Reflux. Common Symptoms Heartburn Globus Chest Pains.

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Presentation transcript:

Reflux

Common Symptoms Heartburn Globus Chest Pains

Complex Reflux Symptoms Mass Reflux Cough/Asthma/recurrent Chest Infections Sore Throat

Complex Symptoms Dysphagia Pain

Differential Diagnoses Cancer Dysmotility –Oesophageal –gastric

Treatment Conservative Medical –PPI –Barrier Surgical

Medical vs Surgical Only three Trials of Lap vs Medicine –Mahon 2005 –Anvari 2006 –Grant 2008 All Show improve QOL at 1 year

Indications for Surgery Lifestyle Breakthrough Symptom Control Complex Reflux Control

Why pH Manometry Prove reflux Avoid dysmotility Manage expectation

Patients All three patients described have –Dysphagia –Odynophagia –Reflux

Hypotensive dysmotility – typical of GORD

Vigorous Achalasia

Structural obstruction at the PIP

Complex Reflux Disease Mr Yuen Soon