Gastroesophageal Reflux Disease - (GERD)
What is GERD?
GERD, or gastroesophageal reflux disease, is often referred to as "heartburn." "Heartburn" is a symptom of GERD in which stomach acid refluxes (pushes upward) from the stomach into the esophagus. It is often described as a harsh, burning sensation in the upper stomach, chest, throat and/or neck. Regurgitation, difficulty swallowing, chronic coughing, nausea, chest pain, and wheezing are other symptoms associated with GERD.
What Causes GERD?
At the bottom of the esophagus is a muscular valve called the lower esophageal sphincter (LES). The LES remains closed until swallowing forces it open; it then closes immediately after swallowing to prevent reflux. Reflux happens when the LES fails to close and stomach acids flow backward into the esophagus.
These acids irritate the lining of the esophagus, causing the "burning" discomfort.
What medical treatments are available for GERD?
Traditional treatment for GERD includes lifestyle changes and drug therapy. These include:
- Using antacids
- Losing weight
- Reducing smoking
- Decreasing alcohol consumption
- Avoiding fatty foods
- Avoiding greasy foods
- Avoiding spicy foods
- Avoiding caffeinated beverages
Drug therapy is used when lifestyle changes are not effective. Some medications commonly used include Tagamet, Zantac and Prilosec.
What surgical treatments are available for GERD?
Nissen fundoplication is the surgical option for the treatment of GERD. It is usually offered when medical therapy no longer works to control the symptoms. It is also offered to young adults who do not want to be on long term medical therapy.
How can it be determined if surgery is appropriate?
Certain tests can be helpful in diagnosing GERD and to determine if the surgery treatment is appropriate. These tests include:
- Upper GI (barium swallow)
Physician looks down into the esophagus and stomach of the patient with a specialized scope.
- 24-hour pH study
A special tube is placed through the nose and down into the esophagus. This is kept in place for 24 hours. This test records the acidity of the stomach contents.
- Esophageal manometry
This is a special tube that is swallowed. It records contractions and pressures within the esophagus.
What is Nissen Fundoplication?
Laparoscopic Nissen Fundoplication is the videoscope surgical procedure used to treat GERD. The procedure is performed using a laparoscope -- a tiny camera which transmits images from inside the body to a video monitor. The video camera and instruments are inserted through five small (one-half inch) incisions. The upper portion of the stomach is wrapped around the lowest portion of the esophagus forming a new valve. This prevents the flow of acid up into the esophagus. The incisions are closed with dissolvable stitches and covered by dressings
What is the typical recovery period following Nissen Fundoplication?
The usual recovery time in the hospital is one to two days. During this time, patients are in some discomfort from their incisions. Pain medication is prescribed for this and patients are sent home with pain medication. The diet of patients following this surgery consist of clear liquids the first day and more solid liquids the second day. When patients go home, their diet consists of soft, mushy types of food - those foods that are easy to swallow. Carbonated beverages are to be avoided, as well as spicy foods. For a period of time, as a patient heals from the surgery, the patient may not be able to belch or to eat as much as before--this is due to the wrapping and creation of the new valve. Patient will be able to leave the hospital as soon as they are able to eat and drink and walk in the hallways. Patients are able to shower once they are home. The length of time before patients can return to work depends on their job. Patients usually must wait five to seven days before returning to an office job, but they must wait one to two weeks before returning to a more physical job. Patients may feel bloated for a few days. Patients are able to drive a few days after returning home.
How does recovery from Nissen Fundoplication compare to that of the traditional, open procedure?
The traditional surgical approach requires a 10 to 12-inch abdominal incision. The hospital stay following this procedure is typically seven to 10 days. The recovery period for this procedure is between six and eight weeks. This procedure is also much more painful than the laparoscopic procedure.