Specialist expertise: Surgical Management of Type 2 Diabetes, Anti-reflux Surgery, Hernia Surgery, General Surgery, Laparoscopic Procedures (Keyhole Surgery), Robotic Surgery, Laparoscopic Cholecystectomy, Bariatric Surgery, Gastric Bypass, Sleeve Gastrectomies, Lower Gastrointestinal Surgery, Upper Gastrointestinal Surgery, Appendicitis, Gallstones, Pancreatitis, Bowel Obstruction, Heartburn, Obesity, Diverticular Disease, Achalasia, Hepato-Biliary and Pancreatic Disease, Gastroparesis.
Most of us have suffered from this condition at some point or other in our lives either because of something we have eaten, how we have eaten it, or a combination of the above. All of us will get a degree of reflux if we eat hot, spicy or acidic food, or consume caffeinated products, carbonated drinks, alcohol, or nicotine, particularly late at night.
But for some patients and individuals this is a chronic problem that can be quite debilitating and can in the long-term lead to not just reduction of quality of life, but also changes within the oesophagus that can eventually become precancerous and then cancerous. This sort of reflux is often associated with hiatus hernias which are weaknesses within the central portion of the diaphragm, which is the muscle that separates the chest from the abdomen. We all have a defect within the central part of the diaphragm which allows our oesophagus to traverse the chest and enter into the abdomen.
However, for those with hiatus hernia in the top section of the stomach, this part of the stomach actually resides in the chest cavity, and this leads to the valve between the oesophagus and the stomach not working correctly and therefore leading to mechanical reflux. This leads to reflux of acidic contents as well as volume reflux of liquid from the stomach into the oesophagus. Sometimes this goes all the way up to the voice box or larynx that can lead to changes in voice, hoarse voice and a bitter taste in the mouth.
Reflux is often mechanical and therefore worse when you lean forward or lie down. This is also why reflux is often worse at night because of this mechanical affect; gravity is helpful for patients with mechanical and volume reflux. Weight also plays a significant factor as being overweight or obese lead to changes in adiposity around the gastro-oesophageal junction and therefore leads to this valve not working properly. For many patients, a small amount of weight loss that is consistent and sustained may significantly help reflux symptoms.
Reflux is also made worse by dietary triggers as described above. But certain things in our diet and the way that we eat also can cause bloating. This sort of bloating or distended stomach, and for those patients who have a faulty valve between the oesophagus and the stomach, will result in worse reflux, which can be acid reflux, volume reflux or both. Avoidance of such dietary triggers and eating slowly so that one does not swallow too much air, known as aerophagia, can also help.