What is it?
Reflux disease is a common problem in our society. This can be mild with occasional heartburn after meals or more of a problem with daily symptoms of food coming into the oesophagus with meals, at night or at any time. This type of reflux may respond to medications such as PPI's eg Somac, Nexus and Losec. Some patients are not completely controlled by these drugs and may be a candidate for an operation to fix the reflux.
What causes Reflux?
Reflux is related to a number of factors. It is normal to reflux at times during and after meals. A belch or burp is a normal reflux episode to prevent bloating. Other reflux episodes can be painful resulting in heartburn and even regurgitation of food and liquids. This can even result in upper airway problems such as asthma and hoarse
voice. Reflux is caused by a combination of factors. There is a valve in the lower oesophagus which keeps stomach content in the stomach. This is called the lower oesophageal sphincter or LES. Constant acid damage to the lining of the oesophagus around this valve weakens it and causes it to shorten. Another reason some people reflux is a hiatus hernia which is stretching of the diaphragm around the oesophagus. The diaphragm is an important muscle that holds the oesophagus tight and aids in preventing reflux. The end result of chronic reflux is Barretts oesophagus. This is where the lower lining of the oesophagus changes from one cell to another. It may result in malignant change which is cancer of the oesophagus.
Just a little update of laryngopharyngeal reflux - increasingly people are dealing with this disorder on a regular basis. We have a strong interest in dealing with patients with laryngopharyngeal reflux, in particular performing fundoplication for these patients. Often this is a very difficult diagnosis to make and most times the routine investigation performed such as gastroscopy is absolutely normal. In order to really diagnose the condition, we need to use high resolution manometry and pH studies including impedance studies. Unfortunately these are not readily available in Melbourne. In our practice, we have access to these facilities and are happy to assess patients for impedance studies and high resolution manometry. In general, these can be very difficult patients to deal with and we are happy to give an opinion. I look forward to working with you all in the future.
What is anti-reflux surgery?
This is an operation that is done through keyhole surgery and attempts to fix all of the problems I have discussed. The principles are reconstruction of the LES or fundoplication and repair of any hiatus hernia. It takes a lot of training and a large number of cases to become proficient at this operation. In my practice, I have performed in excess of 100 anti reflux operations and many more in my training. I perform a Nissen Fundoplication or a partial toupet fundoplication depending on the individual.
If you experience reflux more than weekly or require medication you should have a screening endoscopy to expired Barretts change which needs to be watched very carefully. If your reflux is not being controlled by medication or weight loss then you may be a candidate for surgery. If you suffer Barretts oesophagus, there may be role for surgery to prevent progression to cancer. For more information see the oesophageal cancer section and Barretts oesophagus section. Prior to surgery, you will need an endoscopy and a test to measure the function of the oesophagus called manometer and a test to measure your reflux called 24 hour ph testing.