Summary

Gastro-esophageal Reflux Disease is a chronic condition in which stomach acid refluxes into the esophagus leading to various complications. Lifestyle changes and medication resolves the issue in most cases. However, in some people, when these options do not work out, the case doctor may recommend surgery as the last option. There are four surgical options. While some are new, others have been around from a long time. All of them are effective and the doctor will choose the best option for the patient. In this article, we will learn more.

Introduction to GERD

The food we consume enters the esophagus which is a long tube running from the back of the mouth to the opening of the stomach. Muscles in the esophagus expand and contract to push the food into the stomach. Once the food enters the stomach, acid present there begins breaking down the food in order to start the digestion process. There is a sphincter, or a disc of muscles, called the lower esophageal sphincter (LES) at the junction of the esophagus and stomach. It acts as a valve and prevents the stomach acid and the food in the stomach from refluxing (going back) into the esophagus.

Sometimes, when we consume spicy food or a heavy meal, the stomach acid and/or contents of the stomach can reflux into the esophagus. This is normal and happens to everybody once in a while. The condition is called Gastro Esophageal Reflux or GER. However, in some people, this situation occurs regularly, like say twice or thrice a week. This is because of a weak or damaged LES. The condition lasts long or does not go away quickly. Its now chronic, and called Gastro Esophageal Reflux Disease (GERD).

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Also Read: A little bit of self-care can treat Acid Reflux effectively

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Complications from GERD

GERD can be a major nuisance to the patient. It disrupts his/her professional and personal lives. Consuming food and beverages become a nightmare because of the condition. The patient suffers from frequent acid indigestion and heartburn. He/she experiences nausea and vomiting, abdominal pain, belching, tooth erosion and bad breath.

If not treated effectively, it leads to other complications as well.

• Stomach acid can cause inflammation of the esophagus leading to bleeding or ulcers there.
• The damage to esophageal tissues creates scars. Scar tissue can constrict the esophagus and make swallowing difficult (called dysphagia).
• Long-term inflammation of the esophagus increases the risk of esophageal cancer.
• Barrett’s esophagus: In this, the esophagus starts growing a tissue similar to that found in the lining of the intestines. This increases the risk of a rare type of cancer called esophageal adenocarcinoma.
• Stomach acid entering the lungs can damage the lungs leading to chest congestion, wheezing, recurring pneumonia and asthma.

Treating GERD

Lifestyle Changes

This is the first line of treatment for GERD and in many cases, it is good enough to resolve the condition. Some measures include:

• Losing weight if one is overweight — highly effective
• Avoiding caffeinated beverages as they increase acid levels in the stomach
• Avoiding foods such as fatty foods, peppermint and alcohol that reduce pressure in the lower esophagus
• Avoid foods such as acidic liquids, alcohol and coffee that affect peristalsis or the muscle movements in the digestive tract
• Avoiding fatty foods that slow down gastric emptying
• Avoiding heavy or large meals
• Quitting smoking
• Not lying down immediately after a meal
• Elevating the head while lying down, by using more pillows

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Also Read: Medications and Diet Plan for Treatment of GERD

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Medication

• Antacids: These can be used once in a while for temporary relief but should not be used frequently.
• Histamine blockers: Also called H2 Blockers, these help lower acid secretion and heal esophageal erosions.
• Proton pump inhibitors: These drugs block the three major pathways for acid production and are more effective than H2 Blockers.
• Prokinetic agents: These drugs enhance the functioning of the smooth muscles of the GI tract.

Surgical Options

When lifestyle changes and medication are not enough, surgery may be the only option.

Fundoplication

Also called Nissen Fundoplication, this used to be an open-incisional surgery in the past. But off-late, laparascopic procedures are more common while open-incisional procedure is rare. In this procedure, the upper part of the stomach is wrapped or folded around the outside of the lower part of the esophagus. This helps strengthen the weak LES.

In open-incisional surgery, the surgeon makes a long incision on the abdomen to access the stomach. In laparoscopic procedure, there are multiple, small incisions made on the abdomen, through which tubes are introduced, fitted with surgical instruments to make the necessary intervention.

The patient will be given instructions before the surgery. He/she must follow a clear-liquid diet for 4-5 days leading up to the surgery, must take medication to clean the bowels on the previous day of the surgery, and must not consume anything the day of the surgery.

Fundoplication using laparoscopic method is quite effective and shows a success rate of 90%, five years after surgery.

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Also Read: Do not ignore that sour taste in your mouth

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Linx Reflux Management System

This uses a special device called LINX to strengthen the LES. The device is made up of a ring of titanium magnets wrapped around the LES. The magnets are strong enough to hold the LES together firmly and prevent any reflux. But at the same time, its slightly flexible and allows food to enter the stomach. The magnetic field is also not strong enough to raise a red flag in airport security, or during an MRI scan. The procedure is minimally-invasive and laparoscopic. Several small incisions are made on the abdomen and a laparoscope fitted with a light, camera lens and LINX fitted at the end are used for the procedure. The procedure is quite effective and showed a 91% success rate in one study.

Transoral Incisionless Fundoplication (TIF)

This is a non-invasive and endoscopic procedure, which means, it does not require incisions on the skin, hence there are no scars. A special endoscope is fitted through the mouth and all the way into the stomach. Thereafter, using tools fitted at the end of the scope, the LES is repaired or rebuilt. The procedure is quite popular and shows a success rate of 81% three years after the procedure.

Stretta Procedure

This too is an endoscopic procedure. In this, the scope is fitted with a RF device at the end. Radiofrequency waves emitted by the device heat up the LES. This thickens the muscles in the LES, strengthening it in the process. This is a relatively new procedure and there is not enough data around its efficacy. However, initial results are encouraging.

Recovery

Recovery after the surgery takes anywhere from 2 to 8 weeks depending on which of the above procedures were conducted. Open-incisional surgery requires hospital stay for 2-3 days after which the patient is discharged. In case of LINX, the patient is kept in the hospital for a day and then discharged. In case of TIF and Stretta, they are outpatient procedures, so the patient is discharged the same day. In all these cases, full recovery takes 8 weeks. This means, the patient can return to a normal diet only after 8 weeks. However, 2 weeks after the procedure, he/she can return to work and a normal routine.

In these 8 weeks, he/she will be advised to consume liquid diets in the first 2 weeks, pureed foods for the next 2 weeks, and semi-solid or soft foods for the next 4 weeks. All these ensure the GI tract is not too stressed from the digestion process and recovery can happen quickly. Wounds in the case of open-incisional surgery would be stitched up using sutures. Scars from the wounds will heal in 3-4 months’ time. Some medication, and adequate rest will be advised for the patient in these 2 months.

Accidental consumption of acids

In school or college laboratories, children accidentally consume corrosive acids during science experiments. In chemical factories, adult workers may accidentally consume acids, or intentionally, in order to take their lives. Such a situation leads to corrosive injury in the GI tract. It results in perforations (small holes) in the esophagus and stomach. Symptoms include drooling (excessive salivation), dysphagia (difficulty in swallowing), intense pain in the mouth, chest and stomach. It can also result in stricture or contraction of the esophagus or the opening of the stomach.

Such a corrosive injury is treated using antibiotics or surgery. All other methods which are intuitive, such as giving milk, water, cold juices or an alkali of opposite pH are all dangerous as it can lead to intense heat in the GI tract (caused by exothermic reactions). Activated charcoal is also not recommended as it can cause tissue damage.

Only a doctor is qualified to decide the best course of treatment. He/she will first do an endoscopy to assess the extent of damage and decide the right treatment. So, if you, or any of your dear ones face such a situation, rush to a hospital immediately. Avoid any self-medication, home-remedies or suggestions from people. You will only worsen the damage. Emergency medical help is the best solution always.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 •  Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801

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