The fire in your belly Dip Mukherjee Consultant

The fire in your belly Dip Mukherjee Consultant surgeon >> 0 >> 1 >> 2 >> 3 >> 4 >>

Top Tips for handling reflux patients 1. Listen to patients (til they run out of things to say) before asking questions. Believe them even if things sound nonspecific 2. Impact on life to be assessed: eating, social life and sleep 3. Weed out non ulcer dyspespsia, belching, bulemia 4. Beware of new symptoms especially in white males. It is very much a premalignant condition 5. Lifestyle adjustments work only partially. If they don’t respond to PPI they probably do not have GORD >> 0 >> 1 >> 2 >> 3 >> 4 >>

6. Refer difficult refractory and Unhappy patients 7. Gastroscopy for most referred patients. p. H testing and manometryreserved for patients being considered for surgery. 8. Thin patients with volume reflux with hiatus hernia benefit most from laparoscopic. Antireflux surgery. All paraoesophageal hernia should be repaired in fit patients. 9. Antireflux surgery in well selected patients can be life changing provided expectation are set clearly and well executed 10. Barretts need surveillance even after antireflux surgery >> 0 >> 1 >> 2 >> 3 >> 4 >>

Gastro. Oesophageal Reflux Disease GORD “Following the Jewish tradition, a dispenser of schmaltz (liquid chicken fat) is kept on the table to give the vampires heartburn if they get through the garlic defense. ” >> 0 >> 1 >> 2 >> 3 >> 4 >>

• 10 -40% of population in the Western world (9% daily, 20% weekly) • 40% take time off work • £ 65 million spent on antacids in 1993 • £ 430 million spent on PPI in 1998 • PPI the highest drug expenditure in NHS • Cancer of the oesophagus related to GORD is the most rapidly increasing cancer in western countries >> 0 >> 1 >> 2 >> 3 >> 4 >>

Your Barrier against reflux >> 0 >> 1 >> 2 >> 3 >> 4 >>

Triggers • Chocolate • Caffeine • Citrus fruits • Tomato • Stop drinking (Red wine) • Fatty Foods >> 0 >> 1 Better Tolerated • Apple • Baked potato • Broccoli • Cabbage • Chicken breast, skinless • Egg whites • Green beans, Peas >> 2 >> 3 >> 4 >>

Hiatus hernia >> 0 >> 1 >> 2 >> 3 >> 4 >>

Mechanism >> 0 >> 1 >> 2 >> 3 >> 4 >>

Acid rains >> 0 >> 1 >> 2 >> 3 >> 4 >>

Acid injury >> 0 >> 1 >> 2 >> 3 >> 4 >>

Symptoms >> 0 >> 1 >> 2 >> 3 >> 4 >>

Food sticking in my gullet >> 0 >> 1 >> 2 >> 3 ! >> 4 >>

Diagnosis >> 0 >> 1 >> 2 >> 3 >> 4 >>

Harold Horace Hopkins FRS (1918– 1994) Twice nominated for Nobel prize 1952 Laparoscope 1959 Rod lens system >> 0 >> 1 >> 2 >> 3 >> 4 >>

Checking out the barrier … and the acid sweeper… manometry >> 0 >> 1 >> 2 >> 3 >> 4 >>

Measuring the acid p. H test >> 0 >> 1 >> 2 >> 3 >> 4 >>

Complications stricture >> 0 >> 1 >> 2 >> 3 >> 4 >>

Complications Barretts oesophagus >> 0 >> 1 >> 2 >> 3 >> 4 >>

Complication Cancer >> 0 >> 1 >> 2 >> 3 >> 4 >>

1976 …. the first ever blockbuster drug 1981 >> 0 >> 1 >> 2 >> 3 >> 4 >>

Headache Fatigue Dizzinss Diarrhoea Itching Osteoporosis Blisters Anxiety Depresion >> 0 >> 1 >> 2 >> 3 >> 4 >>

Surgery for reflux !! …. . Is this your cup of tea? >> 0 >> 1 >> 2 >> 3 >> 4 >>

Rudolf Nissen 1955 operations for reflux Nissen R >> 0 1956. 1961. >> Swiss Medical weekly American journal of digestive diseases 1 >> 2 >> 3 >> 4 >>

Bernard Dellemagne Leige 1991 >> 0 >> 1 >> 2 >> 3 >> 4 >>

Recovery & Results Highly effective…… life changing surgery >> 0 >> 1 >> 2 >> 3 >> 4 >>

Case study DF … no wonder she was feeling a bit breathless >> 0 >> 1 >> 2 >> 3 >> 4 >>

… with a chest Xray like this >> 0 >> 1 >> 2 >> 3 >> 4 >>

… May be a CT chest would be handy … hmmm. . an odd hydro pneumothorax ! >> 0 >> 1 >> 2 >> 3 >> 4 >>

Lung windows …these expensive softwares are useful after all!! >> 0 >> 1 >> 2 >> 3 >> 4 >>

EW 80 had a femoral hernia repair under local for terrible COAD. . She was a little surprised as she never smoked >> 0 >> 1 >> 2 >> 3 >> 4 >>

The COAD got worse and she could not eat any more …. We thought that was strange >> 0 >> 1 >> 2 >> 3 >> 4 >>

Thank you >> 0 >> 1 >> 2 >> 3 >> 4 >>