2.  Gastro-Oesophageal Reflux Disorder ● Present in around 10% of the population ● Symptoms or damage to the mucosal lining of the distal oesophagus ● Caused by the contents of the stomach spending a period of time in the distal oesophagus ● Symptoms are not related to the severity of the damage ● Usually a chronic condition with relapses Menezes, N (2007), Surgeons Net

3.  Generally requires long term management  Symptoms relieved in less than 20% of patients without medication  80% need it for relief  Antacids to control episodes of heartburn  PPI’s such as Omeprazole to control gastric acid  In severe cases surgery is an option  Oesophagitis  Barrett's Oesophagus Menezes, N (2007), Surgeons Net

4.  Effective treatment of severe cases of GORD  91% Success rate  needs good selection of patients  Those with a poor response to medical treatment  Patient choice  Barrett’s Oesophagus  Persisting Volume reflux  Regurgitation of gastric contents  Difficult benign strictures Menezes, N (2007), Surgeons Net

5.  Involves surgically improving the viability of the lower oesophageal sphincter  Nissen Fundoplication  Toupet Fundoplication

6.  http://simple-med.blogspot.co.uk/2011_05_01_archive.html http://simple-med.blogspot.co.uk/2011_05_01_archive.html  http://www.youtube.com/watch?feature=play er_detailpage&v=hRIDVQgv5Ek# http://www.youtube.com/watch?feature=play er_detailpage&v=hRIDVQgv5Ek#

7. Canon C L et al. Radiographics 2005;25:1485-1499 ©2005 by Radiological Society of North America http://radiographics.rsna.org/content/25/6/1485/F20.ex pansion.html

8.  Endoluminal gastroplication ● Uses an endoscope to fold the oesophagus and stitch in place to reduce diameterat the gastro-oesophegeal junction  Endoscopic injection of bulking agents ● Endoscope used to inject a bio-compatible polymer substance around the gastro-oesophageal junction. http://guidance.nice.org.uk/IPG404 http://guidance.nice.org.uk/IPG55

9.  Removes the need for long term medication  Laparoscopic procedures the norm ◦ Reduce scars, recovery time etc  Side effects ◦ Dysphagia, belching, bloating and flatulence  Oesophageal motility disorders have the possibility to worsen outcomes ◦ Achalasia Menezes, N (2007), Surgeons Net

10.  Both medical and surgical methods  Both effective – around 90%  Cost effectiveness ● Equals out after 3 years vs medical treatments  Improvement can be increased though losing weight, stopping smoking and reducing alcohol intake

11.  Web Reference 1: http://www.surgeons.org.uk/general- surgery-tutorials/gastro-oesophageal-reflux-disease- gord.htmlhttp://www.surgeons.org.uk/general- surgery-tutorials/gastro-oesophageal-reflux-disease- gord.html ● Menezes, N (2007), Surgeons Net ● Also contains list of papers for further reading  Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults (2010:3) Wileman SM, McCann S, Grant AM, Krukowski ZH, Bruce J, Cochrane Database of Systematic Reviews, John Wiley & Sons/ The Cochrane Library