GERD….Are We Really Dealing With It The Right Way?
1. What is gastritis? How is it different from acid reflux and GERD?
2. Gastritis is inflammation in the stomach cause a sense of burning or dull pain and abdominal bloating in many. When the valve or sphincter (LES)between the food pipe (esophagus) and stomach becomes incompetent, acidic juices in the stomach flow back into the food pipe causing heart burn. GERD is a symptom complex causing reflux of food, difficulty swallowing, coughing, wheezing and chest pain. It is a result of permanent damage to the LES.
3. What causes GERD?
4. GERD is a result of a series of mistakes in food habits and life style habits in most of the patients. In a very few it can present after birth and childhood. To name a few- frequent large meals, deep fried foods, fatty diet, alcohol, smoking, fast foods, preserved and packed foods, obesity, slow motility of the gastrointestinal system secondary to other diseases like diabetes, lots of coffee, tea, chocolates, spicy foods, aerated drinks, stress etc.. cause gastritis, acid reflux and GERD.
5. How do we treat GERD?
6. Most of the patients can be cured with diet, life style modifications and stress relieving exercises. Even then a significant percent need medications and a very few surgery.
8. Yes. A very few patients know that there is a role for surgery. With the advent of powerful acid suppressing medicines, most of the doctors are failing in identifying the right patients that might benefit and some are reluctant in counseling the patients.
9. Why do they need surgery in the first place when drugs are that good?
10. You are right that drugs are pretty good. Though there are some medicines which can push the food down, there are no medicines that can close the LES selectively. When LES is wide open, esophagus gets exposed to the gastric contents and bile in some. They cause serious damage to the esophageal mucosa causing esophagitis which later on changes to Barret’s esophagus and eventually cancer in a small percentage of patients. A Hiatus may exaggerate the symptoms. As of today, it very difficult to predict which patient might develop cancer.
11. How do you differentiate between esophagitis, Barrets esophagus and cancer?
12. This is usually done by endoscopy (a long flexible camera that is passed through mouth to visualize inside of the food pipe and stomach). With advances in technology there are special endoscopes available with Narrow Band Imaging like ours at Sanjeevani PEBLS, which will help us in identifying the cancers at a very early stage.
13. Who all should undergo endoscopy?
14. Any person with persistent symptoms even when on medication, any new symptoms after the age of 40 years, change in character of symptoms, weight loss, decreased appetite, vomiting, unable to take normal quantity of food, black tar like stools, anemia etc., should undergo endoscopy. It is recommended that every one above 40 years should get endoscopy done as a surveillance for cancer.
15. When do you recommend a patient for surgery?
16. A young patient or any one with a life expectancy more than 10 years and on daily medication for acid disease, with a lax LES, Barrets esophagus or a complicated gastritis (Outlet obstruction due to stricture, bleeding, perforation, cancer) are common indications for surgery. Surgical method is then individualized after thorough investigations.
17. What surgery is done for GERD?
18. A laparoscopic fundoplication is done in these patients in which the lax LES is reinforced by the fundus part of the stomach by rotating around it and fixing. This decreases the reflux and thus Barrets esophagus and cancer incidence. After this very few patients need medication on a regular basis.
Dr Pavan Addala
M.B.B.S, M.S (Manipal)
D.N.B Surgical Gastroenterology (Apollo Hospital, Chennai)
Consultant Surgical Gastroenterologist,
Sanjeevani PEBLS Advanced Gastro Center