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.
Dr, Rahul Tugnait
MBBS, MS ( surgery), MRCS(England), FIAGES, FAMS Specialist General Surgeon
Aster Hospital, Mankhool
