Acid reflux, or gastro-oesophageal reflux disease is a very common condition. It occurs when the stomach contents back up into the oesophagus or gullet.
What are the symptoms of gastro-oesophageal reflux disease?
The most common symptom of acid reflux is heartburn – a burning pain behind the breastbone. It is also sometimes referred to as indigestion, usually after a meal. Other symptoms include:
- Regurgitation of acidic tasting fluid into the mouth (“waterbrash”), especially on bending or lying down
- Hoarseness or persistent voice changes and cough
- Feeling of a lump in the throat
- Difficulty with swallowing – seek urgent medical attention if this is a new symptom
What causes gastro-oesophageal reflux disease?
There is a valve at the lower end of the gullet (lower oesophageal sphincter) which relaxes when we swallow to allow food and drink to enter into the stomach. The same valve also closes when the pressure inside the stomach increases, to prevent the backing up of stomach contents into the gullet. Acid reflux occurs when this valve malfunctions, or is weak, allowing stomach contents to back up into the oesophagus and cause irritation.
A hiatus hernia occurs when part of the stomach is pushed up into the chest cavity through the diaphragm. While acid reflux is not directly caused by this, the presence of a hiatus hernia does predispose an individual to gastro-oesophageal reflux.
How is gastro-oesophageal reflux managed?
A combination of lifestyle changes and over the counter antacid medications can help manage acid reflux as a first step
Lifestyle tips to help control acid reflux:
- Avoid smoking – smoking relaxes the lower oesophageal valve or sphincter
- Lose excess weight – being overweight increases the pressure on the stomach
- Keep meal portion sizes small – large meal portions increase the pressure on the stomach
- Avoid eating meals for 2-3 hours before bedtime
- Avoid alcohol – alcohol weakens the lower oesophageal sphincter
- Avoid fried and fatty food
- Avoid coffee
- Elevate the head of the bed by about 6 inches to minimise acid reflux when lying down
- Take over the counter antacid medication as directed
If symptoms persist, despite the above measures, you should seek medical advice.
How is gastro-oesophageal reflux disease diagnosed?
Many people will experience occasional heartburn, especially after meals. However, if heartburn occurs more than three times a week, it will be regarded as chronic acid reflux and will need further investigation:
Gastroscopy or Upper GI endoscopy – This involves passing a thin, flexible tube, with a camera and light source on the end, through the mouth into the oesophagus and stomach. It is then possible to examine these areas for signs of chronic acid reflux, such as inflammation and ulcers from acid burns, as well as complications associated with the condition, such as Barrett’s oesophagus and strictures. Sometimes a tissue sample (or biopsy) may be taken for analysis, or a treatment such as oesophageal dilatation may be carried out at the same time.
Barium swallow and meal – Very occasionally this X-ray investigation may be required to assess a stricture (narrowing) of the oesophagus. Its role is to provide a road map before embarking on gastroscopy and oesophageal dilatation.
Oesophageal manometry – This test is used to assess the pressure measurements of the oesophagus and help identify critically low sphincter pressure. It also helps to identify other functional disorders affecting the oesophageal muscle.
24 hour pH study – This measures reflux of stomach acid during normal everyday activities, such as eating and lying down, in order to objectively assess the degree of acid reflux. A fine tube, connected to a recording device, is passed through the nose into the oesophagus and left for 24 hours to record the degree of acid reflux.
Oesophageal impedance studies – This measures the rate of fluid movements at various points along the oesophagus to assess the degree of acid and non-acid reflux. It is often combined with pH monitoring (see above). You will be supplied with a data collection device to record symptomatic reflux episodes throughout the test period. These symptoms are then correlated with the results of the study.
Surgery for Gastro-Oesophageal Reflux Disease (GORD)
Most patients suffering from chronic acid reflux can manage their symptoms well by adjusting their lifestyles and taking acid-suppressing medications. However, some may be candidates for anti-reflux surgery, including those who:
- Constantly regurgitate stomach contents into the back of the throat and mouth, especially on bending and after a meal (volume refluxers)
- Cannot tolerate acid suppressing medications, or do not wish to take these medications long term
- Some patients with chest and airway complications of acid reflux – e.g. voice changes (after excluding other possible causes), worsening of asthma
- When medications fail to adequately control symptoms
What does anti-reflux surgery involve?
The surgery involves wrapping the upper part of the stomach (fundus) around the lower oesophagus to strengthen the lower oesophageal valve. This stops stomach contents and acid backing up into the oesophagus. Any hiatus hernias present are reduced and the hiatus hernia defect closed to ensure there is no recurrence.
The most common operation performed to control chronic acid reflux is called Nissen fundoplication. This is now performed via keyhole surgery which means smaller incisions, less pain, a reduced risk of complications and a quicker resumption of normal activities.
In the majority of patients the surgery is performed under general anaesthesia, as a day case. However, it may be necessary for some patients to stay in hospital overnight for further monitoring.
The operation takes approximately 45 -60 minutes. After the surgery you will be taken to the recovery room for close monitoring until most of the anaesthetic drugs have worn off and then returned to your room.
How effective is anti-reflux surgery?
Laparoscopic anti-reflux surgery (Nissen fundoplication) is effective in controlling chronic acid reflux in over 90% of patients. However, there is a chance that some patients may need antacids further down the line because of a recurrence of their symptoms.
Will I see my surgeon after my operation?
Mr Agwunobi and his team will visit you on the ward before you are discharged from the hospital. You will be given pain killers to take home and details of necessary dietary adjustments during your recovery period.
A follow-up appointment will be arranged for you to see Mr Agwunobi in 4 – 6 weeks’ time to check on your recovery. You will also be given a contact number to call should you have any concerns following your surgery.
What are the potential risks of the operation?
Surgical complications during this operation are very rare, but include general risks of bleeding, wound infection, blood clots and damage to other organs. Mr Agwunobi will discuss these further with you during your consultation.
What are the side-effects of anti-reflux surgery?
Early during the recovery period, you may notice the following:
- Bloating, due to gas or eating too much too quickly– try to eat small but frequent meals, avoid fizzy drinks and eat slowly
- Mild difficulty with swallowing – this is due to swelling caused by the operation and the creation of the new valve. This sensation is usually short lived and settles within 3 months. Try to stick to a soft diet and avoid dry food substances (see dietary advice).
- Excessive flatulence – but again this improves with time.
How long does it take to recover from anti-reflux surgery?
Your physical recovery should take around 7-10 days. We advise a similar timescale before you start driving again, but please check with your insurance company.
Dietary adjustments will need to be made for about 4-5 weeks before you can resume a regular diet.
Do I need to go on special diet after the operation?
You should make dietary adjustments during the first 4-6weeks following anti-reflux surgery. You will be seen by one of our Specialist Dieticians to discuss this.
Please see our dietary advice for more details.
Please ensure you consult a healthcare professional before making decisions about your health.