- What is gastroesophageal reflux disease?
- What are the symptoms of GERD?
- When is heartburn worrisome?
- What are the preventative treatments for GERD and heartburn?
- Are medications helpful?
- What are the tests for GERD?
- What is involved in laparoscopic surgery for GERD correction?
- How long does recovery take?
- What are the risks and complications of a laparoscopic Nissen fundoplication?
What is gastroesophageal reflux disease?
During normal ingestion and digestion, food travels from the mouth through a tube of muscle called the esophagus to the stomach, where it remains until it moves into the intestine. Muscles in the lower part of the esophagus, known as the lower esophageal sphincter, or LES, tighten keeping food and digestive acids in the stomach. For patients who have gastroesophageal reflux disease, the LES muscles are loose allowing acid to escape, or reflux, into the esophagus, damaging or burning the sensitive esophageal lining.
Prolonged acid reflux, known as gastroesophageal reflux disease, or GERD, reduces the ability of the LES muscle to contract, causing acid to remain in the esophagus longer, leading to extended complications. These complications include scarring, nerve damage, tightening of the esophagus, the formation of ulcers, and bleeding.
What are the symptoms of GERD?
The primary symptom of GERD is heartburn, which occurs as the stomach acid travels through the esophagus and stimulates the nerve fibers. Heartburn is felt as a burning pain in the middle of the chest. It can stretch from the abdomen to the neck and can even extend into the back. Heartburn from acid reflux occurs most often after eating or while lying down, when reflux is more likely to occur. Symptoms can be triggered by spicy foods, caffeine or alcohol. Other more common symptoms of GERD may include the following:
- A dry cough
- Trouble swallowing
- A hoarseness or change in the voice
- Sore throat
When is heartburn worrisome?
Heartburn affects almost everyone at some point in their lives. Heartburn that is experienced several times in a 24-hour period, that occurs many times a month, or that causes hoarseness, coughing, bleeding or swallowing difficulties, is not normal and should be examined.
What are the preventative treatments for GERD and heartburn?
GERD is a chronic condition that cannot be cured. There are numerous treatment options that may reduce the severity and frequency of the symptoms of GERD. They include lifestyle changes, such as:
- Diet modification
- Cessation of smoking and alcohol consumption
- Eating small, frequent meals
- Stress reduction techniques
- Loss of excess weight
- Avoidance of tight clothing and frequent bending
- Sleeping with the head of the bed elevated
Are medications helpful?
Medications are also helpful in reducing acid production or relieving the symptoms of GERD. These medications include antacids, foaming agents, H2 blockers. proton pump inhibitors and pro-motility drugs. A combination of medications that work to address different symptoms may help to relieve the symptoms of GERD. Like all medications though they include risks.
What are the tests for GERD?
Testing for the presence of GERD include the following:
- Esophageal manometry
- Esophageal acid testing
What is involved in laparoscopic surgery for GERD correction?
A laparoscopic Nissen fundoplication is a surgical procedure to tighten the lower sphincter muscle of the esophagus. A Nissen fundoplication is used in the treatment of gastrointestinal reflux disease, also known as GERD. During the procedure the top of the stomach, known as the fundus, is wrapped around the lower esophagus to strengthen the barrier between the stomach and esophagus.
During a laparoscopic Nissen fundoplication three to four small incisions are made in the patient's abdomen where a laparoscope and tiny surgical instruments are inserted. With video guidance, the physician is able to repair the valve. Most patients see an improvement in their GERD symptoms after this procedure, and are less likely to need daily medication for their condition.
How long does recovery take?
Patients usually return home in a day or two and can resume normal activities within a week.
What are the risks and complications of a laparoscopic Nissen fundoplication?
A laparoscopic Nissen fundoplication is considered safe for most patients, yet there are certain risks associated with any kind of surgical procedure. Some of these risks may include the following:
- Recurring heartburn
- Difficulty swallowing
- Esophagus sliding out of place