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GERD & Acid Reflux

GERD and Acid Reflux

GERD (Gasrto-Esophageal Reflux Disease) or Acid reflux, is a very common digestive problem which occur primarily because of weakening of LES valve (the valve between your food pipe and stomach). GERD is a chronic condition where stomach acid frequently flows back into the esophagus, causing symptoms such as heartburn, chest pain, and regurgitation.

In India the same problem is commonly called acidity or heartburn or gas problem or gastric

problem by the patients suffering from this problem. It is kind of lifestyle problem, increasingly becoming common due to westernized or urbanized lifestyle. Although, not a major illness it is a common reason for long term problems leading to poor nutrition, poor sleep, affecting work efficiency, mental health, overall health, social life and ultimately leading to poor quality of life. Most of the patients get good relief with short term medications, but many struggle with this problem despite regular Gastroesophageal disease treatment. Many patients have good relief of their problems on treatment but are unable to stop medication even for a day without having digestive symptom.

Fortunately, there are many advances in the understanding of this problem in the recent times, with newer investigations modalities and GERD disease treatment options. All those who are suffering from this problem for a long time and are on medications for a long time, can certainly hope for better improvement in their health with more advanced Gastroesophageal disease treatment.  Dr Chirag Thakkar at ADRIT clinic is one of the pioneers and the best doctor for GERD treatment in Ahmedabad.

Symptoms of GERD and Acid reflux (The problems faced by patients)

Gastroesophageal reflux disease (GERD) manifests with a range of symptoms that can vary in severity. Each individual can have a varying combination of below given symptoms. Common symptoms include:

  1. Heartburn: A burning sensation in the chest, usually after eating, which might be worse at night or when lying down. Although this is the most common symptom, a significant number of patients with chronic GERD may have different set of below given symptoms without any heartburn.
  2. Regurgitation: A sour or bitter-tasting acid backing up into the throat or mouth.
  3. Dysphagia (difficulty in Swallowing): A sensation of food being stuck in the throat. Thorough evaluation is needed to rule out Achalsia cardia, peptic esophageal stricture and esophageal cancer.
  4. Chronic Cough, Laryngitis, LPR: Frequent coughing, particularly at night, which is not caused by a respiratory condition. Laryngitis that is Inflammation of the larynx (voice box) causing a sore throat, hoarseness, or voice changes is also fairly common in patients with severe acid reflux. This condition is also called Laryngo pharyngeal reflux or LPR.
  5. Breathing difficulty and Asthma: Breathing difficulty is a fairly common symptom of acid reflux, even when the is no lung problem. Those having asthma would have worsening or triggering of the episodes due to GERD. Effective treatment of GERD with improve both breathing problem and Asthma.
  6. Headache: Many patients of acid reflux suffer from headache, when their acid reflux symptoms aggravate. And usually remains under control when acid reflux is controlled with effective treatment.
  7. Palpitation and uneasiness: Palpitation and uneasiness are functional symptoms in response to acid reflux in many patients. Meaning patient have these symptoms due to their body’s inappropriate reaction to acid reflux episodes.
  8. Chronic bad breath and Dental erosions: Acid reflux can cause bad breath, enamel erosion, leading to dental problems.
  9. Ear pain: A small number of patients of acid reflux, having severe volume reflux can have eat pain due to repeated reflux. Most such patients benefit from surgery for acid reflux after proper evaluation.
  10. Sleep disturbances and anxiety: Patients having GERD for many years gradually develop sleep disturbances, either due to poor control of heartburn or sometimes due to night time regurgitation during sleep. Poor sleep and symptom control also leads to mental health issues in many patients.
  11. Weight loss and Generalized weakness: Patients with long term severe acid reflux gradually loose weight due to diet restrictions and loss of appetite. Weight loss along with mental health problems combines leads to a feeling of weakness, low mood, inefficiency in work.

If you experience any of these symptoms regularly, it’s important to consult an expert for a proper diagnosis and treatment plan. Persistent GERD can lead to more serious health issues, including esophagitis, esophageal strictures, or Barrett’s esophagus, a precursor to esophageal cancer. It also lead to a very poor quality of life affection your personal, social, and professional life.

Causes of GERD and Acid reflux

GERD occurs when stomach acid frequently flows back into the esophagus, leading to symptoms like heartburn, chest pain, and regurgitation. As such it is a mechanical problem arising due to weakness of LES valve (Between your food pipe and stomach).

Hiatus hernia, that is enlargement of the opening in the diaphragm which allows the passage of esophagus (food pipe) from chest to the tummy, is one of the factors leading to weakening of the LES valve and GERD. Pregnancy and Obesity are two common reasons for weakening of the diaphragm leading to hiatus hernia and GERD. Some people also have genetic or familial predisposition for weakness of diaphragm muscle.

Unhealthy lifestyle is another major reason for development of GERD and acid reflux. In India, spicy and oily foods, a staple in many diets, can trigger or exacerbate GERD and acid reflux symptoms. Meals rich in chilies, spices, and fat increase stomach acid production and can relax the lower esophageal sphincter, allowing acid to escape into the esophagus. Additionally, irregular meal timings and heavy evening meals contribute to these conditions.

Stress, a significant factor in urban Indian lifestyles, also plays a crucial role in GERD. High stress levels can lead to increased stomach acid production and negatively impact digestion. Furthermore, a growing prevalence of obesity in India is linked to an increased risk of GERD, as excess body weight can pressure the stomach, pushing acid into the esophagus.

Gastroesophageal reflux disease Treatment Options

Lifestyle modification, mainly healthy dietary practice and stress management are the most important aspect of Gastroesopahgeal reflux disease treatment. We strongly recommend these healthy practices to all our patients irrespective of the severity of GERD in their case. Anyone suffering from GERD should make dietary modifications, such as reducing spicy and fatty foods, eating smaller meals, and maintaining a healthy weight. Lifestyle changes like regular exercise, stress management, and avoiding late-night meals are also essential. It is not very difficult to follow these changes. With proper guidance and advice, you can make all these changes without any compromise in your other life commitments.

Medications:

Generally, medications are given for an initial period or 4-6 weeks mainly antacids (PPI like Omeprazole, Pantoprazole, Rabeprazole, or syrups like Digene or Sparacid). With proper diet and lifestyle modifications, majority of patients become symptom free and do not need further GERD disease treatment.

A portion of GERD patients, either need repeated course of antacid medications or need medications continuously. All these patients should undergo investigation in form of an upper GI endoscopy. Diet and lifestyle changes can also be optimized to make sure that patient gets a permanent relief and can stop medications. Even after all these efforts, a small number of patients suffer from GERD more than a year or two. All such patients should undergo further evaluation and consider surgical options for permanent cure.

Surgery for GERD

All those patients who suffer from GERD and acid reflux symptoms for more than a year, and or have a poor quality of life due to GERD, should undergo further evaluation under a doctor who is expert in Gastroesopahgeal reflux disease treatment. In such cases further evaluation would include esophageal manometry, 24 hr pH Impedance study, Blood test to rule out some systemic medical condition that could cause digestive problems, and test to evaluate stomach motility like Gastric emptying study. Evaluation about the stress factor, the impact of the disease on your quality of life also need to be taken into consideration during planning of GERD disease treatment.

All these evaluations would give us the information to take the decision about the surgical option for GERD. If the tests confirm that GERD is severe and is the primary reason for all your symptoms, then a laparoscopic surgery called fundoplication should be considered. When done after proper evaluation under an expert in gastroesophageal reflux disease treatment, and done by a surgeon expert in doing these surgeries, the outcomes are excellent.

This surgery which is called a laparoscopic fundoplication, can be done in two variations, Nissen (full or 360 degree wrap) and Toupet (partial or 270 degree wrap). The difference is the amount of wrap done, to create the new valve. This decision about the type of wrap is taken depending on your primary symptoms, your age and manometry reports. You can take active part in this decision making by discussing this with your surgeon prior to surgery.

Although, endoscopic procedures like Stretta, TIF (Transoral incisionless fundoplication), GERDx, ARMA, ARMS, Banding are some newer treatment options, currently they are not part of the standard guidelines. The outcomes of these procedures are yet to be established. Past results with endoscopic procedure are not very encouraging. Large number of different endoscopic procedures itself suggest that endoscopic therapy is not standardized in the current time. Hence, we are very cautious in advising endoscopic procedures for GERD to our patients.

Why GERD disease treatment at ADROIT

Pioneer: Dr Chirag Thakkar is among the first few to start esophageal manometry and pH Impedance study evaluation in Gujarat. He has also contributed significantly in improving the GERD disease treatment protocols

Experience: ADROIT under the leadership of Dr Chirag is the center with the highest experience of doing esophageal manometry, pH Impedance study and laparoscopic surgery for GERD and Achalasia cardia

Multi-disciplinary approach: We don’t just do procedure, but aim to get patient back to normal life without medications. The treatment includes, proper evaluation, surgery if needed, diet and lifestyle change guidance and support, with excellent long term follow up. And, with patients support and cooperation, are able to do it in most cases.

Patient satisfaction: We are happy to enjoy very high patient satisfaction ratio.

Most advanced technology: We have all the advance facility required for evaluation and treatment for GERD and acid reflux

19+

Years of Experience 

3500+

Esopahgeal Manometry/ 24 hr pH Impedance study

2000+

Laparoscopic surgery for GERD

6000+

Advance laparoscopic and GI surgery

FAQ:

What is the permanent solution for  GERD, Acid reflux, Heartburn, Acidity problems?

Most of the patients who suffer from GERD have a short term problem. And they become symptom free after a course if antacid medications for 4-6 weeks. Although, one should remember that improving your diet and lifestyle are very important to get a permanent solution. Management of stress and maintaining good sleep quality are equally important for all sorts of digestive problems.

Some of these patients either do not get good relief with medications and diet lifestyle changes. And some patients do get good relief but need continuous medications for symptom control. All these patients need proper evaluation by an endoscopy, esophageal manometry and 24 hr pH Impedance study. Many of these patients, who have severe weakness of the LES valve, hiatus hernia and, or severe acid reflux will need a laparoscopic surgery for permanent relief. This surgery is called laparoscopic fundoplication surgery, also called surgery for acid reflux, GERD or hiatus hernia. 

Why is endoscopy necessary?

Endoscopy is done to have a thorough evaluation of your condition. Endoscopy assesses the condition of your esophagus (food pipe), stomach and the valve in between the stomach and esophagus. We can know how much damage has already been done by the acid to your food pipe. This may help us to know how much improvement occurs once we start the medications. Endoscopy also helps us to take a biopsy from stomach for H.Pylori – a type of bacterial infection which is a cause for stomach ulcers and if found positive can be treated with medication. Hence, endoscopy would guide us in planning GERD disease treatment.

What are side effects of PPI antacid?

PPI antacid are overall quit safe medications with minimal severe side effects. Hence anyone having acid reflux can safely take medications for their symptom control.

But when needed for a very long time, it can have many significant side effects. The side effects are mostly so slow that many a times patients and doctors can miss them. These includes vitamin deficiency, osteoporosis leading to weak bones, Kidney problems, Dysbiosis (affect the GUT bacteria) leading to various functional digestive problems like IBS. Hence efforts should be placed to improve the diet and lifestyle so that we are able to stop these medication over time. If medications is needed for symptom control even after diet and lifestyle changes, then further evaluation by manometry and pH study should be done and if necessary surgery for GERD should be considered.

How are the results of GERD. acid reflux, Hiatus hernia surgery (Laparoscopic fundoplication surgery) ?

Laparoscopic fundoplication surgery is the gold standard treatment for patients with severe GERD and acid reflux. When done after proper evaluation, in a proper manner, at a centre with good experience of such surgeries, and followed by a proper post surgery lifestyle measures, the outcomes are great. Patients having acidity problems for many years, those having significantly restricted diet, poor sleep, unable to work normally, all such patients get excellent outcome and are able to stop their antacid medications permanently.  But such surgery should be done only after proper investigations in the form of an endoscopy, esophageal manometry and 24 hr pH Impedance study.

Is esophageal manometry and 24 hr pH Impedance study mandatory prior to fundoplication surgery?

Well, we cannot say it is mandatory. If we wish we can do this surgery without these tests, and is also done at many hospitals, especially the ones where this surgery is not done very frequently. But, the over outcomes are surely better at the hospitals where this surgery is routinely done after proper evaluation (after doing manometry and pH study).

The decision regarding surgery may change after these tests, if these test shows that reflux is very minimal. At times we make changes in surgery depending on the manometry report (Nissen or Toupet). We can better judge the outcomes of surgery. And incorporate supportive treatment modalities in patients where outcomes are likely to be poor, to improve the outcome in such cases. I don’t have any justification for avoiding these tests, if we are already planning for a surgery.

Which one is a better option Laparoscopic Nissen or Toupet Fundoplication?

The long-term studies confirm equally good long term results of both these surgeries. There are individual surgeon and hospital preferences for each procedure. With Toupet fundoplication, the chances of long term and more troublesome difficulty in swallowing after surgery reduces. This is the factor for preference for Toupet fundoplication of some surgeons and patients.

Our experience with Nissen fundoplication is very encouraging, with very small rate of troublesome dysphagia. Hence, we prefer Toupet is a small number of selected patients who have very weak esophageal motility or in very elderly patients. In younger patients we tend to prefer Nissen fundoplication. In situation where patient insist on Toupet fundoplication, out of fear for swallowing difficulty, we don’t find any reason to deny that and hence offer Toupet in such patients also.

How do you judge how much to tighten the valve or wrap?

First of all, we do not tighten anything. You much understand that this surgery does not work by tightening the LES valve. The wrap that we create (nissen or toupet), by wrapping the fundus of stomach around the lower part of food pipe, will create a one way flap valve. Flap valve is something like a mouse trap door, opens in one direction and closed when pushed from the other direction. Allowing passage of anything in only one direction.

Hence when we create a wrap we don’t at all try to tight it, and try to keep is loose enough to allow easy passage of food down to the stomach. And when created properly, even the loose wrap with stop the reflux of acid and food from stomach to the food pipe. It is fine if you do not understand this mechanics, be sure that even Nissen wrap done loosely will not cause difficulty in swallowing and give excellent long term GERD control. Loose wrap done properly will not reduce the longevity of the newly created valve (wrap).

What are the side effects of Laparoscopic fundoplication surgery?

Long-term side effects to this procedure are generally uncommon. Some patients develop temporary difficulty in swallowing immediately after the operation. It resolves within one to three months after surgery. Some patients complain of stomach bloating or more frequent passage of flatus. Again, this is a temporary phenomenon and with time it improves on its own. Your body may take some time to adapt to the newer changes in your food pipe and stomach. The subjective improvement in symptoms varies among patients with majority reporting significant improvement and others reporting marginal improvement.

Will I have any restriction in life after laparoscopic fundoplication surgery?

A person can lead an absolutely normal life after this surgery. In terms of diet and activity.

Patients with GERD can take normal diet all their life after this surgery. The most important care they should take is to stop the habit of eating till full stomach. Eating a couple of bites less than what makes them full. This care should be taken lifelong. Surely, stopping the unhealthy diet pattern should be done without doubt. But that does not mean you cannot eat outside, spicy or fried food. You can have them in moderation once in a while. What any normal person would do to be healthy.

Regarding exercise and activity, there are some restrictions in the initial 3 months. But there are no lifelong restriction what so ever.

When can I resume routine activity and exercise after Laparoscopic fundoplication surgery?

All routine day-to-day household and office activities can be resumed with a few days to a week’s time as one feels comfortable. All activities and exercises that increase the pressure in your tummy and put a strain on your diaphragm muscle need to be avoided for 3 months after surgery. Thus, rigorous exercise, heavy weight lifting, muscle building, and toning exercises, and different yoga asana and mudra should not be done for the first 3 months. Patients are also advised not to drive a two-wheeler for an initial one month.

You need not worry too much as these restrictions are temporary, for a few months only. After 3 months with the permission of your surgeon, you can resume these activities in a gradual manner. There are no lifetime activity restrictions after this surgery.

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