Abdominal pain with meals, sour taste in your throat, and difficulty swallowing-all are symptoms of gastroesophageal reflux disease (GERD). This is more commonly known as heartburn. This condition is caused by acid escaping from your stomach and washing up into your esophagus. The esophagus carries food from your mouth to your stomach and has no protection against the acid. The one way valve separating the stomach and the esophagus is weakened with GERD. Esophageal inflammation will occur causing the symptoms described above. Smoking, caffeine, and alcohol will also contribute to your symptoms.
Your initial diagnosis is usually made by history and physical exam. Upper GI x-ray may be used to view the digestive process and can also show if you have a hiatal hernia (enlarged opening in the diaphragm). Upper endoscopy (EGD) is used to completely visualize the upper digestive tract. Biopsies can be taken, and if necessary, a balloon can be used to open up any narrowing. Esophageal pH monitoring and manometry are performed to determine the exact quantity of acid and the muscle contractions of the esophagus.
Treatment consists of lifestyle changes, medications, and surgery. Weight loss, small meals, smoking cessation, and decreasing your caffeine & alcohol intake will help. Medications will help by either decreasing the amount of acid normally produced or by helping to push the stomach contents downstream instead of washing back up into the esophagus.
When lifestyle changes and medicine fail to relieve symptoms, surgery becomes the best option for treatment. Surgery is also the best option of treatment when complications of reflux occur; such as bleeding, stricture (narrowing from scar tissue), and aspiration (acid dripping into your lungs).
The procedure most often done today for symptomatic reflux is a Laparoscopic Nissen Fundoplication. While under anesthesia, your surgeon will make five small incisions (1⁄2 inch) through which a camera and the instruments will be placed. The abnormal valve between the esophagus and stomach will be re-created by wrapping the top of your stomach around the esophagus. Your stay in the hospital will be 1-3 days and you can return to normal activities in 2-3 weeks. This is far superior to an Open Nissen fundoplication where the hospital stay and recovery is much longer.
Most patients recover completely. Risks of Laparoscopic Nissen fundoplication are rare but include bleeding, infection, damage to internal organs, conversion to open surgery, and dysphagia (difficulty swallowing). Be sure and let us know if you are taking aspirin or blood thinner such as Coumadin.