I have heartburn - What does this mean?

Gastro oesphageal reflux disease (GORD) is the medical term for heartburn and is a common condition due to reflux of acid from the stomach into the oesophagus. A mild degree of acid reflux happens in everyone from time to time and is normal. When this becomes severe or frequent, or if there is associated damage from chronic reflux, then this is considered abnormal and treatment may be warranted. Patients with GORD sometimes also have a hiatus hernia, which is when part of the top of the stomach slips up into the chest due to a widened weakness in the diaphragm (the “hiatus”).

Symptoms of acid reflux are variable, ranging from no symptoms, to relatively minor ones controlled by lifestyle changes or medication, to severe ones unresponsive to medication. Symptoms may also be classified as typical or atypical, which may help predict whether surgery is likely to be helpful. Typical symptoms include heartburn and acid or fluid regurgitation into the mouth, which may be worse when bending over or lying down. Many patients would have tried anti-acid medications themselves or prescribed by their GP or gastroenterologist. An at least partial relief of symptoms with anti-acid medication is a good sign that surgery may help. Atypical symptoms may include chronic cough or asthma-like symptoms, throat symptoms like pain or hoarseness, pain in the upper part of the abdomen, difficulty swallowing food, and vomiting after eating. Patients with atypical symptoms may have other reasons for their symptoms and usually require more investigations, often by other specialists.

What tests are required?

Prior to consideration for surgery, patients may require a number of tests, such as gastroscopy (examination of the esophagus and stomach with a flexible camera, done as a daystay procedure under light sedation). Others may require more complex tests such as measurement of acid and pressure within the esophagus. If necessary, your surgeon may refer you to a gastroenterologist to carry out these investigations. If the diagnosis is uncertain, imaging such as a CT or Ultrasound scan may be requested.

What is the treatment for GORD?

The treatment for GORD begins with lifestyle measures such as weight loss (if required) and avoidance of certain foods or stopping smoking. Other options include anti-acid medications which have often been prescribed by your GP already. If these strategies are unsuccesful, surgery can be considered after careful work-up.

Anti-reflux surgery (also known as fundoplication) are operations to treat gastro-oesophageal reflux disease (GORD). Anti-reflux surgery aims to restore some of the anti-reflux mechanisms that are defective in patients with GORD. This involves fixing the hiatus hernia and performing a fundoplication, where a floppy part of the stomach is used to form a “wrap” around the oesophagus, reducing acid reflux. These operations are usually done laparoscopically or robotically.

What can I expect after surgery?

Patients with typical symptoms usually get a very good result with anti-reflux surgery, with most patients (>80-90%) getting substantial improvement or complete resolution of their symptoms that is durable for many years. There are some risks with surgery but they are relatively small and most patients will have a straightforward recovery. Patients can expect to spend 2-3 nights in hospital and be on a pureed or blended-food diet for 3-4 weeks afterwards. Once recovered, patients will generally return to a completely normal lifestyle.

The content is to be used as a guide only. Always consult your specialist to determine information relevant to you and your circumstances.