Gastro oesophageal reflux is abnormal exposure of the lower oesophagus to gastric contents and that is caused by weakness of the sphincter at the junction between the gullet, the oesophagus and the stomach. That can be due to physiologic weakness of the sphincter or due to anatomic defects such as a hiatus hernia which is of two types, either a sliding or a rolling hiatus hernia. In this condition the mucus lining of the oesophagus gets exposed to the acid that gets secreted by the stomach and also by the bile that refluxes into the stomach which can be more dangerous than the acid itself. This condition is very common and the options of treatment are medical and surgical.
One of the complications that can arise from reflux disease in addition to the ongoing symptoms of heartburn is the fact that as a result of inflammation of the lower end of the oesophagus it can lead to changes in that part of the gastrointestinal tract into a situation which can be premalignant. This condition is called Barrett’s oesophagus in which the normal lining of the lower oesophagus gets changed from a normal, what is called squamous into a reactive new form which is called intestinal metaplasia. As a result of the chronic inflammation and irritation by the bile source and by the acidic material that can lead to development of cancer of the oesophagus which is increasing in incidence.
Medical treatment is very common but surgery has its indication.
Bile reflux into the stomach is relatively common and can make GORD symptoms worse, it is associated with reduced ability of the stomach to drain properly and poor function of the pylorus . Often there are other factors involved in the pathogenesis of the disease and one of them is reflux of bile into the stomach due to incompetent pyloric sphincter and also inability of the stomach to empty properly. Another contributing factor that can often be found is the ability of the oesophagus to clear the contents due to abnormal motility. All these factors in addition to changes in the lower sphincter which is caused by weakness of the sphincter mechanism itself or the presence of a hiatus hernia which mean that there is a defect in the diaphragm where the oesophagus joins the stomach and due to increasing pressure in the abdomen a hiatus hernia can develop. A complicating problem with reflux disease is the fact that it can lead to adult onset asthma and lung fibrosis as a result of silent and ongoing aspiration. Symptoms of asthma get worse and patients tend to have a cough early in the morning as a result of micro aspiration of the contents of the oesophagus and the stomach into the lungs. Another form of reflux disease is what is called a volume reflux when the patient strains or bends forward, particularly to pick something up from the floor, the gastric contents can come back into the oesophagus in the form of regurgitation, usually associated with heartburn and nausea. Symptoms like that are usually difficult to treat and it is one of the important considerations to indicate surgery.