Dubai: A 35-year-old young Emirati man suffering from chronic acid reflux that had triggered the formation of a pre-cancerous Barrett’s oesophagus is now able to keep his food down and has minimised his chances of cancer, with a quick day surgery at a Dubai hospital.
After having undergone a Nissen’s fundoplication surgery (valve repair) with just a mini scar, at the Fakeeh University Hospital (FUH) under Professor Amir Nisar, consultant laparoscopic surgeon, Ismael Sayed Al Hashemi, an energy entrepreneur, is greatly relieved to be free of severe acid reflux disease.
Ever since the surgery, conducted on February 25, he has been able to eat and sleep well.
‘I would suffer constantly’
Recounting his ordeal with Gulf News, Al Hashemi said: “I had some congenital immune deficiencies and in the last three years also developed severe acid reflux or GERD. It was so bad that I could not keep my food down for long periods; I would suffer heartburns and regurgitate my food.”
He added: “It was so severe that my sleeping patterns were disturbed and I was seeking immediate medical help.”
Al Hashemi consulted several gastroenterologists to understand their techniques but most of them suggested an abdominal surgery.
“I was looking or a minimal invasive alternative and no one provided that to me. Therefore, when I consulted Professor Nisar, he immediately understood my problem and offered to relieve me with mini scar-less, minimal invasive surgery that has been carried out as a day procedure. Recently, I underwent an endoscopy and was surprised to know that my oesophagus lining had already healed.”
The procedure
Elaborating on the procedure, Professor Amir said: “I did four different things in this surgery. First, I went in and corrected the hiatus hernia the patient was suffering from. This is a condition where a part of the stomach extends from the diaphragm into the chest space. Next, we released his oesophagus to a lower level. Third, we narrowed the hiatus and reinforced it with a mesh for better results. Finally, we reconstructed a new LES valve [the sphincter separating the stomach form the chest] for this patient.”
He added: “This four-step procedure lasted for an hour and we were able to successfully do it with just accumulative incisions length of 1.6cm in ambulatory care. The patient was able to go home the same day and has reported a dramatic improvement in his health. This is first day case laparoscopic Nissen’s fundoplication in UAE. His acid reflux has disappeared.”
What is acid reflux?
Gastroesophageal Reflux Disease (GERD) is quite common and can affect people in a wide range of age groups like teenagers, to middle aged people to senior citizens.
Professor Nisar said: “One of the reasons why some people who have acid reflux might suffer is due to a congenital weakness of the LES valve. This is a bundle of muscles between the lower-end of the oesophagus entering the stomach. The job of these muscles is to act as a sphincter valve closing after the food has entered the stomach and preventing it from travelling back.
“We see the LES sphincter is weak in new-borns who often bring up milk after a feed. With time, this strengthens. However, in some cases it remains weak resulting in regurgitation even after the child grows up.”
Heartburn occurs due to regurgitation of stomach acid, bile secretions, or a combination of both back into the food pipe or mouth. In many cases, it can cause chest pains that somehow mimic a heart episode and people often mistake it for a cardiac issue. This can also present as sore throat or cough.
Lifestyle choices as triggers
GERD also is commonly found in people who are overweight or in those fond of spicy and fried food and have irregular sleeping patterns. Frequent acid reflux can result in the irritation and thickening of the swallowing pipe. Ulcers and stricture can develop in the gullet.
While experiencing an occasional heartburn due to indigestion is something many report, GERD is a more severe and may result in frequent episodes of heartburn due to a weakness of the LES valve. This causes a hiatus hernia where a part of the stomach is displaced into the chest.
Three types of acid reflux
Professor Nisar explained that reflux usually could result from acid, bile or a mix of bile and acid. “In most cases it presents as a mild heart burn which can be treated conservatively with mild over the counter medication. Moderate cases can be treated with medicines such as proton pump inhibitor and some life style changes.
“When an individual suffers from severe acid reflux, a minimal invasive laparoscopic Nissen’s fundoplication or mini scar less surgery has to be carried out to repair, reconstruct or tighten the LES valve.”
Side effects
In severe cases, constant reflux can result in thickening and inflammation of the oesophagus called as Barrett’s oesophagus, which is usually considered a precursor to cancer.
In the case of Al Hashemi, he had developed Barrett’s oesophagus. Professor Nisar explained: “In this case, the patient had suffered from such severe acid reflux that he was constantly regurgitating the food and as a result of it had developed Barrett’s oesophagus. This is a condition where the pink lining of the stomach comes up in the swallowing tube that connects the mouth to the stomach thickens and gets inflamed with the action of the strong acids and bile from constant reflux. This is recognised as a pre-cancerous condition and is a cause for concern.”
Early recognition and surgery can prevent lethal cancer of oesophagus in GERD patients, advised Professor Nisar.
How to minimise acid reflux
• Reduce weight
• Avoid eating large meals; substitute these with smaller meals that are easy to digest.
• Do not lie down or bend too much forward immediately after having a meal, as this might easily allow your LES sphincter to open and push food and acid back into your gullet
• Snacking close to bedtime is to be avoided as it will leave undigested food in your stomach that can trigger more acidity and reflux
• Cut back on acidic foods such as citrus foods, citrus, tomato, chocolate, mint, garlic, onions, other spicy or fatty foods
• Choose fresh vegetables, fruits in your meals along with low unprocessed food products such as dense carbs and fibre, which will ensure a robust digestion
• Give up on smoking as it can aggravate ones’ acidity
• Cut back on as alcohol, carbonated drinks, coffee, or tea
• People with acid reflux must minimise the use of aspirins, ibuprofen, certain muscle relaxers, or blood pressure medications or take these under doctor’s consultation
• Avoid self-medicating on antacids or proton pump indicators, as indiscriminate use of these medicines can cause more harm
• If GERD persists or gets worst, it is best to consult a gastroenterologist.
Source : Professor Amir Nasir
