General and Gastrointestinal Surgery

Diagnosis Q and A

Do low pressure contractions exclude me from surgery?

No, but it means a different type of operation is necessary.  A partial, rather than a complete wrap, will be performed if needed. 

Does esophageal spasm exclude me from surgery?

No, but symptoms may not completely go away after surgery. Fortunately, most esophageal spasm that occurs concomitantly with reflux does go away if the reflux is eliminated. However, primary esophageal spasm in the absence of reflux will not go away with anti-reflux therapy. This is seen in about 50% of cases of esophageal spasm.

Does achalasia exclude me from surgery?

No, but the operation for achalasia is radically different from the standard anti-reflux operation. The surgical treatment of achalasia involves cutting the lower esophageal sphincter to eliminate the high pressure area, followed by an anti-reflux procedure.

What is an EGD?

An EGD is an esophagogastroduodenoscopy, also known as an upper endoscopy. A tube about ½ inches in diameter is placed through the mouth into the esophagus, stomach and then duodenum. The tube, which is actually a scope, is attached to a video monitor, allowing the doctor performing the procedure to look at those three organs for abnormalities such as reddening, ulcers and tumors.  It is a very common procedure that lasts only a few minutes and is usually performed with sedation.

What is a gastric emptying study?

A gastric emptying study is one that measures the amount of time it takes for a meal to leave your stomach. Normally this takes less than 90 minutes. People who have diabetes or a lot of scarring from peptic ulcer disease may have significantly prolonged emptying of their stomach.

How is a gastric emptying test performed?

The gastric emptying test is a painless test in which one is asked to ingest eggs or hamburger that has been labeled with a tiny amount of radiation.  The radiation present is less than that in a watch or that one is exposed to during an airplane trip. A special (gamma) camera counts the radioactivity in the stomach at different time intervals, thereby allowing the calculation of how long it takes the stomach to empty.

What is an upper GI series?

An upper GI series is a series of x-rays taken as a chalky, pink liquid (barium) is swallowed. This allows the radiologist to observe how things go down the esophagus and to see if any abnormalities exist. It also allows the radiologist to determine if a hiatal hernia is present.

Must I have all these tests to have surgery?

Most patients undergo all of  these tests.  It is important to be 100% sure that the diagnosis is correct, that no other esophageal disorders exist and that the esophagus contracts well prior to any surgery.  However, decisions can be made in some case by using only a few of these tests.

Treatment options 

Reflux Disease