Gastroesophageal reflex disease

The gastroesophageal reflex disease is a chronic condition of mucosal damage caused by acid coming up from the stomach to esophagus. It is usually caused by changes in the junction between stomach and esophagus including abnormal relaxation of lower esophageal sphincter (les) or a hiatal hernia, obesity, zollinger Ellison syndrome, high blood calcium level etc.

 
Signs and Symptoms

• Heart Burn an acidic taste in the mouth

• Regurgitation

 
Less Common:

• Pain in swallowing /sore throat

• Nausea

• Chest Pain

• Coughing

 
Investigation

1. Upper GI Endoscopy

2. Esophageal ph monitoring

3. Barium swallow x-rays study

4. Esophageal manometerY

5. Medical management involves lifestyle modification which includes weight loss, advance of certain Medical management involves lifestyle modification which includes weight loss, avoidance of certain foods, elevating head end of bed, stop smoking and medications like PPI.

 
Indications of operations:

• Failed medical management

• Noncompliance

• High vol reflux

• Severe esophagitis/benign structure

• Barrett’s esophagus

 
The treatment of choice is laparoscopic Nissen fundoplication (floppy) with hiatal hernia repair if present. Patients undergoing laparoscopy has less pain, short hospital stay and faster return to work. We operated two patient at Aster hospital Mankhool both of whom had GERD with a hiatal hernia. Patients were aged 32 years and 56 years on PPI for few years and both had severe symptoms of chest pain. They had undergone endoscopy and PH studies and manometer,

 

 

Understanding Manometry

The throat(esophagus) is a strong tube that interfaces your throat to your stomach. With every swallow, the throat(esophagus) muscle contracts and pushes nourishment into the stomach. At the lower end of the throat, a valve (an uncommon sphincter muscle) stays shut aside from when sustenance or fluid is gulped or when you burp or regurgitation.

 

 

What is esophageal testing, also called manometry, and why is it performed?

Esophageal testing or manometry measures the pressures and the example of muscle withdrawals in your throat. Variations from the norm in the constrictions and quality of the muscle or in the sphincter at the lower end of the throat(esophagus) can bring about agony, heartburn, and/or trouble gulping. Esophageal manometry is utilized to analyze the conditions that can bring about these side effects.

 

 

 

Rahul Tugnait - General Surgery-min-min

Dr, Rahul Tugnait

MBBS, MS ( surgery), MRCS(England), FIAGES, FAMS Specialist General Surgeon

Aster Hospital, Mankhool

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Laparoscopic Total Colectomy and Ileo Rectal Anastomosis

Recently, a case of laparoscopic total colectomy was performed at Aster Hospital, Mankhool.

A patient complaining of abdominal pain, vomiting and constipation came to the Gastroenterology department at Aster Hospital Mankhool. He reportedly was suffering from significant weight loss, loss of appetite, and was syncope due to pain. He was seen by Dr. Amal Upadhyay – Consultant Gastroenterology and upon performing colonoscopy, he was found to have bowel cancer. Post biopsy, he was advised to seek surgical help and the opinion of an oncologist.

Considering his financial situation and the fact that he had no insurance cover, the patient was considering various options including travelling to India for further treatment.

Upon consulting with Dr. Moni Suseelan our Specialist General Surgery at Aster Hospital Mankhool and was advised to undergo laparoscopic total colectomy with Ileo-rectal anastomosis. Upon detailing him on the operative procedure, outcomes and after effects, he was also advised to consult an Oncologist for neo-adjuvant chemotherapy. He was required to undertake chemotherapy after his procedure as per the Oncologist at Saudi German Hospital, Dubai.

The procedure was performed successfully on 23rd  March 2016, and he was tolerated soft diet within few days post operatively, considering the loss of total colon.

 

Dr. Moni Suseelan

MS, FMAS

Specialist General Surgery

Aster Hospital

 

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TRUS Guided Biopsy at Aster Hospital

At Aster Hospital, we offer TRUS guided prostate biopsy. This method obviates the pain & discomfort associated with traditional biopsies yielding much better results.

A patient recently referred by Dr. Nazeer Ahamed (Specialist in Urology) at Aster Jubilee Medical Complex, Bur Dubai was taken in at Aster Hospital to investigate enlarged prostate and high serum PSA.

Case details:

A 50 year old gentleman with enlarged prostate and high serum PSA (prostate specific antigen) was referred for TRUS guided biopsy. The patient was admitted in daycare and was administered an enema. After checking the clotting profile and administering IV antibiotic, the patient was transferred to the Radiology department.

After informed consent, TRUS guided peri-prostatic nerve block was given using 22G Chiba needle. Following this, 12 core biopsies were taken from the prostate under trans-rectal ultrasound guidance.

The peri-prostatic nerve block made the procedure so comfortable that the patient did not need any oral or IV analgesia or any sedation during or after the procedure. On Visual analog pain scale, the pain during & after the procedure was scored to be only 2/10. No IV fluid or transfusion was required.

The patient was discharged in the evening and oral antibiotics were continued for next two days. Post procedural blood in stool disappeared in next 24 hours. Post procedural blood in urine was also seen which disappeared in 36 hours.

 

Dr. Anoop KR Pandey

MD (PGI), DNB, FRCR

Specialist Radiology

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Rescue Cerclage

Since the opening of Aster Hospital, 4 cases of successful rescue cerclage have been performed and were able to continue the pregnancy beyond 29 weeks. The procedure had its challenges and its own rewards as we were able to add colors and new meanings to people’s lives.

The case was referred by Dr. Fousiya at Badr al Samaa Medical Centre as inevitable miscarriage, cervical incompetence in view of open cervical os with membranes bulging into the vagina.

Case details:

A 32 year old lady, at 19 weeks was referred to Aster Hospital as inevitable miscarriage, cervical incompetence in view of open cervical os with membranes bulging into the vagina. She is married since 8 years, and had 2 failed attempts at IVF. This pregnancy was a natural conception and was uneventful till 19 weeks when she experienced pressure in the lower abdomen and blood stained discharge. She consulted her doctor and was diagnosed to have open cervix with membranes bulging into the vagina. She was examined and found to have cervical dilatation of 2.5cm with membranes bulging into the vagina, she was admitted and underwent USG for major anomalies, observed for contractions, bleeding, leaking and any other signs of infection. The couple was counselled about the pros and cons of cerclage at such a situation as she would definitely miscarry if cerclage was not done.

She underwent emergency rescue cerclage (Mc Donald’s suture double with Prolene 1 and mersilene) in the month of September. She was on complete bed rest, progesterone support and thromboprophylaxis since then.  At 36 weeks of gestation she developed preterm premature rupture of membranes and delivered a baby boy weighing 2.6 kg through LSCS on maternal request.

The case was successfully carried out at Aster Hospital, Mankhool.

 

 

 

Dr. Caroline Alphine Jenitha MS, MRCOG

Specialist Obstetrics and Gynecology

 

 

 

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