Anti Reflux Surgery (GERD)

Anti-reflux surgery is a treatment for acid reflux, also known as GERD (gastroesophageal reflux disease). GERD is a condition in which food or stomach acid comes back up from your stomach into the esophagus. The esophagus is the tube from your mouth to the stomach.

Gastroesophageal reflux disease (GERD) is a digestive disorder in which stomach acid or bile flows into the food pipe and irritates the food pipelining. 

There is a ring of muscle between your esophagus and your stomach which controls the flow up of liquid from the stomach into the esophagus. This ring is called “lower esophageal sphincter (LES)”.  

In a situation where this muscle (LES) is weak and unable to effectively discharge its function, the stomach acid or food will flow up (reflux) into the esophagus from the stomach resulting in heartburn or indigestion. 

Signs of heartburn are burning pain or discomfort in the upper-chest and mid-chest, possibly involving the neck and throat. It may worsen when lying down. 

Many people experience acid reflux from time to time. When acid reflux occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week, it is called GERD.

The discomfort of GERD in some people can be managed with lifestyle changes and over-the-counter medications. Mild GERD most times ease by itself over time. However, some people with GERD may need stronger medications or surgical options to ease symptoms.

Symptoms

Signs and symptoms of GERD include:

• Heartburn; a burning sensation in your chest, usually experienced after eating and might be worse at night.  
• Chest pain.
• A sour or bitter taste at the back of your mouth.
• Difficulty swallowing.
• Breathing problems, such as asthma.
• Food regurgitation.
• A feeling of a lump in your throat.
• Nausea.
• Bad breath.
• Vomiting.
• Tooth enamel wearing away.

If you have acid reflux at night [at bedtime], you may also experience:

• A chronic cough.
• Disrupted sleep.
• Asthma that gets worse, or a new one.
• Laryngitis [an inflammation of the larynx].

Causes

DIAGNOSIS FOR SEVERE GERD

If your GERD symptoms don’t get better with treatment, you may carry out some tests for a better diagnosis:

• Endoscopy :To look for inflammation or irritation of the tissue [esophagitis] or remove a small tissue sample for further testing [biopsy].
• Upper GI Series : This is a series of special x-rays that show your esophagus, stomach, and duodenum [upper small intestine].
• Esophageal Manometry : This checks low pressure in the esophagus, as well as the defects.
• pH Testing : This is particularly done to measure the acidic level inside your esophagus.

DIETARY TRIGGERS OF GERD

The dietary triggers of gastroesophageal reflux disease may vary from one person to another. 

The diets that can activate GERD include:

• High fatty foods.
• Spicy foods.
• Certain fruits:
• Pineapple.
• Tomato.
• Onions.
• Garlic.
• Mint.
• Pepper.
• Citrus fruit such as orange, lemon, etc.
• Certain drinks or beverages:
• Alcohol.
• Coffee.
• Tea.
• Soda.

TREATMENTS

GERD treatment aims at reducing the amount of reflux or lessens the damage done to the lining of the esophagus. 

OTC [over-the-counter] or prescribed medications may help in treating the symptoms of GERD. These medicines include:

• Antacids : Coined from two words: ‘anti’ and ‘acid’ [anti-acid], these can neutralize acids in the esophagus and stomach, and thereby stop the heartburn. Antacids can also be combined with a foaming agent [for better results in some people]. These compounds form a foam barrier on top of the stomach, which stops acid reflux. Antacids should not be used for more than 14 days, because of their side effects; which includes:Diarrhea, Altered calcium metabolism, The buildup of magnesium in the body.
• Proton Pump Inhibitions [PPIs]

Also known as acid pumps, PPIs block proteins needed to make stomach acid. PPIs include:

1. Dexlansoprazole [Dexilant].
2. Lansoprazole [Prevacid].
3. Esomeprazole [Nexium].
4. Omeprazole or sodium bicarbonate [Zegerid].
5. Rabeprazole [Aciphex].
6. Pantoprazole [Protonix].

• H2 Blockers

These are effective for chronic reflux and heartburn. They help block acid secretion in the stomach. 

They include:Cimetidine [Tagamet], Famotidine [Pepcid], Nizatidine.

• Prokinetics

These drugs help your stomach empty first, to reduce the acid content in your stomach. They may also help with symptoms like bloating, vomiting and nausea. 

Nonetheless, prokinetics have serious side effects. Many people can’t take them, and if taken, should be for a limited time. Prokinetics include domperidone and metoclopramide [Clopra, Maxolon, Metozolv, Regian].

DIET AND LIFESTYLE CHANGES

The following diets and lifestyle changes are essential and necessary if you desire to reduce the symptoms of GERD you have. They are:

• Avoid foods and beverages that trigger symptoms.

Withdraw yourself from foods that can relax LES, such as: 

• Chocolates.
• Caffeine.
• Peppermint.
• Fatty foods.
• Alcoholic beverages.

Others that can irritate a damaged esophageal lining are:

• Citrus fruits and juices.
• Pepper.
• Tomato products.
• Don’t smoke.
• Eat smaller portions at mealtime.

Eating smaller quantities helps to check symptoms. Also taking meals at least 2 to 3 hours before going to bed lets the acid in your stomach go down.

• Eat slowly.
• Chew your food thoroughly before swallowing.
• Avoid overweight : Obesity often worsens symptoms of GERD. Staying at a healthy weight offers relief.
• Wear loose clothes :Loose clothing relieves pressure on your belly and lower part of your esophagus
• Raise your head; Raise the head of your bed about 6 inches high. It lets gravity lessen the reflux of stomach contents into your esophagus. Don’t use a pillow to raise yourself.
• Acupuncture: Treatment with acupuncture can stop reflux even better than PPIs [proton pump inhibitors], with longer results. However, more research is needed on this area.

Gastroesophageal reflux disease (GERD) is caused by frequent acid reflux. 

Gastroesophageal is a compound word. Gastro refers to “stomach”.  Gastroesophageal simply means “stomach esophagus”. Reflux refers to “what is in your stomach flowing back up into your esophagus”. 

What causes this backup flow? 

We had earlier talked about LES (lower esophageal sphincter), a ring that acts as a valve to the food pipe between the stomach and the esophagus. In normal digestion, your LES opens, when food is swallowed, to allow food into the stomach. It then closes to stop food and acidic juices (in the stomach) from flowing back up into your esophagus. 

But when the LES is weak or relaxes when it shouldn’t, it lets the stomach’s contents flow up or returns into the esophagus. As the acidic stomach content flows up, it irritates the food pipe lining (heartburn).

SURGERY FOR SEVERE GERD

Surgery is the last option when other treatments fail. 

The surgical procedures include:

• Fundoplication ; This helps raise the pressure in your lower esophagus. Done through a laparoscope or via an open surgery.
• Transoral Incisionless Fundoplication [TIF] : This uses an endoscope to wrap the stomach around the LES with a plastic fastener.
• Stretta Procedure : This uses low radiofrequency heat to reshape your LES.
• LINX Surgery : A band of magnetic titanium beads is wrapped just about where your stomach and esophagus meet. The bead’s magnetic attraction keeps it loose enough to let food pass through into the stomach, but tight enough to discontinue reflux.

OUTLOOK

Although GERD gives discomfort and may limit your daily activities, it is rarely life-threatening. Understanding the causes and getting treatment promptly, you should feel quite better.

COMPLICATIONS

Most people do not experience serious complications of gastroesophageal reflux disease. But in rare cases, complications may even be life-threatening. 

These complications may include:

• Esophagitis [an inflammation of the esophagus].
• Esophageal structure [the narrowing of the esophagus].
• Esophageal cancer [a cancer of the esophagus].
• Asthma, lingering cough, or other breathing disorders.
• Barretti esophagus [which involves permanent changes to the lining of the esophagus].
• Erosion of the tooth enamel, gum disease, or other dental problems.

RISK FACTORS  

More than 15 million adults have heartburn daily; including many pregnant women. GERD in infants and children is more common, it can cause frequent vomiting, coughing, and other breathing disorders. 

Other conditions that can increase your risk of GERD may include:

• Hiatal hernia; bulging of the top of your stomach up into the chest through an opening in the diaphragm (diaphragmatic hiatus).
• Overweight (obesity)
• Pregnancy
• Connective tissue diseases such as scleroderma, rheumatoid arthritis, or lupus
• Gastro

Certain factors can increase the severity of acid reflux, they include: 

• Smoking.
• Certain drinks, including alcohol, coffee, chocolate, etc.
• Fatty or fried foods.
• Excessive meals.
• Eating too soon before bed.
• Some medication, such as aspirin.

FAQ

Can GERD be cured?

Yes. Most causes of gastroesophageal reflux diseases [GERDs] can be cured. When diagnosed with GERD, it is best to treat both the symptoms and the root causes.

Is GERD life-threatening?

Frequent acid reflux can be a sign of GERD. Although GERD itself is not a life threat, leaving it untreated can cause more serious health risks and complications.

How long should I take omeprazole for GERD?

To treat symptoms of GERD such as heartburn and acid regurgitation in adults, in situations that your food pipe [gullet] has been slightly damaged. The recommended dose is 20mg once a day for 28 to 56 days. Your doctor may tell you to take a dose of 40mg for a further 8 weeks if your gullet has not yet headed.

Do bananas help GERD?

Bananas can help those with acid reflux by coating an irritated esophageal lining and thereby helping to combat discomfort. Because of their high-fiber content, bananas can also help in strengthening the digestive system and help stop indigestion.

Is milk good for GERD?

“Milk is often thought to relieve heartburn,” Gupta once said. “But you have to keep in mind that milk comes in different varieties [whole milk with the full amount of fat, 2% fat and skimmed or nonfat milk. The fat in milk can aggravate acid reflux.” Hence, skimmed milk is strictly recommended for persons with GERD.

What is anti reflux surgery?
Anti-reflux surgery is a treatment for acid reflux , also known as GERD (gastroesophageal reflux disease). GERD is a condition in which food or stomach acid comes back up from your stomach into the esophagus.

What are the symptoms of GERD?
• Dry persistent cough.
• Wheezing.
• Asthma and recurrent pneumonia.
• Nausea.
• Vomiting.
• Throat problems, such as soreness, hoarseness, or laryngitis (voice box inflammation)
• Difficulty or pain when swallowing.
• Chest or upper abdominal pain.

What causes GERD?
• Acid reflux is when some of the acid content of the stomach flows up into the esophagus.
• The stomach contains hydrochloric acid, a strong acid that helps break down food and protect against pathogens such as bacteria.
• The lining of the stomach is specially adapted to protect it from the powerful acid, but the esophagus is not protected.
• A ring of muscle, the gastroesophageal sphincter, normally acts as a valve that lets food into the stomach but not back up into the esophagus. When this valve fails, and stomach contents are regurgitated into the esophagus, the symptoms of acid reflux are felt, such as heartburn.

How is antireflux surgery performed?
Anti-reflux 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.

What are the advantages of this surgery?
• reduced postoperative pain
• shorter hospital stay
• a faster return to work

What are other options available for treating GERD?
• Lifestyle modifications- changing diet and taking antacids, Losing weight, reducing or eliminating smoking and alcohol consumption, and altering eating and sleeping patterns can also help.
• Drug therapy- You may consult your doctor who depending on your condition will prescribe you antacids, and other acid secretion reducing medications like ranitidine, omeprazole, etc. Which act by reducing acid produced in the stomach.

What precautions one must take after the surgery?
Patients are advised to engage in light activity and should avoid heavy lifting or strenuous activity for a short period of time. Initially liquid diet should be taken which can be slowly replaced with solid foods.

What are the complications which may occur following the surgery?
Although the surgery is safe, few complications may occur rarely which include:
• adverse reaction to general anesthesia
• bleeding
• injury to the esophagus, spleen, liver, stomach or internal organs
• infection of the wound, abdomen, or blood.