Gastroesophageal Reflux Surge... Health Article

Definition

Gastroesophageal reflux surgery is typically performed in patients with serious gastroesophageal reflux disease that does not respond to drug therapy. Gastroesophageal reflux is classified as the symptoms produced by the inappropriate movement of stomach contents back up into the esophagus. Nissen fundoplication is the most common surgical approach in the correction of gastroesophageal reflux. The laparoscopic method of Nissen fundoplication is becoming the standard form of surgical correction.

Purpose

Gastroesophageal reflux surgery, including Nissen fundoplication and laparoscopic fundoplication, has two essential purposes: heartburn symptom relief and reduced backflow of stomach contents into the esophagus.

Heartburn symptom relief

Because Nissen fundoplication is considered surgery, it is usually considered as a treatment option only when drug treatment is only partially effective or ineffective. Nissen fundoplication is often used in patients with a particular anatomic abnormality called hiatal hernia that causes significant gastroesophageal reflux. In some cases, Nissen fundoplication is also used when the patient cannot or does not want to take reflux medication. Surgery is also more likely to be considered when it is obvious that the patient will need to take reflux drugs on a permanent basis. Reflux drugs, like virtually all drugs, may produce side effects, especially when taken over a period of years.

One of the biggest problems in diagnosing and controlling gastroesophageal reflux disease is that the severity of disease is not directly related to the presence or intensity of symptoms. There is also no consistent relationship between the severity of disease and the degree of tissue damage in the esophagus. When reflux occurs, stomach acid comes into contact with the cells lining the esophagus. This contact can produce a feeling of burning in the esophagus and is commonly called heartburn. Some of the other symptoms associated with this condition include:

• chest pain
• swallowing problems
• changes in vocal qualities

Reduced reflux

The reduction or elimination of reflux is as important, and sometimes more important, than the elimination of symptoms. This necessity leads to one of the most important points in gastroesophageal reflux disease. Long-term exposure to acid in the esophagus tends to produce changes in the cells of the esophagus. These changes are usually harmful and can result in very serious conditions, such as Barrett's esophagus and cancer of the esophagus. Because of this, all persons with gastroesophageal reflux disease symptoms need to be evaluated with a diagnostic instrument called an endoscope. An endoscope is a long, flexible tube with a camera on the end that is inserted down the throat and passed all the way down to the esophageal/stomach region.

All gastroesophageal reflux surgery, including Nissen fundoplication, attempts to restore the normal function of the lower esophageal sphincter (LES). Malfunction of the LES is the most common cause of gastroesophageal reflux disease. Typically, the LES opens during swallowing but closes quickly thereafter to prevent the reflux of acid back into the esophagus. Some patients have sufficient strength in the sphincter to prevent reflux, but the sphincter opens and closes at the wrong times. However, this is not the case in most individuals with gastroesophageal reflux disease. These individuals usually have insufficient sphincter strength. In a small number of cases, the muscles of the upper esophagus region are too weak and are not appropriately coordinated with the process of swallowing.

The development of heartburn does not necessarily suggest the presence of gastroesophageal reflux disease, which is a more serious condition. Gastroesophageal reflux disease is often defined as the occurrence of heartburn more than twice per week on a long-term basis. Gastroesophageal reflux disease can lead to more serious health consequences if left untreated. The primary symptoms of gastroesophageal reflux disease are chronic heartburn and acid regurgitation, or reflux. It is important to note that not all patients with gastroesophageal reflux disease have heartburn. Gastroesophageal reflux disease is most common in adults, but it can also occur in children.

The precise mechanism that causes gastroesophageal reflux disease is not entirely known. It is known that the presence of a hiatal hernia increases the likelihood that gastroesophageal reflux disease will develop. Other factors that are known to contribute to gastroesophageal reflux disease include:

• smoking
• alcohol ingestion
• obesity
• pregnancy

The following foods and drinks are known to increase the production of stomach acid and the resulting reflux into the esophagus:

• caffeinated drinks
• high-fat foods
• garlic
• onions
• citrus fruits
• chocolate
• fried foods
• foods that contain tomatoes
• foods that contain mint
• spicy foods

Most patients take over-the-counter antacids initially to relieve the symptoms of acid reflux. If antacids do not help, the physician may prescribe drugs called H₂ blockers, which can help those with mild-to-moderate disease. If these drugs are not effective, more powerful acid-inhibiting drugs called proton-pump inhibitors may be prescribed. If these drugs are not effective in controlling gastroesophageal reflux disease, then the patient may require surgery.