Wirral Life July 2017 | Page 63

W MEDICAL L “IT BURNS!” HEARTBURN, INDIGESTION AND REFLUX BY CONOR MAGEE MD FRCS, CONSULTANT SURGEON I’m currently watching the television- not BBC4, I’m afraid but Hollyoaks! During the break I chanced on advert that informed me there are liquids you can buy for “both kinds of indigestion. This brought a wry smile to my face- indigestion is just one name for a wide variety of symptoms patients can present with. At medical school we learnt of “dyspepsia”- simply meaning “disturbed digestion”. The difficulty with dyspepsia is that it’s different for everybody, fortunately the commonest cause for dyspepsia is simple to diagnose and can be treated very effectively. Most patients will have “Gastro-oesophageal Reflux Disease- GORD”. This describes the condition when contents from the stomach “reflux” (or head back) to the oesophagus (gullet). The oesophagus is the tube between your throat and the stomach whose function is to propel food down in to the stomach. The stomach then digests your food- it’s a muscular organ that churns food and secretes hydrochloric acid to break down proteins. The stomach has a protective layer to help prevent the acids attacking it- this layer is not present in the oseophagus. Normally there is a valve at the bottom of the oesophagus that stops the stomach contents from re-entering the oesophagus. People who have GORD have a weak valve and this allows acid-rich stomach contents to reflux into the sensitive oesophagus causing a characteristic burning sensation in the centre of the upper abdomen that can radiate into the chest. It can be especially problematic at night- often in combination with a hot curry and alcohol- because when you lie flat it is easier for the acid to reflux back. In extreme cases the valve is so weak, patients will vomit undigested food at unexpected times! Often patients will also have an “hiatus hernia”. A hiatus hernia simply means that part of the stomach slides into the chest alongside the gullet. It’s incredibly common, but important to realise it is not a hernia in the abdominal wall- there won’t be a lump to feel- many times patients have asked me why they can’t feel their hiatus hernia! Before talking about how to treat reflux it is of vital importance that patients should seek advice from their GP first. In some cases, reflux can be seen in patients with oesophageal or stomach cancer- any patient, particularly in their 50s or older, with new onset reflux must see their GP!! For many patients the symptoms are mild and can respond to simple liquids that soothe the lining of the gullet (e.g. Gaviscon) or tablets that help neutralize stomach acid (e.g. Rennies). NISSEN FUNDOCPLICATION SHOWING STOMACH WRAPPED AROUND GULLET TO MAKE TIGHTER VALVE General Practitioners often prescribe tablets that can reduce the amount of acid the stomach secretes or even abolish it completely - however it is prudent that patients should undergo a gastroscopy (telescope examination of the gullet and stomach) before starting treatment. Not only can this identify the inflamed oesophagus (oesophagitis) that is characteristic of GORD but it can rule out dangerous conditions such as cancer, or spot conditions that can give rise to cancer if left unchecked. Many patients worry about having a gastroscopy, but it is a simple procedure that often doesn’t require sedation (I have had one and can say it was little more than uncomfortable!). But where do I as a surgeon come into this? Well, there are patients who continue to have severe GORD despite acid treatment- symptoms that rapidly become difficult to live with. I can perform an operation that will tighten up the valve at the bottom of the gullet. It involves freeing up the top of the stomach and wrapping it around the lower gullet. This operation is known as a “Nissen Fundoplication” and used to require a very long cut on the abdomen. Today I perform this using a keyhole technique- patients are able to go home within 1-2 days instead of weeks!! It’s important that the wrap is given time to bed in and this means avoiding heavy meals and carbonated drinks for a few weeks after surgery. The results from fundoplication are dramatic- patients can sleep and not wake with a mouthful of acid or - and durable. There is a real feeling of pride when I perform this elegant operation and patients get results that improve their lives immensely. Mr Magee operates at Spire Murrayfield Hospital and can be contacted there. He can be followed on Twitter @mageefrcs.   wirrallife.com 63