What is reflux?
Reflux means reflux; such as escape from the stomach to the esophagus, from the duodenum to the stomach. Our topic here is reflux, which means that the stomach contents pass backwards into the esophagus.
What is the cause of reflux and how does it occur?
To understand reflux, it is first necessary to understand swallowing and the valve mechanism between the esophagus and stomach. There is no real valve between the esophagus and the stomach, but there is a transition point at the end of the esophagus, which we can call a valve, where the muscles thicken and remains closed except for swallowing. After swallowing, the food is moved towards the stomach by contractions of the esophagus. When the swallowing process reaches this limit, the muscles relax and the bite passes into the stomach.
Factors such as the weakening of this valve mechanism, increased pressure in the stomach or a hiatal hernia cause the stomach contents to leak back towards the esophagus. This condition is called reflux. Reflux is more common in pregnant women and the elderly.
What is reflux disease?
Acidic liquids flowing back from the stomach into the esophagus cause irritation in the esophagus (esophagitis). This irritation causes some complaints in patients. When a complaint occurs, it means that there is reflux disease.
What complaints does reflux disease cause?
Reflux complaints are sometimes typical and make the disease diagnosed immediately. Sometimes it may appear unrelated to the disease. Typical complaints are burning in the chest, which occurs after meals, bitter water coming to the mouth, and pain during swallowing. Non-typical complaints include cough, hoarseness, asthma attacks, chronic pharyngitis and chest pain.
Does everyone with these complaints have reflux?
Normal people who do not have reflux may occasionally experience bitter water coming into the mouth when burping or bending forward, or burning in the chest after eating too much. But these symptoms do not always mean that you have reflux disease.
In which case is reflux disease diagnosed?
Although there are many tests for diagnosis, people with typical complaints Diagnosis of reflux (such as burning in the chest, bitter water coming to the mouth) Temperature is placed and drug treatment can be started immediately. But the most appropriate method for diagnosis is gastroscopy. The diagnosis is confirmed when damage to the esophagus is seen during gastroscopy.
Is it necessary to have gastroscopy?
In addition to being necessary for diagnosis, it is also performed to evaluate the damage caused by reflux. It is also essential for planning treatment and differentiating reflux from other diseases.
Could there be another reason for the complaints?
There may be. Complaints similar to those in reflux can also be seen in ulcers, Barrett's esophagitis (severe esophagitis caused by reflux) and esophageal cancer. These diseases are distinguished from each other by gastroscopy.
Is a biopsy taken during gastroscopy?
It is not necessary to perform a biopsy for patients with reflux esophagitis. However, if there is Barrett's esophagitis or another disease, a biopsy should be performed.
Can it be said that there is reflux disease even if the gastroscopy is normal?
Yes, reflux is normal when the endoscopy is normal. If there are complaints, reflux disease can be diagnosed. Because in some patients, while no abnormality is seen in gastroscopy, the patient may complain of severe reflux. In this case, treatment must be started.
Are there any other diagnostic methods?
Gastroscopy is the first method used to diagnose reflux. But there are other methods as well. pH monitoring, which monitors the escape of gastric fluid into the esophagus for 24 hours, is the best method to detect reflux. But the person has to carry this device in the esophagus for 24 hours.
Taking an x-ray of the esophagus with medicated liquid is also a diagnostic method.
How is reflux treated after it is detected?
There are four types of treatment methods that can be preferred depending on the severity of the disease and the findings in endoscopy: changing lifestyle, adjusting the diet, drug treatment and surgical treatment. These treatment methods can be applied step by step, or if the disease is severe, the treatment at the highest level can also be applied directly.
What happens if it is not treated?
Treatment The purpose of the esophagus is to eliminate complaints, correct irritation in the esophagus and prevent the occurrence of other diseases that may be caused by irritation. If left untreated, irritation of the esophagus and therefore the patient's complaints will continue. As the irritation progresses, stenosis develops in the esophagus, Barrett's esophagitis develops, and even cancer develops.
What changes should be made in life and eating habits?
If complaints increase after eating. It is necessary to organize the meal content and meals. Spicy, acidic and alcoholic foods should be avoided and overeating should not be avoided. Patients with night complaints should stop eating 3-4 hours before going to bed. Raising the head of the bed and sleeping on the left side reduces complaints.
Losing weight also contributes greatly to the reduction of complaints.
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How long should medication be used?
Since this disease is chronic and occasionally flares up, medication treatment should be long-term. For this, it is necessary to use medication under the supervision of a physician.
Is there any harm in using medication constantly?
Although there is a decrease in stomach acid secretion in long-term use of these medications, they are harmful to the person. It is not enough to give. No negative effects on the development of cancer due to long-term use of medication have been detected.
Does reflux recur after the complaints resolve?
Reflux Since the disease is a chronic disease, there will be flare-ups from time to time. In this case, it is necessary to use the same treatment methods. In other words, food changes and drug treatments are applied again.
What should be done if the complaints do not improve with these medications?
Step treatment according to the severity of the disease. If there is no improvement with treatment, it is necessary to treat it with surgery. Sometimes the findings on endoscopy may be severe enough to require direct surgical treatment of the disease.
How does the treatment change if there is also a hiatal hernia in the endoscopy?
Most of the reflux patients have a hiatal hernia ( hiatal hernia) tiring. In this case, direct surgery is a more appropriate treatment option. Because hernia cannot be corrected with medication; It causes reflux to continue.
When is surgery necessary?
In the following cases, it is necessary to have surgery directly without trying other treatments for reflux: if there is no response to drug treatment, If exacerbations occur frequently, if negative conditions (such as stenosis, Barrett's esophagitis, cancer) develop due to reflux, if there is insufficiency in the valve in the lower part of the esophagus, if there is a hernia along with reflux, and if the patient is young (under 50 years of age).
What happens if surgery is not performed?
If the severity of the disease requires surgery but surgery is not performed, it is necessary to use high doses of medication for a long time. But in this case, treatment success is low. In addition, surgery is necessary in cases such as stenosis in the esophagus, Barette's esophagitis and cancer development, and drug treatment is not performed.
What is done in the surgery?
The purpose of the surgery is to connect the esophagus to the stomach. is to create a new cover mechanism at the junction. This prevents stomach contents from escaping into the esophagus. To achieve this purpose, the large part of the stomach is wrapped around the esophagus and attached to prevent it from dissolving. If the person also has a stomach hernia (hiatal hernia), this hernia hole is repaired.
How many types of surgeries are there?
Although the procedure performed in the surgery is the same, there are two methods: open and closed (laparoscopic).
Is open or closed surgery better?
There is a difference between open and closed reflux surgery in terms of success in treating the disease. There is no. However, performing reflux surgery using the open method was both more difficult and more uncomfortable for the patient. Nowadays, this surgery is performed with a closed method. Closed method (laparoscopy) not only facilitates the surgery but also brings great convenience for the patient.
Is it necessary to use medication after the surgery?
It is necessary to use medication, especially in people whose complaints do not improve sufficiently after surgery. using medication The duration may sometimes be short and sometimes long.
Can anyone have surgery?
Anyone can have surgery if there is no other disease that would prevent surgery in people who are deemed suitable for surgery for the treatment of the disease. Since reflux surgery is more recommended especially for young people, these people have fewer diseases that prevent them from having surgery. Being overweight does not prevent surgery. It is more appropriate for overweight people to undergo surgery after losing weight.
What is the treatment if there is reflux due to another disease (such as scleroderma)?
In this case, of course, it is necessary to treat the underlying disease. Otherwise, direct reflux treatment will fail. Therefore, it is necessary to determine the cause of reflux well when evaluating the patient.
How does the surgery change daily life?
Sometimes there may be difficulty in swallowing or burping after the surgery. In fact, this difficulty is partly intended. Most of these resolve within 3-6 months. There will be no change in eating and drinking habits and other activities.
How many days will I stay in the hospital, when will I return to work?
In the hospital 1 -After staying for 2 days, patients return home and can start their work after a week's rest.
Are there any drawbacks to the surgery?
Perforation of the esophagus or stomach during the surgery, There may be undesirable conditions such as inflammation of the wound site. These are also treated.
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