GERD or Acid reflux disease is a chronic condition of mucosal damage of stomach and esophagus (food pipe) due to exposure of acidic contents from stomach to esophagus. Normally after ingestion of food, stomach secretes hydrochloric acid for digestion of food contents. The acid produced inside stomach are prevented from going up to esophagus by some anatomical factors which acts like valves/ sphincters during the process.
Factors responsible for abnormality of these anatomical barriers (like wide hiatus, lax crural muscle, abnormal angle of His e.t.c) result in reflux of acidic contents into (food pipe) and causes mucosal damage. Chronic mucosal damage may alter the epithelial lining of lower esophagus which is called as Barrets Esophagus. Barrets is a precursor for Cancerous involvement of esophagus.
Clinical features of Gastroesophagial reflux are characteristics and comprises of upper central abdominal pain, chest pain/ discomfort, nausea, vomiting, feeling of heaviness after every meal, reflux of acidic contents to throat especially at night, breathlessness during reflux. Sometimes in advanced stage patient may see a clinician with complaints of chronic cough not getting better inspite of medications, throat pain, change in voice, recurrent dental/ gum infections, recurrent burping.
PELVINIC’S WAY OF MANAGING PATIENTS WITH GERD
Once a patient suffering with these problems establish it to be reflux problem, he/ she needs to be seen either by Gasteroenterologist or GI surgeon for proper treatment. Dr Sandip Banerjee, a reputed GI surgeon after diagnosing them based on clinical features ask his patients to undergo Upper GI Endoscopy to confirm and in some cases Esophageal manometry and 24 Hr pH monitoring.
These class of patients after confirmation of diagnosis are managed on basis of their stage of disease. For early developed GERD patients, medical management consisting of antireflux and anti H-Pylori medications are given and are being followed up over a period. During follow up, patients with no satisfactory improvement or those patients who have turned dependent on medications are advised for surgery. For patients with advanced disease or with formation of Barrets esophagus, surgery is advised straightaway.
The type of surgery required for reflux cure are
- Laparoscopic Nissen’s Fundoplication
- Laparoscopic Toupets Fundoplication
- Laparoscopic Anterior/ Posterior Fundoplication.
The decision of doing any specific procedure lies in expertise of Dr Banerjee and with the correct approach, he has successfully treated many patients suffering with this problem. Post procedure patients are asked to take only liquid diets for 2 weeks. With some lifestyle modifications advised after surgery, patients can regain their healthy life from the horrors of their past experiences.