Gastro Oesophageal Reflux Disease (GORD)

The oesophagus carries food from the mouth to the stomach. The lower oesophageal sphincter is a ring of muscle at the bottom of the oesophagus that acts like a valve between the oesophagus and stomach.

Gastro Oesophageal Reflux Disease (GORD)

Gastro Oesophageal reflux disease, or GORD, is a chronic disease that occurs when the lower oesophageal sphincter does not close properly and stomach contents leak back, or reflux, into the oesophagus.

When refluxed stomach acid touches the lining of the oesophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GORD. Heartburn that occurs more than twice a week may be considered GORD, and it can eventually lead to more serious health problems.

Anyone, including infants, children, and pregnant women, can have GORD.

Symptoms

Nissen Fundoplication

The main symptoms are persistent heartburn and acid regurgitation. Some people have GORD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GORD can also cause a dry cough and bad breath.

The most frequent symptoms of GORD are so common that they may not be associated with a disease. Self-diagnosis can lead to mistreatment. Consultation with a physician is essential to proper diagnosis and treatment of GORD.

Causes

  • Hiatal hernia- hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest.
  • Alcohol use
  • Overweight
  • Pregnancy
  • Smoking

Also, certain food and drinks are associated with reflux

Diagnoses

  • Medical History
  • Response to Omeprazole PPI Drugs
  • A recent study 12 demonstrated a potential role for a proton pump inhibitor, omeprazole, in the diagnosis of GORD.
  • Barium Swallow Radiograph
  • Uses x rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus
  • Endoscopy
  • Oesophageal pH study

Treatment

Conservative Treatment

  • Life style modification
  • Medications including antacids, Foaming agents, H2 receptor blockers, Proton Pump inhibitors

Surgical Treatment

Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Laparoscopic Fundoplication

This surgery is performed under general anaesthesia.

If a combination of lifestyle changes and drug therapy does not remedy reflux symptoms, a Fundoplication can be a very effective surgical procedure to correct reflux. This procedure involves wrapping the upper portion of the stomach around the base of the oesophagus to reinforce the strength of the lower oesophageal sphincter. Until recently, the procedure required a large abdominal incision. A hospital stay of 2-3 days is usually required, and the time to full recovery and return to work is 2 weeks.

A laparoscopic Fundoplication is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to perform the procedure through five tiny incisions, most of which are less than a half-centimetre in size. One advantage of this method is a brief hospitalization. Other advantages include less pain (less of a need for pain medication), fewer and smaller scars, and a shorter recovery time.

Laparoscopic Fundoplication is a safe and effective treatment of GORD. However, in rare cases the laparoscopic approach is not possible because it becomes difficult to visualize or handle organs effectively. In such instances, the traditional incision may need to be made to safely complete the operation

 

  • Obesity Surgery Society of Australia & New Zeland
  • The International Society for Diseases of the Esophagus
  •  Australia &New Zeland Gastric & Oesophageal Surgery Association
  • The Centre For Bariatric Surgery
  • OSSAN
  • Epworth Healthcare
  • Fellow of the Royal Australian College of Surgeons
  • The Royal Melbourne