What are the Risk Factors?
- Being overweight or obese
- Smoking, coffee or alcohol can allow the sphincter to relax.
- Hiatus hernia – part of stomach migrates upwards through the diaphragm thus disrupting the sphincter mechanism.
- Stomach pain (pain in the upper abdomen)
- Non-burning chest pain may be confused with heart attack
- Hoarseness of voice and/or persistent sore throat or lump in throat
- Chronic cough or new onset asthma
- Dental erosion
- Recurrent lung infections (called pneumonia)
How is it diagnosed?
Acid reflux is usually diagnosed based upon symptoms and the response to treatment. Your doctor will refer you if your symptoms are not controlled by simple lifestyle changes and/or antacid medication.
Diagnostic Tests include:
A small, flexible tube with a camera is passed into the oesophagus, stomach, and small bowel to assess the damage caused by refluxing acid.
24-hour oesophageal pH study
- A 24-hour oesophageal pH study is the most direct way to measure the frequency of acid reflux. It is usually reserved for people whose diagnosis is unclear after endoscopy.
- The test involves inserting a thin tube through the nose and into the oesophagus. The tube is left in the oesophagus for 24 hours. During this time the patient keeps a diary of symptoms. The tube is attached to a small device that measures how often stomach acid is reaching the oesophagus. The data are then analysed to determine the frequency of reflux and the relationship of reflux to symptoms.
- An alternate method for measuring pH uses a device that is attached to the oesophagus and broadcasts pH information to a monitor worn outside of the body. This avoids the need for a tube in the oesophagus and nose. The main disadvantage is that an endoscopy procedure is required to place the device (it does not require removal, but simply passes on its own in the stool).
pH and Manometry Study
- Oesophageal manometry involves swallowing a tube that measures the muscle contractions of the oesophagus. This can help to determine if the lower oesophageal sphincter is functioning properly.
- Weight loss
- Raise the head of the bed six to eight inches
- Avoid acid reflux-inducing foods
- Quit smoking
- Avoid large and late meals
- Antacids are commonly used for short-term relief of acid reflux. However, the stomach acid is only neutralized very briefly after each dose, so they are not very effective.
- Proton Pump inhibitors (PPI) are strong anti-acid medications that are the mainstay of treatment and may have to be taken lifelong.
Who needs Anti Reflux surgery?
The vast majority of patients with reflux disease respond well to appropriate acid-suppressing drugs and do not need surgery. However, for a small group of patients surgery can be helpful. There are three main reasons patients wish to have surgery:
- Failure to respond satisfactorily to adequate doses of medication
- Intolerable side effects from medication.
- A desire to be free of long-term medication
- Patients with a large hiatus hernia
Anti Reflux Surgery
- Fundoplication is a surgical technique that strengthens the barrier to acid reflux when the sphincter does not function normally.
- This can be done laparoscopically (keyhole) which leads to a speedier recovery and less postoperative pain.
- Some patients have a hiatus hernia associated with their reflux disease and repair of this hernia is undertaken at the same time as anti-reflux surgery.
- The stomach is pulled down from the chest and the opening in the diaphragm, through which the oesophagus passes from the chest into the abdomen, is stitched and tightened.
- During the procedure the top part of the stomach (the fundus of the stomach) is gathered, wrapped and stitched around the lower end of the oesophagus.
- This wrap (or fundoplication) produces a one-way valve from the oesophagus to the stomach to prevent reflux of acid.
- The operation usually takes between 1 and 1½ hours.
How long will I be in hospital?
Most patients will come into hospital on the day of their operation, and will be able to go home with an overnight stay. If there is any issue with pain control or ability drink, you may be kept in for a few days.
What should I expect after surgery?
- Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.
- Once you are awake, you will be asked to drink some water to ensure that the repair is not too tight.
- You can expect some soreness mostly during the first 24 to 48 hours and may experience shoulder pain due to filling of your abdomen with gas.
- You are encouraged to be up and about the day after surgery.
- You will probably be able to get back to your normal activities within a week to 10 days. These activities include showering, driving, walking upstairs, lifting, working and engaging in sexual intercourse.
- You will be given a special diet sheet to adhere to for the next 6 weeks. This will allow the inflammation at the lower end of the gullet to settle and ensure that you get adequate nutrition during the recovery phase.
What complications can occur?
The risk of serious complication is very small however the potential problems are stated below.
- Damage to the oesophagus, stomach or lung lining, leading to leakage from this area and sometimes necessitating a further laparoscopic procedure, chest drain, or an open operation, to address the problem. These problems can require prolonged hospitalisation to resolve.
- Bleeding, possibly requiring a further laparoscopic procedure or open operation.
What are the effects of Surgery?
- Most patients will have some difficulty in swallowing in the immediate postoperative period. It is important during this period to stick to the diet sheet, reduce portion size and chew your food properly. In a small number of patients the repair might be too tight and prevent swallowing. This may have to be corrected by endoscopy and dilatation of the area or in extreme cases surgery and disruption of the wrap.
- As you are unable to burp effectively you might experience some abdominal bloating, discomfort and increased flatulence. It is therefore advisable to avoid fizzy drinks.
- You might also experience fullness after taking a few bites of your meals, due to the alteration of your stomach. Eating small portions throughout the day helps in keeping up your nutrition.
- Most of these symptoms tend to settle down over time and most of the patients are satisfied with the operation. Follow-up indicates that 10 years after surgery, 70-80% of patients continue to experience relief from symptoms.