GERD, also known as Gastro-esophageal reflux disease or acid reflux disorder refers to the condition characterized by the back flow(reflux) of the stomach content like stomach acid and bile into the esophagus. The esophagus is the hollow, muscular organ that carries food and liquids from the throat to the stomach.
Normally, during digestion process, the lower oesophageal sphincter (LES) present at the junction of esophagus and stomach opens to let the food pass into the stomach and closes to block the back flow of the food and stomach acidic juices into the esophagus. However, in case of GERD, the reflux occurs due to weak LES or if it works or relaxes in inappropriate way.
GERD is always associated with the chronic heartburn which is most common symptom of GERD. Acid regurgitation that is reflux of gastric acid into mouth is the other common symptom. Other less common symptoms are;
- Pain and difficulty in swallowing
- Dysphagia that is the abnormal sensation of food being sticking in esophagus.
- Chronic sore throat
- Excessive saliva production.
- Inflammation of larynx, gums etc.
- Bad breath
- Tooth enamel erosion.
The factors that are responsible for causing GERD are;
- Abnormalities in LES.
- Abnormal contractions of oesophagus
- Prolonged time in stomach emptying
- Hiatal hernias
- Dietary foods like coffee, fatty foods, chocolates, alcoholic beverages can trigger reflux.
- Obesity and pregnancy also contribute in procuring GERD symptoms.
Following enlisted are the treatment options for treating GERD and acid reflux;
These include alteration in sleeping habits. Patients are recommended to sleep at night with slightly elevating your upper body as patients experiencing heart burn might have reflux at night. This position is of benefit to avoid the reflux at night.
Encourage smaller and earlier meals in the evening as it results in lesser expansion of the stomach that may reduce the reflux. Some foods and beverages like chocolates, caffeinated drinks, alcoholic beverages, peppermint etc. are responsible for promoting the reflux, and thus should be avoided.
Consumption of fatty foods should be reduced. Smoking should be stopped. Spicy and foods containing acids like carbonated beverages, tomato or citrus juice should be avoided.
Following drugs are recommended to lessen the symptoms;
- Foam barriers
- Proton pump inhibitors
- Histamine antagonists
- Pro-motility drugs
Following are surgical treatments that aid to relieve and cure the GERD and its symptoms.
Fundoplication: This is the standard surgical intervention to tighten and strengthen the LES. In this, the higher part of the stomach is draped around the outer side of the lower part of oesophagus to give strength to LES. This surgery can be done as
Open fundoplication surgery – Open Fundoplication surgery is done when either it is not possible or not safe to perform the laparoscopic surgery. The reasons can be many, which include history of prior abdominal surgery, obesity or bleeding during the operation. The surgeon is the best person to decide which procedure is best suited for you.
Minimally invasive/ laparoscopic Fundoplication (also known as Nissen Fundoplication)
If you are suffering from the GERD symptoms and medicines and other non-surgical methods have not helped, you can be considered for Fundoplication surgery.
Surgical procedure for laparoscopic fundoplication
Laparoscopic Fundoplication, also known as Nissen Fundoplication, is done under general anaesthesia. After taking all aseptic precautions, surgeon makes tiny incisions in your abdomen and a sterile tube is inserted through which Carbon dioxide gas is passed to separate the abdominal wall and underlying organs. Then, a laparoscope is inserted through one of the incisions and the laparoscopic images are projected on the monitor to inspect the area. Once it is done, the specialized surgical instruments, trocars and cannulas are inserted through other incisions.
The weak lower oesophageal sphincter is reinforced by draping the upper part of the stomach to the lower part of oesophagus. This helps in reinforcing the LES to avoid the reflux.
Recovery is usually easy and smooth after the surgery. You shall get discharged from the hospital the next day of the operation. You may feel some pain and discomfort for few days which can be resolved with pain medications. You can resume your daily activities within a week, but heavy work and exercises should wait for 8-10 weeks. Your doctor may advise you to start with liquid diet and gradually switch to semi solids and then solid food.
The results of Fundoplication surgery for GERD are good. You can expect relief from the acid reflux syndrome. Acid reflux medicines are usually not required after the procedure.
We encourage you to educate yourself about GERD surgery in India, benefits from the right kind of GERD Surgery in India procedure and then make an informed decision.