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Initial Consultation: We will go through your symptom history , how it affects your life and review your medication. We will carry out tests such as endoscopy and suggest best way forward including surgery if indicated.
OGD (Endoscopy): This is examination of your gullet (oesophagus),stomach and duodenum performed with a local anaesthetic throat spray with optional IV sedation. The procedure takes a few minutes and allows the endoscopist to assess if there is damage to the gullet from acid reflux – oesophagitis or changes in the lining of the lower oesophagus know as Barrett’s. This condition is precancerous requires monitoring. We also lookout for the presence of a hiatus hernia and measure the size. Hiatal hernia is defined as protrusion of part if stomach through the diaphragm into the chest . There are 2 types the more common sliding variety or rolling type. This denotes that the opening in the diaphragm through which the gullet passes is wide. You will also be checked for any inflammation in the stomach (gastritis) and duodenum. Samples may be taken to see if there is any infection from bacteria called H Pylori.
Oesophageal Manometry: This is a test performed to measure the muscular activity (peristalsis) in the oesophagus and the pressure of a muscle in the lower oesophagus where it meets the stomach. This is called as Lower Oesophageal sphincter (LOS) and the pressure is around 15mmHg. A normal functioning LOS protects the oesophagus from excessive acid refluxing from the stomach. Patients with hiatal hernia and those with severe heartburn and/or regurgitation tend to have a defective ‘valve’. This test also allows us to establish that the motility of the oesophagus is normal which is essential to carry out an antireflux procedure. The test usually takes 20 min and involves insertion of a soft tube (pressure transducer) through the nasal orifice the end of which lies in the stomach and you will be asked to take a series of swallows with water. The procedure is carries out without sedation in a sitting position. Some patients who cannot tolerate the procedure can be offered an alternative xray procedure called video-oesophagram
24 hr Oesophageal pH Test: This test is used to determine the time acid refluxes into the lower oesophagus and is expressed as % of the total 24 hr time. A normal exposure is anything below 4% or an acid score (DeMeester) of less than 14.4. Once again this test is done by passing a fine tube via the nasal opening and the tip positioned just above the oesophageal sphincter. It is attached to a recorder which your wear along your waist and you will be sent home with this device to return in 24hrs. There is another tubeless method called BRAVO capsule which also monitors the acid reflux and is implanted in the lower part of the gullet.
Follow-up Consultation: Depending on the history and findings of the above tests we will go through all the options and discuss appropriate medical and surgical treatment.