One-stop shop for acid reflux

Posted on 12 June 2023

The opening of the Upper Gastro-intestinal Unit at Mediclinic Heart is good news for long-term acid reflux sufferers.

Gastroesophageal reflux disease (GORD), or acid reflux, is a common condition, with a worldwide incidence of around 5-10%. Most cases can be treated with medication, but where symptoms do not respond to conventional treatment, quality of life can be severely affected. For these patients, the Upper Gastro-intestinal Unit at Mediclinic Heart offers welcome relief.

Heartburn and regurgitation (the sensation of having food you have already swallowed travel back up the oesophagus and into your mouth) are among the most common symptoms of acid reflux, says specialist surgeon Dr Everett Asante of the Upper Gastro-intestinal Unit. Apart from being unpleasant, they may also lead to depression, anxiety and a small risk of oesophageal cancer if ongoing. “This is one of the worst impacts of severe acid reflux, and one of the reasons we wanted to highlight the condition,” Dr Asante explains.
Most patients visiting the Upper Gastro-intestinal Unit have already tried a course of proton pump inhibitors (usually an effective treatment for acid reflux) but have found their symptoms have not improved after a long period on the medication.

This is where the tests provided by the unit are useful. Typically, this kind of reflux does not respond to treatment because of multiple factors, and the challenge is to uncover its cause. Dr Asante and his team do this through a range of assessments, including:

Gastroscopy

A camera is inserted into the stomach via the oesophagus to investigate the presence of inflammation or excess fluid in the stomach.

pH study

A probe is passed through the nose and into the lower oesophagus, so activity in this area can be monitored over a 24-hour period. The data collected helps to identify whether the reflux is pathological in nature.

Manometry test

This may also be recommended to measure the function of the oesophagus and its ability to keep acid within the stomach. This is done by measuring the integrity of the lower oesophageal valve (located at the lower part of the oesophagus before it joins the stomach), which prevents stomach acid from coming up into the oesophagus.

The unit can offer several solutions, ranging from non-invasive to surgical procedures, once it has identified the cause of the condition. Dr Asante says surgery isn’t always advised, especially if the patient has not responded well to medical interventions in the past. In these cases, it’s unlikely that the surgery will be successful, he says. If the patient does qualify for surgery, the unit performs several related procedures. The best solution may be a Nissen fundoplication, in which the top part of the stomach is wrapped around the lower portion of the oesophagus to simulate a new valve. In cases where the patient is affected by an additional oesophagus movement disorder, a similar procedure will be performed, although a smaller area of oesophagus will be “wrapped” by the stomach.

Dr Asante says the unit is the only one in the country to offer endoscopic fundoplication, a minimally invasive procedure that involves using an endoscope inside the stomach and oesophagus. “This is a major improvement on existing techniques because it transforms the surgery into a day procedure, with less downtime for the patient and less recovery time required. We’re very proud and excited to be able to offer this service, which truly differentiates the unit.”

One of the most significant benefits of the unit, Dr Asante adds, is that it functions as a one-stop shop for patients who feel frustrated and concerned about their condition. They have access to a team of dedicated experts, who can conduct a series of investigations, diagnose the problem and treat it – at a time when many have given up hope. “Just because acid reflux is common doesn’t mean it doesn’t have a huge impact on those living with it. We consider it an honour to be able to reduce that impact.”