Gastroesophageal reflux disease (GERD)
Is a common problem in the society
In lay terms, this refers to a condition where juices from the stomach regurgitate abnormally backwards into the esophagus
This causes symptoms of heartburn and reflux commonly. Not infrequently, it may also lead to chest pain, dysphagia, cough and hoarseness of voice.
Almost everyone in their lifetime have experienced heartburn and reflux once in a while. When this becomes a regular affair and causes distress and interferes with daily life, it is labelled as a disease – GERD.
FAQs
What causes GERD?
There are many causes of GERD- excess of spicy food, smoking, alcohol, stress, tea, coffee can cause it. Sometimes, people may have a structural defect called hiatus hernia that can cause it. This means that a part of the stomach goes into the chest and therefore stomach acid and juices wash the lower esophagus causing heartburn and reflux
What happens if GERD is left untreated?
The acid and juices from the stomach can damage the mucosa of the lower end of the esophagus in GERD. This may in the long term lead to inflammation (scientifically called esophagitis), ulcers, precancerous lesions called Barrett’s, and even cancer. In fact, GERD is the commonest cause of esophageal adenocarcinoma.
What is the treatment of GERD if it is due to hiatus hernia?
If it is a small hiatus hernia, it should be managed conservatively. However a large hiatus hernia demands a surgical repair by a procedure called fundoplication.
What is fundoplication and how is it done?
Simply put, the fundoplication operation entails bringing the stomach back to the chest, putting stitches to make the hole through which the stancha enters the chest smaller and wrapping the stomach on itself so that it does not go back to the chest.
It is done laparoscopically at our center. Patients typically get a surgery with 4-5 small holes, each of 5 mm in width leaving behind tiny scars. The pain is minimal and can managed on oral analgesics for 2-3 days. Patients are usually discharged 24 hours after surgery. They are asked to take a soft diet for the first few days before they get a full solid diet.
I have heartburn and reflux for a long time. My gastroenterologist has given me pantoprazole which keeps me fine most of the time but not always. Should I get a fundoplication?
This would require evaluation by clinical assessment and some tests. They are – endoscopy, manometry and pH study. Endoscopy may pick up a hiatus hernia or esophagitis or Barrett’s and in these situations, surgery is indicated. Manometry helps in confirming GERD and excluding other causes of similar symptoms. It is important to remember that long term use of pantoprazole has been associated with side effects and patients should discuss the risk-benefit ratio with their doctors regarding different modalities of treatment.
Can GERD cause cough and breathlessness ?
Many of our patients with GERD are referred by our ENT colleagues because many suffer from cough and breathlessness. This happens because the acid vapour from the reflux destroys the surface lining of the upper and then lower airway tract over a long period of time. Tests such as pH meter and endoscopy can usually confirm the correct diagnosis.
Achalasia
Achalasia cardia is an uncommon disease which produces disorder of the normal movement of the esophagus.
Instead of normal motion from oral cavity to the stomach, in achalasia, the esophagus becomes motionless. Furthermore, the pressure in the junction of esophagus and stomach becomes very high. This does not allow liquids to travel downwards and this may also enter the lungs creating recurrent infection.
Patients typically complain of dysphagia, mostly and initially to liquids. It is also accompanied by reflux and chest pain. This triad is typical of the disease.
The treatment of the disease is lifelong. The present therapy cannot alter the movement in the esophagus but it can decrease the pressure of the junction so that food, both solid and liquid, can travel normally into the stomach.
This is achieved by cutting the muscles at the lower end of the esophagus. This gives immediate relief to the patient. This can also lead to reflux of stomach content into the esophagus as a side effect.
Technically, this procedure can be done endoscopically (Dilatation, POEM) or laparoscopically (cardiomyotomy). The former is a day care surgery whereas the latter requires a 24 hour stay in the hospital. The efficacy of the procedures are equivalent except in a subgroup (called type 3) where POEM is better. The laparoscopic surgery however has the advantage of producing less reflux.
Here is how we do the surgery – (use your discretion whether you want to see it)
Achalasia cardia treatment should be done in a dedicated center with both endoscopic and laparoscopic expertise. Also, patients should be under lifelong check up.