Thinking about surgery?
The frequency of heartburn is the main factor that should be considered in determining the best treatment. Heartburn may be infrequent, frequent or persistent. Infrequent bouts usually sass to lifestyle modifications and traditional Otc medications. Frequent heartburn is mostly relieved with proton pump inhibitors. On the other hand when heartburn is persistent the situation is quite separate as it is considered a warning sign of acid reflux disease. In view of the fact that the natural history of esophageal damage caused by acid reflux can involve rare and serious consequences, other treatment options should be seriously considered. Actually, surgical operation is being reserved for those who can institute serious complications.
But how can we elect those who are more susceptible to complications?
1- By documenting the presence of illustrated changes in the appearance of the surface lining the esophagus.
2- By documenting that the cause of these changes is mostly attributable to acid reflux.
3- By documenting the connection of esophageal motility functional disorder.
These would be translated into Endoscopy, 24-hour esophageal acid monitoring and esophageal manometry respectively.
The aim of these procedures is to predict the possible for complications and to confirm the cause- ensue connection in the heartburn sufferer. These together with failure of medications to ease symptoms (as revealed by the need for continuous drug treatment or of increasing doses of medication) would be an indication for surgery. Other factors associated to failure of curative treatment include: non compliance with drug therapy, the financial burden of medications and the preference for surgical operation especially in young patients.
The purpose of surgical operation is to ensure the intra-abdominal location of the lower esophageal segment which has the lower esophageal sphincter at its lower end. That would keep it positioned where a obvious (intra-abdominal) pressure is maintained. The diaphragmatic opening through which the lower esophagus passes is also narrowed and the top part of the stomach (called fundus) is wrapped around the lower esophagus and sutured to itself to tighten lower esophageal end. This carrying out is called Nissen Fundoplication and is considered the most productive and proven procedure.
Recently, innovative techniques have allowed surgeons to achieve this carrying out laparoscopically. It takes about 90 minutes and improves symptoms in 90% of patients. The carrying out may reverse damage caused by acid reflux disease and patients may be able to stop medications completely. However, it has been reported that after 5 years some patients would wish proton pump inhibitors to control symptoms.
The carrying out may also be associated with some complications as difficulty in swallowing, inability to vomit and failure to fully ease reflux symptoms.
Patient option is the key to effectiveness of this carrying out and should in general be indicated on the basis of inpatient preference. If hiatal hernia or frequent pulmonary aspiration is associated with acid reflux disease they add more indications for the carrying out and results are much improved.
Always consult your doctor to determine if surgical operation is an standard option for you.
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