Gastroenterology FAQs

Frequently Asked Questions About Esophageal Reflux and Other Gastric Disorders

If gastroesophageal reflux is only occasional, what is the best treatment?

Definitely lifestyle and proper nutrition. Weight loss positively affects and prevents occasional reflux from becoming chronic.

In reflux disease, is surgery always necessary?

No, there are very precise indications, dictated by international guidelines. Surgery is necessary in cases of:

• Extradigestive disorders: chronic cough, hoarseness, chronic sore throat or ear, tooth enamel erosions, recurrent respiratory infections, or asthma conditions aggravated by reflux.
• Digestive disorders: burning behind the sternum and acidity in the mouth, when the patient does not respond to medical therapy or when they have frequent relapses, or if they do not want to undergo chronic therapy, perhaps because of younger age.

Is it true that reflux is not always acidic?

Yes. In some cases, instead of gastric juice, it is bile that flows back and medications are completely ineffective, so surgical therapy is beneficial.

What tests allow the diagnosis of gastroesophageal reflux?

• Esophagogastroduodenoscopy (EGDS): It highlights possible damage of the esophagus by the acid contents flowing into it.
• Ph-impedancemetry: Measures the quality and quantity of refluxes.
• Esophagogram: This test shows the motility of the esophagus and stomach.

Is surgical treatment of reflux safe?

Surgery has now reached high standards and in expert hands, any risks are reduced to a minimal level. However, a small share of complications can always be present. The most frequent, in the case of reflux surgery, is the difficulty in swallowing, fortunately, this is transient. On the contrary, it should be emphasized that surgery is particularly effective in patients with severe reflux, especially if accompanied by chronic disorders, such as cough. The patient will see the symptom disappear, in addition to the reflux, shortly after surgery.

What does an improved lifestyle mean?

First of all, better nutrition, both by reducing the amount of food taken and the mode of intake. In fact, six small daily meals are recommended, consisting of foods that are easy to digest. You should avoid fats, chocolate, and mint. Smoking and alcohol must be avoided. You should avoid going to bed immediately after meals and the headboard of the bed should be raised by 25-30 °. It is good to perform aerobic and light physical activity, but avoid heavy workouts in the gym.

Frequently Asked Questions About Hiatal Hernia

How are hiatal hernia operations conducted?

There is no medical cure at present for hiatal hernia and therefore the only treatment is surgery. Of course, a thorough pre-operative study must be conducted to determine which hernias are to be performed. The intervention must then be customized in relation to the size of the hernia, the type, the challenges it creates, and the association or not with reflux. Smaller hernias, if asymptomatic, do not require special therapies, but an improvement in lifestyle.

The GP told me that the extrasystoles I suffer from are due to hiatal hernia. It's true?

Probably yes, as the herniated stomach tract in the chest is located just behind the heart and can stimulate it to make irregular beats.

If I am overweight am I more at risk?

Women and people with obesity are more affected by hiatal hernia than their normal-weight peers.

Frequently Asked Questions about Achalasia

Are achalasia and megaesophagus the same thing?

No. Achalasia is the failure to release the lower esophageal sphincter (cardia), while the megaesophagus can be a complication of achalasia. More precisely, it is the dilation of the esophagus that occurs when achalasia is not treated for a long time.

Is achalasia related to cardiac arrhythmias?

Generally not, although in some cases it can be irritating and stimulate the appearance of extrasystoles.

What are the symptoms of achalasia?

• Difficulty swallowing in the first place, with the feeling that the food bolus stops behind the sternum.
• Slimming.
• Vomiting immediately after the meal.
• When you wake up, find the pillow wet with saliva or food.
• Halitosis or bad breath.

What are the non-surgical treatments for achalasia?

Balloon dilation and botulinum toxin injection are the most common. They are reserved for patients at high surgical risk due to age or health problems. There are also other endoscopic techniques, some experimental, but they have not yet reached a safety level and efficacy that can be considered a regular standard of care.

Is esophageal dilation effective?

It is effective in 70% of cases at one year, but over time its effectiveness decreases. However, it is frequently burdened by the complication of gastroesophageal reflux.

Is surgery effective?

Yes, surgery that consists of the section of muscle fibers of the lower esophageal sphincter is effective and, in expert hands, very safe, although like all surgical procedures, it can present complications.