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Reflux Operation: What do I need to know?

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Heartburn (pyrosis) is a disturbing symptom of reflux of aggressive stomach acid into the esophagus. If acid inhibitors no longer help and a change in the stomach's position can be detected, surgery can help to reduce the symptoms. The following text presents the currently available keyhole surgeries and explains the risks.

In a reflux disease, aggressive gastric acid flows back into the esophagus and irritates the mucous membrane there. In 90% of cases, it is responsible for a shift of the stomach. He is then no longer completely in the abdominal cavity, but slips through a hole in the diaphragm into the chest (hiatal hernia). During an operation (antireflux operation), the stomach can be pulled back into the abdomen and the passage of the stomach through the diaphragm be narrowed [2]. This is done either by a direct suture or a net is sewn into the diaphragm. This quite new operation method is called 3-shift procedure. In order to prevent the stomach from re-sliding upwards and to establish a more favorable angle between the stomach and the esophagus, the upper part of the stomach is sutured to the diaphragm (fundopexy).

To reduce gastric acidity in the esophagus, the gastric entrance is additionally narrowed. For this purpose, the upper part of the stomach is formed into a cuff and placed around the rest of the stomach [2]. It creates so under the actual stomach entrance another intended bottleneck. Depending on whether the stomach is folded in half and is sutured to the opposite diaphragm or a complete cuff is formed from the upper stomach, this surgery is called Semifundoplicatio (after Toupet) or Fundoplicatio (after Nissen-Rosetti).

All these operations can all be performed with a keyhole technique in most cases. This means that only very small cuts in the abdomen have to be placed and operated with the help of a camera and specially made instruments in the abdomen. Experience reports have confirmed that this method can lead to a faster recovery time and above all to less pain after the operations.

As with any surgery, there are basically risks of bleeding or injury to nerves and surrounding organs and a risk of infection. However, keyhole technology has made these risks very rare. If the gastric cuff is stitched too tightly, some patients experience difficulties with swallowing, which usually recede after three to twelve months. Partial gas from the stomach can no longer escape through the narrow esophagus, a regurgitation is impossible. Ingested air and gases in the stomach must then find their way through the intestine, which can manifest itself in a feeling of fullness and flatulence. If the stomach slips out of the sewn cuff, a second operation must be done in rare cases.

Many people suffer from it: Burning pain behind the sternum, pressure in the stomach area and acid regurgitation after eating. Often the symptoms get worse in a lying position, when drinking alcohol or after consuming acidic foods. Popularly these complaints are called heartburn. They are - if they occur more frequently - expression of another disease: gastroesophageal reflux disease (GERD). Those who suffer from heartburn are not alone in this, because about 20% of the population in the western industrial nations suffer from it.

There are several surgical options for gastroesophageal reflux, but all have in common that some important criteria must be met.

First of all, surgery should only be considered if there is a long-term need for treatment and effective acid blocking drugs can not relieve the symptoms. This means that the heartburn over long periods of time must occur again or constantly. If this is the case, some research must be done to objectively measure the extent of reflux. This includes a so-called pH-metry, ie a measurement of the pH value in the lower esophagus. This measurement shows how severe the acid load in the esophagus actually is and how often it occurs. In addition, it can be measured by means of a manometry, how strong is the relaxation of the circular muscle actually and whether additionally there is a paralysis of the esophagus. Only in combination of these results of the examination with the patient's psychological stress should the possibility of surgery be discussed. It is also important that all drug treatment options should be exhausted. In rare cases patients suffer from intolerance to proton pump inhibitors. If you can not tolerate omeprazole and pantoprazole, but you still have constant gastroesophageal reflux, surgery may be a good long-term alternative.

Oatmeal consumption reduces the likelihood of heartburn. In heartburn, stomach acid rises into the esophagus and causes chest and neck pain. This happens over a longer period of time it is called reflux disease. The mucous membranes of the esophagus can take permanent damage. The high content of fiber in oatmeal binds the stomach acid and thus reduces the amount of acid present. The likelihood of gastric acid secretion into the esophagus is reduced and the symptom of heartburn is temporarily improved.

How and why do oatmeal help with heartburn?

Oatmeal is made from seeds of oats. To understand the effects of oatmeal in the stomach, the properties of the oat seed must be considered.

Germination is primarily by water absorption. The large amount of fiber acts as a kind of sponge. When the oat seeds come into contact with water, it "sucks up" the liquid. The stored water causes the fibers to swell and the shell of the seed bursts. The plant begins to germinate. This mechanism of fluid retention is used in the treatment of reflux disease. The oatmeal reaches the stomach with food and absorbs the gastric juice there.

The sour porridge then passes into the intestine, where the acid is neutralized by the juice of the pancreas. The reflux disease is mainly caused by a disturbed closure of the stomach entrance. This can be favored by overweight. Oatmeal can also help in reducing weight (weight reduction) in regular use in addition to the acid-reducing effect. The swelling effect of oatmeal produces a faster and longer-lasting satiety.

In summary, fiber in oatmeal reduces the incidence of heartburn. When taken regularly, they are proven to reduce the development of reflux disease and its associated sequelae, such as oesophageal mucosal changes (such as Barrett's esophagus) and esophageal cancer.

GermanMedicalGroup + 49 (7221) 39-65-785 Flugstrasse 8a 76532 Baden-Baden Germany Reflux Operation: What do I need to know? Reflux Operation: What do I need to know? 2018-05-12 Reflux Operation: What do I need to know?

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