Gastrointestinal Surgery

The Division of GI Surgery is dedicated to providing comprehensive surgical care for

patients with basic and complex gastrointestinal diseases. Patients are referred to our

surgeons from across the India for management of a variety of benign and malignant GI

disorders via open and laparoscopic approaches, including:

Repair of primary, recurrent, and complex abdominal wall hernias

Gastroesophageal reflux disease, hiatal hernias, and achalasia

Weight-loss surgeries (gastric bypass, vertical sleeve gastrectomy, adjustable gastric

banding, and revisions)

Gallbladder disease

Colon and rectal cancer

Enterocutaneous fistula and short bowel syndrome

Anorectal disease including rectal prolapse, incontinence

Comprehensive list of Surgical diagnoses

Gastro esophageal reflux disease, also known as GERD, is a condition that results from the

acid in the stomach splashing up into the esophagus. When the sensitive lining of the

esophagus is exposed to stomach acid a burning pain (heartburn) may result.

Symptoms of GERD may include:

Heartburn----a burning feeling in the upper abdomen. It can travel through the chest and

into the throat and neck. It is believed to be caused by an acid irritating the esophagus.

Regurgitation-a warm, salty, bitter taste in the mouth. It occurs when stomach contents

flow back into the esophagus and into the mouth. It frequently occurs with belching.

Chest pain----pain in the chest is believed to reflect spasm in the esophagus. It is caused

by acid irritating the esophagus. This can mimic a heart attack.

Hoarseness or laryngitis----these can develop if the acid and/or stomach contents reach

the mouth and throat.

Dental disease----occurs because of the effects of the acid on teeth.

Choking/Wheezing---may occur especially at night when stomach contents may enter the

lungs. This is called aspiration. In patients with asthma, wheezing and shortness of

breath may be aggravated by reflux.

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In severe GERD other symptoms that may occur include:

Difficulty swallowing

Painful swallowing

Bleeding esophageal ulcers

Stomach acid causes inflammation and ulceration, usually in the lower esophagus. Severe

inflammation and ulceration over time lead to scarring and stricture of the esophagus.

Patients with esophageal strictures commonly describe food as getting "stuck" especially

foods such as bread and meats. Ulcers in the esophagus caused by the acid of stomach

contents usually cause painful swallowing and often bleeding. Another condition that may be

seen in patients with long standing GERD is Barrett's esophagus. Barrett's esophagus is a

change in the lining of the esophagus caused by years of acid reflux and inflammation.

Some research suggests that people with this condition may be at a slightly higher risk for

developing cancer of the esophagus. This condition is usually identified in patients that have

undergone an upper endoscopy procedure.

What causes GERD?

There are several factors that may contribute to GERD. The most common factor is a weak lower

esophageal sphincter (LES). The LES acts as a valve to the stomach, remaining closed until

swallowing forces the valve open. Normally the LES closes immediately after swallowing to prevent

reflux. In people who experience reflux, the LES may be weak and stomach acid splashes back into

the esophagus.

Hiatal Hernias are also commonly associated with GERD. A hiatal hernia occurs when part of the

stomach bulges up through the diaphragm and into the chest. The diaphragm is a flat muscle that

separates the chest from the abdomen. Coughing, vomiting, straining, weight gain and pregnancy

can all contribute to a hiatal hernia. Some research suggests that a hiatal hernia can prevent the

LES from functioning properly. Hiatal hernias are a very common abnormality, however not all

patients with hiatal hernias have GERD. The exact relationship between hiatal hernia and GERD is

unknown.

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Other factors that may contribute to GERD include:

Fatty foods

Smoking

Chocolate

Caffeine

Alcohol

Obesity

Pregnancy

Delayed stomach emptying

How is GERD Treated?

Gastroesophageal reflux disease can be managed with dietary and lifestyle changes, and/or

medications. Medical management consists of taking medication designed to decrease acid in the

stomach. Medications such as Zantac, Axid, Pepcid, Prilosec are commonly used. The reflux does not

stop, it continues without the stomach acid, therefore symptoms disappear. Since reflux disease is a

mechanical problem, medical treatment can alleviate symptoms of GERD but may not cure the

problem.

Reasons for Surgery

There are many reasons to consider a surgical approach to GERD. These include:

symptoms continue with medications

severe esophagitis

hoarseness or laryngitis thought to result from GERD

repeated bouts of lung infections caused by aspiration of acid into the lungs

asthma that is thought to result from GERD

inability to comply with lifestyle and dietary modifications

expense of many of the medications used for reflux

complications from GERD such as strictures or Barrett's esophagus

Dr. Satish Pattanshetti and Dr. Neeraj V Rayate

Website: www.dossindia.com Email us: info@dossindia.com

Sohrab Hall, 4th Floor, Oppo. Jehangir Hospital, Sasoon Road, Pune 411001. Maharashtra India.