20100630-health-0101
    Dr. Phil Gachassin
Wednesday, July 7, 2010
Written by Lisa Hanchey

Patients opting for incisionless reflux surgery are back at work the next day — and medication free.


Belching, burning, bloating. These are just a few symptoms of heartburn, an all-too common malady among those of us who eat the rich, greasy food favored in Cajun country.  But we now know this seemingly minor inconvenience could be a symptom of a more dangerous ailment — gastroesophageal reflux disease. Left untreated, GERD can lead to dental erosions, gum disease, erosive esophagitis — even esophageal cancer.

A condition where food or liquid backs up from the stomach to the esophagus, GERD is one of the most common conditions in the U.S., with an estimated 10 to 20 percent of the population suffering from symptoms. Causes include hiatal hernia — a condition where a portion of the stomach, which is supposed to be in the abdomen, is brought up into the chest — smoking, weight gain and genetics. So, how do you tell the difference between merely inconvenient indigestion and potentially serious GERD?
 
After eating too much or too fast, people sometimes suffer from indigestion or heartburn, an uncomfortable or burning feeling in the chest or throat. Acid indigestion occurs when you actually taste stomach fluid in the back of your mouth. Having symptoms of heartburn or acid indigestion more than twice a week can, however, be a sign of the more serious GERD.

“GERD occurs when the valve between the stomach and the esophagus fails to properly close, allowing the stomach’s contents to back up, or reflux, into the esophagus,” explains Lafayette general surgeon Dr. Phil Gachassin. Other symptoms of GERD include regurgitation, hoarseness, asthma or asthma symptoms, sleep problems and coughing.

People are quick to blame Cajun cuisine’s kickin’ spices or Mexican food’s red-hot peppers for post-meal discomfort. But, the real culprit is not seasoning, but rather fatty, greasy and fried food. Less obvious triggers consist of tomato-based dishes, citrus fruits, alcoholic beverages, caffeinated and carbonated drinks, chocolate (say it isn’t so!) and, surprisingly, peppermint. “A lot of times, people eat a heavy meal at a restaurant, have a drink, and on the way out, they eat a peppermint,” Gachassin says, “and when they go home and lay down, the reflux is worse. For some reason, we know that peppermint reduces the pressure of the esophageal sphincter, which is where the valve is located.”

Typically, GERD symptoms are treated with drugs called proton pump inhibitors — Prilosec, Prevacid, Aciphex, Protonix, Nexium and Zegerid. When these medications fail to work, doctors consider surgery. For years, surgeons used a fundoplication procedure, an open repair through an incision in the belly area. Recovery time from this invasive procedure is four to six weeks. More recently physicians have been performing laparoscopic repair, making three to five small incisions in the belly through which a laparoscope and other tools are inserted to allow the surgeon to see inside the stomach and do the repair. Laparoscopic repair cuts recovery time to two weeks.

This year, however, Gachassin became the first doctor in Lafayette to try a brand-new, incisionless technique called Transoral Incisionless Fundoplication, which uses the EsophyX device. With TIF, patients having the procedure can be released the next day.
Prior to TIF, a patient undergoes a battery of tests to confirm that he indeed suffers from GERD. Then, the patient comes into the hospital and is put to sleep. Through the mouth, the surgeon inserts the EsophyX device, which travels down the esophagus and into the stomach. Using a manipulator on the end of the EsophyX, the doctor forms tissue folds, then does suturing through the device to create a new valve on the inside where the esophagus goes into the stomach. This surgical manipulation of the tissue at the gastroesophageal junction prevents reflux. “When you are eating, that’s a one-way valve, and food will go down, but food won’t come up,” Gachassin explains. “So, it prevents acid from going into the esophagus.”

After the surgery, patients can usually go home the next day. For a couple of weeks, they follow a soft diet. “But, that’s it,” Gachassin says. “They can go back to work the next day. There are no incisions, so there’s faster recovery, no pain, and much less risk of blood loss or herniation.”

Candidates for the procedure include patients with small hiatal hernias, and those “who suffer from reflux and don’t want to take their medication anymore,” Gachassin observes. This year, Gachassin performed the incisionless procedure on patients who had been on medications for over 20 years. “They haven’t taken any medications since their surgeries,” he says.

With the deluge of ads for GERD medications, consumers wonder whether GERD is an increasing problem or just becoming more recognized. “I think it’s definitely almost a lifestyle disease,” Gachassin opines. “As we eat different foods that encourage reflux, gain weight or drink alcohol, we see it more often. But, the reason that we talk about it more and more and more is because we now have medications that can be used to treat it, and there’s a lot of advertisement about it. A lot of it can be alleviated with lifestyle changes. But, for those patients who have tried lifestyle changes and are not having any success, we usually leave them on long-term medications. So, we would typically wait for patients to go through the medication, and if it’s not working or if it does work, but they are tired of taking the medications or are on them too long, then we recommend the surgery to re-create that valve.”

Gachassin recommends that people who suffer from reflux symptoms more than a couple of times a week see a doctor. “The reason that we really want to see patients that have reflux is because GERD can lead to esophageal cancer,” he says. “The more that you irritate your esophagus from acid and food contents going up, the greater the chance or risk you have of cancer. So, patients who are suffering from GERD that is more than a couple of times a week definitely need to be seen by a physician, and ultimately will need a workup — not necessarily to have surgery, but to see that there have been no changes to the lining of the esophagus that can cause cancer. And, if the patient is having that and is on medications, we recommend getting the surgery to prevent it from worsening.”

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