Reflux

Causes of Reflux

There are many factors that lead to the development of GERD:

• Weak LES Function: Malfunction of the lower esophageal sphincter (LES).
• Hiatal Hernia: When the stomach pushes up through the diaphragm, it can affect the lower esophageal sphincter (LES).
• Obesity: Increased pressure in the abdominal area can cause stomach acid to flow back into the esophagus.
• Eating Habits: Large meals, spicy foods, fatty dishes, and caffeine consumption.
• Lifestyle Factors: Smoking, alcohol use, and lying down immediately after eating.

Symptoms of Reflux

• Heartburn: A burning sensation in the chest, especially after meals.
• Acid Regurgitation: Sour or bitter stomach contents rising into the mouth.
• Difficulty Swallowing: Feeling as if food is stuck in the esophagus.
• Chronic Cough: Caused by irritation of the throat due to reflux.
• Hoarseness and Sore Throat: Reflux can affect the vocal cords and cause discomfort.

Long-term GERD can lead to inflammation of the esophagus (esophagitis), ulcers, or conditions like Barrett’s esophagus that increase the risk of cancer.

Diagnosis of Reflux

• Medical History and Symptoms: Evaluation of signs like heartburn and swallowing difficulty.
• Endoscopy: A camera is used to inspect the esophagus for signs of irritation or damage.
• 24-hour pH Monitoring: Measures acid levels continuously over a 24-hour period.
• Barium Swallow Test: Imaging test to visualize the esophagus and stomach.

Treatment Options for Reflux

1. Lifestyle Modifications

• Eat smaller meals.
• Avoid trigger foods.
• Maintain a healthy weight to reduce abdominal pressure.
• Elevate the head while sleeping to prevent acid reflux at night.

2. Medications

• Antacids: Neutralize stomach acid.
• H2 Blockers: Reduce acid production.
• Proton Pump Inhibitors (PPIs): Significantly reduce stomach acid.

3. Surgical Treatments

If GERD symptoms cannot be controlled through lifestyle changes or medication, surgical options may be considered. The most common procedures include:

1. Laparoscopic Nissen Fundoplication (LNF)

• Procedure: The top of the stomach (fundus) is wrapped around the lower esophagus to strengthen the LES.
• Advantages: High success rate (~90%), minimally invasive, and may eliminate the need for long-term medications.
• Recovery: For 1–2 weeks, a soft diet is recommended initially.
• Ideal For: Patients with mild to moderate GERD.

2. Roux-en-Y Gastric Bypass (For Obesity + GERD)

• Procedure: Preferred for obese patients (BMI >35) with reflux; helps reduce weight and GERD symptoms.
• Advantages: Addresses both obesity and GERD together.

3. Hiatal Hernia Repair

• Typically performed with fundoplication if a hernia contributing to reflux is present.

Who Is a Candidate?

• Chronic GERD not controlled by medication
• Complications (esophagitis, Barrett’s esophagus)
• Patients who do not want lifelong medication use

Risks and Considerations

• Temporary difficulty swallowing (common after fundoplication)
• Bloating and gas (gas-bloat syndrome)
• Rare complications: infection, issues with LINX device
• Consult a general surgeon to determine if surgical options are appropriate for you.

Reflux Prevention

• Limit smoking and alcohol consumption.
• Eat a balanced diet and avoid overeating.
• Practice stress management, as it can significantly impact the digestive system.