Reflux

Common Symptoms

• Heartburn

• Globus

• Chest Pains

Complex Reflux Symptoms

• Mass Reflux

• Cough/Asthma/recurrent Chest Infections

• Sore Throat

Complex Symptoms

• Dysphagia

• Pain

Differential Diagnoses

• Cancer

• Dysmotility– Oesophageal– gastric

Treatment

• Conservative

• Medical– PPI– Barrier

• Surgical

Medical vs Surgical

• Only three Trials of Lap vs Medicine– Mahon 2005– Anvari 2006– Grant 2008

All Show improve QOL at 1 year

Indications for Surgery

• Lifestyle

• Breakthrough Symptom Control

• Complex Reflux Control

Why pH Manometry

• Prove reflux

• Avoid dysmotility

• Manage expectation

Patients

• All three patients described have – Dysphagia

– Odynophagia

– Reflux

Hypotensive dysmotility – typical of GORD

Hypotensive dysmotility – typical of GORD

Vigorous Achalasia

Vigorous Achalasia

Vigorous Achalasia

Structural obstruction at the PIP

Complex Reflux Disease

Mr Yuen Soon