Reflux

Gastro-oesophageal Reflux is the medical term used to describe a condition in which stomach contents - food and gastric acid - frequently flow back up out of the stomach into the oesophagus [spelt esophagus in the US hence GER on some websites not GOR].

 

The food that comes up may or may not flow all the way out of the mouth. It may be forceful vomiting which rapidly and completely empties the stomach, or it can be more like a "wet burp" that doesn't reach the mouth.

 

The usual cause in CdCS, is a Hiatus Hernia (hiatal hernia in the US), whereby a bit of the stomach bulges through the diaphragm (the muscle that separates the chest cavity from the stomach). The oesophagus is the tube that connect your mouth to your stomach when you swallow.

A rare form of hiatus hernia may be present at birth because the diaphragm or stomach have not developed properly.

  

Diagnosis

The diagnosis for a hiatus hernia is based on a person's reported symptoms. The doctor may then order tests to confirm the diagnosis. If a barium meal is ordered, the person drinks a chalky white barium solution, which will help any protrusion through the diaphragm to show up on the x ray that follows. Currently, a diagnosis of hiatus hernia is more frequently made by  endoscopy. This procedure is done by a gastroenterologist (a specialist in digestive diseases). During an endoscopy the person is given an intravenous sedative and a narrow tube is inserted through the mouth and oesophagus, into the stomach where the doctor can visualize the hernia. The procedure takes about 30 minutes and may cause some discomfort, but usually no pain. It is done on an outpatient basis.

 

Allopathic treatment

There are several types of medications that help to manage the symptoms of a hiatus hernia. Antacids are used to neutralize gastric acid and decrease heartburn. Drugs that reduce the amount of acid produced in the stomach (H2 blockers, H is the acid forming part) are also used. This class of drugs includes famotidine (sold under the name Pepcid), cimetidine (Tagamet), and ranitidine (Zantac). Omeprazole (Prilosec) is not an H2 blocker, but is another drug that suppresses gastric acid secretion and is used for hiatus hernias. Another option may be metoclopramide (Reglan), a drug that increases the tone of the muscle around the oesophagus and causes the stomach to empty more quickly.

 

Surgical treatment

The term fundoplication is composed of fundo-, referring to the fundus (the upper portion) of the stomach + -plication, an operation for reducing the size of a hollow organ (in this case, the stomach) by taking folds or tucks in its walls.


During fundoplication, the part of the stomach closest to the oesophagus is gathered, wrapped, and sutured around the lower end of the oesophagus and the lower oesophageal sphincter. This increases the pressure at the lower end of the esophagus and thereby reduces acid reflux. During fundoplication, other surgical steps frequently are taken that also may reduce acid reflux. If there is a hiatus hernia, the hernial sac may be pulled down from the chest and sutured so that it remains within the abdomen. The opening in the diaphragm  through which the oesophagus passes from the chest into the abdomen also may be tightened.


Fundoplication may be done using a large incision in a laparotomy (cut into the abdominal cavity or thoracotomy {cut into the thoracic cavity}) or with a laparospcoe {keyhole surgery} that requires only several small punctures of the abdomen. The advantage of the laparoscopic method is a speedier recovery and less post-operative pain.  


A few CdCS children have had this done and have been pleased with the results.