Normally once the food is chewed it goes from the mouth to the esophagus and to the stomach, where it is mixed with the acid gastric juice for its digestion. The esophagus and the stomach are separated by a sphincter (lower esophageal sphincter), which is a band of muscular fibers that close the valve that prevents the food and the stomach acids from going back to the esophagus.
The gastroesophageal reflux disease (GERD) is a condition where the food or liquid go back from the stomach to the esophagus. This partially digested material is a very acid liquid that irritates the esophagus, causing a painful sensation and being able to produce inflammation through time.
Gastroesophageal reflux is a common condition that usually occurs without symptoms after eating. Reflux occurs if the sphincter does not close adequately, thus, the gastric contents can return to the esophagus and cause the symptoms.
The risk factors for the development of reflux are pregnancy, hiatal hernia and overweight / obesity among others.
What are the symptoms?
The symptoms of reflux include burning sensation in the stomach, or in the lower part of the chest, which moves upwards behind the central part of the chest until it reaches, sometimes, the mouth. That pain is known as heartburn and it is a type of burning pain under the sternum that increases with flexion, body inclination, and the intake of food, and is relieved with antacids. It is more frequent or worse at night.
Another very frequent symptom is the sudden presence of food in the mouth without nausea or vomit (regurgitation). There can also be an acid sensation in the mouth.
These symptoms occur frequently when the person lies down and, above all, after eating big meals, after eating certain type of foods or when drinking alcoholic beverages.
Other symptoms are eructs, nausea, vomiting, hoarseness or voice changes, throat irritation and repeated throat infection, difficulty to swallow and chronic coughing.
What treatment possibilities exist?
The general measures include, among others: weight loss, to avoid lying down after meals, sleeping with elevated head in bed, taking medicines with abundant water, avoid grease, and avoid consumption of alcohol and tobacco.
Antacids are not the most adequate medication for the treatment of this disease. These medications neutralize the acid avoiding its action on the wall of the esophagus and the stomach; in general terms are only indicated in minor conditions. The reflux disease usually improves, but after some time without symptoms it can reappear. In recurrent cases, when there is no relief with medication, it is necessary to perform surgical intervention. This is performed laparoscopically.
Laparoscopic Repair of Hiatal Hernia
Small incisions are made (1 cm.) in the abdomen through which the instruments are inserted as well as a fiber optic camera while the patient is under the effect of general anesthesia. The stomach and the lower part of the esophagus are relocated again in the abdominal cavity, the hiatus is adjusted and the stomach is sutured in its position within the abdominal cavity.
The upper part of the stomach (depth) is wrapped around the esophagus (fundoplication) to reduce the reflux.