hernia ( a protrusion of the upper part of the stomach through the diaphragm ) which disrupted the function of the LES making it unable to close properly . Another test involves the detection of acid re�ux events into the oesophagus by the use of a 24-hour impedence test and manometry . This consist of passing a thin wire probe with multiple sensors into the lower part of the oesophagus at the LES . Over a 2�-hour period , the sensors will detect the incidence and duration of any acid back �ow into the oesophagus .
Re�ux is very common in pregnancy and it is caused by increasing levels of hormones combined with pressure from the growing foetus . It is usually worst during the third trimester and the symptoms almost always go away after delivery .
Fatty and spicy foods , certain types of medication , tight clothing , smoking , drinking alcohol , vigorous exercise or changes in body position ( bending over or lying down ) may cause the LES to relax , leading to re�ux / GERD .
OTHER CONDITIONS TO E�CL�DE : Achalasia ( LES fails to relax and food is held up in the oesophagus ), oesinophilic oesophagitis
MANAGEMENT OF REFLUX
1 . LIFESTYLE MODIFICATION In a lot of cases , how we live and the stresses we encounter can be modified and this can reduce the incidence of GERD . In many cases , changing diet and taking over-the-counter antacids can reduce how often and how harsh the symptoms can be . Losing weight , stop smoking , reduced alcohol consumption , altering eating and sleeping patterns can also help . Avoid eating right before bedtime so that you have at least two hours to digest your food before lying down . Exercise regular and control your weight to avoid becoming overweight or obese . A large round abdomen will increase the pressure on the LES leading to back �ow of stomach acid into the oesophagus .
2 . MEDICATION If symptoms persist after these lifestyle changes , drug therapy may be required . Antacids neutralise stomach acids and over-the-counter medications reduce the amount of stomach acid produced . Both may be effective in relieving symptoms . Prescription drugs ( Proton Pump Inhibitors � omeprazole , pantoprazole , esomeprazole , vocinti , etc ..) may be more effective in healing irritation of the oesophagus and relieving of symptoms . Long-term usage of these medication are thought to be generally very safe . The presence of helicobacter pylori infection in the stomach will necessitate a course of antibiotics to eradicate the infection as it causes increase in acid production .
most commonly performed operation is fundoplication which was first described in the late 1950 ’ s ( Nissen fundoplication ). This involves fixing the hiatal hernia , if present , and wrapping the top part of the stomach around the lower end of the oesophagus . There are various technique or degree of stomach wrap ( Nissen , Toupet , Dors ) and they all reinforce the LES to recreate the �one-way valve� to prevent acid re�ux . Once performed , medication is stopped . With technological and medical advancement , the surgery is now commonly performed by keyhole techniques using several small incisions � Laparoscopic fundoplication .
Re�ux / GERD in the vast majority of people is a benign condition and it may be a re�ection of the symptoms of modern life . Modification of our lifestyle , eating habits and general well-being can be enough to mitigate this problem . Medication or surgery can be use in those with more troublesome symptoms but it is very important that in these cases we do not miss the spectre of cancer .
Dr Kan Yuk Man is a senior consultant surgeon specialising in surgical oncology at Farrer Park Hospital and Mount Elizabeth Hospital in Singapore .
3 . SURGERY Despite lifestyle changes and medication , some people will not respond and they will continue to have re�ux . For such people and for those who do not wish to continue on life-long medication , surgery is an option which is very effective in treating GERD . The
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