Indigestion Treatments Loneon

More severe reflux

In some patients, gastro-oesophageal reflux is a very difficult problem requiring continuous treatment with high doses of PPI’s or perhaps not responding. In these cases, it is often necessary to quantify the level of acid reflux (rather than the snapshot of the problem viewed at endoscopy). This can be done using probes passed via the nose into the stomach which measure exposure of the oesophagus to acid over 24 hours whilst the patient carries out normal daily activities. At the same time, a similar probe can measure the muscular activity of the oesophagus and the valve between the stomach and oesophagus (lower oesophageal sphincter). These tests (oesophageal manometry and 24hour pH study) are used to determine the nature of the problem more accurately and, in some cases, lead Doctors to advise that an operation is the best option to control the reflux.

Anti-reflux surgery London

Surgery is only occasionally needed to control reflux but when it is, it can be very successful, particularly if suitable individuals are selected carefully. Surgery is best considered in those for whom drug treatment and lifestyle measures fail to control the symptoms enough. It is also considered as an alternative to lifelong drug therapy with PPI’s, particularly as there used to be some concern about the safety of suppressing acid production long term. This concern has not turned into reality, however, as PPI’s have now been used for decades continuously without significant concerns. As a result, successful control of reflux on a standard dose of a PPI long term is preferable to surgery. The debate becomes more finely balanced when higher doses are needed to control symptoms.

Surgery involves an operation to create a more effective valve between the oesophagus and stomach – called a fundoplication – and is nowadays nearly always performed laparoscopically (keyhole surgery). The outcome is generally good especially when patients are selected carefully. One of the commonest side effects after surgery is that the tighter valve, whilst preventing reflux, will not allow release of gas from the stomach (belching) leading to discomfort and bloating (gas-bloat syndrome). As with all surgery, the surgeon would discuss with you in detail the risks and benefits of undertaking this type of operation.

Lifestyle and dietary measures to control reflux

There are a whole variety of measures recommended to control reflux, many of which are a little impractical (such as raising the head of the bead at night) or not particularly effective. In some patients, reflux is going to happen even if the diet and lifestyle is exemplary. In others, however, it is readily apparent that lifestyle changes are needed. The following are the most important changes:

1. Fatty food is the main trigger to reflux – not acid or spicy food, although these may worsen symptoms – fat delays the emptying of the stomach, hence the reason your curry or fish and chips still feel like they are in your stomach in the morning. This therefore gives more time with acid and volume in the stomach making reflux more likely. Hence, reducing your intake of fatty foods is often the main dietary change recommended.

2. Going to bed not too long after a meal, especially a large or fatty meal is perhaps the commonest trigger to reflux, particularly in busy working people. Getting home earlier may not be practical but eating more in the day and having a light meal in the evening is a practical way round this.

3. Losing weight. Being overweight is not always the cause of reflux but is often a factor making it worse. At its simplest, the effect of increased abdominal girth leads to increased pressure on the stomach and therefore makes reflux more likely.

4. Smoking – this sounds like an easy one to blame, but smoking definitely makes reflux worse. It may, for example have a weakening effect on the valve and it tends to lower saliva production. Saliva is actually the body’s own natural antacid in that it neutralises acid in the oesophagus. Many patients with conditions that reduce saliva develop significant problems with reflux. Smoking is essentially doing the same thing.

Why come to LBH Digestion for your indigestion?

Each of the specialists at the Digestion Treatment Centre, London Bridge are highly experienced in the investigation and treatment of upper gastrointestinal disorders, including all aspects of endoscopy. There is also excellent access to all types of specialist investigation that might be required in one of the best private hospitals in the UK. One of the specialists, Mr. Simon Atkinson is well recognised as an expert in the surgical treatment of reflux.

How do I get treatment?

To get further information or treatment, please contact one of our consultants at The London Bridge Digestion centre, on:

tel: +44 (0) 20 7403 3814