Gastro-esophageal reflux disease is different from simple post-prandial reflux (the occasional backwash of stomach content in the esophagus), as it is an inflammation of the esophageal mucosa caused by constant daytime and /or nighttime gastro-esophageal reflux.
What are the causes of GERD (Gastro-Esophageal Reflux Disease)?
GERD is caused by a failure of the lower esophageal sphincter (LES), the band of muscle separating the esophagus from the stomach. Normally the lower esophageal sphincter relaxes to allow food and liquid to flow down into the stomach and then it closes. However, it can weaken and malfunction, allowing acid from the stomach to backup into the esophagus.
Though this condition can occur for no apparent reason, it is often caused by a hiatal hernia, which is the protrusion of part of the stomach into the thoracic cavity through the esophageal hiatus. The partial or total failure of the lower esophageal sphincter and other anti reflux barriers is the main anatomical condition leading to Gastro-esophageal reflux disease.
Signs and symptoms of Gastro-Esophageal Reflux Disease and Hiatal hernia:
The most common symptoms of Gastro-esophageal reflux disease are heartburns, postprandial retrosternal pains and night pains, accompanied by a burning feeling rising from the stomach.
Possible initial symptoms of GERD may be faringitis, recurrent and asthmatic bronchitis, inflammations in the oral cavity accompanied by dental caries, chest pains. Patients who experience the above mentioned symptoms should immediately seek medical attention by an otolaryngologist or a pneumologist or a cardiologist.
How to diagnose Gastro-Esophageal Reflux Disease and Hiatal hernia
It is possible to diagnose Gastro-esophageal reflux disease by checking its typical symptoms and by running the following tests and screenings: x-ray examination, endoscopic examination, 24-hour PH metry and esophageal manometry.
Possible complications of Gastro-Esophageal Reflux Disease: Esophagitis and Barrett’s Esophagus
Gastro-esophageal reflux disease causes inflammations and ulcers and, if left untreated, it may develop serious complications such as severe internal bleeding, Barrett’s Esophagus and severe stricture of the esophagus.
Treatment for Gastro-Esophageal Reflux Disease
Initial treatment for GERD usually includes the prescription of medications that control acid and a low-fat diet, free of alcohol, coffee, tea and tobacco. When GERD is accompanied by hiatal hernia the symptoms are more severe and the patients may experience frequent relapses. In such cases laparoscopic surgery is recommended.
Laparoscopic surgery to treat Gastro-Esophageal Reflux Disease and Hiatal Hernia
Laparoscopic surgery for Gastro-esophageal reflux disease involves reducing the hiatal hernia by applying a biological prosthesis and strengthening the lower esophageal sphincter by wrapping the upper part of the stomach around it. The surgeon procedure is commonly performed laparoscopically, with 4 to 5 incisions made by the surgeon, and lasts about 60-70′. The hospital stay for the patient ranges from 24h to 48h and the recovery is faster compared to open surgery. This type of procedure has shown excellent immediate and long-term outcomes.
Post surgery recommendations
Patients who have undergone laparoscopic surgery for Gastro-esophageal reflux disease and hiatal hernia should adopt the following recommendations:
- quit smoking for good;
- chew your food carefully and slowly;
- cut back on alcohol, coffee, tea and soda.