Minimally Invasive Surgery           Dr.Hassan M.Hashem Alshater       Laparoscopic General Surgeon

Dr.Hassan M.Hashem Alshater

Minimally Invasive Surgery

Laparoscopic General Surgeon

Gastroesophageal reflux disease GERD

Overview:

  • It is the reflux of stomach acid into the esophagus, which leads to irritation esophageal mucosa, and with continuation of this abnormal condition damage in the structure of the esophagus occurs (inflammation of esophagus, ulcer, narrowing of esophagus and is a risk factor for cancer)

 

Etiology:

  • Reflux occurs as a result of weakness or relaxation of the lower esophageal sphincter

failure to close this valve allows the passage of gastric acid into the esophagus

  • The arrival of gastric acid in esophagus causes inflammation of the esophageal mucosa
  • Scarring and fibrosis may occur in lumen of the esophagus leading to narrowing of esophagus

 

Symptoms:

  • Heartburn: usually occurs after food, most often at night
  • Chest pain
  • Difficulty swallowing
  • Feeling of a compressive mass in middle of chest
  • The disease may develop:
  • Chronic cough
  • Inflammation of the larynx
  • Sleep disturbance

 

Causes:

  • Diaphragmatic hernia
  • Obesity
  • Pregnancy
  • Connective tissue disorders
  • Delayed gastric emptying
  • late meal at night
  • Fried and fatty foods
  • Alcohol
  • Coffee
  • Aspirin

 

Diagnosis:

  • Clinical examination with detailed clinical story
  • Upper gastrointestinal endoscopy
  • Measurement of esophageal pressure
  • Barium swallow of esophagus and stomach

 

Treatment:

  • Lifestyle modification:
  • stop smoking
  • avoid alcohol and caffeine
  • avoid fried and fatty foods, tomato sauce, chocolate, mint, onions and garlic
  • not eating late
  • eat slowly and chew well
  • avoid lying down after eating
  • raise the head of the bed
  • weight observation

 

  • Medication:
  • antacids: Maalox, fast acting to reduce acidity but does not help in the healing of the esophagus
  • drugs that reduce acid production:

H2 receptor blockers Ranitidine and Famotidine

proton pump inhibitors such as Lansoprazole and Omeprazole (more effective than H2 receptor blockers)

  • Baclofen causes tension in the lower esophageal press

 

  • Surgery:

Laparoscopic repair of diaphragmatic hernia (when reflux is caused by a diaphragmatic hernia)

Laparoscopic gastric fundoplication: full (Nissen)or partial (Toupet)

 

The stomach is folded by wrapping it around the lower esophageal press to narrow the opening and prevent reflux.

 

  • LINX Device: it is a series of magnetic metal beads placed around the lower esophageal sphincter

this device is implanted endoscopically, magnetization between the beads is precisely calculated to allow food to pass from esophagus to stomach but does not allow reflux to occur

  • Transoral incisionless fundoplication by upper endoscopy (TIF)