Kenneth R. DeVault
Anti-reflux surgery controls reflux symptoms in a majority of patients. Unfortunately, that control comes with a price in some patients with the development of new, postoperative symptoms. These symptoms vary widely and can include dysphagia, increased abdominal gas (gas bloat syndrome), and several other symptoms. All of these are very common if inquired for by questionnaire. For example, in a study of 60 patients with 1-year follow-up, some gastrointestinal symptom was present in 93% of patients, but only 19% said that they had symptom that disturbed their lifestyle.1 There are many symptoms that may accompany both typical (heartburn and regurgitation) and atypical (pulmonary or ears, nose, and throat) presentations of reflux. These include dysphagia, epigastric pain, nausea, and vomiting.2 If the primary symptoms are relieved by surgery, there is a chance that a preexisting less-appreciated symptom may now become primary and appear to be attributable to surgery when, in fact, it was really present all along. In addition to new symptoms, the persistence or return of the reflux symptoms that resulted in the surgery initially is an important issue. Whereas much attention is given to each of these recurrent gastroesophageal reflux disease (GERD)-attributed symptoms in other chapters in this book, our goal will be to explore symptoms occurring after surgery, but not related to the surgery itself.
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.