Gastric reflux, also called gastro-esophageal reflux disease (GERD), is a condition where the stomach’s contents (food or liquid) rise up from the stomach into the esophagus, a tube that carries food from the mouth to the stomach. Food mixed with the stomach’s digestive acids can irritate and damage the esophagus.
Normally, the stomach’s contents are retained in the stomach with the help of the lower esophageal sphincter (LES), a muscle that contracts and relaxes to maintain the one-way movement of food. However, gastric reflux occurs when the LES weakens. The exact cause of this is not known, however, certain factors including obesity, smoking, pregnancy and possibly alcohol, may contribute to GERD. Common foods such as spicy foods, onions, chocolates, caffeine- containing drinks, mint flavorings, tomato-based foods, citrus fruits and certain medications can worsen gastric reflux.
Living with gastric reflux is inconvenient as symptoms can severely interfere with your life. You may have to follow certain dietary restrictions and reflux occurring in the night can hinder a good night’s sleep, thereby affecting alertness and productivity the next day.
Food travels from the mouth through the esophagus, a long, narrow tube that opens into the stomach. This food pipe is lined by muscles that expand and contract to push food down the tube, a process called peristalsis. The stomach secretes acid and other digestive enzymes for the digestion of food and stores food before it enters into the intestine.
A band of muscles called the lower esophageal sphincter (LES) are present at the junction of the esophagus and the stomach. This acts as a valve, preventing the reflux of acid and chyme (food mixed with acid and digestive enzymes) from the stomach into the food pipe.
Heartburn is usually the main symptom of GORD, characterized by a burning-type pain in the lower part of the mid-chest, behind the breast bone. Other symptoms include a bitter or sour taste in the mouth, trouble swallowing, nausea, dry cough or wheezing, regurgitation of food (bringing food back up into the mouth), hoarseness or change in voice and chest pain.
Your doctor may order some of the following tests to diagnose gastric reflux:
The outcome of treatment varies from person to person. Some may experience mild recurring symptoms, while for others, treatment can be very successful. Most people respond well to lifestyle changes and medications. However, a relapse is very common after cessation of medications, so the condition does require monitoring.
When medications fail to resolve symptoms, surgery is recommended. The success rate of surgery is approximately 92%.
If left untreated, chronic GORD can cause serious complications such as inflammation of the esophagus, esophageal ulcers, narrowing of the esophagus, chronic cough and reflux of liquid into the lungs (pulmonary aspiration). Some people develop Barrett’s esophagus, a condition characterized by changes in the oesophageal lining, which can lead to oesophageal cancer.
If conservative treatment options fail to resolve your GORD, your doctor may recommend a surgical procedure called Nissen Fundoplication. Nissen Fundoplication surgery reinforces the lower oesophageal sphincter’s ability to close and helps to prevent gastro-oesophageal reflux from occurring. This surgery can be performed laparoscopically through tiny incisions in the abdomen or through an open approach, which requires a large abdominal incision.
After the surgery, you should keep the area clean and dry, and not shower or bathe during this time. The incisions usually heal in about 5 days. You may feel soreness around the incision areas. If the abdomen was distended with gas, you may experience discomfort in the abdomen, chest or shoulder area for a couple of days while the excess gas is being absorbed. Contact your doctor immediately if you have a fever, chills, increased pain, bleeding or fluid leakage from the incisions, chest pain, and shortness of breath, leg pain or dizziness.
Laparoscopy is much less traumatic to the muscles and soft tissues than the traditional method of surgically opening the abdomen with long incisions (open techniques). It is also associated with a shorter hospital stay, less post-operative pain and faster recovery.
Before the procedure, you may be instructed to be on a liquid diet for two days. Your surgeon will prescribe a solution for you the day before surgery to cleanse your bowel.
Surgery is found to be beneficial in approximately 92% of patients. However, as with any surgery, Nissen Fundoplication may involve certain risks and complications which include infection, injury to blood vessels, stomach or esophagus, swallowing difficulties, gas embolism (gas bubbles in the bloodstream) and the need for a laparotomy (performed through a larger abdominal incision). Sometimes, the new valve weakens or loosens months or years after the surgery, causing symptoms again. If symptoms are severe, the surgery may need to be repeated.
Your surgeon may give you a prescription pain medicine or recommend non-steroidal anti-inflammatory drugs (NSAIDs) for the first few days to keep you comfortable. Your surgeon may instruct you about your diet and activity restrictions. Care should be taken with your wound. You are advised not to lift heavy objects for 8 to 12 weeks.
Shortly after surgery, you can gradually resume your daily activities. You are encouraged to start walking as early as possible to reduce the risks of blood clots and pneumonia. You will be able to get back to work in 2 to 3 weeks.
Any costs involved will be discussed with you prior to your surgery.