Thursday, March 26, 2015
It's Been So Long
Wow.. It really has been a long time since I've sat down at my computer and wrote down what's going on - Almost Three years since my last post, let me catch you up! I'm going to give it a try (have lots of entries in my journal) and explain what life has been like over the past few years post Nissen Fundoplication. Here it goes!!
Thursday, March 29, 2012
Understanding Barrett's Esophagus
Barrett’s esophagus (BE) or intestinal metaplasia (IM) is a change in
the epithelial lining of the esophagus. BE develops as a result of
chronic exposure of the esophagus to refluxed stomach acid, enzymes and
bile.
It occurs when a patient’s lower esophageal sphincter or valve no longer closes properly to prevent acid backwash into the lower esophagus. This results in recurrent mucosal injury. Such injury is accompanied by inflammation, and ultimately a cellular change (metaplasia) to a specialized columnar epithelium.19
Gastroesophageal reflux disease or GERD is a chronic form of heartburn, which according to a Harvard Medical School Report, affects 10% of Americans on a daily basis.35 Acid related diseases are climbing in severity and they are a growing cause of sleep problems and work absences. This indicates an increasing need for early intervention, prevention and therapeutic services for this and other digestive concerns.
Chronic heartburn, being the leading cause of Barrett’s esophagus,31 is a digestive concern that requires understanding and about which the public should be made more aware, as it is the beginning of a potential progression toward esophageal cancer.32
According to the American Gastroenterological Association (AGA), which published a Medical Position Statement on the Management of
Barrett’s esophagus in March 2011, endoscopic eradication therapy – such as radiofrequency ablation (RFA) – for patients with confirmed high-grade dysplasia (advanced precancerous cells) is recommended instead of surveillance or immediate esophagectomy.
For patients with confirmed low-grade dysplasia (less advanced precancerous cells), endoscopic eradication therapy is recommended as a therapeutic option, and it should be discussed as such with patients. For patients with non-dysplastic (early precancerous cells) Barrett’s, the AGA states:
It occurs when a patient’s lower esophageal sphincter or valve no longer closes properly to prevent acid backwash into the lower esophagus. This results in recurrent mucosal injury. Such injury is accompanied by inflammation, and ultimately a cellular change (metaplasia) to a specialized columnar epithelium.19
Gastroesophageal reflux disease or GERD is a chronic form of heartburn, which according to a Harvard Medical School Report, affects 10% of Americans on a daily basis.35 Acid related diseases are climbing in severity and they are a growing cause of sleep problems and work absences. This indicates an increasing need for early intervention, prevention and therapeutic services for this and other digestive concerns.
Chronic heartburn, being the leading cause of Barrett’s esophagus,31 is a digestive concern that requires understanding and about which the public should be made more aware, as it is the beginning of a potential progression toward esophageal cancer.32
According to the American Gastroenterological Association (AGA), which published a Medical Position Statement on the Management of
Barrett’s esophagus in March 2011, endoscopic eradication therapy – such as radiofrequency ablation (RFA) – for patients with confirmed high-grade dysplasia (advanced precancerous cells) is recommended instead of surveillance or immediate esophagectomy.
For patients with confirmed low-grade dysplasia (less advanced precancerous cells), endoscopic eradication therapy is recommended as a therapeutic option, and it should be discussed as such with patients. For patients with non-dysplastic (early precancerous cells) Barrett’s, the AGA states:
“Although endoscopic eradication therapy
is not suggested for the general population of patients with Barrett’s
esophagus in the absence of dysplasia, we suggest that RFA, with or
without endoscopic mucosal resection (EMR), should be a
therapeutic option for select individuals with nondysplastic Barrett’s
esophagus who are judged to be at increased risk for progression to
high-grade dysplasia or cancer.”
The AGA goes on to reinforce the importance of a…
“…shared decision making where the
treating physician and patient together consider whether endoscopic
surveillance or eradication therapy is the preferred management option
for each individual.”
Incidence
- In a study published in 2005, BE’s prevalence was estimated to affect 3.3 million adults over 50 years of age in the United States.3,14,36
- The prevalence of BE in the adult population is 0.4% to 1.3%, although recent reports from gastroenterology-selected populations suggest a higher prevalence.5
Barrett's and Esophageal Adenocarcinoma
- From 1975 to 2001, the frequency of esophageal adenocarcinoma rose approximately six fold in the U.S. from four to 23 cases per million people. At the same time, the rate of deaths due to this form of esophageal cancer has grown seven fold, from two to 15 deaths per million people.4
- Patients with Barrett’s esophagus have an increased risk of developing esophageal adenocarcinoma6 at a rate that is 30 to 125 times higher than patients without this condition.7
- The American Cancer Society estimates that during 2010, approximately 16,640 new esophageal cancer cases were diagnosed.8
- Even with aggressive therapy, the five-year survival rate from adenocarcinoma is only around 17%.8
Gastroesophageal Reflux Disease (GERD) and Barrett's Esophagus
- Approximately 13% of Caucasian men over age 50 who have chronic reflux will develop Barrett’s esophagus.4
- In a study conducted by the Veteran Affairs Health Care System and Stanford University, 25% of patients over 50 years old without acid reflux symptoms were found to have Barrett’s esophagus.14
- GERD is common in the U.S. adult population. Symptoms of acid reflux, including heartburn, occur:
- Weekly in 18% of U.S. adults16
- Monthly in almost 44% of U.S. adults16
"The presence of Barrett’s esophagus is considered to be the primary risk factor for developing esophageal cancer."
Johnston, et al 2008
http://www.barrx.com/healthcare-professionals/why-treat-barretts-esophagus.php
Very Informative
I came across this power point presentation today when researching a list of doctors recommendations for post op diets. I found it to be informative and answers many questions. Hope it does the same for you. University of Kentucky Medical School
Post op Diet via the web
What the doctors say... Here are just a few links for post op diets
Winchester Surgeons at 83 Memorial Drive · Winchester, TN 37398
Robert A. Catania, MD, FACS with the Department of General Surgery @ the Naval Medical Center Portsmouth
NEWTON-WELLESLEY SURGEONS, INC. at 2000 WASHINGTON STREET, SUITE 365 in NEWTON, MA 02462
Livestrong website Livestrong website via the web
UCLA Center for Esophageal Disorders
The Harbin Clinic located in Georgia
University Of Virginia
Aaron S. Bransky, MD located at 6309 Preston Road, Suite 1200 Plano, Texas 75024
University of North Carolina School of Medicine
UPMC is Affiliated with the University of Pittsburgh Schools of the Health Sciences
Living with Reflux website
University of Michigan Health System
For a list of Aurora facilities with a dietitian, please call Aurora Health Care toll free at 888-863-5502.
Winchester Surgeons at 83 Memorial Drive · Winchester, TN 37398
Robert A. Catania, MD, FACS with the Department of General Surgery @ the Naval Medical Center Portsmouth
NEWTON-WELLESLEY SURGEONS, INC. at 2000 WASHINGTON STREET, SUITE 365 in NEWTON, MA 02462
Livestrong website Livestrong website via the web
UCLA Center for Esophageal Disorders
The Harbin Clinic located in Georgia
University Of Virginia
Aaron S. Bransky, MD located at 6309 Preston Road, Suite 1200 Plano, Texas 75024
University of North Carolina School of Medicine
UPMC is Affiliated with the University of Pittsburgh Schools of the Health Sciences
Living with Reflux website
University of Michigan Health System
For a list of Aurora facilities with a dietitian, please call Aurora Health Care toll free at 888-863-5502.
What is a Nissen Fundoplication
What is a Nissen fundoplication it is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia. In GERD it is usually performed when medical therapy has failed, but with paraesophageal
hiatus hernia, it is the first-line procedure. The Nissen
fundoplication is total (360°), but partial fundoplications known as
Belsey fundoplication (270° anterior transthoracic), Dor fundoplication
(anterior 180-200°) or Toupet fundoplication (posterior 270°) are also
alternative procedures with somewhat different indications.
Who invented or preformed the first procedure - Dr. Rudolph Nissen (1896–1981) first performed the procedure in 1955 and published the results of two cases in a 1956 Swiss Medical Weekly.[1] In 1961 he published a more detailed overview of the procedure.[2] Nissen originally called the surgery "gastroplication." The procedure has borne his name since it gained popularity in the 1970s.
What type of techniques are used to preform this surgery -In a fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter. The esophageal hiatus is also narrowed down by sutures to prevent or treat concurrent hiatal hernia, in which the fundus slides up through the enlarged esophageal hiatus of the diaphragm. In a Nissen fundoplication, also called a complete fundoplication, the fundus is wrapped all the way 360 degrees around the esophagus. In contrast, surgery for achalasia is generally accompanied by either a Dor or Toupet partial fundoplication, which is less likely than a Nissen wrap to aggravate the dysphagia that characterizes achalasia. In a Dor (anterior) fundoplication, the fundus is laid over the top of the esophagus; while in a Toupet (posterior) fundoplication, the fundus is wrapped around the back of the esophagus. The procedure is now routinely performed laparoscopically and robotically using the da Vinci Surgery System. When used to alleviate gastroesophageal reflux symptoms in patients with delayed gastric emptying, it is frequently combined with modification of the pylorus via pyloromyotomy or pyloroplasty.
You should feel relief because - Whenever the stomach contracts, it also closes off the esophagus instead of squeezing stomach acids into it. This prevents the reflux of gastric acid (in GERD).
Some complications have been reported such as -Nissen fundoplication is generally considered to be safe and effective, with a mortality rate of less than 1%. Studies have shown that after 10 years, 89.5% of patients are still symptom-free.[4] Complications include "gas bloat syndrome", dysphagia (trouble swallowing), dumping syndrome, excessive scarring, vagus nerve injury, and rarely, achalasia.[5] The fundoplication can also come undone over time in about 5-10% of cases, leading to recurrence of symptoms. If the symptoms warrant a repeat surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection.[6] Postoperative irritable bowel syndrome, which lasts for roughly 2 weeks, is possible. In "gas bloat syndrome", fundoplication can alter the mechanical ability of the stomach to eliminate swallowed air by belching, leading to an accumulation of gas in the stomach or small intestine. Data varies, but some degree of gas-bloat may occur in as many as 41% of Nissen patients; whereas the occurrence is less with patients undergoing partial anterior fundoplication.[7] Gas bloat syndrome is usually self-limiting within 2 to 4 weeks, but in some it may persist. The offending gas may also come from dietary sources (especially carbonated beverages), or involuntary swallowing of air (aerophagia). If postoperative gas-bloat syndrome does not resolve with time, dietary restrictions, and counselling regarding aerophagia; correction may be necessary, either by endoscopic balloon dilatation[citation needed] or repeat surgery to revise the Nissen fundoplication to a partial fundoplication.[7] Vomiting is often difficult or even impossible with a fundoplication. In some cases, the purpose of this operation is to correct excessive vomiting. However, when its purpose is to reduce gastric reflux, difficulty in vomiting may be an undesired outcome. Initially, vomiting is impossible; however, small amounts of vomit may be produced after the wrap settles over time, and in extreme cases such as alcohol poisoning or food poisoning, the patient may be able to vomit freely.
Who invented or preformed the first procedure - Dr. Rudolph Nissen (1896–1981) first performed the procedure in 1955 and published the results of two cases in a 1956 Swiss Medical Weekly.[1] In 1961 he published a more detailed overview of the procedure.[2] Nissen originally called the surgery "gastroplication." The procedure has borne his name since it gained popularity in the 1970s.
What type of techniques are used to preform this surgery -In a fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter. The esophageal hiatus is also narrowed down by sutures to prevent or treat concurrent hiatal hernia, in which the fundus slides up through the enlarged esophageal hiatus of the diaphragm. In a Nissen fundoplication, also called a complete fundoplication, the fundus is wrapped all the way 360 degrees around the esophagus. In contrast, surgery for achalasia is generally accompanied by either a Dor or Toupet partial fundoplication, which is less likely than a Nissen wrap to aggravate the dysphagia that characterizes achalasia. In a Dor (anterior) fundoplication, the fundus is laid over the top of the esophagus; while in a Toupet (posterior) fundoplication, the fundus is wrapped around the back of the esophagus. The procedure is now routinely performed laparoscopically and robotically using the da Vinci Surgery System. When used to alleviate gastroesophageal reflux symptoms in patients with delayed gastric emptying, it is frequently combined with modification of the pylorus via pyloromyotomy or pyloroplasty.
You should feel relief because - Whenever the stomach contracts, it also closes off the esophagus instead of squeezing stomach acids into it. This prevents the reflux of gastric acid (in GERD).
Some complications have been reported such as -Nissen fundoplication is generally considered to be safe and effective, with a mortality rate of less than 1%. Studies have shown that after 10 years, 89.5% of patients are still symptom-free.[4] Complications include "gas bloat syndrome", dysphagia (trouble swallowing), dumping syndrome, excessive scarring, vagus nerve injury, and rarely, achalasia.[5] The fundoplication can also come undone over time in about 5-10% of cases, leading to recurrence of symptoms. If the symptoms warrant a repeat surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection.[6] Postoperative irritable bowel syndrome, which lasts for roughly 2 weeks, is possible. In "gas bloat syndrome", fundoplication can alter the mechanical ability of the stomach to eliminate swallowed air by belching, leading to an accumulation of gas in the stomach or small intestine. Data varies, but some degree of gas-bloat may occur in as many as 41% of Nissen patients; whereas the occurrence is less with patients undergoing partial anterior fundoplication.[7] Gas bloat syndrome is usually self-limiting within 2 to 4 weeks, but in some it may persist. The offending gas may also come from dietary sources (especially carbonated beverages), or involuntary swallowing of air (aerophagia). If postoperative gas-bloat syndrome does not resolve with time, dietary restrictions, and counselling regarding aerophagia; correction may be necessary, either by endoscopic balloon dilatation[citation needed] or repeat surgery to revise the Nissen fundoplication to a partial fundoplication.[7] Vomiting is often difficult or even impossible with a fundoplication. In some cases, the purpose of this operation is to correct excessive vomiting. However, when its purpose is to reduce gastric reflux, difficulty in vomiting may be an undesired outcome. Initially, vomiting is impossible; however, small amounts of vomit may be produced after the wrap settles over time, and in extreme cases such as alcohol poisoning or food poisoning, the patient may be able to vomit freely.
NF surgery
This is a video uploaded unto YouTube via Tampa General Hospital all rights belong to them. I have watched several videos on this surgery and have found that this one proved to be the most informative. It is a little long at just over an hour. But in reality that is how long the procedure takes. The surgeon and the narrator answer questions during the video of the surgery. Please follow this link to the YouTube site - http://www.youtube.com/watch?v=pa-b1-5SMKw&noredirect=1
Day 34
Today so far has been a really good day. I have tried to introduce some activities that I previously enjoyed back into my daily life. Although I am tired I do not feel that I have overdone it or by any means hurt the outcome of my surgery. Today I have heartburn free and reflux free. I do not believe I will ever be gas free, one can only hope.
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