Gastro-oesophageal Reflux Disease (Gord)
This is a prevalent condition with up to half the population suffering with symptoms such as heartburn in any given month. Recent evidence based guidelines for the diagnosis and management of reflux disease have recently been published in the United States.
Reflux is caused by the failure of the lower oesophageal sphincter. The reflux of stomach contents into the oesophagus leads to symptoms typically heartburn and these then cause oesophageal injury leading to oesophagitis, stricture (narrowing), Barrett’s oesophagus (a change in the lining of the oesophagus) and potentially cancer.
Initial management should include weight loss where needed; avoid any foods that cause symptoms (typically coffee, alcohol, spicy foods); elevation of the head of the bed and avoiding late night eating.
Empirical treatment with a proton pump inhibitor (PPI’s) such as omeprazole is recommended for 8 weeks in the setting of typical symptoms of heartburn and regurgitation. Medical treatment is incredibly effective; however on cessation of PPI’s there is a potential for relapse and for those at risk of relapse this will normally be within 3 months.
For some patients with reflux consideration may be given to surgical interventions; this is performed laparoscopically (keyhole). Where surgery is considered manometry (a specialist test to examine oesophageal function) must be undertaken.
This is a keyhole operation through five small holes. The oesophageal opening into the chest is dissected and hiatus hernia any (where present) repaired followed by the wrapping of the fundus of the stomach (fundoplication) around the gastro-oesophageal junction.
What is a hiatus hernia?
This is where the stomach bulges through the diaphragm (hiatus) into the chest. These are more common with age. They can be associated with GORD but are often asymptomatic.
Who should have surgery?
It is recognised that surgery requires an experienced surgeon especially around the oesophagus. There are small risks as with any surgery but there is a very high level of patient satisfaction and excellent outcomes. Surgery will normally require a short stay in hospital.