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What is acid reflux syndrome

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					                                   Acid Reflux Information Sheet
What is acid reflux syndrome?
Acid reflux syndrome, properly referred to as “gastroesophageal reflux disease” (GERD), is a chronic condition in which
stomach acids escape, or reflux, into the lower esophagus. The acids inflame the lining and wall of the esophagus,
causing heartburn and other symptoms. Acid reflux syndrome generally does not go away on its own and at times
requires surgical intervention to treat properly. The surgery (Nissen fundoplication) has a very high success rate, with
about 90% of patients experiencing complete relief or a significant reduction in the amount of reflux.

How do I know if I have acid reflux syndrome?
Patients with reflux of acid up into the esophagus may experience a variety of symptoms: heartburn, chest pain or
achiness, hoarseness, sore throat, wheezing, asthma, sinus problems, vocal cord polyps, and others. Usually heart
disease must be ruled out as a possible source of chest symptoms.
Dr. Beutel generally orders tests, such as a twenty-four-hour pH study, a manometry, an upper endoscopy, and/or an
upper GI series, as well as taking a careful history and doing a thorough physical exam. These tests help to determine
how much acid is actually refluxing, the state of the lower esophageal lining, and the effectiveness of the esophageal
contractions and sphincter. Also, the tests will help rule out any other abnormalities that may be influencing the
situation.

I have acid reflux syndrome. What happens next?
In some cases, if the diagnosis is acid reflux syndrome, laparoscopic surgery may be the best treatment.
The patients with minimal reflux can do well with antacids, so they do not need surgery. Others have moderate reflux
for which surgery becomes an alternative. For those who have nearly continuous reflux during the day or the night, or
both, surgery may be the best option.
Nissen fundoplication continues to be successful in reducing or eliminating the abnormal or excessive acid in the
esophagus. “Fundoplication” refers to wrapping the "fundus," or top part of the stomach, around the lower esophagus.
This procedure creates a functional valve around the lower esophagus, which then prevents most of the reflux of acid
or stomach juices from coming up, or refluxing, into the espohagus. At the same time, it allows nearly normal
swallowing activity, and most patients are capable of “burping” which allows release of trapped stomach gas.
The procedure usually takes two to three hours. Nissen fundoplication is considered a safe procedure; however, the
success of the operation rests on the skill and experience of the surgeon, as well as the cooperation of the patient.

What are the results of the surgery?
At least 90% of patients have good, very good, or excellent results. In most patients no further stomach medications
are needed beyond the first few weeks. In a few cases medication may still be needed, but in those, a low dose of a
less expensive medicine is often adequate. Patient adjustment to the “wrap” or “tuck” in the stomach can take from
four weeks to a year.
Mild gas bloating may occur after Nissen fundoplication. This is a feeling of fullness particularly after meals, which will
be less of a problem as the patient learns to eat more slowly and smaller meals. Avoiding carbonated beverages and
greasy or heavy foods, and taking a Reglan tablet a little while before meals will also help. Usually this symptom tapers
off after several days or a few weeks. Certain aspects of Dr. Beutel’s operative technique have helped to minimize this
problem for his patients.

What are the risks of the operations?
Risks include bleeding, which could lead to splenectomy (unusual), perforation of esophagus or other organ, which
could lead to other operations and serious infections in the abdomen or chest (< 0.5%), and difficult adjustment to the
operation, which could require revisional surgery. Considering both short term and long term, fewer than 10% of
patients should require revisional surgery. Approximately 5% of cases will need to resort to an open incision as opposed
to using a minimally invasive laparoscopic technique.
                                    If you have any questions, please ask!
I have read and understood the above information:
                                 Acid Reflux Post-Op instructions
Post-Op Care:
       You will wake up in the recovery room. When your blood pressure, pulse, and breathing are stable,
       you will be moved to a regular hospital room. For laparoscopic procedures, there may some
       discomfort in the shoulders that should leave within a few days. Most patients will be home within
       24 hours after surgery. Pain medication may be needed during the first 3 to 7 days after the
       operation.

At Home:
Diet
      Pureed diet for three days. Soft diet for three weeks.
      Eat slowly and chew well. Take small bites. No eating on the run.
      Avoid steak and bread for 3-4 weeks.
      Avoid carbonated "fizzy" drinks and greasy foods.
      Breads may cause a slow or troublesome passage to the stomach, so be careful.

Medications
    At first, use Reglan 10 mg. one half-hour before meals, to help prevent excessive bloating.
    Gradually wean off the Reglan over a 3-4 week period, if possible, but keep some with you to use if
      bloating symptoms occur.
    Otherwise, use your usual medicines.
    Antacids or laxatives are okay.
    You will probably not need Prilosec, Prevacid, or Aciphex.
    Pepcid over the counter can be taken if needed.

Activity
    Walking is good. Stairs are okay.
    No weight lifting or strenuous activity for six months.
    Driving is okay after seven days.
    Shower or bathe as usual.

Office appointment
      You must return to Dr. Beutel’s office for a post-op appointment about one week after surgery.
       Please call Birkdale Surgical at 704.892.0558 if you have not already made an appointment.

When to call the office:
      If you develop a temperature higher than 100.5º F.
      If the incision becomes red or swollen, or there is more than a little drainage from it.
      If you have any questions.

  GO TO THE EMERGENCY ROOM or CALL 911 for any chest pain or other medical emergency!
This includes fainting, dizziness, or severe pain in the abdomen. If for some reason you are unable to reach the office,
    you can always visit the emergency room for the more urgent things and the surgeon on call can be contacted.

                                   If you have any questions, please ask!

				
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posted:8/15/2014
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