We all suffer from a reflux of acid (acid indigestion/heartburn) from time to time, especially after a heavy meal. However, in normal health there is a natural protective mechanism in the lower oesophagus (the tube that runs from your throat to your stomach) to ensure that any acid reflux is not excessive or prolonged.

What Is Gastro-oesophageal Reflux Disease (GORD)?

Gastro-oesophageal reflux disease (GORD) occurs when the natural protective mechanism in the lower oesophagus starts to deteriorate. Often this is because the muscle in the lower oesophagus, known as the Lower Oesophageal Sphincter (LOS) fails. When this sphincter fails, the stomach acid leaks back up into the oesophagus, known as acid reflux. The oesophagus is the tube that runs from your throat to your stomach and when it becomes very inflamed this painful condition is known as Oesophagitis.

GORD is a common and chronic condition. It is estimated that 10-20% of the population suffer with this condition at least once a week and it is the most common cause for indigestion and heartburn.

What Are The Symptoms Of Gastro-Oesophageal Disease?

Heartburn is the most common symptom, a burning feeling rising from the stomach or lower chest up towards the neck. This symptom can be made worse by consuming heavy meals, lying down, stooping and straining.

The other common symptom is the regurgitation of unpleasant sour tasting acid into the throat and mouth

In most cases, gastro-oesophageal reflux disease (GORD) can be diagnosed by discussing your symptoms with your GP, but there are a number of different ways that GORD can be confirmed.

A procedure known as an endoscopy is the main diagnostic procedure that is used to confirm GORD. For more detailed information on this procedure, please click here.

Who Is At Risk From Developing Gastro-Oesophageal Disease?

You are at risk from GORD if you have or do any of the following:

Pre-existing condition eg: cardiac sphincter failure or Hiatus Hernia
Smoking
Heavy alcohol consumption
High fat diet
High Caffeine consumption
Pregnancy
Obesity
Wear excessively tight clothes
Consume large portions
A previous history of cardiac surgery
Hiatus Hernia
Take medications such as: Tricyclics, Anticholinergics, Nitrates, Calcium-channel blockers and Benzodiazepines.

Try your best to help yourself

Things you can do to improve your symptoms
There are a number of self-care techniques that may help to relieve the symptoms of gastro-oesophageal reflux disease (GORD).

If you are overweight - loose weight, because it will reduce the pressure on your stomach.

If you are a smoker - quit because tobacco smoke can irritate your digestive system.

If you eat large portions - cut down to smaller more frequent meals to try to reduce the pressure on your stomach.

If you eat late - eat earlier and try to have your evening meal three to four hours before going to bed so that it is well digested before you lay down.

If there are triggers making you worse - avoid them. For example, alcohol, coffee, chocolate, tomatoes, fatty or spicy, foods are often triggers for many sufferers.

If lying flat is a problem - raise the head of your bed by placing wood or blocks under your bed feet.

If you take regular medication - check with your GP
to see if they could be contributing towards your GORD, as
alternative medicines that do not inflame your symptoms may be available.

If you haven't tried Antacids - then give then a try! Many of the 'over the counter' Antacid medications are effective at alleviating mild - moderate symptoms, as they will neutralise the effects of stomach acid.

If you have tried all the above and nothing works - then go to your GP, who may recommend a medication that is not available over the counter, such as Proton-pump inhibitors, H2-receptor antagonists or Prokinetics.

Although many patients get effective relief from either self-help or their GP's recommendations, a significant proportion of patients will require specialist help from an expert in Gastro-Oesophageal Reflux Surgery to avoid the potentially serious long-term complications of acid reflux.

Serious Complications Of Acid Reflux

Oesophageal Ulcers
The excessive acid produced by gastro-oesophageal reflux disease can seriously damage the lining of your oesophagus and eventually lead to the formation of ulcers. These ulcers can bleed, causing pain, and making swallowing difficult.

Oesophageal Stricture
Repeated damage to the lining of your oesophagus can lead to the formation of scar tissue. If the scar tissue is allowed to build up, it can lead to a narrowing of your oesophagus. This is known as oesophageal stricture. An oesophageal stricture can make swallowing food both difficult and painful.

These strictures can be treated by inserting a deflated balloon and then inflating it to stretch the oesophagus. This procedure is usually carried out under local anaesthetic, with the help of an image-guided microscope. This technique allows the Consultant to carefully view and position the balloon down the narrowed Oesophagus without the need for any incisions.

Barrett's Oesophagus
Repeated episodes of GORD can lead to changes in the cells of the lining of your lower oesophagus; a condition known as Barrett's Oesophagus.

These cells are not cancerous, but there is a small increased risk that they can become cancerous. Every year, 0.5% of people who have Barrett's Oesophagus will go on to develop cancer of the oesophagus.

If you have Barrett's Oesophagus, you will be advised to have regular endoscopy checks (a microscopic camera inserted down the oesophagus) in order to monitor your condition. Please click here to read more detailed iformation on Endoscopy procedure.

In some high-risk patients there are a number of techniques that can be used to try to reduce the risk of cancer developing. These include using an endoscope to destroy the abnormal cells through the use of heat waves or lasers.

Are You In Need Of Expert Help With A Gastro-Oesophageal Problem?

How Is Anti-Reflux Surgery Carried Out?

Until recently, the traditional anti-reflux surgery on offer involved a large abdominal incision and a painful and lengthy recovery period.
Not surprisingly, it was not a popular option by many, unless their symptoms were the most severe.

However, this technique has recently been revolutionized by modern thinking surgeons, interested in utilizing minimally invasive
techniques. Minimally invasive techniques require advanced surgical training and should only be undertaken by a surgeon with expertise in laparoscopic surgery. The main advantage to the patient regarding this technique, is that the previous need for making a large abdominal incision can now be avoided.

Laparoscopic anti-reflux surgery (also referred to as Laparoscopic Nissen Fundoplication) is performed to surgically reinforce the "valve" between the oesophagus and the stomach, by wrapping the upper portion of the stomach around the lowest portion of the oesophagus.

In a laparoscopic procedure, surgeons use small incisions (5 to 10mm) to enter the abdomen through canula (a narrow tube-like instrument). A laparoscope, which is connected to a tiny video camera, is then inserted through the small incision (key hole surgery), giving the surgeon a clear and magnified view of the patient's internal organs, which is then projected onto a digital screen. The procedure to reinforce the valve is then performed from "inside" the abdomen through other key hole incisons after expanding the available space by pumping carbon dioxide gas into the abdominal cavity.

In a laparoscopic surgery to alleviate gastroesophageal reflux, the surgeon makes several incisions to gain access to the stomach and Oesophagus (A). Using the laparoscope, the stomach is visualized (B), and the ligament connecting the stomach to the liver is divided (C). The upper part of the stomach is brought up around the base of the esophagus (D), and stitched into place (E). (Illustration by GGS Inc.)

What Are The Expected Results After Anti-Reflux Surgery?

Studies have shown that the vast majority of patients who undergo this procedure are symptom-free or have significant improvement in their symptoms.

The advantage of using such an up-to-date laparoscopic approach as previously described, is that this method it usually provides:

A reduced postoperative pain
A shorter hospital stay
A faster return to work
An improved cosmetic result

WHAT IS THE RECOVERY LIKE?

The post-operative pain following this procedure is generally mild, although some patients may require pain medication. It is not usually for anti-reflux medication to be required after surgery.

Patients are encouraged to engage in light activity soon after surgery and discharge home within 1-3 days.

Your diet after surgery may require some modification, beginning initially with very liquid like food, followed by gradually re-introducing soft and then more solid food.

You will probably be able to get back to your normal activities within a short amount of time. You should expect to be back at work and driving within 2 weeks of surgery.

Are There Any Risks Associated With Laparoscopic Anti-Reflux Surgery?
All surgery involves an element of risk from developing complications. Risks such as bleeding, delayed healing, scaring, infection, nausea and vomiting or injury to the oesophagus, stomach or spleen will all be discussed openly at consultation with Mr Agwunobi, as well as his scrupulous efforts to manage and minimise these risks to their lowest possible potential.

Smoking will adversely affect wound healing and smokers may be precluded from having this type of surgery.

Although Laparoscopic Anti-Reflux Surgery is regularly performed without any complications, all surgery, no mater how expertly or carefully it is performed, carries risks and the importance of a full evaluation and consultation with Mr Agwunobi to discuss your understanding and expectations in relation to these risks cannot be over emphasised.

How Do I Find Out If I Am A Suitable Candidate For Gastro-Oesophageal Surgery?

If you wish to find out if you are a suitable candidate for Gastro-Oesophageal surgery, Mr Agwunobi will carry out a full evaluation of your individual needs and circumstances and provide you with a comprehensive verbal and written explanation of any recommended treatment or surgery.

Mr Agwunobi understands the importance of the surgery you are contemplating and throughout your consultation you will be encouraged to ask as many questions as you wish and to take your time in making a decision to proceed with any treatment or not.

Find out more

If you would like to find out more about Gastro-Oesophageal Surgery and discover if you are a suitable candidate for this procedure, please telephone 0161 432 2061 , email or use the Contact form to organise a consultation appointment.

Gastro-oesophageal reflux

An Introduction To Gastro-Oesophageal Surgery