REFLUX DISEASE

Gastro-esophageal reflux disease, also known as gastric reflux, occurs when stomach contents leak back into the esophagus. Stomach content is noticeably acidic. At the same time, the stomach contents almost always contain bile and pancreatic juices. Alkaline bile and pancreatic juices can also cause irritation of the esophagus, like stomach acid. Reflux disease occurs when acidic and/or bilious stomach contents come into the esophagus and come into contact with it for a long time, and the esophagus cannot protect itself from the acid and/or bilious stomach contents.

The esophagus is protected from the irritating effects of these liquids in 2 basic ways. .

Cleaning mechanism of the esophagus itself: The normal movements of the esophagus towards the stomach and the alkalinity of the saliva reduce the irritating effect of the liquids coming from the stomach to the esophagus.

Muscle structure that prevents gastric fluid from ascending to the esophagus: The muscles in the lower part of the esophagus and at the entrance to the stomach form a special structure and create a valve mechanism there. This mechanism, which is opened when we pass a bite while eating, normally either allows the contents of the stomach to rise or allows it to rise for a very short time or in large amounts.

Reflux disease occurs when these protection mechanisms, especially the valve mechanism, are disrupted. Apart from this, excessive increase in stomach acid secretion and difficulties in emptying the stomach also cause reflux. Many triggering situations cause this valve mechanism to loosen, resulting in reflux, esophagitis and other problems.

Some of these triggering situations are;

• Eating habits: Overfilling of the stomach and especially sleeping with a full stomach, fatty and fried foods, eating in a hurry, eating foods with tomato paste and sauce er, excessive coffee consumption, carbonated drinks

• Overweight: Hiatal hernia, which is the most common cause of reflux, is much more common in obese people than in normal people. Excessive fat in the abdomen increases the pressure in the intra-abdominal cavity, making reflux easier to occur. Poor eating habits, which have a causal effect on the formation of obesity, facilitate the formation of reflux.

• Pregnancy and clothing such as corsets that tightly hug the abdomen: They cause reflux by increasing intra-abdominal pressure (similar to being overweight)

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• Some medications:

  • Alpha-Blockers used in the treatment of prostate

  • Angina Pectoris Nitrates used in the treatment of

  • Theophylline used in the treatment of asthma

  • Bisphosphonates used in the treatment of osteoporosis

  • Used in the treatment of arthritis, pain and antipyretics Anti-Inflammatory drugs

• Alcohol: Especially fermented drinks (beer and red wine) have an increasing effect on reflux. Alcohol delays gastric emptying and causes intragastric pressure to remain high for a long time. It also facilitates the formation of reflux by reducing the pressure of the valve mechanism.

• Smoking: It is one of the most important factors that facilitate the formation of reflux by reducing the closing pressure of the valve mechanism and increasing the amount of stomach acid.

• of course stress

• Although hiatal hernia and reflux disease are not the same thing, contrary to popular belief, hiatal hernia It facilitates the formation of reflux.

Clinical Symptoms

Reflux disease is quite common in our country and reflux is observed in approximately 20% of adults. Pathological events begin with the return of stomach acid along with food into the swallowing tube. While the stomach wall has an acid-resistant type of mucosa, a covering, the thin and delicate covering (mucosa) of the swallowing tube is not resistant to acid. The sensitive esophagus tissue begins to be damaged when it encounters acid. Complaints vary depending on the severity of this damage and reflux. Although reflux disease has many different symptoms, the most common symptoms are burning sensation behind the rib cage and dry cough. For this reason, the initial diagnosis is made primarily by ear-nose-throat specialists. Hoarseness or difficulty swallowing may occur. Again, patients often complain of bitter water coming into the mouth. Especially the complaints worsen at night. It is possible to roughly divide the symptoms into typical and atypical.

Typical Symptoms

• Burning behind the breastbone

• Mouth Discharge of bitter water or food residues

• Burping, bloating

• Difficulty in swallowing, feeling of stuck in the throat

Atypical Symptoms

• Palpitation, feeling of pressure on the heart

• Hoarseness, chronic pharyngitis and sinusitis diseases

• Scratchy cough

• Bad breath

• Shortness of breath, shortness of breath feeling

 

Diagnosis

The most effective and easiest method is endoscopy (inspection of the esophagus and stomach). looking inside with a tool). With this method, the condition of the valve, damage to the esophagus and other disorders on the stomach surface are detected. is absolved. In patients with clinically significant reflux that cannot be detected by this method, further examinations can be performed to measure the amount of acid and pressure in the esophagus. However, these are rarely needed.

 

Complications Caused by Reflux Disease

The inner layer of the stomach is protected against acidic or extremely alkaline irritants. Although resistant, the inner layer of the esophagus is very sensitive to them. In fact, most of the complaints are due to irritation of this inner layer. In addition to complaints, due to this irritation, ulcers and related bleeding may occur in the esophagus. In untreated patients, esophageal stenosis may develop over time and, more importantly, cancer may develop due to reflux. As reflux continues for a long time without treatment, changes begin in the cells covering the internal structure of the esophagus. This is also called “Barrett's Esophagus”. The risk of esophageal cancer for a patient diagnosed with Barrett's Esophagus increases 120-150 times compared to a person without reflux. This rate is approximately 40 times higher in a reflux patient who has not developed Barrett's esophagus. 10% of patients with untreated "Barrett's Esophagus" have a risk of developing cancer over many years. However, this should not be exaggerated. In our country, this disease generally has a mild course and can be easily treated. "Barrett's Esophagus", which can progress to cancer, is rare.

 

Treatment

Unless surgical treatment is performed, reflux can be life-threatening, although its severity varies from person to person. It is a chronic disease that lasts for a long time. Therefore, reflux patients should know this, avoid situations that increase reflux, and if possible, learn to control complaints with simple measures. Many patients did not use medication with simple precautions. can control symptoms. Therefore, he can list the precautions he needs to take as follows:

What reflux patients should do

• First of all, do not go to bed immediately after eating. Wait at least 3 hours before going to bed. Because the amount of stomach acid is high while lying down. When you lie down, put your head and neck area up. When sleeping, lie on the left side if possible.

• Acidic and carbonated drinks, alcohol (especially fermented ones), coffee (including decaffeine), fatty foods, fried foods, sauces, mayonnaise, cream, bitter foods. and stay away from foods such as spicy foods, chocolate, onion and garlic.

• Eat especially low-sugar foods. In most people who follow the "Stone Age Diet", which is a low-sugar diet, reflux disappears on its own within a few days.

• Blood thinners or painkillers should be used as little as possible.

• You should definitely quit smoking.

• Eat small but frequent meals. Do not bloat your stomach. Eat slowly and chew thoroughly. Put down the fork after each bite and chew each bite at least 10 times. If you have a dental problem, be sure to solve it.

• You must be at your ideal weight. Lose weight. (All reflux complaints of some overweight patients may disappear when they lose 10-15 kg)

• Do not tighten the belt too much, avoid tight clothing.

• >Stay away from work that requires a lot of strength.

• Consult with the physician who prescribes the medications you use for your other diseases and change the medications that ease reflux, if possible.

• Drink liquids preferably not during the meal, but an hour before or after the meal. in

 

Medical Treatment

With these measures, the complaints will greatly decrease or disappear. However, medical treatment should be started in patients who do not get better. For this purpose, medications are used to control stomach acid or reduce its secretion. Thus, the amount of acid entering the esophagus is reduced. The most effective drugs used today in the treatment of reflux disease are drugs called proton pump inhibitors (PPI). These medications are generally used once a day, in the morning, half an hour before a meal. With these drugs, which quickly reduce stomach acid, esophageal healing is completed in approximately 6 to 12 weeks. However, since the valve mechanism does not improve and the disease is chronic, it may be necessary to repeat this treatment from time to time or even use it for life. Although long-term use of these drugs is safe, some serious problems have been reported in new publications. They have been shown to increase the risk of hip fractures and susceptibility to some infections, especially in the lungs. Another group of drugs is prokinetic drugs such as metchlorpamide. These facilitate the passage of substances in the stomach into the intestines and prevent the contents from ascending to the esophagus. However, their long-term use is dangerous due to side effects. Another group of drugs that have become popular recently are drugs containing alginic acid. The best known of these is undoubtedly "Gaviscon". This medicine is taken after meals and remains like a film on the stomach contents, trying to prevent the stomach contents from escaping upwards with a barrier effect. It has been shown that the success rate increases when used together with PPI.

 

Endoscopic Methods

In recent years, there is no treatment other than medication and surgery for reflux patients. be the method Recently, endoscopic treatments have been developed. The aim of these methods is to tighten the area where the esophagus and stomach meet, similar to surgery, and to prevent the stomach contents from escaping into the esophagus. However, these treatment methods are new and their long-term results are unknown, so they are not recommended for every patient.

 

Surgical Methods

Precautions taken. and the disease persists despite medication

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