Gastro-esophageal reflux disease is a common condition affecting millions of people worldwide. In healthy individuals there is a very effective one-way valve mechanism between the gullet and the stomach which prevents gastric acid from entering the gullet. Due to variety of factors the valve mechanism can fail which will lead to the lining of the gullet being exposed to acid and the patient experiencing the symptom of heartburn.
The risk factors for developing GERD are:
If left untreated GERD can lead to the following complications:
The diagnosis of GERD can de made based on the history and if necessary performing a esophagogastroscopy or 24 hr pH (acid) monitoring test. Not all patients will need a gastroscopy, definite indications for a gastroscopy are:
The mainstay of GERD treatment is medical therapy with a PPI (protonpump inhibitor: a type of drug highly effective in suppressing the secretion of gastric acid). The majority of patients will experience complete relief of their heartburn after initiating PPI therapy. Surgical therapy is usually indicated in the following scenarios:
Anti-reflux surgery (if done for the correct indications) can produce excellent long- term relief of heartburn without the hassle and expense of taking daily medication. There are a variety of surgical procedures available to treat GERD of which the "Nissen fundoplication" is the most widely used. All of the currently available procedures are based on the same principle though: restoration of the normal barrier to gastric acid reflux while exposing the patient to the minimum risk of morbidity and mortality. Except in the presence of a clear contra-indication, all anti-reflux procedures should be done in a minimally invasive / laparoscopic manner.
Risks or complications following anti-reflux surgery include: