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Gastric reflux, or heartburn, is a condition that affects many people although mostly in the form of an occasional heartburn episode—controllable with an antacid—which is the extent of the suffering.
Others, however, may suffer from G.E.R.D. (Gastro-Esophageal Reflux Disorder) on a more frequent basis, sometimes even daily. Heartburn attacks experienced on a daily basis can provoke more serious conditions such as ulcers and an eventual narrowing of the esophagus.
Most of the time, people who suffer from heartburns can make lifestyle changes that will dramatically improve their condition. For instance, making sure not to lie down after eating, avoiding tight clothing, quitting smoking, losing weight and eliminating fatty and acidic foods from the diet will usually solve the problem of heartburn altogether. By taking specially prescribed medications in combination with these precautions, heartburn can become a rare, or nonexistent occurrence.
Yet for some people, despite medication and lifestyle changes, heartburn persists in the form of chronic acid reflux. In severe cases, the lower esophageal sphincter (LES) may actually be weakened; allowing the acids from the stomach to flow upwards into the lower esophagus. If the condition is due to a weakened LES, no amount of medication or lifestyle change will help the problem. In these extreme conditions, surgery might be the final option.
Surgery will usually focus upon strengthening the LES in order to permanently prevent the upward flow of acids into the esophagus. Due to the advances in modern technology, namely the use of video (or a laparoscope), large incisions are no longer necessary. This significantly alters the amount of scarring and pain that often accompanied the operation.
In the past, it was common for patients to spend up to six weeks recovering from this operation. Nowadays, with the use of the technique known as "Laparoscopic Nissen Fundoplication", very small incisions are necessary and the recovery time is much faster. Often patients will spend only a day or two in the hospital and can recover their normal working activity within a week.
- Redness around or significant drainage from incisions
- Persistent fever over 101 degrees Fahrenheit or chills
- Persistent and/or productive cough
- Persistent nausea or vomiting
- Prolonged soreness or no relief from prescribed pain medication
- Difficulty swallowing that persists longer than a few weeks
- Any problems that may be related to your surgery or problems you are not sure of
- Hiatal hernia- hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest.
- Alcohol use
- Also, certain food and drinks are associated with reflux
- Medical history
- Response to Omeprazole
A recent study 12 demonstrated a potential role for a proton pump inhibitor, omeprazole, in the diagnosis of GORD.
- Barium swallow radiograph
Uses x rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus
- Lifestyle Changes -
You may be instructed to:
change your diet to reduce or ease symptoms. Certain foods can relax the LES or increase acid in your stomach.
Avoid the following:
- Beverages with and without caffeine (carbonated drinks, coffee, tea)
- Citrus foods
- Fatty and fried foods
- Spicy foods
- To relieve the symptoms of GERD:
- Eat several small-volume meals daily instead of three large meals
- After eating: avoid bending over, lying down or sleeping until 2-4 hours have passed
- Stop smoking and drinking alcohol (Both increase stomach acid and irritation) (Alcohol opens the LES)
- Maintain your recommended weight
- Lose weight if necessary
- Exercise after speaking with your physician regarding an exercise program
- Wear loose fitting clothing, belts
- Raise the head of your bed 6-8 inches with books or blocks or put a wedge under the head of your mattress or sleep over several pillows
- Medical Treatment
- Drug Therapy –
If your symptoms persist after lifestyle changes, drug therapy may be discussed with your physician. The use of antacids help to neutralize stomach acids and over-the counter- antacids decrease stomach acids that are produced. These may relieve the symptoms; however, in some people, they may cause constipation or diarrhea side effects. Your physician may recommend H-2 blockers (ranitidine, cimetidine, famotidine, nizatidine). H-2 blockers can cause confusion in elderly people. Cimetidine and ranitidine may increase the effects of alcoholic beverages. Cimeditine should be taken at least one hour apart from antacids or antacids will decrease the drug's effectiveness. If you are a male and need to take H-2 blockers on a long term basis, talk with your physician about the rare possibility that your sperm count may be affected. Check with your physician about avoiding taking aspirin or anti-inflammatory drugs. These drugs can affect the protective lining of your stomach.
In addition to the H-2 blockers, your physician may wish to prescribe more powerful medications called proton pump inhibitors. Some of these generic prescription drugs are metoclopramide, cisapride, and bethanechol chloride. Metoclopramide acts to empty the stomach faster. Some side effects may occur from these drugs. Metoclopramide can cause fatigue or other more serious effects. Cisapride can cause abdominal cramps, diarrhea, constipation or the jitters. If bethanechol is taken too soon after eating, nausea and vomiting may occur.
Your physician may prescribe drugs that stop the production of stomach acid. Examples include omeprazole and lansoprazole. These drugs are usually prescribed for short-term use. Side effects of omeprazole are abdominal or stomach pain. Lansoprazole can cause diarrhea and stomach pain or nausea.
- Esophageal Dilation -
If you have a narrowing in your esophagus or start to have trouble swallowing, your physician may recommend you have one or several dilatation procedures to enlarge your esophagus. Usually this procedure is performed after you have intravenous medication to keep you free of pain and comfortable. Flexible rubber tubes (bougies) of increasingly larger sizes are placed into your esophagus to make it wider.
If you do not respond well to life style changes or drug therapy, require dilation procedures or need medication continually to control symptoms, or have to live with your condition, you may be asked to consider undergoing a surgical procedure. In the past, a large abdominal incision was made and resulted in significant pain after surgery. The hospital stay was 7-10 days and recovery at home was six weeks or more. With recent advances, the technique has been modified using a laparoscopic (advanced minimally invasive) approach that avoids the need for a large abdominal incision. Pain is significantly less. The length of in-hospital stay averages 2 days and return to work can occur within 2 weeks. Your physician may recommend laparoscopic anti-reflux surgery, also known as, laparoscopic nissen fundoplication.
- Engage in light activity at home.
- Experience mild post operative pain and having pain medication available as needed.
- Feeling some tightness from swelling of the esophagus and some difficulty swallowing may happen.
- This should gradually go away within 2 months.
- Not having to take anti-reflux medications after surgery.
- Having a modified diet starting with liquids followed by gradually taking solid foods. Eat small meals frequently and chew food well. Ask your physician about dietary restrictions after surgery. You may be asked to eat foods such as soup, gelatin, bananas, pudding, or yogurt because they are easy to swallow and digest. Don't gulp to avoid gas bloat and make it easier for swallowing. You may be asked to avoid carbonated drinks for 3-4 weeks.
- Resume normal activities such as showering, stair climbing, working, lifting, driving and having sexual intercourse after discussing these with your physician.
- Call and schedule a follow-up appointment within one to two weeks after surgery. Schedule any additional follow-up appointments.
- Have any stitches removed depending upon the type your physician uses.
- Increase in frequency of passing gas.
Though the surgery is considered safe, complications may occur as for any surgery. Complications that may occur during surgery include:
- Injury to organs such as liver, stomach, esophagus or spleen
- Adverse response to general anesthesia
- Even though infrequent, complications that may occur after surgery include:
- Infection involving the wound, blood or abdomen
- Increased bloating or gas
- An inability to vomit
- Difficulty in swallowing
- Failure of surgery to eliminate GERD
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