The esophagus is the most important part of the human body,whichhelps in the movement of food from the mouth to the stomach. It is also known as a food pipe that runs through the chest and tight opening in the diaphragm. Hiatus is that tight opening in the diaphragm.
As the esophagus enters the stomach, muscle valve contracts to seal the stomach, forming the lower esophageal sphincter (LES). The LES opens and allows the food passage to the stomach and then closes quickly. Once it’s closed, it remains in the closed position, which prevents food or acid within the abdomen from refluxing back up into the esophagus. This type of medical condition gives birth to very know complications, the Gastroesophageal Reflux Disease, which, when treated, needs an expert on your side.
GERD occurs when stomach acid and enzymes flow back into the esophagusdue to weak muscles of LES. The returning of the acid and enzymes irritates and damages the lining of the esophagus, making it difficult for the patients.
(1.) Chest pain
(2.) Difficulty in Swallowing
(3.) Burning sensation in the chest (heartburn) partially with spicy food
(4.)A sensation of a lump in your throat
(5.)Regurgitation of food or reflux of liquid food contents
(6.) Recurrent cough, change in voice
The esophagus passes through the diaphragm,and the phrenoesophagealmembrane seals space, maintaining the aperture in the diaphragm enough to pass the food pipe.
In some patients, the opening of the diaphragm is wider than usual, which allows the esophagus herniate from its normal position and permitting the lower esophagus. The upper part of the stomach is displaced upwards through the enlarged opening, producing a complication called hiatus hernia.
In most cases, a portion of the stomachregularly moves up and down through the hiatus, producing a sliding hiatus hernia, thereby causing the reflux of food acid and digestive enzymes to come up and damage the esophageal lining.
(1.) Laryngitis, change in voice, coughing, new-onset asthma.
(2.) Bad breath and bitter taste,
(3.) Persistent heartburn
(4.) Food regurgitating into the mouth and sometimes through the nose
In the beginning phase of the treatment the patients need to make some minor changes in their lifestyle along with proper medications:-
(1.)Avoid spicy food, Consume small, more frequent meals lessens the degree of damage
(2.)While sleeping, adjust the head of the bed by six inches, to decrease pressure on the diaphragm. It will help you maintain an average weight.
(3.)After the meal,the patient should avoid lying down and avoid eating within two to three hours of bedtime.
(4.)Medications like H2receptor antagonists and proton pump inhibitors.
(5.)Smoking cessation is also important for reducing hiatus hernia symptoms.
In the case of both medical conditions, surgery is the best option that provides a potential cure for the patients suffering from Hiatus Hernia; otherwise, the patients need to depend on lifetime medication. Medications and lifestyle changes help to decrease the reflux or minimize the adverse effects. For example, the mucosal damage is less for patients with PPIs, but the reflux process continues. However, in surgery, the reflux process is averted, and normal physiological functions are restored.
Based on the symptom and severity of the complication and intolerance to prolonged medications and its side effects, the fundoplication surgery is advised. There is potential lifetime medication as well as associated side effects of PPI and hence, this surgery is offered early for younger patients..
Almost for all cases, the surgery is performed with a laparoscopic approach. The esophagus is dissected to bring it back to the normal position. Apart from that, if diaphragmatic hiatus is repaired to normal size and part of the stomach is mobilized to do a wrap that acts like a valve or sphincter preventing further reflux. Laparoscopic Nissen fundoplication or Toupet fundoplication are techniques with long term results and very minimal complications. Recovery time after laparoscopic fundoplication for hiatus hernia is short and patient needs to be in hospital for 3-4 days.
If Hiatus Hernia and GERD is what you are concerned about, then you can consult Dr. Prakash to provide the best treatment for these types of the medical condition and the details of laparoscopic fundoplication.
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