MBBS, MS – General Surgery
These are known as proton pump inhibitors. There are several different types of proton pump inhibitors. These drugs dramatically reduce the gastric acid shutting it down to minimal levels.
Recently, a case of endoluminal perforation has been reported with MSA resulting in severe dysphagia . PPIs have been the mainstay of medical management of GERD. However, about 20% to 30% of patients with erosive reflux disease and 40% of patients with non-erosive reflux disease do not respond to PPIs.
On the other hand, patients with extraesophageal symptoms are much more difficult to diagnose and should undergo pH monitoring sooner in the diagnostic algorithm. Unremitting GERD can result in complications including esophagitis with scarring and stricture formation, Barrettâ€™s esophagus and cancer, specifically adenocarcinoma. These types of symptoms may often require daily medication, which can be a significant adverse impact on the patientsâ€™ quality of life.
It is placed laparoscopically around the lower esophageal sphincter (LES) without altering hiatal or gastric anatomy. The beads separate during swallowing as well as during belching or vomiting . Therefore, adverse events, such as dysphagia, inability to belch, and vomiting, are less frequent as compared to the traditional ARS. A published literature suggests that MSA is equally effective with less procedure duration as compared to ARS . The most common adverse event with MSA procedure is dysphagia for which the device may have to be removed in some patients.
This causes heartburn and other symptoms. Chronic or severe acid reflux is known as gastroesophageal reflux disease (GERD). Fundoplication is known as Laparoscopic Nissen fundoplication. It is a surgical procedure where the upper curve of the stomach is wrapped around the oesophagus and stitched.
It is important that you discuss the costs of this, and all, procedures with your insurance carrier, your doctor, and your hospital prior to deciding on the correct procedure for you. The preparation for this procedure is much like preparing for fundoplication. But, you should check with your doctor about the correct preparations for you.
Post operatively after 6 hr of surgery liquids were initiated to the patient and they were given liberally after an hour of tolerating the same. The patient was discharged for follow up after having liquids. 47. Lipham JC, Taiganides PA, Louie BE, Ganz RA, Demeester TR. Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease.
The introduction of magnetic sphincter augmentation (MSA) has marked the beginning of a new era in the surgical management of these patients. MSA device (LINX System; Torax Medical Inc., Shoreview, MN, USA) consists of a small flexible band of interlinked titanium beads with magnetic cores.
Some patients will be subjected to surgical management with Laparoscopic Fundoplication, which involves making incisions in the torso and wrapping part of the stomach around the base of the esophagus, which is the gold standard for efficacy. Though surgery posts its own risks and post-operative issues, there was no other option around until recently, when Stretta therapy was introduced. There are also other medication which are used in some very particular cases, some of them are Sucralfate acid suppressants, Potassium competitive acid blockers, GABA receptor agonist, transient lower esophageal sphincter relaxation reducers . In some very peculiar conditions, some other drugs used are selective serotonin reuptake inhibitors , tricyclic antidepressant, prokinetic agents and pain modulators.
Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/statbriefs/sb44.js. Accessed December 19, 2012. Currently, this procedure is indicated for patients over 18 years whose GERD symptoms are not adequately controlled by other methods, who do not have hiatal hernia or history of hiatal hernia, are healthy enough to undergo anesthesia and laparoscopic surgery, do not have any other metal implants (such as pacemakers), and do not have a diagnosis or any history of psychological disorders (particularly schizophrenia or psychotic disorders). During clinical trials, a patient with schizophrenia reported psychosomatic symptoms that the patient believed were caused by the implant. Further research is needed for the implantâ€™s appropriateness for patients with a diagnosis of psychological disorders.
Key Medical Procedures
Moreover, no significant improvement is observed in symptoms with doubling the dose of PPIs . The potential adverse effects of using PPIs for long term are also a matter of concern. These adverse effects include Clostridium difficile infection, bone fractures, hypomagnesemia, and higher incidence of chronic kidney disease in susceptible populations [3-5].
Ask your doctor about relaxation techniques, such as progressive muscle relaxation or guided imagery. Herbal remedies. Herbal remedies sometimes used for GERD symptoms include licorice, slippery elm, chamomile, marshmallow and others. Herbal remedies can have serious side effects, and they may interfere with medications.
Elderly patients are also at higher risk. Obese patients should be thoroughly evaluated before surgery. Recovery is slightly different for each type of surgery, but depends primarily on whether your surgery is laparoscopic or traditional. While laparoscopic surgery has a quicker recovery time and less pain that traditional, it may not be appropriate for every person with GERD.
Hernia Repair Surgery
In some very rare cases if the medication is not effective then acid reflux can also be treated by a surgery known as Fundoplication. Acid reflux is a very common condition in which you feel a burning pain in your lower chest area, this is also known as heartburn. This happens when the stomach acid flows back up into the food pipe. There is a valve at the entrance of your stomach which a ring of muscles called the lower esophageal sphincter .