13 September 2018
Mr Simon Dexter a consultant in general, upper gastro-intestinal and bariatric surgery at Spire Leeds tells us more about GORD
Gastro-oesophageal reflux disease (GORD) is a common condition affecting around one in ten of the adult population. It can be painful and result in heartburn; a sense of burning extending upwards in the chest.
Other symptoms include regurgitation of fluid or food, sometimes with vomiting. Acid reflux can also cause a persistent cough, and sometimes affects the voice causing hoarseness.
The condition is usually a result of a weakening of the valve mechanism between the oesophagus (gullet) and the top of the stomach, or the lower oesophageal sphincter. This can result in a hiatus hernia, which often coexists with reflux disease. Stomach content, which contains high concentrations of acid, then refluxes back up into the oesophagus. Reflux disease is commonly diagnosed and treated on the basis of the clinical history alone. Endoscopy is usually the first line investigation. This may show the presence of a hiatus hernia and will reveal any complications of reflux. Most people with GORD are successfully treated with simple antacids or drugs, known as PPIs, designed to reduce stomach acid. This doesn’t prevent reflux, but means the fluid which does reflux is less likely to cause pain or damage to the oesophagus. PPIs are generally well tolerated but occasionally may cause troublesome side effects, limiting their use.
Surgery for gastro-oesophageal reflux is designed to reinforce the lower oesophageal sphincter, restoring the one-way valve, rather than interfering with stomach acid production. Surgery is almost invariably laparoscopic (keyhole) and involves an overnight stay in hospital at most.
The most common operation is a fundoplication. This involves repairing any hiatus hernia which is present and then using the top of the stomach to create an ink-well type valve. This is a very effective procedure reducing acid related symptoms by over 90%, with patients able to come off their medications. The operation can have side effects sometimes making it difficult to release gas, or burp. Most learn to avoid fizzy drinks, or gulping air during eating. The operation is very effective but does weaken over time in some patients who may develop recurrent symptoms.
A relatively new operation which is gaining popularity due to its simplicity and effectiveness is the LINX procedure, which involves placement of a ring of magnetic beads around the lower oesophageal sphincter. The LINX holds the sphincter in a closed position but allows it to open up on swallowing or burping. So far this procedure appears to be very safe and effective in the first five years, although very longer term outcomes are not yet available.