I recently had surgery for a hiatus hernia and reflux, performed by Mr Jenkinson. The whole experience went very smoothly, with minimal pain and discomfort right after surgery, and a recovery process that has been, so far, very straightforward.
Having surgery is no picnic for anybody to undergo, but I feel very fortunate that Mr Jenkinson was my doctor. He communicates in a very confident, clear and reassuring manner, tempered with kindness. I felt from the start that I was in good, experienced, skilful hands, and so it has proved.
All of the arrangements around the procedure were handled very efficiently and pleasantly, by Natalie, which reduced the stress considerably. I am most grateful that I can now look forward to a better quality of life.
Everyone has experienced the uncomfortable feeling of heartburn when acid refluxes from the stomach into the oesophagus (gullet). To experience this occasionally is normal.
However, if acid regurgitation into the oesophagus becomes more frequent, it can start to have a detrimental effect on a person’s health and sense of wellbeing. This condition is termed acid reflex disease, or in medical language, gastro-oesophageal reflux disease (GORD).
The good news about acid reflux disease is that if it is investigated appropriately and diagnosed accurately, then there are extremely good treatment options both through drug therapy or safe surgery.
What is the Relationship Between Acid Reflux and A Hiatus Hernia?
In normal anatomy, the oesophagus passes from the chest cavity into the abdominal cavity through a small hole in the diaphragm. A hiatus hernia occurs when this hole becomes bigger. Because the abdominal pressure is greater than the chest cavity pressure, the upper stomach is sucked through the hole in the diaphragm from the abdomen into the chest, this causes regurgitation of stomach acid into the oesophagus and unpleasant heartburn sensations.
Hiatus hernias are common, they will affect approximately 20% of people. Not everyone with a hiatus hernia will develop reflux, however if you suffer with severe acid reflux and have a hiatus hernia, then it is likely that a surgical operation to fix this anatomical abnormality will help resolve your symptoms.
What are the Symptoms?
The three most common symptoms associated with reflux of acid into the oesophagus are:
- Heartburn, which typically is a deep burning sensation in the chest
- Acid regurgitation or the feeling of acid or bile in the back of the throat
- Dysphagia or difficulty with swallowing, particularly dry, solid food
These are the three most common symptoms that doctors will associate with reflux disease, however there are several much less common symptoms that can be caused by acid reflux that may be missed by your doctor. These include:
- A hoarse voice
- A chronic cough, particularly at night
- Wheeziness or asthma
- Recurrent chest infections
- Recurrent sinusitis
How is Acid Reflux Diagnosed?
The most common test for reflux disease is the gastroscopy, this involves looking at the oesophagus and stomach through a flexible telescope.
If the gastroscopy does not show any abnormality in the oesophagus caused by acid reflux, then further investigation with measurement of the pressures in your oesophagus and direct measurement of acid reflux over 24 hours using a sensor can be recommended. This is called oesophagus manometry and 24 hour pH measurement.
The third investigation that sometimes is considered for acid reflux disease is the barium swallow and meal. This involved the swallowing of a liquid which shows up on an X-ray video camera.
What are the Treatment Options?
Treatment of acid reflux and its symptoms should start with some changes in lifestyle that may be all that is required. These changes would include avoiding foods and drinks that may contribute to acid reflux episodes such as; caffeine, alcohol, spicy foods and chocolate and stopping smoking.
The time of the evening meal should also be altered so that there is adequate time for stomach emptying before lying down in bed. There should at least 4 hours between the last meal, snack or drink and bedtime.
Being overweight or obese contributes to acid reflux and therefore weight loss can have an effect on improving symptoms.
Drug Treatment
The mainstay of treatment is drugs that will profoundly suppress the amount of acid that the stomach secretes. These drugs are called proton pump inhibitors (PPIs). The two most common of these drugs are Omeprazole (Losec) or Lansoprazole (Zoton). These drugs are highly effective in treating the symptoms of acid reflux disease. If a low dose of the drug does not work, the dose can be increased significantly from one tablet a day to up to three tablets twice a day. Most patient’s symptoms will be significantly improved with PPI therapy.
What is the Surgical Treatment of Acid Reflux Disease?
Anti-reflux surgery is an extremely effective treatment for acid reflux disease. It is usually only indicated in patients who have not had a significant effect from acid suppression drug therapy, or do not want to take drug therapy long term.
Anti-reflux surgery is performed via laparoscopic or keyhole surgery. It requires a general anaesthetic and the duration of the procedure is normally approximately one hour. A patient will stay in hospital usually for one night.
The operation involves the wrapping of the floppy upper part of the stomach (fundus) around the weakened lower oesophagus sphincter valve. This causes a much more effective and strong sphincter to prevent acid refluxing from the stomach into the oesophagus.
What are the Effects and Side Effects of Surgery?
In patients who are refractory to drug treatment, anti-reflux surgery normally has an excellent effect in curing their symptoms. The vast majority of patients will no longer need to take any type of acid suppression drug and will not notice any further symptoms such as heartburn or acid regurgitation following surgery.
There are, however, common side effects to the operation that a patient needs to be aware of. Because the new valve can sometimes be tight, this can lead to an initial difficulty with swallowing, particularly of dry foods such as bread and chicken. In the vast majority of patients however, any initial difficulty swallowing will settle within days or weeks. Other common side effects include difficulty with belching or vomiting. This can cause an increased build up of gas within the stomach, the feeling of bloating in the abdomen and increased passage of flatus and/or diarrhoea. Again, these side effects will settle down within a few weeks of the operation.
The main message is that if reflux is a real problem for you then surgery to fix this is safe and highly effective.