Gastroesophageal reflux disease
Gastroesophageal reflux is a disease that is caused by acid that is produced in the stomach that goes up into the esophagus. This causes patients to feel heartburn and pain often after eating or lying down. The main treatment for reflux is medication to decrease the production of acid in the stomach. At times, despite medication, patients have symptoms from reflux.
If patients still have reflux despite the best medical therapy, we recommend that patients undergo an evaluation to see if surgery can help to control reflux. The rationale behind the surgical option is to create a barrier between the esophagus and the stomach to prevent acid from coming up from the stomach and causing symptoms.
In order to provide the best surgical outcome, we obtain the following studies to determine the patient’s anatomy, the esophageal function and the relationship between the patient’s symptoms and the amount of acid coming up to the esophagus:
- Esophagram—This study is performed by a radiologist. The patient drinks barium under an X-ray, which highlights the anatomy of the esophagus and stomach.
- Manometry—This study is performed in a GI lab. A small probe is placed in the esophagus through the nose. The patient swallows with the probe placed in the esophagus to provide information about esophageal function
- 24 hour pH impedance—This study is performed in a GI lab. A small probe is placed in the nose. The patient wears the probe for 24 hours. During that time, the patient keeps a journal of all of the symptoms. The record of the symptoms and the amount of acid that comes up to the esophagus during the study provides the degree of esophageal reflux.
These studies allow us to advise patients about the best surgical option and the degree of success with surgical treatment of reflux. The three surgical options that we provide are
- Nissen fundoplication
- Toupet fundoplication