What is acid reflux relief?

In medically oriented terms, antonyms of the word relief include pain, distress or damage. That links its meaning to both subjective and objective aspects. Subjective, denoting sensations experienced by the sufferer such as pain and objective, meaning physical findings detected by specialists which are either functional distress or organic damage. Actually relief is related to control measures and it quantitatively signifies removal of an unpleasant existence or reduction of its magnitude. The definition of relief, therefore encompasses alleviation of pain, relaxation of distress and healing of damage. Acid reflux on the other hand has two sides; the subjective side (symptoms) which reflects the symptom of heartburn and the objective side (signs) that reflects the functional and/or organic signs of esophageal changes. Acid reflux relief is therefore a broad term that covers all the measures used to control symptoms and signs of acid reflux disease. Normally, the lower esophageal sphincter remains closed except during swallowing. This prevents the passage of food and acid from the stomach into the esophagus. If the lower esophageal sphincter becomes weakened or relaxed, stomach acid may back up into the esophagus. Frequent acid reflux can irritate and inflame the lining of the esophagus, causing symptoms and signs of acid reflux. A better understanding of relief would thus entail knowledge of some aspects of normal structure and function, so that changes in the disease and its control could be easily considered. Actually acid reflux relief involves both preventive and curative measures, and in addition to treatment; orientation with the causes, symptoms and complications of acid reflux are essential for proper management. Acid reflux relief includes: dietary changes,lifestyle modifications, specific medications and surgical operations.Basic knowledge of the underlying causes and progression of acid reflux and answering frequently asked questions about its relief; add to the depth of understanding.

Friday, March 7, 2008

Acid Reflux Relief logoAssessment of esophageal length

Esophageal shortening is a consequence of scarring and fibrosis associated with repetitive esophageal injury. Anatomic shortening of the esophagus can compromise the ability to perform an adequate tension-free fundoplication and may result in an increased incidence of breakdown or thoracic displacement of the repair. Esophageal length is best assessed preoperatively using video roentgenographic contrast studies and endoscopic findings. Endoscopically, hernia size is measured as the difference between the diaphragmatic crura, identified by having the patient sniff, and the GE junction, identified as the loss of gastric rugal folds. We consider the possibility of a short esophagus in patients with strictures or those with large hiatal hernias (greater than 5 cm), particularly when the latter fail to reduce in the upright position on a video barium esophagram.
The definitive determination of esophageal shortening is made intraoperatively when, after thorough mobilization of the esophagus, the GE junction cannot be reduced below the diaphragmatic hiatus without undue tension on the esophageal body. Surgeons performing fundoplication have reported varying incidences of esophageal shortening, attesting to the judgment inherent in defining and recognizing undue tension. An advantage of transthoracic fundoplication is the ability to mobilize the esophagus extensively from the diaphragmatic hiatus to the aortic arch. With the GE junction marked with a suture, esophageal shortening is defined by an inability to position the repair beneath the diaphragm without tension. In this situation, a Collis gastroplasty coupled with either a partial or complete fundoplication may be performed.
Potential pitfalls of laparoscopic fundoplication include the elevation of the diaphragm due to pneumoperitoneum, potentially contributing to a false impression that esophageal length is adequate, and the limited ability to mobilize the esophagus relative to the transthoracic approach. In our experience, the failure to appreciate esophageal shortening is a major cause of fundoplication failure and is often the explanation for the slipped Nissen fundoplication. In many such instances, the initial repair is incorrectly constructed around the proximal tubularized stomach rather than the terminal esophagus. Surgeons opting to perform fundoplication laparoscopically in the setting of potential esophageal shortening must be vigilant of esophageal tension, technically facile at extensive mediastinal mobilization of the esophagus while preserving vagal integrity, and able to perform a laparoscopic or open transabdominal Collis gastroplasty should esophageal lengthening be necessary.