The need to belch is a common experience but a feeling of gas, fluid or even food running up the chest would suggest significant reflux. Reflux may become sufficiently disabling to interrupt social activities, work or sleep.
Reflux may be due to a mechanical problem with the gastro-oesophageal junction or the stomach. The loss of function at the lower oesophageal sphincter allows acid, food or bile to pool in the lower oesophagus repeatedly. This leads to oesophagitis, erosions / ulcers or even inflammatory strictures.
GERD may also be related to herniation of the stomach up the chest ie. hiatal hernia, as the absence of the diaphragmatic pinch by the crura and the negative intrathoracic pressures will encourage retrograde flow of gastric contents.
Occasionally patients with gastric carcinoma may report reflux rather than early satiety. Patients with reflux symptoms will have OGD, pH studies & manometry for evaluation.
Treatment for reflux is usually effective with medications. Once the acidity of the refluxate is reduced, there usually is good improvement, and with addition of prokinetic medication, most patients will manage with few breakthrough episodes.
Surgery is considered for those who remain symptomatic even with medications and life-style changes, or patients who cannot tolerate the medications. The principles behind surgery for reflux are :
i. to maintain an intra-abdominal position for the lower oesophagus.
ii. to recreate a sphincter-like wrap at the upper part of stomach to function like a valve (fundoplication).
The operation may be performed either in open procedure or laparoscopically.
The investigations and treatment of various causes for reflux require time with the doctor for detailed and continued clinical evaluation. Findings on various procedures or imaging require careful correlation with symptoms and well-being. Often the benign causes are effectively treated with standard and uncomplicated treatments.