Anti-Reflux
Occasionally liquid or gas reflux is considered normal. When the mixture refluxes
into the esophagus more frequently than normal, or for longer periods than normal,
this is GERD. .Some people are born with a naturally weak lower esophageal sphincter
(LES) also known as a Hiatal hernia. The LES acts like a one-way valve at the top
of the stomach, allowing food to pass through into the stomach. Normally, the LES
closes immediately after swallowing to prevent back up of stomach juices, which
have a high acid content, into the esophagus. GERD occurs when the LES does not
function properly, allowing acid to flow back and burn the lower esophagus causes
irritation and inflammation of the esophagus, resulting in heartburn and eventually
damage of the esophagus.
Reflux Surgery
Tests done for Anti-Reflux (GERD)
Upper Gastrointestinal (GI) Series
The upper gastrointestinal (GI) series uses x-rays to diagnose problems in the esophagus,
stomach, and duodenum. It may also be used to examine the small intestine (duodenum).
The upper GI series can show a blockage, abnormal growth, ulcer or a problem with
the way an organ is working. During the procedure, you will drink barium, a thick,
white, milkshake-like liquid. Barium coats the inside lining of the esophagus, stomach,
and duodenum, and makes them show up more clearly on x-rays. Using a machine called
a fluoroscope; the radiologist is also able to watch your digestive system work
the barium through it. The upper GI series takes 20 minutes, but the x-rays for
the small intestine may take anywhere from 2 to 4 hours (this is not commonly done).
Upper Endoscopy
An upper endoscopy enables a surgeon to examine the lining of the esophagus, stomach
and duodenum (first portion of the small intestine); this is more effective than
upper GI series for detecting source of bleeding or inflammation, ulcers or tumors
of the esophagus, stomach and duodenum. During this procedure, a bendable, lighted
tube about the thickness of the little finger is placed through the mouth and advanced
into the stomach and duodenum. On one end of the tube, there is a light and a miniature
inbuilt camera. Various instruments can be passed through the endoscope allowing
the surgeon to treat many abnormalities with little or no discomfort or take biopsies
so they may be analyzed in the lab. Upper endoscopy is performed to evaluate symptoms
of persistent upper abdominal pain, nausea, vomiting, difficulty swallowing or heartburn.
Finding the cause of bleeding from the upper gastrointestinal tract is easily done
with this method. This procedure can also diagnose Barrett’s esophagus.
PH studies
Manometry
Esophageal manometry is a test used to examine the esophagus of patients with symptoms
of reflux. The manometry test examines the muscle function of the esophagus (swallowing
tube) and determines the effectiveness of the valve between the esophagus and stomach.
Before inserting the tube, the nose is anesthetized to make this procedure more
comfortable. The test consists of pulling the tube back very slowly through the
esophagus and also performing swallows with water. You will not be sedated for this
test as sedation will affect the pressures of the esophagus.
Manometry and 24 Hour pH Monitoring
An esophageal manometry examines the muscle function of the esophagus and determines
the effectiveness of the valve between the esophagus and stomach. Twenty-four hour
pH monitoring determines whether there may be an abnormal amount of acid coming
back up into the esophagus. The test is performed by inserting a small pH catheter
into the nose and passing it into the esophagus and /or stomach. The pH catheter
will be in place for approx. 24 hours. During this time, you should continue your
normal activity and diet.
Manometry and 48 Hour BRAVO Monitoring
An esophageal manometry examines the muscle function of the esophagus and determines
the effectiveness of the valve between the esophagus and stomach. BRAVO monitoring
requires that a miniature pH capsule be attached to your esophagus. While the capsule
is attached, it measures the pH in the esophagus and transmits that information
to a pager-sized device worn on your belt or waistband. You will be asked to keep
a journal, recording when you have symptoms. After the 48 hour period, return the
pager device and journal to the Endoscopy Center.
