Gastro-Oesophageal Reflux Disorder ● ● ● ● ● Present in around 10% of the population Symptoms or damage to the mucosal lining of the distal oesophagus Caused by the contents of the stomach spending a period of time in the distal oesophagus Symptoms are not related to the severity of the damage Usually a chronic condition with relapses Menezes, N (2007), Surgeons Net Generally requires long term management Symptoms relieved in less than 20% of patients without medication 80% need it for relief Antacids to control episodes of heartburn PPI’s such as Omeprazole to control gastric acid In severe cases surgery is an option Oesophagitis Barrett's Oesophagus Menezes, N (2007), Surgeons Net Effective treatment of severe cases of GORD 91% Success rate needs good selection of patients Those with a poor response to medical treatment Patient choice Barrett’s Oesophagus Persisting Volume reflux Regurgitation of gastric contents Difficult benign strictures Menezes, N (2007), Surgeons Net Involves surgically improving the viability of the lower oesophageal sphincter Nissen Fundoplication Toupet Fundoplication http://simple-med.blogspot.co.uk/2011_05_01_archive.html http://www.youtube.com/watch?feature=play er_detailpage&v=hRIDVQgv5Ek# Canon C L et al. Radiographics 2005;25:1485-1499 ©2005 by Radiological Society of North America http://radiographics.rsna.org/content/25/6/1485/F20.ex pansion.html Endoluminal gastroplication ● Uses an endoscope to fold the oesophagus and stitch in place to reduce diameter at the gastro-oesophegeal junction Endoscopic injection of bulking agents ● Endoscope used to inject a bio-compatible polymer substance around the gastro-oesophageal junction. http://guidance.nice.org.uk/IPG404 http://guidance.nice.org.uk/IPG55 Removes the need for long term medication Laparoscopic procedures the norm ◦ Side effects ◦ Reduce scars, recovery time etc Dysphagia, belching, bloating and flatulence Oesophageal motility disorders have the possibility to worsen outcomes ◦ Achalasia Menezes, N (2007), Surgeons Net Both medical and surgical methods Both effective – around 90% Cost effectiveness ● Equals out after 3 years vs medical treatments Improvement can be increased though losing weight, stopping smoking and reducing alcohol intake Web Reference 1: http://www.surgeons.org.uk/generalsurgery-tutorials/gastro-oesophageal-reflux-diseasegord.html ● ● Menezes, N (2007), Surgeons Net Also contains list of papers for further reading Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults (2010:3) Wileman SM, McCann S, Grant AM, Krukowski ZH, Bruce J, Cochrane Database of Systematic Reviews, John Wiley & Sons/ The Cochrane Library