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What is fundoplication?
- Fundoplication is the standard surgical method for treating gastro-esophageal reflux disease (GERD).
- GERD causes inflammation, pain (heartburn), and other serious complications (such as scarring and stricture) of the esophagus.
- GERD results when acid refluxes (regurgitates, or backwashes) from the stomach back up into the esophagus.
- Under normal conditions, there is a barrier to the reflux of acid from the stomach. One part of this barrier is the lower-most muscle of the esophagus (called the lower esophageal sphincter). Most of the time, this muscle is contracted (constricted, or tight), which closes off the esophagus from the stomach.
- In patients with GERD, the sphincter does not function normally. The muscle is either weak or relaxes inappropriately.
- Fundoplication is a surgical technique that strengthens the barrier to acid reflux when the sphincter does not function normally.
What happens during fundoplication?
During the fundoplication procedure, the part of the stomach that is closest to the entry of the esophagus (the fundus of the stomach) is gathered, wrapped, and sutured (sewn) around the lower end of the esophagus and the lower esophageal sphincter. (The gathering and suturing of one tissue to another is called plication.) This procedure increases the pressure at the lower end of the esophagus and thereby reduces acid reflux.
Also, during fundoplication, other surgical steps frequently are taken that also may reduce acid reflux. For instance, if the patient has a hiatal hernia (which occurs in 80% of patients with GERD), the contents of the hernia sac (the stomach) may be pulled down from the chest and the opening the diaphragm (the hiatus) through which the esophagus passes from the chest into the abdomen sutured so that stomach remains within the abdomen. Fundoplication may be done using a large incision (laparotomy in the abdomen or thoracotomy in the chest) or a laparoscope, which requires only several small punctures in the abdomen. The advantage of the laparoscopic method is a speedier recovery and less post-operative pain.
What are alternatives to fundoplication?
Although fundoplication is the standard surgical method for treating GERD, endoscopic methods for treating GERD are being developed. Endoscopy utilizes endoscopes, which are long flexible tubes that are passed by the doctor through the mouth into the esophagus and stomach. The inside of the esophagus can be viewed through the endoscope and various instruments can be passed through channels in the endoscope.
In one endoscopic method for treating GERD, an instrument is inserted that delivers an electrical current to the lower esophageal sphincter. This results in scarring which tightens the sphincter. In asecond method, sutures are placed in the sphincter to tighten the sphincter. Another treatment for GERD invloves placing a ring around the lower esophageal sphincter to prevent acid from refluxing into the esophagus. This is called the LINX procedure.
Other methods also have been employed experimentally. Endoscopic methods offer a simpler way of treating GERD than fundoplication. As more data is being accumulated as to how effective, safe, or long-lasting they are, their use is increasing.
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Endoscopy is a broad term used to described examining the inside of the body using an lighted, flexible instrument called an endoscope. Endoscopy procedure is performed on a patient to examine the esophagus, stomach, and duodenum; and look for causes of symptoms such as abdominal pain, nausea, vomiting, difficulty swallowing, or intestinal bleeding.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes. Signs and symptoms of esophagitis include:
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- Chest pain
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- Sore throat
- Difficulty swallowing
Treatment of esophagitis includes diet, lifestyle changes, and medication depending upon the cause.
Esophagus PictureThe esophagus is a muscular tube connecting the throat (pharynx) with the stomach. See a picture of the Esophagus and learn more about the health topic.
Gastroesophageal Reflux Disease (GERD)GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are:
- regurgitation, and
Take the GERD QuizWho is at risk for developing GERD? Are you? Take this quiz to learn what GERD is, if you're at risk, and what you can do about it.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest.
Causes of heartburn include dietary habits, lifestyle habits, and medical causes.
Treatments for heartburn include lifestyle changes, OTC medication,prescription medication, and surgery.
Heartburn and Pregnancy
Heartburn during pregnancy is quite common. During pregnancy the lower esophageal sphincter muscle becomes weakened , which likely occurs due to the effect of the high levels of the hormones estrogen and progesterone during pregnancy. Fortunately, this resolves after pregnancy. Management of heartburn during pregnancy are generally involves lifestyle changes and avoiding foods that promote heartburn, for example, don't smoke, avoid tight clothing, eat small, frequent meals, chew gum, or sip liquids.
The effect of heartburn medications on the fetus is unknown, so it is best to check with your OB/GYN if you feel you need medication to treat heartburn.
Heartburn Foods SlidesLearn the symptoms of heartburn and which foods cause heartburn or GERD. Discover home remedies and which foods may provide treatment for heartburn relief.
Hiatal Hernia Overview
Hiatal hernia is a condition in which a thin membrane of tissue connects the esophagus with the diaphragm becomes week, and a portion of the stomach slides up into the esophagus. Causes include obesity, pregnancy, straining during a bowel movement, aging, and ascites.
There are generally no symptoms of a hiatal hernia, and it is discovered during another medical procedure to test for GERD, or other swallowing problems.
LaparoscopyA laparoscopy is a minimally invasive surgical procedure that is used to treat diseases of the gastrointestinal tract. Surgery is performed through three or more 5 to 10 mm incisions in the abdomen. A blood test, lung function test, ECG, chest X-ray, and other tests may be performed prior to surgery.
Reflux laryngitis is caused by acid refluxing back up through the esophagus and voice box. Reflux laryngitis causes irritation and inflammation of the lining of the esophagus, larynx, and throat; and can lead to symptoms, signs, and other problems like esophagitis, sinusitis, strictures, throat clearing, swallowing problems, asthma, chronic cough, and growths on the vocal cords. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat.
Reflux laryngitis can be treated with diet chanes, OTC medication, prescription medication, and lifestyle changes.
Surgery QuestionsSurgery is the branch of medicine that employs operations in the treatment of disease or injury. Prior to surgery you might consider asking your surgeon questions about the operation (procedure).
The Digestion Process (Organs and Functions)Digestion is the complex process of turning the food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food. Learn more about digestion and the body parts that make it possible, including the:
- small intestine,
- liver, and