Sievering Surgical Clinic

Sieveringer St 9, A-1190 Vienna Tel: 328 8777

Gastroenterology Unit

Reflux Disease

Diagnosis & Treatment

Reflux disease

Patient information on swallowing disorder

General information on Reflux Disease


Definition

The most common gastro-intestinal peristaltic disorder is esophageal reflux disease. About. 6% of the population suffer on a regular basis. Nearly half of these patients during endoscopic examinations show signs of oesopgageal inflammation.

Gastro-oesophageal reflux is usually accompanied by heartburn senstation but this may lack fully in many patients. Heartburn is a burning sensation in the center of the chest that often occurs after eating, bending over, with exercise, and sometimes at night when lying down. Approximately one in 10 adults has heartburn at least once a week and one in three monthly. Some pregnant women experience heartburn almost daily as a result of increased pressure on the abdomen and hormonal changes. Although its name implies otherwise, heartburn has nothing to do with your heart. Rather, these symptoms indicate a condition called gastroesophageal reflux disease, or GERD. This fact sheet offers some tips on how to relieve heartburn caused by this condition.

What is known is that in the context of reflux disease, a disturbed motility of the esophagus exists. Whether the reflux disease is a primary or a secondary Motilitätsstörung, research must now, however, remain open. What are the manometric findings in patients with reflux disease? From the definition, that peptic stomach contents into the esophagus zurückläuft and then through a longer linger on the corrosive damage that can cause Ösophagusschleimhaut are expected Manometric findings deduce.

Thus, the resting pressure of the lower esophagus Ösophagussphinkters the humiliated, the sphincter may weaken inadequate without previous Schluckakt called "inappropriate relaxation" and thus encourage reflux. Also, the Ösophagusperistaltik is disrupted, i.e. Clearancefunktion of the esophagus, reflux into the stomach to drive is disabled.
Causes

The gastro-oesophageal reflux disease is the most common benign disorder in the gastroenterological practice: according to high medical and economic importance of an effective therapy. Their emergence is probably a combination of four important factors:

    1. The incompetence of the lower Ösophagussphinkters:
    2. A disturbed oesophageal clearance:
    3. The reduction in local protective factors:
    4. Increased aggressiveness of Refluxates. Modulating effect dietary factors and other lifestyle habits.


Very different symptoms, some patients have no symptoms:



     * Heartburn
     * Bloating.
     * Stool irregularities.
     * Gastric gaz.
     * Chronic bronchitis, asthma.

Diagnostic

The way is the history, with the symptom of heartburn at least 80% of the cases is available. The suspected diagnosis is confirmed by the endoscopic evidence of reflux demonstrated by their severity is classified:

Grade l: Punktförmige erosion of the esophageal mucosa

         la) with white coverings = necrosis

         lb) without the pads

Grade II: Linear erosions on the wrinkle ridges

Grade III: circular confluent erosions

Grade IV reflux with complications (stricture, ulcer)

A Barrett's metaplasia per se says nothing about the state of acute inflammation, but has only one previous serious injury to the esophagus reflux out. In special cases (with reflux disease without morphological damage to the esophagus according to a so-called reflux grade 0 or clarification of difficult differential diagnosis against other Ösophagitisformen) is the long-term pH-metry for diagnosis of security required. In the primary diagnosis of reflux disease Manometrie plays a minor role but it is essential before a planned operational anti-reflux surgery.

A crucial criterion for the success of the therapy is still the patient selection, by a preoperative diagnosis must be secured. This includes a history of collecting especially the endoscopic detection, long-term Manometric and pH-metric findings.

Conservative treatment

To treat GERD, we recommend the following:

* Raise the head of your bed by six inches to allow gravity to help keep the stomach's contents in the stomach. (Do not use piles of pillows because this puts your body into a bent position that actually aggravates the condition by increasing pressure on the abdomen.)
* Eat meals at least three to four hours before lying down, and avoid bedtime snacks.
* Eat moderate portions of food and smaller meals.
* Maintain a healthy weight to eliminate unnecessary intra-abdominal pressure caused by extra pounds.
* Limit consumption of fatty foods, chocolate, peppermint, coffee, tea, colas, and alcohol — all of which relax the lower esophageal sphincter. Also, avoid tomatoes and citrus fruits or juices, which contribute additional acid that can irritate the esophagus.
* Give up smoking, which also relaxes the lower esophageal sphincter.
* Wear loose belts and clothing.

 


In less severe cases, almost always a sufficient dietary transition (several small, protein-rich meals throughout the day, the avoidance of later food intake, weight reduction) or a change in lifestyle habits. Symptomatic Antacids can also be given. In moderately severe cases, the H2-receptor antagonists, possibly combined with Prokinetika indicated. With a consistent drug therapy can now almost all of the severity of reflux within three months of successful treatment.

A crucial characteristic of the disease, however, is the persistent recurrence tendency in severe cases, so that even after successful Acute therapy with a recurrence rate of approximately 90% within the first 200 days to be calculated. Logically, therefore, was in further studies a prophylactic treatment with omeprazole reviewed. However, here also showed that despite a daily dose of 20 mg omeprazole, the relapse rate after one year already amounted to 25 ° Z0 and after a further two years to 33% increase.

Apart from the relatively rare cases where a strong component biliary reflux, should the failure of prophylactic therapy primarily to a lack of patient compliance in long-term therapy due. These have contributed surely cast doubt on the drug safety, but also the relatively high cost of long-term therapy.
Surgical risk increases with:

    1. Age on 75th
    2. Overweight.
    3. Smokers.
    4. Alcohol abuse.
    5. Chronic lung disease.

Operational procedures

The back is now waning euphoria about the long-term drug therapy seems today to a new renaissance of surgical anti-reflux therapy be conducted. Moreover, the anti-reflux surgery today in minimally invasive technique can be carried out. thus the "comfort" of the patient in comparison to the previous open surgery significantly improved. The aim of surgical treatment must be present. even under the conditions of the so-called "minor access surgery" the same high level of quality and safety to maintain, which in recent years for open surgery was achieved.

A crucial criterion for the success of the operation is still the patient selection, by a preoperative diagnosis must be secured. This includes a history of collecting especially the endoscopic detection, long-term Manometric and pH-metric findings. It must, above all, those patients will be identified from a surgical anti-reflux therapy no significant improvement of symptoms to expect, for example, patients with non-cardiac-chest-pain, nonspecific dyspepsia, etc. irritabile Colon, where the reflux symptoms only an insignificant part of the overall symptomatology represents.

A second important condition is the election procedure. Until the introduction of laparoscopic anti-reflux surgery was the world's Fundoplicatio after Nissen enforced as a standard procedure.

Treatment approaches by far surpasses, can be expected. The previously discussed often called "Postfundoplikations syndromes" (Cuff solution telescope phenomenon Gasbloat) clinically barely play a role. However, the patient is on passager postoperative dysphagia and limitations in the ability to vomit, however. strictly speaking, these positive results but currently only for the open technique really proven. The real advantage of the laparoscopic approach is the significant reduction of postoperative Hospitalisationszeit and convalescence. Whether this benefits the slightly higher operational expense to justify, it is still in further clinical studies will be evaluated. In each case, including the introduction of laparoscopic Fundoplikatio contributed to the anti-reflux surgical therapy more than once again as an alternative to long-term drug therapy should be considered, especially in severe forms of disease and in younger patients.
After treatment of a routine case: 1 p.o. Days evenings: gavage ex, the removal of Robinson drainage, schluck as tea

2. p.o. Tag: Kostaufbau
Anesthesia General anesthesia.

Possible complications

    1. Dysphagia (swallowing disorder).
    2. Pneumonia.
    3. suture leakage.
    4. Wound healing.
    5. Thromboembolic complications

Length of hospital stay 4-7 days per course after

Glossary of Terms

Seminars

More information on reflux disease Reflux disease

 

 

| 25.01.2011 | Read more | Print |

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