Medical management has been revolutionised by proton pump inhibitors such as oemeprazole and lansoprazole. This decreases the amount of acid produced from the stomach and therefore improves symptoms. However, since this is a new drug, the long term effects of it use are unknown. It is known to cause osteoporosis and interacts with platelet drugs such as aspirin. The link to cancer is unknown.
Simple measures to manage reflux are:
- avoid foods that trigger symptoms as occasionally there can be an allergy component
- stop smoking
- avoid alcohol
- not to eat too late at night
- sleep with an extra pillow
- weight loss, this is the most important thing if your BMI is over 25, if your BMI is over 30 then actually a gastric bypass would be the correct operation to cure the reflux and help reduce weight.
Anti-reflux surgery is safe with excellent results. Patients who can be considered for surgery are as follows:
- patients not able to tolerate medications such as lansoprazole due to side effects
- patients not wishing to take medication for the rest of their life
- patients who are still symptomatic despite medication or requiring double doses of medication
Mr Sultan would be delighted to assess you if you have the above or just want some advice on management of reflux, please contact us to book your private consultation. Following a consultation Mr Sultan would perform an endoscopy to assess for inflammation and a hiatus hernia. If there are swallowing problems then samples from the oesophagus would be taken.
There are two ways to measure the actual reflux produced. Firstly, a probe can be passed through the nose into the oesophagus and remains in place 24 hours and patients are asked to perform normal activities without taking medication and acid levels are measured. Secondly, an alternative which is not available on the NHS is the Bravo capsule test. This does NOT involve a probe through the nose so is much more comfortable and the capsule is placed at the time of endoscopy. This also measures the acid levels over a 48 hour period and all you have to do is carry a small bag which collects the data wirelessly.
Following this, Mr Sultan will re-assess things in clinic and discuss surgery further if appropriate. The operation performed is a laparoscopic Toupet fundoplication. This is a keyhole procedure performed with 5 small scratches and the hiatus hernia is fixed and the stomach is wrapped around the gullet 270 degrees to prevent reflux. It is safe and can de performed as a day case. You would need to remain on a sloppy diet for 6 weeks and then the majority of time swallowing returns to normal. Care must be taken with bread and meat. To gain the rewards of curing the reflux, there can be some side effects such as flatulence, gas bloat, diarrhoea and recurrence of symptoms. 90% of patients are happy at 10 years as a general rule. Please contact us to book your private consultation.