How do I know I may have reflux disease?
The commonest symptom is heartburn. This a burning sensation starting from top of the belly and going up the chest. Often you may feel acid coming up to the throat or mouth.
Some people may bring acid, food or bile up. This typically happens after a late meal, eating spicy food, drinking wine etc. This may make people avoid food, constantly having to make lifestyle adjustments.
You may feel that you have never received a clear explanation and understanding of the problem that has a big impact on your life. You may even start wondering whether this is all in your imagination. You may have concluded that there is no cure or effective treatment.
Your friends and family who all had occasional heartburn may have dropped not so subtle hints that you are overreacting to a trivial problem.
Everybody I know gets heartburn occasionally. Why do I suffer so much?
This is because every individual gets some movement of acid and fluid from stomach up into the gullet. The difference is some people get reflux well over the normal range. This can be accurately measured using tests.
Do I have more acid than others?
Probably not, you may have too much acid in the wrong place i.e. in gullet rather than in the stomach.
Why does this happen?
Normally there is a barrier between stomach and gullet to stop acid from stomach to go up the gullet. This is defective in patients who suffer with above symptoms. This can be clearly diagnosed using a test called high resolution oesophageal manometry.
It is possible to measure extent of acid reflux using another test called pH impedance test.
What problems I may develop?
The majority of patients will just have disabling symptoms affecting social and family life, work, sleep and freedom to eat and drink. Asthma, hoarseness, dry mouth, sore throat, tooth erosion, choking at night and vomiting are also common.
Ulcers in the gullet, narrowing of the gullet and development of a slightly precancerous condition called barretts oesophagus are significant problems but are rarer.
What treatment is available?
Medical treatment with tablets or liquid remedies are effective, however symptoms return once you stop.
This is however appropriate for majority.
Symptoms improve but reflux events do go on. Patients often do not feel it as what comes up is non-acidic or only weakly acidic.
Lifestyle changes are advisable and should be tried. However, they are difficult to sustain and only modestly effective.
Key hole surgery in appropriate patients is very effective to cure reflux.
What is the name of this Antireflux surgery?
It is called Laparoscopic Nissen Fundoplication named after Rudolf Nissen who discovered this.
The operation has undergone many developments since discovery including the introduction of the key hole technique.
How do I know this will work for me?
Careful assessment before surgery is very important. This includes the surgeon listening to the patient and understanding the impact on the individual patient.
All patients needing endoscopy can can be done under sedation.
Special tests are needed to predict the success of surgery:
Integrity of the reflux barrier is assessed with high resolution manometry. Degree of acid reflux and whether this is the cause of what patient feels as symptoms pH impedance study.
How is the surgery done?
This is done by key hole (laparoscopic or minimal access) technique. This involves making 5 very small holes in the belly.
A high definition camera and TV monitor I used to visualise and remotely perform the operation.
Essentially any stomach that has gone upto the chest (hiatus hernia) is brought down and top part of the stomach is wrapped round the lower part of gullet.
What is the expected recovery?
Patients usually go home in 1 to 2 days and stop taking pain killers in 4 to 5 days. They have to eat a liquidised diet for about a week and is generally advised to avoid hard bread, steak etc for a month.
What problems can happen after surgery?
Rarely patients have difficulty in swallowing , bloating, and flatulence. Very rarely they can develop diarrhoea.
On the whole, more than 95% of patients experience a major improvement in their life.