procedures performed
- GERD
Gastro Esophageal Reflux Disease, commonly known as GERD, is the symptomatic reflux of gastric contents into the esophagus. It occurs most commonly as a result of a transient lower esophageal sphincter relaxation. Risk factors associated with this disease include the consumption of caffeine, chocolates and fatty foods as well as smoking, obesity and pregnancy. The presence of a Hiatal Hernia defect is another significant cause for Gastro-Esophageal Reflux Disease.
The patient usually complains of heartburn, burning sensation (pirosis) which usually starts 30-90 min after a meal, worsens with reclining, and gets better with antacids, standing or sitting. Patients may also complain of sour taste, sore throat, chronic cough and even wheezing (asthma like symptoms).
The diagnosis of GERD is usually done with a good medical history and clinical impression. Other diagnostic modalities may include esophageal manometry, 24 hour PH monitoring and a barium swallow. Endoscopy should be performed in patients who are unresponsive to initial empirical therapy, those who have chronic GERD and those with symptoms suggestive of complicated disease (anorexia, weight loss or difficulty swallowing), to exclude the presence of the Helicobacter Pylori bacteria by biopsy and to rule out a Barrett’s esophagus.
Treatment usually starts off with lifestyle modifications, which can include weight loss, reduction of meal size, avoiding late meals, changes in diet, etc. Pharmacologic treatment will include certain medications that reduce the gastric output of the stomach; most commonly proton pump inhibitors (Omeprazol) and also the H2 blockers (Ranitidine).
For refractory or severe disease and the presence of changes in the mucosa of the gastro-esophageal area as a result of the constant presence of the acid reflux (Barrett’s esophagus), a surgical procedure called Nissen Fundoplication may offer not only significant relief of the symptoms produced by GERD but also revert the changes seen in Barrett’s.
Complications due to the GERD’s disease may include chemical esophagitis, esophageal stricture, aspiration of gastric contents, upper gastrointestinal bleeding and changes in the mucosal lining of the gastro-esophageal area called Barrett’s esophagus (as a result of the constant presence of the acid reflux this may predispose to Esophageal Adenocarcinoma).