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Gastroesophageal Reflux Disease (GERD)

What Is It?
When you eat, food travels from your mouth down the esophagus to your stomach. The food must pass a one-way valve called the lower esophageal sphincter (LES), the opening into your stomach. The LES opens when you swallow, allows food to enter your stomach, then closes quickly. With GERD, the LES may not work normally and allows food and stomach acid to travel back (reflux) into the esophagus. The acid can travel backward as far as your throat. Eating certain foods and taking certain medications can add to the problem. Additionally, smoking, caffeine, and alcohol all increase the level of acid in your stomach and can make your symptoms worse. Sometimes the LES opening is weakened or enlarged (hiatus) in the diaphragm which allows the stomach to bulge into the chest cavity. This is called a hiatal hernia and you can have one without having GERD.

How GERD May Progress
Exposing tissue in the esophagus to stomach acid over a long period of time can lead to inflammation, ulcers, and scarring (called a stricture). Individuals with severe GERD may have difficulty swallowing (called dysphagia), and often have the sensation that food is stuck in their throat. GERD may also increase the risk of cancer of the esophagus.

Symptoms
The symptoms of GERD may include:

  • A burning feeling in the chest (heartburn)
  • A bitter or sour taste in the back of the mouth
  • Belching
  • Nausea
  • Worsening of the above symptoms when bending over or lying down
  • Chronic cough and hoarseness

Diagnosis
Your physician or our surgeon may perform a thorough physical exam or put you through endoscopic swallowing tests to help determine if there are any problems. These type tests allow the physician to rule out problems such as ulcers. You may also be given a barium upper GI series of x-ray films which monitors barium dye that you swallow to catch any reflux action on film. The x-ray may also show whether or not you have a hiatal hernia. If surgery is a possibility, you may undergo an esophageal manometry to measure the muscle tone of the LES. Also, you may under go a pH monitoring test, which measures the amount of acid that washes back from your stomach into your esophagus.

Treatment Simple
Simple life style changes, such exercising to lose excess weight, can often go a long way to reduce the symptoms of GERD. Sleeping with the head of your bed raised may also help reduce symptoms.

Other simple actions such as smoking and alcohol cessation can help reduce symptoms.

GERD is sometimes treated with over-the-counter antacids to neutralize stomach acid and can be purchased without a prescription. Your physician may prescribe stronger medications. These medications are called proton pump inhibitors (PPIs) and suppress most of the stomach's acid production.

If you have a stricture in your esophagus, your physician may dilate your esophagus. You will receive a sedative to keep you comfortable and free from pain. A lubricated dilator or a balloon is inserted into the esophagus and filled with water or air to stretch your esophagus's width enough to pass solid food.

When surgery becomes the primary option, it can be performed either using a laparoscopic or open technique. Your physical condition may dictate which technique will be taken. In either case, the surgeon will tighten the hiatal opening with stitches. Next, the top of the stomach will be wrapped around the outside of the esophagus. This added support will help prevent reflux. To make sure the wrap is not too tight the surgeon may temporarily insert a rubber tube into your esophagus. Finally the wrap is permanently stitched in place.

The most common risks and complications associated with a lapaorscopic fundoplication include:

  • Injury to the liver, spleen, esophagus, or stomach during surgery.
  • Bleeding
  • Increased gas or bloating
  • Difficulty swallowing
  • Failure to completely eliminate GERD


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