TOWNSEN MEMORIAL

WHAT IS GASTROESOPHAGEAL REFLUX DISEASE (GERD)

During normal ingestion and digestion, food travels from the mouth through a tube called the esophagus to the stomach, where it remains until it is pushed into the intestine. Muscles in the lower part of the esophagus just above the stomach, called the lower esophageal sphincter (LES), tighten to keep food and digestive acid in the stomach. In people with gastroesophageal reflux disease, these muscles loosen and allow acid to escape (reflux) into the esophagus, the sensitive lining of which is then damaged or burned.

Prolonged acid reflux, known as gastroesophageal reflux disease (GERD), reduces the LES’ ability to contract, causing acid to remain in the esophagus longer and leading to extended burning. This, in turn, causes scarring, nerve damage, tightening of the esophagus, the formation of ulcers, and bleeding.

SYMPTOMS OF GERD

The symptoms of Gerd can lead to much more serious diseases. Here is a short video that talks about health concerns if Gerd is not treated.

Surgery has proven to prevent reflux 95% of the time when performed by experienced surgeons. We have a new testing procedure that measures air and any juice that goes up the esophagus where it does not belong. It’s called the impedance esophageal manometry.

It has proven that the medications used for heartburn and other reflux symptoms do not prevent reflux and surgery does.

The most common symptom is heartburn, the burning sensation felt in the center of the chest when acid partially digested food moves from the stomach to the esophagus. Other signs that you may have GERD include:

• Belching
• Regurgitation of food
• Nausea and vomiting 
• Vomiting blood
• Hoarseness or change in voice
• Sore throat
• Difficulty swallowing
• Cough or wheezing
• Chest pain

WHEN IS HEARTBURN WORRISOME?

Whenever symptoms persist despite over-the-counter medicines and/or lifestyle modifications, medical treatment should be sought. If these measures do not resolve the symptoms or if there is difficulty swallowing or bleeding, it is time to find out what’s going on.

WHAT ARE PREVENTATIVE TREATMENTS FOR GERD AND HEARTBURN?

Preventative and non-surgical treatments for acid reflux include:

• Diet modification
• Cessation of smoking and alcohol consumption
• Examination of medications for caffeine, alcohol, etc.
• Loss of excess weight
• Avoidance of tight clothing and frequent bending
• Sleeping with the head of the bed elevated

Stop heartburn and reflux with an outpatient surgery procedure by an experienced surgeon who has performed over 1000 procedures and has a 23-year track record of excellence.

ARE MEDICATIONS HELPFUL?

Medications are typically prescribed when preventative measures prove ineffective, and before surgery is recommended. The most common types of medication are H-2 blockers (Axid, Pepcid, Tagamet, Zantac), drugs that increase peristalsis, and tighten the LEW (Reglan), and proton pump inhibitors (Prevacid or Prilosec).

WHAT ARE THE TEST FOR GERD?

Testing for the presence of GERD may include a barium “swallow” (upper GI), esophagogastric duodenoscopy, esophageal manometry, and pH probe.

WHAT IS INVOLVED IN LAPAROSCOPIC SURGERY FOR GERD CORRECTION?

Surgery to correct GERD is called gastroesophageal fundoplication, or stomach wrap. In a one hour, minimally invasive procedure performed under general anesthesia, the top of the stomach is wrapped gently around the esophagus to imitate normal LES pressure. Laparoscopy, which involves the insertion of a thin tube with a camera on the end so the surgeon can see inside the body and operate without the need for a large or “open” incision, allows for small incisions (1/4 to 1/2 inch), shorter recovery time and less post-operative pain.

HOW LONG DOES RECOVERY TAKE?

Patients usually return home the same day as surgery and can resume normal activation within days.

HOW LONG BEFORE RESULTS ARE APPRECIATED?

Heartburn should end immediately after surgery.

WHAT ARE THE RISKS AND COMPLICATIONS?

Many patients experience difficulty in swallowing for one to three weeks following surgery. Risks include injury to the nearby major organs (spleen, liver, esophagus, stomach), bleeding, infection, splenectomy (removal of the spleen), failure to eliminate GERD, prolonged swallowing difficulty, and inability to vomit. Dr. Thomas has had only one complication in 17 years and 600 procedures and the patient recovered well.

WHAT’S INVOLVED IN THE ENDOSCOPIC TIF PROCEDURE?

Transoral incisionless fundoplication is a new advanced technique where the stomach is wrapped from the inside of the esophagus using an endoscope and without the need for an incision. It is performed under general anesthesia and requires overnight hospitalization. Only Hiatal hernias that can be reduced with the endoscope can be done by this method. So far the results have been very good, however, long term results are not yet available. Dr. Thomas will have you decide if this or the laparoscopic Nissen is your best choice.