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GASTRO-OESOPHAGEAL REFLUX DISEASE (GERD), OESOPHAGITIS

UNDERSTANDING THE PROBLEM

Gastro-esophageal reflux disease (GERD) is a condition where the lower oesophageal sphincter (the muscular ring at the lower end of the oesophagus) is abnormally relaxed and allows the stomach's acidic contents to flow back or 'reflux' into the gullet (oesophagus). People suffering from the disease will experience symptoms like heartburn and an unpleasant taste in the back of the mouth. Repeated episodes of gastro-oesophageal reflux causes inflammation of the inner lining of the oesophagus (Oesophagitis). The severity of the disease may vary from one person to another, thus, at times it can be controlled with self-help measures and medication but in some cases, surgery might be necessary to correct the problem.

UNDERSTANDING WHO SUFFERS
  • Gastro-oesophageal reflux is a common condition and the one of the most frequent causes of indigestion. In many cases, the disorder cannot be attributed to any specific cause but the following conditions can contribute to the problem.
    • Hiatus hernia (The stomach pokes through the diaphragm, preventing the muscle fibres of the diaphragm from closing the lower end of the oesophagus. The oesophagus remains wide open which allows stomach acid to get into the oesophagus)
    • Overweight (If the person is overweight the excessive fat in the abdominal cavity increases the pressure inside it. This causes the contents of the stomach to travel up into the gullet. Loss of weight reduces stomach acid reflux)
    • Pregnancy (Because the uterus increases in size during pregnancy, it presses on the stomach, creating higher pressure inside it, which increases the tendency to reflux. In addition, hormonal changes lead to relaxation of the oesophageal sphincter during pregnancy)
    • Meals (The more the stomach is stretched by food, the higher the tendency to reflux. The tendency is also increased by eating fatty meals as fat delays gastric emptying. Avoiding large rich meals, particularly in the evening reduces the tendency to reflux)
    • Foods (Chocolate, peppermint, coffee, fruit juices and alcohol prevent the oesophageal sphincter from working properly)
    • Tobacco (Tobacco prevents the oesophageal sphincter from working properly, reduces the rate at which the stomach empties and increases stomach acid production)
    • Constipation (Constipation increases the tendency to reflux by raising pressure inside the stomach cavity)
    • Lying down (The tendency to reflux increases when you are lying down. This is just due to gravity)

    Most people have heartburn at some time, perhaps after a large meal.
    However, about 1 adult in 3 has some heartburn every few days, and nearly 1 adult in 10 has heartburn at least once a day. In many cases it is mild and soon passes. However, it is quite common for symptoms to be frequent or severe enough to affect quality of life. Regular heartburn is more common in smokers, pregnant women, heavy drinkers, those who are overweight and those aged between 35 and 64 years.

POTENTIAL SIGNS AND SYMPTOMS

The main symptom of gastro-esophageal reflux oesophagitis is heartburn (a burning feeling which rises from the upper tummy (abdomen) or lower chest up towards the neck. It is confusing, as it has nothing to do with the heart!)

Other common symptoms are:

  • Pain in the upper abdomen and chest
  • Feeling sick
  • An acid taste in the mouth
  • Bloating
  • Belching
  • Indigestion (dyspepsia) and
  • A burning pain when swallowing hot drinks.
  • Like heartburn, these symptoms tend to come and go and tend to be worse after a meal.

Some uncommon symptoms are:

  • A persistent cough, particularly at night.
  • Difficulties in breathing and suffering from hoarseness (because the refluxed fluid irritates the larynx and respiratory tract)
  • Gum problems / bad breath / sore throat

The symptoms of gastro-oesophageal reflux can resemble those of a peptic ulcer, chest pains (angina pectoris), muscle pains, back problems, constipation, irritable bowel syndrome, gallstones, pancreatic disease etc. These conditions will sometimes have to be ruled out before the diagnosis can be made.

EXAMINATIONS USUALLY REQUIRED

With typical symptoms, tests are not usually necessary. Many people experiencing acid leaking up (refluxing) into the gullet (oesophagus) are diagnosed with 'presumed acid reflux'. In this situation typical symptoms are eased by treatment. Tests may be advised if symptoms are severe, or do not improve with treatment, or are not typical of GERD.

Common tests in more advanced cases include:

Gastroscopy (endoscopy): A thin, flexible telescope is passed down the oesophagus into the stomach. With inflammation of the lining of the oesophagus (oesophagitis), the lower part of the oesophagus looks red and inflamed. However, if it looks normal it does not rule out acid reflux. Some people are very sensitive to small amounts of acid and can have symptoms with little or no inflammation to see. Two terms that are often used after an endoscopy are:

  • Oesophagitis: This term is used when the oesophagus can be seen to be inflamed.
  • Endoscopy-negative reflux disease. This term is used when someone has typical symptoms of reflux but endoscopy is normal. A test to check the acidity inside the oesophagus may be done if the diagnosis is not clear.
  • Other tests such as heart tracings, chest X-ray, etc, may be done to rule out other conditions if the symptoms are not typical.
PROPOSING TREATMENT AND WHY AIMIS

Patients who do not respond well to lifestyle changes or medications or those who do not wish to continually require medications to control their symptoms may consider undergoing a surgical procedure. Surgery is very effective in treating GERD. The most commonly performed operation for GERD is called a fundoplication (usually a Nissen fundoplication, named for the surgeon who first described this procedure in the late 1950’s).

Fundoplication is the standard surgical method for treating GERD. This surgical technique will strengthen the barrier to acid reflux when the sphincter does not function normally. During the procedure, the fundus of the stomach is gathered and wrapped and sutured around the lower end of the esophagus and the lower esophageal sphincter. This procedure will reduce acid reflux by increasing the pressure at the lower of the esophagus.

The da Vinci Fundoplication surgery is a robotic-assisted surgery using cutting edge technology for a safe, effective and minimally invasive procedure for the treatment of GERD. The technology enables the doctor to perform the delicate operation with enhanced precision, superior vision and dexterity and improved access to the affected area.

AIMIS is an expert in Da Vinci Minimal invasive Nissen Fundoplication (acid reflux surgery) surgery and provides advanced techniques offering many advantages over standard laparoscopy such as:

  • Greater precision using wristed surgical instruments.
  • Minimal Scarring
  • Better margins with potential less disruption to surrounding tissue
  • Patient that are treated with a robotic fundoplication will typically leave the hospital in one to two days and able to return to their normal activities within a week.

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

Some people are born with a naturally weak sphincter (LES). For others, however, fatty and spicy foods, certain types of medication, tight clothing, smoking, drinking alcohol, vigorous exercise or changes in body position (bending over or lying down) may cause the LES to relax, causing reflux. A hiatal hernia is found in many patients who suffer from GERD. This refers to the condition in which the top part of the stomach bulges above the diaphragm and into the chest cavity. This phenomenon is thought to contribute to the development of acid reflux. Surgery for GERD also fixes the hiatal hernia.

FURTHER INFORMATION ON INCREASED RISK GROUPS

Other conditions that can increase the risk of GERD include:

  • Obesity (Extra weight causes extra pressure on the stomach and diaphragm and can result in reflux)
  • Dry mouth
  • Asthma (Researchers are still investigating exactly how asthma increases the risk for GERD. In some cases, reflux starts as a result of continuous coughing and pressure in the lungs. Also, some medications prescribed for asthma may loosen the lower oesophageal sphincter)
  • Diabetes (Some patients who have diabetes also have gastroparesis, a condition in which the stomach takes longer to empty, allowing the contents of the stomach to reflux. This also can happen in people whose stomach nerves and/or muscles do not work properly.)
  • Peptic ulcers cause reflux because food does not move from the stomach to the small intestine efficiently.
  • Connective tissue disorders, sometimes cause reflux because thicker muscular tissues keep the stomach muscles from relaxing and contracting properly
  • Zollinger-Ellison syndrome is a condition characterized by high levels of stomach acid, usually caused by a tumor in the pancreas or small intestine (called a gastrinoma). Zollinger-Ellison syndrome increases the risk for reflux.
  • Foods do not cause GERD, but in some people, certain foods can trigger reflux. Common foods that can worsen symptoms include onions, tomato sauce, mint, carbonated drinks, chocolate and other foods containing caffeine, as well as spicy foods and foods with a high fat content. Other triggers include alcohol, smoking, large meals, and lying down too soon after eating.
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

Further tests that might be required are:

  • A barium swallow radiograph (x-ray) is useful for identifying structural abnormalities and erosive esophagitis. For this test, the patient drinks a solution containing barium, and then x-rays of the digestive tract are taken. This test can show stricture, active ulcer craters, hiatal hernia, erosion, or other abnormalities. However, it cannot reveal mild irritation.
  • Upper endoscopy, also called esophagogastroduodenoscopy orpanendoscopy, is more accurate than a barium swallow radiograph. It is also more invasive and expensive. It is widely used in GERD for identifying and grading severe esophagitis, monitoring patients with Barrett's oesophagus, or when other complications of GERD are suspected. Upper endoscopy is also used as part of various surgical techniques.
  • Monitoring for Barrett's oesophagus . Barrett's oesophagus is diagnosed using endoscopy. Monitoring High-Risk GERD Patients. Some experts recommend a one-time screening test for BE using endoscopy in high-risk patients (such as Caucasian overweight men) with chronic GERD.
  • pH monitor examination. The (ambulatory) pH monitor examination may be used to determine acid backup. It is useful when endoscopy has not detected damage to the mucus lining in the esophagus, but GERD symptoms are present. pH monitoring may be used when patients have not found relief from medicine or surgery. A new method known as the Bravo pH test uses a small capsule-sized data transmitter that is temporarily attached to the wall of the esophagus during endoscopy. The capsule records pH levels and transmits these data to a pager-sized receiver the patient wears. Patients can maintain their usual diet and activity schedule during the 24 - 48-hour monitoring period. After a few days, the capsule detaches from the oesophagus, passes through the digestive tract, and is eliminated through a bowel movement.
  • Manometry. Manometry is a technique that measures muscular pressure. It uses a tube containing various openings, which is placed through the oesophagus. As the muscular action of the oesophagus puts pressure on the tube in various locations, a computer connected to the tube measures this pressure. Manometry is useful for the following situations:
    • To determine whether a GERD patient would benefit from surgery, by measuring pressure exerted by the lower oesophageal sphincter muscles.
    • To detect impaired stomach motility (an inability of the muscles to contract normally) that cannot be surgically corrected with standard procedures.
    • To determine whether impaired peristalsis or other motor abnormalities are causing chest pain in people with GERD.
WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Upper Gastrointestinal Problems including:
Fundoplication Surgery, Minimally Invasive Heller Myotomy Surgery, Subtotal Gastrectomy Esophageal Stent Placement, Esophageal Surgical Repair, Esophagectomy, Esophagus Replacement and other minimal invasive procedures involving the best American and International surgeons who are experts in the field

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for Upper Gastrointestinal problem and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Greater precision
  • Minimal Scarring
  • Better margins with potential less disruption to surrounding tissue
  • High patient satisfaction
  • Minimal pain
OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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