Acidity / Gastro Esophageal Reflux Disease and its Management

Gastro esophageal reflux disease is a fairly common in General population. The symptoms may vary from acidity, heartburn ,regurgitation of food in mouth ,epigastric pain getting aggravated with spicy food, belching  to atypical symptoms like chest pain, difficulty in swallowing , change in voice ,dental erosions. Few elderly patients may develop pneumonia due to chronic aspiration.

Side effects of acidity or GERD include changes in the mucosal lining of Esophagus to Columnar ,the condition known as Barretts Esohagus. Barrets esophagus if not treated aggressively may lead to Cancer of the Esophagus.

What avoids acidity What promotes acidity
  • Salivary bicarbonate ,esophageal movements
  • Intrabdominal positive pressure
  • Intact Gastro esophageal junction and crural diaphragm
  • Intact high pressure Lower esophageal sphincter
  • High fibre food and fruits
  • Obesity
  • Smoking, alcohol, fatty food
  • Spicy Food, chocolates
  • Lax hiatus/Hiatus hernia
  • Delayed gastric emptying

Investigations done for Acidity

Endoscopy

24 hour pH study

Manometry

CT Scan /Barium Study

 

Treatment –

Lifestyle modification ,food alteration ,stopping smoking ,weight reduction, proton pump inhibitors and anti H.pylori treatment  are intergral part of Medical treatment of GERD. Surgery has its own definite indications.

Surgical Management-

Laparoscopic Surgery has revolutionized Surgery for GERD or acidity. Surgery known as Fundoplication and its variants Laparoscopic Nissens Fundoplication ,Toupets Fundoplcation and Dorr Fundoplication is done for acidity.

When is Surgery advised for Acidity-

Relapse or recurrence in patients medicines/incomplete resolution after medicines.

Young patients who may require lifelong PPI’s due to persistent symptoms.

Long duration of symptoms.

Large hiatus hernia.

Complications of medicines-Calcium deficiency and Osteoporosis,anemia ,bacterial overgrowth etc.

Barretts esophagus ,Ulceration ,Stricture or recurrent aspirations.

 

Surgical Procedures –

Laparoscopic Nissens Fundoplication is the most popular Anti reflux Surgery. It is a 360 wrap of fundus of stomach above the GE Junction . Surgery aims at bringing the GE Junction into the abdomen which may have migrated into the thorax due to shortening as a result of chronic reflux or due to laxity of hiatus .The GE junction is augmented by this wrap which prevents reflux into esophagus.

Gastro Esophageal Reflux Disease and its Management

 

Obese patients with body mass index above 32.5 require Laparoscopic Gastric bypass (RYGB) instead of Fundoplication. Bariatric Surgery resolves both  the issues, GERD and Obesity at a time.

Long Term results –are good with 90% of patients completely free of medications and symptoms .Some patients may experience short term bloating post surgery which settles with dietary modification.

Dr Kedar Patil at Presize Clinic Pune is a acidity specialist and provides acidity treatment in form of endoscopy and Laparoscopic Surgery for Acidity.

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