Alkaline reflux gastritis is a disease that develops as a result of the dysfunction of the neural control valve mechanism called pylorus, located at the exit of the stomach. Since the stomach outlet remains open all the time, bile emptied into the duodenum, right near the stomach outlet, escapes into the stomach, especially when the stomach is empty. Since bile has irritating chemical properties for the stomach, the covering mucosal structure lining the inside of the stomach is destroyed over time and alkaline reflux gastritis develops. Alkaline reflux gastritis is diagnosed with an endoscopic examination called gastroscopy. It is not possible not to diagnose alkaline reflux gastritis in a gastroscopy performed under normal standards. However, unfortunately, even though the patient has alkaline reflux gastritis, the disease cannot be diagnosed in many gastroscopy performed, therefore the disease is tried to be treated with wrong approaches, that is, it cannot be treated.
In our country, university hospitals, state hospitals, private hospitals and private health centers. lots of endoscopy (gastroscopy and colonoscopy) are performed. There are some international medical standards regarding the environment and method for performing the correct gastroscopy (stomach endoscopy) on a patient. In private hospitals and health centers, due to economic reasons, in public hospitals and university hospitals, due to the large number of patients, lack of experienced staff, etc. For reasons, endoscopy is often performed outside the required standards. For these reasons, most of the results obtained are far from accurate.
In order to perform a healthy and accurate endoscopy; Gastroscopy should be performed under anesthesia. However, in many centers, gastroscopy is performed without anesthesia, only by rinsing the patient's throat with local anesthetic. The reason for this is to save the monetary cost of giving anesthesia to the patient and the time required for anesthesia. During gastroscopy performed without anesthesia, the patient is in a panic and the physician is in a rush to finish the procedure as soon as possible. One should not think that such a procedure will give healthy and accurate results. Sufficient time should be spent on gastroscopy, the international standard is minimum 20 minutes excluding introduction. As I have personally witnessed, some We see that endoscopy is performed on 30 patients or even more in endoscopy centers a day, and my physician friends are proud of these numbers. If you consider that the process of preparing the patient and cleaning and sterilizing the gastroscopy instrument takes at least as long as the procedure itself, you can perform the procedure for a net 4 hours a day within an 8-hour working period between 9 am and 17 pm without any breaks. In this case, there is a total of 8 minutes per patient per day. If you spend 3 minutes entering it, the physician will have 5 minutes to examine the inside, which is not normal. You do not show the necessary meticulousness during gastroscopy, you cannot apply the necessary maneuvers and examination methods, as a result, you cannot see many things inside the stomach.
Gastroscopy depends entirely on the practice and eye experience of the person performing it. Therefore, it is necessary for an endoscopist to have sufficient experience. In our country, many physicians who participated in endoscopy procedures alongside their instructors during their assistantships perform endoscopy in the field after their assistantships. In training and research hospitals, assistants already perform gastroscopy. Unfortunately, the number of experienced endoscopists in our country is actually very low. This situation limits the term "Endoscopist" to the person who knows how to insert and remove endoscopy from the patient.
The device on which gastroscopy is performed must have adequate equipment and usage features. Especially in many centers in the private sector, most endoscopies are performed using old, outdated devices that have lost their technical features and are at least 15-20 years old. Of course, the results obtained from operations performed with devices that are not regularly maintained, that are not adequately cleaned and sterilized, and that have insufficient light sources are often inadequate. The reason for most of the endoscopies performed is not only alkaline reflux gastritis, but also cancer, polyp, esophagitis, hiatal hernia, esophageal reflux, etc. It is not possible to detect many serious stomach diseases in the early stages. On the other hand, before gastroscopy, the patient remains hungry and standing for a long time. A stomach that remains empty and upright for a long time may be caused by physical reasons. It is natural that bile leakage cannot be detected. In order to detect bile leakage;
1) The patient must be completely relaxed and the intra-abdominal pressure must decrease, which can only be achieved with anesthesia. Performing the procedure without anesthetizing the patient will cause bile leakage not to be detected.
2) During the procedure, the patient must remain in a supine position for a sufficient period of time to see that there is bile leakage, and additional time is required for this. .
3) Again, during the procedure, the opening and closing function of the pyloric valve is normal or defective, that is, whether the pylorus is functioning or not, can only be monitored by observing the pylorus for a sufficient period of time. If you do not monitor the pylorus for enough time, you cannot see the non-functioning pylorus. The short time allocated for the procedure causes the disorder in the pylorus function not to be detected.
4) In some cases, some warning tests and maneuvers need to be performed to observe the non-functioning pylorus, which requires additional time. Gastric contractions and the contraction of the stomach part in front of the pylorus often create the impression that the pylorus is closing. However, by observing the pylorus after the peristaltic wave has passed, it can be revealed that the pylorus has not closed. The short time allocated for the procedure prevents us from making this observation.
All these reasons we have mentioned above lead to bile leakage, which is present in many patients, not being observed and alkaline reflux gastritis disease not being detected. The patient is present, he has complaints, but the disease cannot be detected. This situation makes alkaline reflux gastritis appear like a ghost disease. Many endoscopists do not take a tissue biopsy (punch biopsy) from the stomach during gastroscopy due to time and shortcomings in the instruments used. However, if a biopsy is taken and the pathological result obtained after the biopsy highlights antral gastritis and metaplasia, this result is already evidence of the presence of bile leakage. Alkaline reflux gastritis treatment is both very difficult and very easy. A patient with alkaline refluxgastritis should not expect much from drug treatment. Short-term PP in the initial period of treatment Injection and antacid treatment may be beneficial in repairing damage to the gastric mucosa. However, the success of the treatment and the reduction or improvement of the patient's complaints depend on some changes that the patient must make in his life.
Our stomach has some features. The most important of these is that solid substances entering the stomach stimulate the stomach and cause the milking movements called peristalsis to begin. These movements continue until the stomach is emptied. This feature is very useful in the treatment of alkaline reflux gastritis. A patient with alkaline reflux gastritis should eat something, but not too much, at regular intervals of approximately one hour, starting 1 hour after meals. A few biscuits, a small sandwich, a handful of roasted chickpeas, a few slices of fruit, etc. These nutrients entering the stomach in this way cause the stomach to start milking movements. While it tries to empty itself by throwing these nutrients in the stomach into the duodenum, it also evacuates the bile fluid, if any. On the other hand, while the forward milking movements of the stomach continue, there will be no backward bile leakage. In this way, the stomach protects itself from bile leakage and the damage caused by bile.
The time we spend sleeping after going to bed in the evening is the most suitable time for bile to fill the stomach, since our stomach is empty and inactive. What can a patient with alkaline reflux do during this period? The most appropriate method for this is to raise the upper part of the patient's bed by 30 degrees, from the waist up. Lying in a 30-degree horizontal position instead of a full recumbent position causes the bile to flow downwards into the advanced parts of the intestine, rather than into the stomach, due to the effect of gravity. Disciplined application of these two practices by the patient is much more beneficial to patients with alkaline reflux than long drug treatments. On the other hand, Trying to treat these patients with medication for very long periods of time, and the fact that the drugs used cause pharmacological ineffectiveness and side effects after long-term use, is another overlooked aspect of the issue. These patients are especially treated for internal medicine and family medicine. Since bile production-reducing drugs prescribed by e-physicians are easily prescribed to patients and the use of these drugs without any time restriction will cause disruption in the excretion of many waste substances excreted with bile, many undesirable effects may occur in the long term. There may be a small number of patients who cannot benefit from these methods. For these patients, there is also a surgical option, that is, the option of having surgery. Many internists and family physicians offer the option of surgery to patients with alkaline reflux gastritis, which cannot be treated medically, as useless interventions. This slur for alkaline reflux gastritis surgeries is that postoperative gastric emptying is rapid and therefore the diet rules that the patient undergoing surgery must follow. However, since the gastric outlet valve of a patient with alkaline reflux gastritis is constantly open, the patient's stomach may also be empty even if the surgery is not performed. He ejaculates quickly and even if he doesn't have surgery, he still needs to follow the same nutritional rules. On the other hand, the expansion of application areas, especially of laparoscopic surgery, has significantly changed the surgical techniques that can be performed for alkaline reflux gastritis, enabling surgeries to be performed with much lower risk and complication rates.
As a result, we can say the following. Alkaline reflux gastritis is not a phantom disease. For patients with alkaline reflux, this is not a fate they have to suffer for life. The majority of patients can benefit significantly from medication-assisted applications, as we stated above. For especially young and middle-aged patients who cannot benefit from these applications, surgical treatment is a treatment option that should not be feared.
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