Spectrum of care:
The outpatient clinic treats adults with the following problems:
- Examination and surgical treatment for gastroesophageal reflux disease and diaphragmatic hernia.
- Examination for inguinal or abdominal hernia, gall bladder stones, chronic appendicitis, etc., with provision for day surgery
- Removal of skin moles, subcutaneous formations (freckles, nevi, lipomas, etc.)
- Treatment of minor injuries (abrasions, lacerations, sprains, etc.)
- Treatment of inflammatory skin diseases (abscesses, suppurations, inflammations, furuncles, etc.)
In the surgical outpatient clinic for the treatment of reflux disease of the esophagus and diaphragmatic hernia, we mainly deal with gastroesophageal reflux disease (synonyms = GE reflux, GERD), which is caused by excessive return of gastric contents back into the esophagus. Gastric juices irritate and eventually damage the mucosal surface in the esophagus, pharynx and larynx, depending on how high the reflux extends.
A diaphragmatic hernia is a loosening of the diaphragmatic cricus ( an opening made of muscle) at the point of passage of the esophagus through the diaphragm from the chest to the abdominal cavity. The larger opening in the diaphragm then allows the upper part of the stomach to slide into the chest.
The symptoms of reflux are divided into:
- classical, which indicate lower oesophageal involvement - these include heartburn, pain behind the sternum, regurgitation of gastric juices (regurgitation), pain when swallowing.
- extraesophageal ( extraesophageal), which are a sign of damage to the mucous membranes of the higher parts of the oesophagus or pharynx and larynx. Patients complain of irritated throat (globus), hoarseness, cough, asthma, airway inflammation, halitosis, frequent sinusitis, etc. Symptoms may also combine depending on whether the stomach contents are acidic or non-acidic.
The cause of reflux is often a combination of several factors. It is a disorder of the closure mechanism between the oesophagus and stomach - most commonly a weakening of the lower oesophageal sphincter and a diaphragmatic hernia. Hereditary factors, lifestyle and dietary habits contribute to this. Irritating diet, smoking, being overweight increase the risk.
Examination of reflux
- Gastroscopy, which is the basic examination, determines the degree of involvement (inflammation) of the mucous membranes in the oesophagus, and may also reveal an esophageal sphincter or diaphragmatic hernia.
- X-ray examination ( swallowing a contrast agent) is another examination used to verify the diagnosis of reflux - it will determine the size of the diaphragmatic hernia.
- 24-hour pH metrics with impedance - will calculate the frequency of reflux and correlate it with the symptoms felt by the patient, it will also show how far the reflux extends into the oesophagus and will also detect non-acid reflux. Esophageal manometry is used to rule out a disorder of esophageal peristalsis. ENT and pulmonary specialty tests (extra-esophageal symptoms) then complete the spectrum.
How reflux is treated
First, conservative treatment is always attempted - lifestyle modification ( eating 5 times a day, last intake 3 hours before sleep) , smoking ban, weight reduction. Limit or eliminate unsuitable foods.
When regimen measures are not enough, medical treatment (PPIs, H2 blockers, prokinetics), diaphragm rehabilitation ( diaphragmatic breathing training) may be beneficial for some.
Surgical treatment is indicated when conservative treatment including medication has insufficient effect or when the diaphragmatic hernia is larger.
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