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) 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 can have GORD.

Symptoms

The main symptoms are persistent heartburn and acid regurgitation. Some people have GORD without heartburn. Instead, they experience pain in the chest, a feeling of hoarseness in the throat, 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.

Causes

• 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
• Certain food and drinks are associated with reflux

Diagnosis

Tests to diagnose GORD include a barium swallow x-ray (this helps to spot abnormalities such as a hiatal hernia and severe inflammation of the oesophagus) and an endoscopy procedure (a scope which is put down the throat while under anaesthetic).

Conservative Treatment

• Lifestyle 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 Nissen’s Fundoplication

This surgery is performed under general anaesthesia.

If a combination of lifestyle changes and drug therapy does not remedy reflux symptoms, a Nissen’s 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. 

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

In some cases a laparoscopic approach is not possible because it becomes difficult to visualise or handle organs effectively. In such instances, the traditional incision may need to be made to safely complete the operation.