Heartburn

This is a condition where you will feel a burning sensation in the chest behind your breastbone. This can happen at any time of the day. Certain activities such as lying down and bending over are more likely to bring on your symptoms. Some people get it after a big meal. Other people may experience the symptoms in any position or any specific activity. In some people it may not cause any burning sensation as such but may find a lot of fluid is coming into the gullet and sometimes taste the fluid at the back of the throat.

What causes heartburn?

Heartburn suggests that some of the acid from the stomach is refluxing into the gullet. The gullet isn’t built to be exposed to acid and therefore you feel the burning sensation when the acid comes into the gullet.

All of us have some acid come into the gullet from time to time but don’t feel the heartburn. This is because only a small amount of acid enters the gullet. There is a valve between the gullet and the stomach which stops and limits the amount of acid coming into the gullet. Also, the gullet promptly pushes the acid back into the stomach.

You will feel the symptoms if either the gullet is exposed to acid for prolonged periods, or a lot of acid refluxes into the gullet or if it happens frequently.

There are many reasons why acid from the stomach will reflux into the gullet. This includes a weakening of the valve between the gullet and the stomach, or poor clearance of the acid by the gullet.

Obesity is a known cause of reflux and heartburn. Heartburn improves with weight loss either by dieting or from weight loss surgery.

Does Hiatus hernia cause reflux / heartburn?

This is a popular myth. Hiatus hernia by itself if it’s a small one is unlikely to cause any significant symptoms. Not all patients that have a hiatus hernia have reflux and not all the patients that have reflux have hiatus hernia. Click Hiatus hernia (link to the Hiatus hernia page) for more information.

What can untreated heartburn cause?

If untreated, the lower part of the gullet can develop inflammation from burning due to acid. In some, constant and recurrent burning can lead to scar formation and can cause problems with swallowing.

If the acid exposure continues untreated for many years, this can result in a condition called Barrett’s oesophagus, which increases the chances of developing cancer.

In rare situations, the acid that is coming into the gullet can enter the windpipe and cause asthma type symptoms and very rarely sinusitis.

What investigations do i need?

All patients who are suffering from heartburn will need at least one endoscopy to assess the gullet and the stomach. If you want to consider having an operation, you will need a few more tests. This include a manometry (measurement of pressures in the gullet and also to assess if its moving properly) and pHmetry, to measure the amount of acid that the gullet has been exposed to and if your symptoms are caused by this acid exposure.

Treatment of heartburn ranges from doing nothing if it settles by itself, to short or long term antiacid medication and surgery. These options can be discussed at the consultation with Mr Jayanthi

Gastric Sleeve

A gastric sleeve surgery is a restrictive procedure where the size of your stomach is reduced therefore limiting the amount of food you can eat which will help towards weight loss.

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Sleeve gastrectomy is a procedure, where the stomach is stapled. As a result, the stomach (which is ‘bag’ shaped) is changed into a ‘tube’. The capacity of the stomach is significantly reduced. This results in feeling full even after a small meal and hence reducing the volume of food eaten each meal time.

Furthermore, research has also shown that following this operation, hunger is suppressed. There is also evidence that all the obesity associated health problems improve significantly following sleeve gastrectomy.

Risks on this operation include that of leak from the staple line, injury to liver, spleen and bowel.

Mr Jayanthi performs this operation using keyhole techniques. The patient stays in the hospital for about 1-2 days following the operation.

Gastric Band

A gastric band involves dividing your stomach into two by placing a silicone band around the stomach therefore creating a small pouch at the top of your stomach (roughly the size of a golf ball).

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Adjustable gastric band is one of the commonest operations performed worldwide.

Why is it called ‘adjustable’?

Adjustable gastric band consists of a plastic ring with a balloon, which goes around the upper part of the stomach. This is connected to a port underneath the skin. The balloon in the band offers the ‘adjustability’. The band is filled with saline to cause a small gastric pouch above the band. This will make patients feel full even after small meals. The optimal amount of inflation or filling of the band varies with each patient. If the band is under filled you are able to eat more. On the other extreme you will not be able to swallow if the band is over filled. Therefore, it is important to achieve a happy medium. This can take anywhere from a few months to a year.

What are the risks?

This procedure is safe and most of the patients will be able to go home either later the same day or after overnight stay. There are however some risks as with any other operations. Specific to this operation, there is a chance of injury to the stomach, spleen and liver during the operation. Liver diet will go a long way to minimise the chances of injury to the liver.

The port site under the skin can get infected. This infection can then track down to the band and may only be treatable by removal of the band. Therefore careful aseptic technique should be employed while filling or de-filling of the band.

Slippage, erosion, infection

In the long run, there are chances of the band slipping over the stomach. This can result in vomiting, unable to swallow, and or weight regain. In some instances this can lead to the band eroding into the stomach. Patient can become very unwell as a result of the erosion. Urgent medical help from an expert is essential in this situation. The port can also get infected as a result of the erosion with the infection tracking from within.

How successful?

Overall, adjustable gastric band can achieve significant & sustained weight loss. Gastric band matches and in some cases can do better than a gastric bypass in terms of weight loss. Patient with diabetes can see improvements in the condition as they loose weight.

Gastric Bypass

In the UK, the most common gastric bypass surgery is a combination of restrictive and malabsorptive procedure procedures called Roux-en-Y (RYGB) which creates a two-way weight reducing effect.

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Gastric Bypass combines the effects of both restriction & a mal-absorption. In this operation, stomach is reduced in size and bowel is re-routed in a fashion that food bypasses stomach and enters small bowel (often called roux-en-Y).

Following Gastris Bypass, patients not only feel full even after small meals but their calorie absorption is decreased. Research has shown that, gastric bypass also results in a number of changes in the gut hormone signals. The collective effects of these changes include early satiety (feeling full) and decrease in hunger. This results in healthy eating and assist patients to loose weight effectively and more importantly results in sustained the weight loss.

Gastric Bypass improves all obesity-associated conditions. The effect on diabetes is most striking. Type 2 Diabetes improves almost immediately after Gastric Bypass. This effect on Diabetes is unique to Gastric Bypass (of all the weight loss operations). High blood pressure, high cholesterol, reflux, weak heart improve in over 90% of the patients after Gastric Bypass. A recent study has confirmed that heart condition also improves following gastric bypass. Quality of life improves with patients more active in their day-to-day life, at work and in society.

Risks of this operation include join leaks, injury to bowel, stomach, liver and spleen. Mr Jayanthi performs Gastric bypass using keyhole techniques. Patients can be discharged after 48hrs.

Heartburn

What causes heartburn?

Does Hiatus hernia cause reflux / heartburn?

What can untreated heartburn cause?

What investigations do i need?

What investigations do i need?

Gastric Sleeve

Gastric Band

Gastric Bypass

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