Reflux Oesophagitis is a common condition where an excess of gastric juices (Mostly acidic) inappropriately rise up the Oesophagus. This is usually either due to an excess of acid production or incompetent (non-functioning) valve. The latter may benefit from surgery.
The symptoms of reflux are common in the community and most patients are adequately treated by Proton-Pump inhibitor medications (i.e. Losec / Omeprazole / Pantoprazole or similar).
These can all have profound benefits in decreasing reflux symptoms.
If there are new symptoms or reflux (and over 50yrs), persistent symptoms or concerning features then a gastroscopy can be performed to confirm diagnosis. This is the passage of a flexible camera over the tongue and into the stomach. This is a safe and quick day-case procedure performed with sedation and numbing throat spray.
This Gastroscopy may show a hiatus hernia. This is the elevation / herniation of the stomach through the diaphragm (Breathing muscle) and into the chest. Although this is rarely dangerous, it can make the gastro-oesophageal valve non-functional resulting in acid passing freely up into the oesophagus. The Oesophagus does not have the protective lining of the stomach, and therefore the low pH burns it's lining.
Once the diagnosis is confirmed then “maximal medical therapy” and lifestyle modifications are actioned. If there is sub-optimal response to these, surgery can be entertained. Large studies have shown that in the correctly selected patient population, satisfaction post operative is over 90%.
Surgery is keyhole repair of any hiatus hernia and fundoplication. Fundoplication is the wrapping around of the top part of the stomach in order to “tighten the valve” and inhibit acid reflux. The hiatus hernia is repaired using sutures (not mesh). The operation takes approximately 2 hours and typically requires a 2-night hospital stay. It is recommended that patients stick to a soft diet for 2-3 weeks after surgery. Generally patients can return to work 1-2 weeks post op, and lift heavy objects after 4 weeks.
