There is usually a circular ring of muscle at the lower end of the esophagus called the lower esophageal sphincter. After swallowing, this muscle relaxes, allowing food to enter the stomach, and then contracts to prevent food and acidic contents of the stomach from entering the esophagus. However, when this muscle is weak or relaxed, acidic fluid from the stomach may flow back into the esophagus and damage the esophageal mucosa.
What are the typical symptoms of GERD?
Typical symptoms of GERD include acid reflux, heartburn, and difficulty swallowing.
How is GERD diagnosed in patients with these clinical symptoms?
The preferred method of diagnosis is upper gastrointestinal endoscopy. In patients with normal endoscopy but persistent symptoms, lower esophageal manometry and 24-hour monitoring of esophageal acid reflux are further diagnostic methods.
What are the complications of prolonged acid reflux?
If left untreated, prolonged GERD can lead to ulceration of the esophageal mucosa, esophageal stricture, aspiration pneumonia, sore throat and Barrett’s esophagus (risk of progression to esophageal cancer).
How severe is GERD that requires surgery?
Surgery is required when a patient presents with symptoms that
Not responding well to medication;
Inability to take medication on time due to occupation or other reasons;
A large amount of reflux;
Endoscopic findings of severe esophagitis;
Benign esophageal strictures;
Barrett’s esophagus (no poor differentiation or cancer).
What is the best procedure to treat GERD?
Laparoscopic fundoplication is now recognized worldwide as the gold standard for the treatment of severe GERD. The procedure involves wrapping the upper part of the fundus around the lower esophagus to create an anti-reflux valve. The operation is performed with five small incisions of 5 mm to 10 mm. Compared to traditional open-heart or open-chest surgery, it is less invasive, results in shorter hospital stays, reduces blood loss and patient pain, improves quality of life, and more importantly, provides the same long-term anti-reflux results as traditional surgery.
Are there any complications of the surgery?
Bloating and dysphagia are the most common postoperative complications, occurring in about 5% of cases. However, the majority of symptoms resolve two to three months after surgery. Only a very small number of patients require endoscopic esophageal dilatation.
How long is the hospital stay? How long is the procedure?
The postoperative hospital stay is only two to three days. The average procedure time is 90 minutes.