Acid reflux Back From Stomach To Esophagus
The stomach acid and sometimes even food in the stomach comes back into the food pipe (ESOPHAGUS).
Acid Reflux leads to Heartburn, Acidity, Excessive burping, bad breath, hoarseness of voice and recurrent throat infections.
RECURRENT SORE THROAT AND PAIN IN THROAT DUE TO ACID REFLUX INJURY
ACID REFLUX LEADS TO HEARTBURN AND BURNING SENSATION IN THE CENTRE OF THE CHEST
It may worsen at night and may cause a choking sensation which wakes up the patient from sleep feeling very scared.
Gastro Esophageal Reflux Disease (GERD)
If acid reflux symptoms happen more than twice a week, you have GERD
The Commonest cause is weakness of the one way circular muscle valve called Lower Esophageal Sphincter (LES) in the lower part of the food pipe and entrance to the stomach which closes as soon as food passes through it.
If the LES doesn’t close all the way or if it opens too often, acid produced by your stomach can move up into your esophagus.
The commonest cause of a Loose LES is due to a Hiatus Hernia.
Other important causes of GERD are OBESITY and PREGNANCY.
Also dietary and lifestyle habits cause GERD, most importantly
Excessive alcohol, carbonated drinks, excessive coffee and tea
Smoking
Eating heavy meals just before bedtime or exercising after a big meal.
SHOWS GASTRO ESOPHAGEAL REFLUX DISEASE
Hiatus Hernia
This is a condition where there is widening of diaphragmatic opening between the chest and abdomen.
The upper part of the stomach and LES move above the diaphragm.
Normally, the diaphragm helps keep acid in our stomach.
But if you have a hiatal hernia, the acid can move up into your esophagus and lead to GERD.
PROBLEMS OF GERD
- Risk of Acid ESOPHAGITIS (inflammation)
- BARRET’S ESOPHAGUS (PRE-MALIGNANT condition in which there are changes in the esophageal lining due to chronic acid damage)
- ESOPHAGEAL CANCER.
Apart from changes and symptoms of the food pipe, people have other symptoms like bad breath sore throat, voice changes, choking sensation while sleeping
Tests to be Done before Acid Reflux Surgery and Hiatus Hernia Surgery
- Upper GI Endoscopy to confirm the diagnosis and assess the damage of the esophagus.
- 24 hour pH metry to see and to decide whether patient needs medical or surgical treatment)
- ESOPHAGEAL MANOMETRY to rule out other peristaltic disorders of the esophagus.
TREATMENT OF GERD
First line management
- Medicines
- Life style modifications in early cases.
Surgical Management
- Most effective tool for GERD
- Addresses both the problems of weakening of the LES and the pressure gradient across the LES
Most common surgery performed is a Hiatal Hernia Repair with a Fundoplication
These are done using minimally invasive techniques ( Laparoscopic / Robotic Surgery).
These ensure a faster return to normal life and ensures an excellent quality of life.
ACID REFLUX SURGERY USING MINIMAL ACCESS TECHNIQUES
ACID REFLUX SURGERY
WHO ARE THE CANDIDATES FOR SURGERY
- Young patients not wanting to take long term medicines
- Esophagitis not responding to medical management
- Barrett’s Esophagus confirmed on Endoscopy
- Extra Esophageal Symptoms ( recurrent sore throat, chest infection, voice changes etc.)
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