Gastroesophageal reflux disease (GERD) is caused by the leaking of stomach contents backwards from the stomach into the esophagus. This causes irritation to the esophagus, causing heartburn and other symptoms. GERD is extremely common among Americans, with more than 60 million people suffering from it on a monthly basis and more than 15 million people suffering daily. Approximately 40 percent of all Americans may suffer from heartburn. If symptoms persist and go untreated, gastroesophageal reflux may cause ulcers in the esophagus, narrowing of the esophagus, respiratory problems and esophageal cancer.
The two major symptoms of reflux disease are: heartburn or regurgitation (defined as acid liquid coming up into the mouth). Other symptoms include:
- Difficulty swallowing
- Asthma (40% of asthmatics have Reflux Disease)
- Recurrent cough
- Teeth erosion
BRAVO pH Monitoring
Forty-eight hour BRAVO pH monitoring determines whether there may be an abnormal amount of acid or stomach content coming back up into the esophagus. The test is performed by inserting a small pH capsule attached to a tube, called a probe, through the nose, passing it into the esophagus and attaching the capsule to the wall of the esophagus. Once the capsule is attached to the wall of the esophagus, it is dislodged from the probe and the probe is then removed. Before doing this, the nose is anesthetized to make this procedure more comfortable. The patient wears an external monitor at home that records the data from the pH capsule and they are encouraged to do their usual activities. After two days, the patient returns the receiver and the capsule.
The pH monitoring test is important because it helps us determine the effectiveness of the valve at the lower end of your esophagus in preventing the leakage of acid from your stomach back into your esophagus and/or measure the contractions of your esophagus.
The esophageal manometry is used to examine the esophagus of patients with symptoms of heartburn, regurgitation, unexplained choking, coughing, trouble swallowing, asthma and chest or stomach pain. The manometry test examines the muscle function of the esophagus (swallowing tube) and determines the effectiveness of the valve between the esophagus and the stomach. The test is performed by passing a small tube through the nose into the stomach. Before inserting the tube, the nose is anesthetized to make this procedure more comfortable. The test consists of pulling the tube back very slowly through the esophagus, performing swallows with and without water, which takes approximately 30 minutes once started.
Upper endoscopy allows physicians to check for esophageal disease such as strictures, inflammation and cancer. A lighted flexible scope is placed down the esophagus to view the lining of the esophagus and stomach. Patients are fully sedated during the procedure.
24-hour Impedance-pH Monitoring
Twenty-four hour pH monitoring determines whether there may be an abnormal amount of acid or stomach contents coming back up into the esophagus. The test is performed by inserting a small pH tube into the nose and passing it into the esophagus and/or stomach. Before doing this, the nose is anesthetized (numbed) to make this procedure more comfortable. The patient wears the pH tube home and it will be in place for approximately 24 hours. They are encouraged to do their usual activities. In 24 hours, the patient will return and have the pH tube removed.
Nissen fundoplication surgery
Most cases of GERD can be easily treated with lifestyle changes and/or medications. But for some people, Nissen fundoplication surgery may be an option when over-the-counter or prescription medications are no longer effective and lifestyle changes do not improve symptoms.
Fundoplication involves wrapping the upper part of the stomach around the lowest part of the esophagus to create a tight band designed to significantly decrease reflux. The procedure may be performed using a laparoscope, an instrument that is connected to a tiny video camera and then inserted through a small incision to look at the abdomen and pelvis. The surgeon is then able to see a magnified view of the patient’s internal organs on a television screen, and the entire operation is performed internally. Fundoplication also may be performed as a standard surgical procedure without a laparoscope.
Post-operative pain following laparoscopic fundoplication is generally mild, and patients typically leave the hospital after one to three days. Normal activities may be resumed after a short time, and anti-reflux medicine is usually not necessary following the procedure. Diet may be modified after surgery, beginning with liquids before gradually eating solid foods. The procedure is considered safe, but as with any operation complications may occur. Following fundoplication, studies have shown that the majority of patients either have no symptoms of GERD or show significant improvement.
EsophyX TIF Procedure
EsophyX TIF is a completely incisionless procedure that reconstructs the antireflux barrier to provide a solution to the anatomical root cause of GERD. The procedure is for patients who are dissatisfied with current pharmaceutical therapies or are concerned about the long-term effects of daily use of reflux medications.
The procedure is performed under general anesthesia and reconstructs the antireflux barrier to restore the competency of the gastroesophageal junction. Most patients can go home the next day and return to work within a few days.
Reoperative Antireflux Surgery
Laparoscopic redo fundoplication is a reoperative surgery for failed anti-reflux surgeries. Ten percent of patients experience a recurrence of symptoms after laparoscopic surgery for gastroesophageal reflux disease.
The Heller myotomy procedure is performed with a laparoscope aided by the da Vinci™ robotic system for patients suffering with achalasia; a condition that prevents swallowing. During the procedure, the lower esophageal sphincter is divided to eliminate symptoms.
LINX Reflux Management System
The LINX Reflux Management System is used for treating GERD when medication no longer provides adequate symptom control. The LINX System is another option to the standard surgery for GERD, such as Nissen fundoplication. The LINX System is:
- Less invasive. Placement of the LINX System does not involve significant alterations to anatomy that may limit future treatment options. With the Nissen fundoplication, the top part of the stomach is wrapped around the lower esophagus to improve the reflux barrier.
- Removable. If needed, the LINX System can be removed during a laparoscopic procedure similar to the implant procedure. Removal of the device generally leaves the esophagus the same as before the implant.
- Well-tolerated. After surgery, patients usually go home the same day or the next day. Patients are able to eat a normal diet after surgery. With Nissen fundoplication, patients are restricted to a liquid diet that is slowly advanced over weeks to normal food.
For additional information, please visit: http://toraxmedical.com/linx/.