Oesophagus or the food pipe passes from the chest in to the abdomen traversing a partition ( diaphragm ) through a gap called as Hiatus and enters the stomach at oesophago gastric junction.
The oesophago gastric ( OG ) junction is a high pressure zone of 3-4 cm length just above the stomach.
What does OG Junction do?
OG junction prevents reflux of gastric contents into the chest, during times of increased intra abdominal pressure by increase in its tone. It also relaxes when a oesophageal peristalsis pushes the food across it while eating.
What are symptoms of reflux disease ?
Typical symptoms are those of heartburn /regurgitation ,made worse when patient bends or lies down.
There may be difficulty in swallowing, Nocturnal cough or blackish stools due to oesphageal ulcers.
What is Hiatus Hernia?
Oesophagus crosses the diaphragm at the Hiatus. Sometimes this hiatus is too lax. This allows the abdominal organs, usually stomach or sometimes colon to travel upwards into the chest.
This condition is called hiatus hernia.
How is Gastro esophageal reflux diagnosed?
Reflux is diagnosed by a simple OPD Level test called as endoscopy in which a camera is introduced through the mouth into the stomach to see the inners of oesophagus and stomach.
Endoscopy shows the evidence of reflux such as oesophageal erosion/Ulcer.
How to treat reflux?
Vast majority of reflux disease are treated with Dietary management and life style modification and Medicines.
But in case of endoscopic e/o damage to esophageal mucosa, the disease has to be treated surgically.
Why to treat a reflux?
An neglected reflux besides discomfort to the patient, due to the constant damage of oesophageal mucosa can cause complications such as erosions, ulcer, stricture or even an oesophageal cancer.
Surgical treatment is an option in two types of patients.
- When medical treatment has failed.
- In young individuals in whom medical treatment has been successful but wish to lead a medication free life.
The surgical option for reflux disease is called as Fundoplication.
In this, the Fundus ( Upper part ) of stomach is wrapped around the lower oesophagus to create an artificial valve mechanism which prevents reflux and herniation of abdominal organs into the chest.
The surgery can be carried out laparoscopically ( Key Holes )and needs 1 day of hospital stay.