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ABDOMEN THE MAGIC BOX - IV (March, 2004)

Abdomen, the Magic Box ! (part IV)
The Reverse Flow Disease - ? GERD or GORD ?
Cows and some quadrupeds are required to gulp food in a hurry when available and later voluntarily bring it back into the mouth for thorough mastication before swallowing again. Man does not have to eat in such great haste and even if he does, cannot do this act of rumination. The natural and rightful and normal flow is generally only forward in the entire intestinal tract. Few exceptions are the “burping” of air in very young babies and some instances of “eructations” in adults too. Anything more reverse flow of either gas or any intestinal or stomach content in the reverse direction into the food pipe in the chest or into the mouth itself or bringing it out as vomitus indicate some abnormality/disease, which may indicate some relatively minor ailment or a serious disease.

Sudden serious reverse flow:
This is due to sudden obstruction to the lumen of intestines due to some serious and sudden disease. It can be slow and long standing also. It is called Acute (sudden) or Chronic (slow & gradual, long standing) intestinal obstruction. This may often need a surgical operation as either emergency or a planned (elective) procedure.

Persistent, regular & long standing reverse flow (GERD or GORD):
The food pipe from the throat to the stomach, called as Oesophagus, (also spelled as Esophagus) is guarded at its junction with stomach by a unidirectional sphincter or sleeve of muscle called as Cardiac Sphincter. This can rarely relax, allowing burping or eructations, when there is too much gas bloating in the stomach. But if this sphincter regularly and persistently becomes non functional, stomach contents, often acidic in reaction can flow back into the food pipe or gullet very easily. Reverse flow can occur even after a more or less normal full meal, when the abdominal pressure increases during normal activities like bending, lifting a weight or due to tight dress or even straining at stools or urination. This abnormal flow can also occur when a person lies flat or lies on his stomach. Apart from the embarrassment of audible noise and sour fluid regurgitating into the mouth at inconvenient occasions and surroundings, it can also produce severe burning sensation in the middle of the chest and front of neck, particularly if the fluid regurgitated is highly acidic, as it often is This hyperacidity or excessive acid production in the stomach can occur due to various causes ( see “When the House is on fire” newsletter). This disease of Reflux of Gastric (Stomach) contents into the Oesophagus (or Esophagus) is called as Gastro Oesophageal ( Eso..) Reflux Disease, the acronym being GORD or GERD.

In severe and long standing GERD, the stomach contents reverse flowing into the throat during sleep can enter the windpipe and lungs, producing chronic respiratory infection or asthmatic attacks. Long standing GERD can also lead to ulceration in the oesophagus (oesophagitis) and later to narrowing due to scarring and even cancer can occur.

Diagnosis & treatment of GERD:
Careful and detailed history taking and thorough clinical examination, as always often leads to proper diagnosis. This would be confirmed by few special investigations/tests like Upper G.I.Endoscopy, Contrast X-rays of oesophagus, oesophageal manometry, and oesophageal pH studias and rarely oesophageal biopsy..Usually only one or two of these tests will suffice to clinch the diagnosis.

Treatment consists of diet and measures to reduce acidity of stomach secretions, drugs that may help restoring normal directional flow of food along the gullet and improve cardiac sphincter function. Other measures are directed towards reducing intra abdominal pressure at all times during routine activities and while sleeping. Raising the whole cot at its head end by about 12” wooden blocks while sleeping is a very helpful measure. Small and more frequent bland meals, avoiding bending, lifting weights, tight dresses and reducing body weight are all helpful measures.

Surgical Treatment of GERD:
If drugs, diet and other measures have failed after a period of trial, surgical methods of controlling the disease are available. These anti reflux surgeries, were till now performed by the open method. Currently the operation can also be performed by the laparoscopic methods in advanced laparoscopy centers. But surgery is indicated only if other measures fail, because it has its own drawbacks and complications.

In case you would like some more clarifications do not hesitate to ASK !

Dr. M.Mohan Rao, MBBS,MS,FICS,MCH,

M.D. & Chief Surgeon, Dr. U Mohan Rau Memorial Hospital.
E-mail: mmr@mohanraohospital.com




 

  

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