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OVERVIEW : GASTROESOPHAGEAL REFLUX DISEASE
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.
Investigations done for Acidity –
24 hour pH study
CT Scan /Barium Study
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.
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.
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.