Home Patient Consumer Info Surgical Conditions Gastro Oesophageal Reflux Disease GORD

Surgical Conditions

Gastro Oesophageal Reflux Disease (GORD)

The oesophagus carries food from the mouth to the stomach. The lower oesophageal
sphincter is a ring of muscle at the bottom of the oesophagus that acts like a valve
between the oesophagus and stomach.

Gastro Oesophageal reflux disease, or GORD, is a chronic disease that occurs when
the lower oesophageal sphincter does not close properly and stomach contents leak
back, or reflux, into the oesophagus.

When refluxed stomach acid touches the lining of the oesophagus, it causes a burning
sensation in the chest or throat called heartburn. The fluid may even be tasted in the
back of the mouth, and this is called acid indigestion. Occasional heartburn is common
but does not necessarily mean one has GORD. Heartburn that occurs more than twice
a week may be considered GORD, and it can eventually lead to more serious health
problems.

Anyone, including infants, children, and pregnant women, can have GORD.

Symptoms

The main symptoms are persistent heartburn and acid regurgitation. Some people
have GORD without heartburn. Instead, they experience pain in the chest, hoarseness
in the morning, or trouble swallowing. You may feel like you have food stuck in your
throat or like you are choking or your throat is tight. GORD can also cause a dry
cough and bad breath.

The most frequent symptoms of GORD are so common that they may not be
associated with a disease. Self-diagnosis can lead to mistreatment. Consultation
with a physician is essential to proper diagnosis and treatment of GORD.

Causes

• Hiatal hernia- hiatal hernia occurs when the upper part of the stomach
  is above the diaphragm, the muscle wall that separates the stomach
  from the chest.
• alcohol use
• overweight
• pregnancy
• smoking

Also, certain food and drinks are associated with reflux

Diagnoses

• Medical history
• Response to Omeprazole
  - A recent study 12 demonstrated a potential role for a proton pump inhibitor,
  omeprazole, in the diagnosis of GORD.
• barium swallow radiograph uses x rays to help spot abnormalities such as a
  hiatal hernia and severe inflammation of the oesophagus.
• Endoscopy

Treatment

Conservative treatment

• Life style modification
• Medications including antacids, Foaming agents, H2 receptor blockers, Proton
  Pump inhibitors

Surgical treatment

Surgery is an option when medicine and lifestyle changes do not work. Surgery may
also be a reasonable alternative to a lifetime of drugs and discomfort.

Laparoscopic Nissen Fundoplication (Reflux surgery)

This surgery is performed under general anaesthesia.

If a combination of lifestyle changes and drug therapy does not remedy reflux
symptoms, a Nissen Fundoplication can be a very effective surgical procedure to
correct reflux. This procedure involves wrapping the upper portion of the stomach
around the base of the oesophagus to reinforce the strength of the lower oesophageal
sphincter. Until recently, the procedure required a large abdominal incision. A hospital
stay of 3-5 days was usually required, and the time to full recovery and return to
work was measured in weeks.

A laparoscopic Nissen Fundoplication is a minimally invasive approach that involves
specialized video equipment and instruments that allow a surgeon to perform the
procedure through four tiny incisions, most of which are less than a half-centimetre
in size. One advantage of this method is a brief hospitalization. Most of the time it
will require an overnight stay. Other advantages include less pain (less of a need
for pain medication), fewer and smaller scars, and a shorter recovery time.

Laparoscopic Nissen Fundoplication is a safe and effective treatment of GORD.
However, in rare cases the laparoscopic approach is not possible because it
becomes difficult to visualize or handle organs effectively. In such instances, the
traditional incision may need to be made to safely complete the operation.