Q. What is reflux oesophagitis?
A. In a normal person there is a one way valve-like mechanism situated at the junction of oesophagus (food pipe) and the stomach. This mechanism prevents the food and the gastric acid from coming up in the oesophagus. Whenever this mechanism becomes defective, the acidic matter from the stomach enters the oesophagus causing inflammation in the lining of the oesophagus. This is known as reflux oesophagitis.
Q. What is Hiatus Hernia?
A. Normally the stomach lies entirely in the abdominal cavity. When part of the stomach slides into the chest, this is known as hiatus hernia.
Q. What causes reflux oesophagitis?
A. The most important factors responsible for weakening of the valve- like mechanism are :
* Obesity
* Heavy smoking, tobacco chewing, strong alcohol, excessive amount of strong tea, coffee, spicy food. Consumption of pain killers like Aspirin.
* Repeated pregnancies.
* Increasing age.
Q. What are the symptoms of reflux oesophagitis?
A. The patients normally complain of burning sensation in the chest behind the breast bone.It classically becomes worse on lying down or on bending forward. The patients may also complain of sour fluid coming into the mouth on lying down.
Q. How to diagnose this disease?
A. With availability of fiberoptic endoscope, this investigation is now a procedure of choice. With an endoscope, a physician can see the inflamed lining of the oesophagus and the sliding of the stomach in the chest. Oesophageal Manometry & pH studies are recent investigations which help in accurate assessment of the degree and severity of the problem.
Q. How to treat this condition?
A. 95 percent of cases of reflux oesophagitis can be successfully managed without an operation.
* It is important to reduce the weight proportionate to the height. This helps in reducing the pressure in the abdomen.
* Tobacco chewing, smoking, alcohol, excessive tea and coffee must be stopped immediately and permanently. Aspirin should be avoided, if possible.
* It is known that anxiety can make the valve-like mechanism ineffective. Anxiety should be controlled by the practice of meditation, Yoga etc.
* Avoid wearing tight clothes.
* Small quantities of food at a time, repeated every 3 -4 hours, instead of 2 large meals in a day.
* Avoid lying down and bending forward immediately after taking food.
* The head end of the bed should be elevated by 3 – 4 inches by placing blocks under the head end of the bed.
We usually prescribe liquid antacids to neutralize the acid in the stomach. Drugs to improve contractions of muscles of esophagus to empty the acid contents are useful. Now effective drugs are available to control acid secretion.
We advise operation for hiatus hernia ONLY IF THERE IS ABSOLUTELY NO RELIEF INSPITE OF FOLLOWING THE ABOVE INSTRUCTIONS.
Even if operation for hiatus hernia is planned, it will be a total failure if the patient is overweight. Therefore, it is of utmost importance to achieve optimum weight. Laparoscopic hiatus hernia repair is performed in the majority of patients. Open surgery may be needed in certain situations. Your doctor will discuss the pros & cons of the procedure with you.
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