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For more information on General Surgery, please contact the GP Liaison Department on:

T: 020 7234 2009

or visit

Gastro-Oesophageal Reflux Disease

Acid reflux is extremely common, with

one in four people experiencing some

symptoms on a weekly basis.

When to refer

patients with

acid reflux?

Gastro-Oesophageal Reflux Disease


It is also a major health economic

issue with drug expenditure (primarily

PPIs) accounting for over £200 million

per year.

Although drug costs are falling, drug use

overall continues to increase and there

remains considerable pressure on us all

to reduce this.

Gastro-Oesophageal Reflux Disease

(GORD) is a known risk factor for the

development of Barrett’s Oesophagus,

which, in turn, can lead to oesophageal

cancer (although the percentage of

patients developing cancer remains

relatively small). Although outcomes

from oesophageal cancer treatment

have improved dramatically in the last

20 years (we now have a five-year

survival in excess of 50% for patients

having surgery in our unit), the majority

of patients still present with advanced


The recent ‘Action against Heartburn’

campaign highlighted the importance of

early diagnosis of oesophageal cancer

through the identification of patients with

persistent (three weeks) or unexplained

symptoms of reflux. Patients who

continue to experience symptoms despite

treatment, as well as those with dysphagia,

unexplained anaemia or weight loss should

also be referred urgently. Patients with

Barrett’s Oesophagus should be enrolled

in a surveillance programme and many can

be successfully managed with endoscopic


For patients with confirmed GORD,

indications for surgery include those with

particularly severe symptoms (including

volume regurgitation) and those in whom

medical therapy is poorly tolerated or

who do not wish to continue long-term

medication. Surgery can be extremely

effective, but patient selection remains

crucial to a successful outcome, arguably

more so than any other operation we

perform as Upper GI surgeons. Patients

should never be persuaded to have surgery

for reflux. They must choose this option

having been appropriately counselled as to

the risks, benefits and alternatives.

We investigate patients thoroughly, using

a multidisciplinary team-based approach.

This way, patients may be appropriately

managed with medication, endoscopy or

Mr Andrew Davies

Consultant Upper GI

and General Surgeon

Mr Andrew Davies is a Consultant

Upper GI and General Surgeon

at Guy’s & St Thomas’ NHS

Foundation Trust and London

Bridge Hospital. The department

is a tertiary referral unit for

London and the South East of

England for oesophago-gastric

cancer and complex benign upper

GI disorders. He has expertise in

advanced laparoscopic surgery and

a particular interest in anti-reflux

surgery. He is also a specialist in

surgery for abdominal hernias,

gallstones and oesophago-gastric

cancer. With Mr James Gossage, he

has established the London Surgical

Group, which offers clinic availability

at London Bridge Hospital and the

City of London Medical Centre.

He has a strong academic

background and currently holds

positions at King’s College London

Honorary Senior Lecturer, as well as

the Karolinska Institute in Sweden.

He regularly reviews articles for

leading surgical journals and has

been a speaker at a number of

international conferences.

surgery without the need for constant

referrals via their GP. Surgery is tailored

to the individual patient and frequently

performed by two Consultant surgeons

working in tandem. It generally involves

a one-night stay in hospital and

nearly all procedures are completed

laparoscopically. More information on

anti-reflux surgery can be found at