Reflux disease affects around 40% of adults. Symptoms can range from mild (an occasional ache that can be annoying) through to debilitating (daily bothersome problems despite medicine causing many problems). It is a frequent reason for people seeing a doctor with 2% of GP consults related to GORD and usually these patients need to come back multiple times.
GORD can lead to some serious health problems. Refluxant onto the lower gullet causes irritation and erosions that can bleed (causing anaemia), scar down (preventing swallow) and even perforate (becoming a surgical emergency). Over many years, this irritation can cause changes in the cell type,
becoming something called Barretts Oesophagus… sometimes leading on to oesophageal cancer. Reflux into the throat can also cause problems with the teeth, vocal cords and airways. Many people suffer severe lung infections through reflux and the occasional unlucky few can even scar down the airway.
Many of these patients become dependent on an acid lowering medication called Proton Pump Inhibitors. When this is used for many years it can become costly and has recently been shown to have some concerning problems. These include kidney dysfunction, brittle bones, imbalance in the gut microbiome and possibly an increase in a type of stomach cancer.
For these reasons, surgery can be considered for many patients who suffer from reflux disease!
NOTE: HIATUS HERNIA OFTEN MAKES REFLUX WORSE BUT IT IS NOT THE SAME THING.
- See our discussion on the management of hiatus hernia
Indications for Surgery:
The modern surgical approach to reflux disease is usually with a procedure called a fundoplication. In most cases it is using keyhole and needs 2 to 3 nights in hospital. Modified diet is recommended for around six weeks with step up every 2 weeks from fluids to pureed food and finally a soft diet. Pain is usually not a big problem and most people return to their usual duties after two weeks.
The steps of the procedure:
- General anaesthetic causes the patient to not be aware,
- Keyhole entry with 5 small cuts,
- Separate the upper stomach and lower gullet from the diaphragm and tighten the hole in diaphragm through which the gullet passes,
- Wrap a piece of stomach from one side to the other, creating a pinch valve to minimise reflux, and
- Sometimes a gastroscope is passed down to check repair and see that everything can get through ok.