant
improvement in their GERD symptoms.
Long-term side effects to this procedure are generally uncommon.
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. Some patients report stomach bloating.
Rarely, some patients report no improvement in their symptoms.
What complications can occur?
Although the operation is considered safe, complications may
occur as they may occur with any operation.
Complications may include but are not limited to:
• adverse reaction to general anesthesia
• bleeding
• injury to the esophagus, spleen, stomach or internal
organs
• infection of the wound, abdomen, or blood
Your surgeon may wish to discuss these with you. (S)He will
also help you decide if the risks of laparoscopic anti-reflux
surgery are less than non-operative management.
When to call your Doctor
Be sure to call your physician or surgeon if you develop any
of the following:
•Persistent fever over 101 degrees F (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 (pus) from any incision
•Redness surrounding any of your incisions that is
worsening or getting bigger
• You are unable to eat or drink liquids
|
