Specialist Gastric and Oesophageal Cancer Surgery in Sydney

What is gastro-oesophageal reflux disease (GORD)?

• • Gastro-oesophageal reflux is a normal phenomenon. GORD, on the other hand, is chronic reflux of stomach contents or bile into the oesophagus causing symptoms with or without complications.
  • Complications: Inflammation (oesophagitis), Bleeding causing anaemia and bloody stools, strictures (narrowing) of the oesophagus, Barrett’s oesophagus, oesophageal cancer, respiratory and dental disease.
  • Risk factors: Obesity, smoking, Helicobacter pylori infection, hiatus hernia, diseases and medications that cause reduced stomach emptying (e.g., diabetes) and certain foods such as chocolate, caffeine and carbonated drinks

When to seek surgical help?

• • Patients should seek surgical advice if they have GORD as it may cause multiple complications. They may have underlying Barrett’s oesophagus which in turn can cause cancer.
  • Symptoms: Typically, heartburn and regurgitation. Patients may also experience atypical symptoms such as bloating, upper abdominal pain, difficulty or pain during swallowing, chest pain, sore throat, dental caries cough and shortness of breath.

What is the management of GORD?

• • Any of these symptoms may need investigations or screening in the form of Gastroscopy.
  • Gastroscopy: This allows surgeons to assess the degree of inflammation and rule out any other pathologies.
  • Oesophageal physiology: This includes two tests (24 hr ph monitoring and manometry) and involves a thin tube being inserted into the patient’s oesophagus via their nose. These ascertain the degree of acid reflux and the functional ability of the oesophagus.
  • Medical management involving antiacid medications (Proton pump inhibitor — PPI) along with lifestyle modification is the initial treatment unless complications from GORD are found, medical treatment fails and if patients prefer.
  • Laparoscopic fundoplication: This is a key-hole operation to tighten the junction between the oesophagus and stomach, and wrapping of the stomach around the lower part of the oesophagus to recreate a valve to prevent acid reflux. This is a long-lasting treatment compared to PPI.

What to expect following the operation?

• • Commonly patients stay 1-2 days following the operation when performed in an elective setting.
  • Return to light duties is possible within a week although heavy lifting is recommended to be avoided for 4-6 weeks.
  • Patients may need PPI for a couple of weeks following surgery