Symptoms
Fundoplication addresses the symptoms of GERD. These include:
Heartburn
Regurgitation of food or sour liquid
Difficulty swallowing (dysphagia)
Chest pain
Chronic cough
Laryngitis (hoarseness)
New or worsening asthma
Disrupted sleep
Causes
Fundoplication is a treatment for GERD, not a disease with causes. The causes of GERD, which necessitate a fundoplication in some cases, are:
Weak lower esophageal sphincter (LES)
Hiatal hernia
Obesity
Delayed stomach emptying
Certain foods and beverages (e.g., fatty foods, chocolate, caffeine, alcohol)
Smoking
Pregnancy
Medicine Used
Fundoplication aims to reduce or eliminate the need for long-term medications for GERD. However, medications before fundoplication often include:
Antacids: For immediate relief of heartburn.
H2 blockers: To reduce acid production. Examples include famotidine (Pepcid), cimetidine (Tagamet HB).
Proton pump inhibitors (PPIs): To block acid production and heal the esophagus. Examples include omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium).
Prokinetics: To help the stomach empty faster (less commonly used). After fundoplication, medications may still be required temporarily to manage post-operative discomfort or if reflux persists, but the goal is to minimize or eliminate their use.
Is Communicable
No. GERD and the need for fundoplication are not communicable or contagious. They are not caused by infectious agents and cannot be transmitted from person to person.
Precautions
Precautions related to fundoplication are primarily post-operative and focus on healing and preventing complications. These include:
Following dietary recommendations (e.g., starting with liquids and soft foods).
Avoiding heavy lifting or strenuous activity for a period of time.
Managing pain as prescribed.
Monitoring for signs of infection (fever, redness, drainage at the incision site).
Being aware of potential side effects such as gas and bloating.
Attending follow-up appointments with the surgeon.
Chewing food thoroughly
Eating smaller, more frequent meals.
Avoiding lying down immediately after eating.
Sleeping with the head elevated.
Avoiding foods and drinks that trigger reflux.
How long does an outbreak last?
Fundoplication is a surgical procedure designed to provide long-term relief from GERD symptoms. It's not an "outbreak." The success of the procedure is measured over time. GERD is a chronic condition; fundoplication is a treatment to manage it.
How is it diagnosed?
The need for a fundoplication is determined based on the diagnosis of GERD and the severity of symptoms, response to medical therapy, and diagnostic testing. Diagnostic tests for GERD include:
Upper endoscopy: To visualize the esophagus and stomach.
Esophageal pH monitoring: To measure the amount of acid refluxing into the esophagus.
Esophageal manometry: To measure the pressure and function of the esophagus and LES.
Barium swallow: X-ray of the esophagus, stomach, and duodenum after drinking a barium solution.
Timeline of Symptoms
Symptoms of GERD can be chronic and fluctuating. A general timeline might look like this:
Initial onset: Symptoms may start gradually, with infrequent heartburn or regurgitation.
Progression: Over time, symptoms may become more frequent and severe, potentially leading to complications like esophagitis.
Medical management: Medication can help control symptoms, but may not always provide complete relief.
Surgical intervention: Fundoplication may be considered if medical management is insufficient or if there are complications.
Post-operative: Initially after fundoplication, there may be temporary dysphagia (difficulty swallowing). Most experience symptom relief within weeks to months. Long-term, the goal is sustained symptom control.
Important Considerations
Success rate: While generally effective, fundoplication is not always a permanent solution. Some patients may experience recurrence of GERD symptoms over time.
Side effects: Potential side effects include difficulty swallowing (dysphagia), gas and bloating, and difficulty belching or vomiting.
Alternative treatments: Lifestyle modifications and medications should be tried before surgery.
Surgeon experience: The surgeon's experience and expertise can affect the outcome of the procedure.
Patient selection: Not all patients with GERD are good candidates for fundoplication. The decision to proceed with surgery should be made in consultation with a gastroenterologist and surgeon after careful evaluation.
Long-term follow-up: Regular follow-up appointments are important to monitor for recurrence of GERD symptoms or complications.
Lifestyle Modifications: It's crucial to continue lifestyle modifications that help manage GERD, even after surgery.