At Home Christian Jessen 2014 - 91

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How is acid reflux treated?

It is a chronic disease that requires a change
of lifestyle and long-term medical therapy:
* Anti-reflux measures: Avoid late meals,
stop smoking, raise the head of the bed,
avoid being overweight and reduce intake
of caffeine, spicy food and chocolate
* Medication: Antacids (Rennie, Gaviscon),
Zantac (Ranitidine) and Proton Pump Inhibitors
(PPIs) such as Omeprazole and Lansoprazole.
These medications tend to neutralise the acid
or reduce its production within the stomach
* Prokinetics: Anti-sickness medications that
will speed up the emptying process of the gullet
and stomach. This will reduce the risk of the
refluxed acid irritating the gullet

What are the surgical options?

Lump in
your throat?

In the UK, 25% of adults experience symptoms of reflux weekly,
and 5-10% have the symptoms daily. Are you one of them?

n

ormally, food and drink
travels one way from the
gullet to the stomach. If it
travels the opposite way,
it is called reflux, which can occur at
any time or position, and with any food.

This will result in a sensation of acid (heartburn)
felt in the lower part of the chest. It is a very
common symptom that affects around 50% of
the western population at least once a month.

Why does acid reflux occur?

Food passes down the gullet (also known as the
oesophagus) into the stomach. There is a band
of muscle (a sphincter) between the gullet and
stomach which relaxes to allow food down, but
then tightens up to stop food leaking back up.
However, a defect in this ring can cause food
and drink, mixed with acid in the stomach, to
trickle into the gullet leading to irritation. This
is associated with sliding of the upper part of
the stomach into the chest (a hiatus hernia).

What are the symptoms?

Acid reflux symptoms can include:
* Heartburn
* Acid regurgitation into the gullet
* Discomfort, pain or soreness with swallowing

* Atypical symptoms: cough at night, sensation
of foreign body in the throat, husky voice, chest
pain, asthma and recurrent chest infection
How is acid reflux diagnosed?

The severity of irritation at the lower gullet could
be confirmed during endoscopic (telescopic
camera) examination. This involves passing a thin,
flexible tube with a camera at its tip down into the
gullet. An alternative is 24-hour pH monitoring;
this test will measure the level of acid reflux to the
lower gullet using a fine thin tube through the nose
into the gullet which stays for a 24-hour period.
You should seek medical help when persistent
acid reflux symptoms are not responding to
anti-reflux measures, particularly if you are having
trouble with swallowing food, nausea, vomiting,
weight loss, anaemia or bleeding.

Is acid reflux dangerous?

Occasional reflux symptoms carry no harm but
persistent reflux could cause ulceration, bleeding
or scarring. Long-term uncontrolled reflux
symptoms may lead to the development of
Barrett's lining of the oesophagus; this is a change
of the lining of the lower gullet. Such lining carries
a small risk of developing cancer in the future and
needs regular endoscopic surveillance.

Although surgery is the only effective and longterm therapy for recurrent progressive reflux induced
inflammation of the gullet, it is only used in around
10% of cases. The operation includes tightening
the lower oesophagus valve to prevent acid
leaking up from the stomach and repairing
any associated hiatus hernia. This is usually
done through keyhole surgery (laparoscopic) with
quick recovery. It is used when:
* There are persistent symptoms in spite
of medical therapy for at least six months
* Patients are unable to continue on the
medication for one reason or another
* Patients have a large hiatus hernia, which
carries a risk of twisting on itself; a serious
complication of hiatus hernia

MEET THE ExPERT

Mr Al-Bahrani (pictured,
bottom right) completed
his Oesophago-Gastric
(OG) cancer resection
training at the Addenbrooke's
Hospital in Cambridge
Currently, he is the lead clinician of the
Upper Gastrointestinal unit at Watford
General Hospital (WGH), Hertfordshire, as
part of the Mount Vernon Cancer Network.
He introduced the enhanced recovery
programme for OG cancer patients at
WGH. He did a fellowship at Seoul
National University Hospital in South
Korea, a world-leading centre in gastric
cancer treatment and research. He is
specialised in benign and malignant
(cancer) conditions of the oesophagus
and stomach, and general surgery.

FOR MORE INFORMATION
Visit www.mralbahrani.co.uk
Call Marguerite Watkins (secretary)
on 01582 765015.
Email primesecretarial@gmail.com
Call Spire Bushey Hospital, Bushey,
Watford on 0208 901 5555 or call
Spire Harpenden Hospital, Harpenden
on 0800 585112.


http://www.mralbahrani.co.uk

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