Reflux (GERD) Surgery: Symptoms, Causes, and Treatment

Reflux (GERD)

Gastroesophageal reflux disease (GERD) is a chronic digestive disease that occurs when stomach acid or, occasionally, bile flows back (refluxes) into your food pipe (esophagus). The backwash of acid irritates the lining of your esophagus and causes GERD signs and symptoms.

In normal digestion, once we eat, food travels from mouth to 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.

Book Appointment

Consult Online

+91 8866020505

Emergency Contact

Risk Factor

The majority of foreign body ingestions occur in the children ages of 6 months and 6 years. In adults, foreign body ingestion occurs more commonly in those with psychiatric disorders, developmental delay & alcohol intoxication. Edentulous adults are also at greater risk of ingesting foreign bodies, including an obstructing food bolus or their dental prosthesis. Patients presenting with food bolus impaction often have underlying esophageal pathology directly leading to the impaction. Commonly ingested foreign body are short-blunt objects (coins), long objects (more than 6 cm: tooth brush), sharp pointed objects (chicken & fishbones, paperclips, toothpicks, needles, dental bridges), disk batteries, magnets, narcotics packets.

Diagnosis

When symptoms are severe or not relieved by the treatments need more complete diagnostic evaluation.

Endoscopy (Esophago-gastroscopy) is an important procedure. A small lighted tube with a tiny video camera on the end (endoscope) is passed through mouth into the esophagus (food pipe) and stomach (food bag) to see any ill-effect of acid like inflammation or irritation of the tissue lining the esophagus (esophagitis). If the findings of the endoscopy are abnormal or questionable, biopsy (removing a small sample of tissue) from the lining of the esophagus.

Esophageal manometric and impedance studies -- pressure measurements of the esophagus -- occasionally help identify low pressure in the LES or abnormalities in esophageal muscle contraction.

For patients in whom diagnosis is difficult, doctors may measure the acid levels inside the esophagus through pH testing. Testing pH monitors the acidity level of the esophagus and symptoms during meals, activity, and sleep. Newer techniques of long-term pH monitoring are improving diagnostic capability in this area.

Symptoms

Complications

Long-standing inflammation of esophagus can lead to following complications

Esophageal Ulcer: Stomach acid can severely erode tissues in the esophagus, causing an open sore to form. The esophageal ulcer may bleed, cause pain and make swallowing difficult.
Esophageal Stricture/ Stenosis (Narrowing of the esophagus): Damage to cells in the lower esophagus from acid exposure leads to formation of scar tissue. The scar tissue narrows the food pathway, causing difficulty swallowing.
Precancerous changes to the esophagus (Barrett's esophagus): In Barrett's esophagus, the color and composition of the tissue lining the lower esophagus change. These changes are associated with an increased risk of esophageal cancer. The risk of cancer is low, but need regular endoscopy exams to look for early warning signs of esophageal cancer.

Book
Appointment

Consult
Online

CAll Now

Reflux Treatment

Medical Treatment

Treatment aims at decreasing the amount of reflux or reducing damage to the lining of the esophagus from refluxed materials. Life style, dietary modification along with medication are cornerstone of medical treatment.

Avoiding foods and beverages that can weaken the LES is often recommended. These foods include chocolate, peppermint, fatty foods, coffee, and alcoholic beverages.
Foods and beverages that can irritate a damaged esophageal lining, such as citrus fruits and juices, tomato products, and pepper, should also be avoided if they cause symptoms.
Decreasing the size of portions at mealtime may also help control symptoms. Eating meals at least 2 to 3 hours before bedtime may lessen reflux by allowing the acid in the stomach to decrease and the stomach to empty partially.

Medicine

Life Style Modifications

Weight reduction: Overweight often worsens symptoms. Weight loss is found to improve symptoms.
Stop Cigarette : Cigarette smoking weakens the LES. Stopping smoking is important to reduce GERD symptoms.
Elevation of Bed: Elevating the head of the bed on 6-inch blocks or sleeping on a specially designed wedge reduces heartburn by allowing gravity to minimize reflux of stomach contents into the esophagus. Do not use pillows to prop yourself up; that only increases pressure on the stomach.

Surgical Treatment

Know about GERD Surgery

Surgery now a day used to treat GERD is known as Laparoscopic anti-reflux surgery (medically called as Laparoscopic Nissen Fundoplication). This surgery 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.

In a laparoscopic procedure, surgeons use small incisions 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 patients internal organs on a television screen.

The entire operation is performed inside after the abdomen is expanded by inflating gas into it.

Preparation for Surgery

Our expert team members shall help you to prepare you for surgery.

Pre-operative testing

in most cases, you will need some tests before your surgery. The tests routinely used include:

Anaesthetic Assessment before Surgery:

Our expert team of Anaesthetist will ask you questions pertaining to your health and to assess your fitness for surgery. You are requested to tell them in detail about your current and past medical ailments, allergic reactions you’ve had in the past and current medicines that you are taking like blood thinning medicine. This medicine should be stopped prior to surgery to minimize the risk of bleeding during /after surgery.

Anaesthesia

Anaesthesia is the use of drugs to make the body unable to feel pain for a period of time. General anaesthesia puts you into a deep sleep for the surgery. It is often started by having you breathe into a face mask or by putting a drug into a vein in your arm. Once you are asleep, an endotracheal or ET tube is put in your throat to make it easy for you to breathe. Your heart rate, breathing rate, and blood pressure (vital signs) will be closely watched during the surgery. A doctor watches you throughout the procedure and until you wake up. They also take out the ET tube when the operation is over. You will be taken to the recovery room to be watched closely while the effects of the drugs wear off. This may take hours. People waking up from general anaesthesia often feel “out of it” for some time. Things may seem hazy or dream-like for a while. Your throat may be sore for a while from the endotracheal (ET) tube.

Informed Consent

Informed consent is one of the most important parts of getting ready for surgery. It is a process during which you are told about all aspects of the treatment before you give written permission to perform the surgery.

Getting ready for Surgery

Depending on the type of operation you have, there may be things you need to do to be ready for surgery:

Emptying your stomach and bowels (digestive tract) is important. Vomiting while under anaesthesia can be very dangerous because the vomitus could get into your lungs and cause an infection. Because of this, you will be asked to not eat or drink anything starting the night before the surgery or atleast 6 hours before surgery.
Laxative: You may also be asked to use a laxative or an enema to make sure your bowels are empty.
Shaving of Operative part: You need to have an area of your body shaved to keep hair from getting into the surgical cut (incision). The area will be cleaned before the operation to reduce the risk of infection.

Recovery from Surgery

Pain

You may feel pain at the site of surgery. We aim to keep you pain free after surgery with the help of latest and most effective technique or analgesic (pain relieving medicine).

Eating and Drinking

You will be allowed orally liquids once you recover from effect of anaesthesia medicine and you don’t have nausea or vomiting. Gradually you can add soft to normal diet.

Activity

Our health care team will try to have you move around as soon as possible after surgery. You are encouraged to get out of bed and walk the same day. While this may be hard at first, it helps speed your recovery. It also helps your circulation and helps prevent blood clots from forming in your legs.

Going home

Once you are eating and walking, and then you are ready to go home, in most case in next day following surgery. Before leaving for home our health care team shall give you detailed guidance regarding diet, activities, medications & further plan of treatment

Risks and side effects of surgery

There are risks that go with any type of medical procedure and surgery is no longer an exception. Success of surgery depends upon 3 factors: type of disease/surgery, experience of surgeon and overall health of patients. What's important is whether the expected benefits outweigh the possible risks.

Complications in major surgical procedures include:

Complications related to Anaesthesia: Reactions to drugs used (anesthesia) or other medicines. Although rare, these can be serious because they can cause dangerously low blood pressures.
Complications related to underlying medical illness like heart disease, diabetes, kidney disease, obesity, malnutrition.
Complications related to Specific Operations: Injury to the near by organs, bleeding and infection. You are encouraged with discuss in detail with our health care team before you give your consent for surgery.

Conversion to open surgery: In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs (appendix) effectively. Factors that may increase the possibility of converting to the open procedure may include perforated & densely adherent appendix to nearby organ, obesity, a history of prior abdominal surgery causing dense scar tissue, or bleeding problems during the operation. The decision to convert to an open procedure is strictly based on patient safety.
Side effect of Surgery: 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.

Life After Surgery

Nutrition

Our health care team shall advise you in detail regarding dietary habits, Briefly, your diet begins with liquids followed by gradual advance to solid foods.

Exercise

Patients are encouraged to engage in light activity while at home. You will be able to get back to your normal activities within a short amount of time (week).