Gastroesophageal Reflux Disease (GORD)
In the UK approximately 30% of the population suffer from symptoms of gastroesophageal reflux disease and a quarter of these seek medical help. Over 1 1/2 million people require long term medication including powerful antacid proton pump inhibitor drugs.
Over 1/2 millon people in the UK suffer from persistent symptoms despite medical treatment.
What is GORD
- A common digestive condition that can affect people of all ages, including children.
- Occurs where stomach acid, and sometimes contents, leak back (reflux) into the oesophagus.
- When acid comes into contact with the lining of the oesophagus it causes a burning sensation in chest or throat called heartburn.
- The fluid may reach the back of the mouth causing acid indigestion.
What are Signs/Symptoms
- Persistent heartburn and acid regurgitation into throat and mouth. Usually worse after eating, when bending over or lying down.
- Chest pains.
- Hoarseness of voice, especially in the morning.
- Difficulty swallowing.
- The feeling of food getting stuck in the throat leading to a choking sensation.
- A dry cough.
- Tooth decay, gum disease or unpleasant taste in mouth and bad breath.
- In more serious cases may cause oesophageal ulcers or bleeding.
- Asthma suffers may suffer worsening symptoms due to stomach acid irritating the airways.
What are the Causes of GORD
- In many cases there is no identifiable reason why the condition develops.
- A problem with the lower oesophageal sphincter (LOS) the muscle located at the bottom of the oesophagus (gullet) that goes into the stomach.
- Hiatus hernia – this occurs when the upper part of the stomach pushes through the diaphragm (the muscle wall that separates the stomach from the chest).
- Being overweight.
- Eating a diet high in fat.
- High alcohol use.
- Your stomach taking longer than it should to dispose of stomach acid, this is known as gastroparesis and is common in people who have diabetes as high blood sugar levels may damage the nerves that control the stomach.
Possible complications of GORD
- Oesophageal Ulcers – long term damage to the lining of the oesophagus from excessive acid production.
- Oesophageal Stricture – repeated damage to the lining of the oesophagus may lead to scar tissue forming, if allowed to build up this may narrow the oesophagus.
- Barrett’s Oesophagus – repeated reflux can lead to changes in the cells that line the lower oesophagus. It is estimated that 1 in 10 people with GORD will develop Barrett’s oesophagus. Barrett’s oesophagus does not in itself cause any noticeable symptoms however there is a small risk that the cells affected by Barrett’s oesophagus may become cancerous and develop into oesophageal cancer. In patients that are diagnosed with Barrett’s oesophagus it may be recommended that they undertake regular endoscopies (every 2-3 years) to ensure that the cells have not changed.
- Oesophageal Cancer – it is estimated that each year in England 1 in 200 people with Barrett’s will develop oesophageal cancer.
- Medication – a trial on high does proton pump inhibitors (PPI’s) may be suggested.
- Conservative treatment – lifestyle modifications.
- Surgical treatment – this is an option when medication and lifestyle changes have not improved symptoms. It would also be considered if long-term medication is not an option.
The Operation: 'Laparoscopic Anti-reflux Operation + Nissen’s Fundoplication'
- Surgery is intended to relieve the symptoms of reflux or heartburn. These symptoms occur due to the weakness in the sphincter at the bottom of your oesophagus, which would normally stop the reflux of stomach acid into the oesophagus. In approximately 90% of people the operation is successful in preventing reflux and alleviates most if not all symptoms. Most people are able to stop their antacid medication following anti-reflux surgery.
- Five small incisions are made allowing a camera, which displays on a monitor in theatre, and instruments to be passed into the abdomen. The upper part of the stomach is wrapped around the lower end of the oesophagus to prevent reflux of stomach contents.
Possible complications of Surgery
- Gas-bloat Syndrome – because the surgery tightens the sphincter between the oesophagus and the stomach it can sometimes prevent air travelling back up preventing you from burping. This can cause bloating and an inability to belch. If you suffer from these symptoms it is advised that you avoid foods that cause gas, such as beans and cabbage.
- Perforation of the oesophagus or stomach.
- Visceral injury
- As with all keyhole surgery there is a possibility that the procedure may need to be converted to an open one.
- After your surgery you may experience difficulty swallowing straight away. You should start with fluids only and then gradually build your diet up, progressing to soup and soft foods. You will gradually be able to introduce foods of a thicker consistency. Ensure that you chew your food well, eat slowly and drink fluid with your meals to keep food moist. Avoid fizzy drinks, crusty bread, tough meat and raw vegetables as they may be difficult to swallow. Everybody is different and there are no hard and fast rules of what you should or shouldn’t eat, but the best advice is to take your time and build up slowly.
- The small wounds in your abdomen are closed using dissolvable sutures and small dressings will cover these. Dressings can be removed after 4-5 days. Try to keep the wounds clean and open to the air as much as possible.
- Due to lack of activity after your operation your chances of developing a chest infection or blood clots increases. This may be prevented by performing deep breathing activities and gentle movement.
- Remember that it may take up to three months for things to settle completely.
- You should refrain from driving for at least 48 hours after surgery, but in some cases it may take up to two weeks. Only drive once you feel able to perform an emergency stop without difficulty. (Please check with your insurance company about any special restrictions).
- You should avoid any heavy lifting for two to three weeks.
Quotes from previous patients
- “Best thing I ever did. Symptoms all disappeared immediately after surgery."
- "Wished I had it done sooner.” DBR
- “Certainly improved quality of life and would recommend to anybody with acid reflux not to take Gaviscon but to have surgery” HC
- “Having suffered from heartburn it was life changing. No reflux at night.
- "Don’t need to carry antacid medications around anymore” MC
- “Would recommend to anybody. Can only eat so much and when full have to stop eating – so cannot overeat.” MC
- “Delighted with outcome. Not taken antacid medication since operation. Have recommended a friend to have surgery” HC