23 January 2018
At some stage in their lives almost everyone will suffer from acid reflux - most commonly heartburn or regurgitation from the stomach back into the mouth.
What is acid reflux?
Gastro-Oesophageal Reflux Disease (GORD) is a chronic condition caused when the lower oesophageal sphincter allows acid and bile to flow back or ‘reflux’ from the stomach into the oesophagus.
It can affect men and women of any age and often gets progressively worse.
For most people it is an unpleasant sensation that passes in a matter of minutes, but for others it can be a daily problem turning every meal into an unpleasant and painful experience.
At Spire Parkway Hospital, Solihull, Birmingham West Midlands, Consultant Gastrointestinal Surgeon Mr Rishi Singhal is treating the condition with the LINX System – a new treatment option that can reduce or eliminate the symptoms with a simple operation with patients usually leaving the hospital on the same day.
Here Mr Singhal answers some questions about the illness and the treatment.
Q: At what stage would you advise someone with Gastro-Oesophageal Reflux Disease to see their GP and what treatments might they expect to receive?
A: If someone is regularly suffering from heartburn or regurgitation then they need to see their GP - first to check that it isn't something even more serious such as cancer of the oesophagus. First stage treatment will usually be anti-acid medication of some kind.
Q: Is there a particular age group or sex that is more affected than others.
A: The more common patients will be aged above 40 years old but this is a condition that can affect anyone and I have done operations on people in their teens and early twenties.
Q: When might surgery become an option?
A: Anyone who has clinically proven reflux and does not want to take lifelong medications should consider anti-reflux surgery. Moreover, some patients may not experience complete control of symptoms with medications anyway. More importantly, there are side effects associated with chronic long term use of such medications.
Q: How does the LINX System differ from other treatment options?
A: The LINX system is designed to augment the natural sphincter at the lower end of the oesophagus. It is thus quite physiological and patients can eat and drink normally without any restrictions. They don’t experience the side effects of a fundoplication operation such as gas bloat, flatulence and inability to burp.
Q: What does the operation consist of?
A: The procedure is done under general anaesthetic. The surgeon will make four or five small incisions in your stomach to gain access to the lower oesophageal sphincter (LOS). A sizing tool is passed around the LOS to measure the diameter of the oesophagus, before the appropriately-sized device is put into place.
The procedure generally takes less than an hour and starts working immediately. You will normally be discharged the following day and encouraged to start eating normal food immediately. Typically, you will be able to resume your normal daily activities in less than a week.
Q: How long does the LINX System continue to provide relief from reflux symptom?
A: It has been designed as a long-term implant. Studies have been conducted that evaluate the clinical safety and performance of the LINX device in patients which have been implanted for different lengths of time. For questions regarding your implanted LINX device, please speak to your doctor.
Getting back to eating after LINX surgery
You will want to activate the LINX band right away, allowing it to open and close with the passing of food. Take a few sips of water before you take your first bite of food and continue to sip water in between your first few bites.
Eat slowly and keep portions and bite sizes small. If you start with a ‘cup full’ as your initial portion you can increase this as you feel more comfortable.
It is important not to let yourself get too hungry so make sure you eat every 3 to 5 hours. Stay hydrated with regular sips of water and keep a drink nearby in case you need to sip with food.
About ten days after surgery, you may begin to notice discomfort while swallowing – don’t be alarmed. Continue to eat solid or semi-solid food with regular drinks but AVOID going to a liquid diet.
If the discomfort persists over several weeks or becomes severe contact your implanting surgeon.
For the first three weeks it is advisable to avoid eating bread crusts, pasta, rice or pizza as well as steak and other ‘tough’ meats. If you do want to eat any of these ‘tough’ foods then moisten them in stews or with sauces.
If immediately after surgery you feel nauseated eat bland foods like mashed potatoes, yogurt or thin soups.
Q: How quickly could I have a consultation, and how much would it cost?
A: It depends on the availability of the consultant you wanted to see, but we pride ourselves on getting you fast access to diagnosis and you can often get a consultation within 24/48 hours. Initial consultation fees vary by consultant, but between £175-£250 is a reasonable guide.
Q: If I need surgery, how quickly could I have it?
A: We have no waiting lists at Spire Parkway, but again it depends on the availability of the consultant you wanted, but as a guide, and subject to your pre-operation assessment, between one and two weeks.
Q: I don’t have health insurance, can I self-pay?