Acid Reflux Disease

Acid reflux or gastroesophageal reflux disease (GERD) is a common digestive condition in which acid and food from the stomach flow back frequently into the esophagus causing heartburn, regurgitation, cough, hoarseness of voice, etc. The precise cause for GERD is not fully understood. The lower esophageal sphincter, which refers to an area in the lower esophagus and whose function is to act as a valve and keep food in the stomach, fails to function properly either due to an inherent weakness or a hiatal hernia. Obesity, chronic cough, and pregnancy can all contribute to this problem.

If untreated, GERD can lead to serious complications such as erosive esophagitis (ulcers in the lining of the esophagus causing bleeding and pain), strictures (narrowing from constant scarring causing difficulty with swallowing), Barrett’s esophagus (permanent pre-cancerous change in the cell lining of esophagus), esophageal cancer, and chronic pulmonary disease such as asthma or emphysema.

Initial treatment for GERD includes lifestyle changes and acid suppressive medications. Lifestyle changes include weight loss, elevating bed, avoid use of tobacco, alcohol, coffee, greasy food, and eating late at night. Acid suppressive agents like Prilosec or Aciphex are effective in controlling symptoms in majority of patients.

An anti-reflux operation called laparoscopic fundoplication is indicated in patients whose symptoms are not fully controlled with lifestyle changes and medications, in those who have Barrett’s esophagus with increased risk for future cancer, or in patients who choose not to take medications for life. The goal of laparoscopic fundoplication is to wrap the upper portion (fundus) of the stomach around the lower esophagus in order to create a valve like mechanism that will prevent reflux of acid and food. With laparoscopic fundoplication, the overwhelming majority of patients can expect to be symptom free without need for medications soon after surgery. Since surgery is performed using small incisions, patients typically return home within 24-36 hours and resume baseline function within a few days.

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