WHAT IS REFLUX?
Reflux is the name given to the fluid content that should be in an organ moving to another area. For example, the leakage of urine from the bladder into the upper urinary tract is called vesicourethral reflux, and the leakage of the contents of the stomach into the esophagus is called gastroesophageal reflux. Since Gastroesophageal Reflux disease is seen in one in every 5 people, this disease comes to mind when reflux is mentioned. The food we eat reaches the stomach through the esophagus. The acid and bile contents of the stomach do not normally leak into the esophagus. There is a (sphincter) valve system at the junction of the esophagus and stomach. With this system, while food is allowed to pass through the esophagus, stomach contents are prevented from escaping into the esophagus. Thanks to this valve, the inner lining of the esophagus (multilayered squamous epithelium), which is not resistant to acid and bile, is protected from being destroyed. At the same time, acid and bile cannot reach the throat (larynx) and lungs and have a harmful effect in these areas.
If this valve system fails, the stomach contents leak into the esophagus. This condition is called gastroesophageal reflux disease. .
HOW DOES REFLUX OCCUR?
In humans, there is a very complex sphincter system that regulates the passage between the esophagus and the stomach(we can call it a valve). In this way, food in the stomach, and especially acid and bile during fasting, is prevented from escaping into the esophagus. The most important cause of reflux is the inadequacy of the sphincter system between the stomach and the esophagus, or it develops as a result of this system, popularly known as hiatal hernia, slipping from the abdominal cavity to the chest cavity and doing its job inadequately. In reflux disease, there is no high stomach acid. Even at normal or even low acid levels, stomach contents entering the esophagus cause damage to the esophagus. It is not necessary to have valve insufficiency for reflux to occur. Reflux may also occur in esophageal diseases and gastric emptying disorder.
WHAT COMPLAINTS DO PATIENTS HAVE?
Burning, which starts from the upper stomach area and can spread along the midline of the rib cage, is the most typical. It is a complaint. The reason for this is that there is nothing in the stomach. It is the damage caused by acid and bile, which should normally be present, escaping into the inner lining of the esophagus, which cannot withstand this. Sourness after meals and the stomach contents coming towards the mouth may occur in the future. As the stomach contents pass into the larynx, sore throat, hoarseness and cough may occur.
Two out of three patients with unexplained cough have reflux. Again, there is a close relationship between Reflux and Asthma in some cases.Patients' It is common for people to suspect heart disease due to chest pain and to see a heart doctor or even undergo angiography. Half of the patients whose cardiac angiography is normal have reflux disease.
In the later stages of the disease, sudden awakenings may occur at night due to stomach contents escaping into the respiratory tract.Scientific studies have shown that reflux disease affects the quality of life of people as much as heart failure. It shows that it is broken.
HOW IS THE TREATMENT OF REFLUX DISEASE?
Reflux patients should eat small amounts and especially should not lie down on a full stomach. Fatty foods, raw vegetables and fruits (especially tomatoes, onions, citrus fruits), tomato paste, tea, coffee, acidic drinks, soudjouk, salami, sausages, yeast pastries and especially alcohol should be avoided. He should not do heavy sports and should lie on his left side as much as possible in beds with a 30 degree incline. There is no scientific evidence that food regimens and social life measures have a significant benefit in the course of the disease.
The most effective agent in the treatment of the disease is the use of drugs called proton pump inhibitors. Reflux patients with a hiatal hernia or a wound in the esophagus may need to use these medications for life. Reflux patients have two options: medical and surgical. In medical treatment, proton pump inhibitors (omeprol, lansor, prosec, Nexium, etc.) that reduce the stomach acid level are used. In reflux, leakage from the stomach to the esophagus continues while under medical treatment, but since low-acid stomach fluid escapes, the patient does not complain of burning and the damage to the esophagus is eliminated. Valve failure in patients under drug therapy Complaints recur after discontinuation of treatment in proportion to The main reason for this is that PPI group drugs do not have corrective effects on the actual disorder that is the cause of the disease, and they relieve the patient by reducing the acid level as long as the drug is taken. Unless this disorder is corrected, some patients have to use medication throughout their lives.
Continuous medication ( Are there any side effects of using PPI?
General definition of the drug: It is an active substance whose benefits outweigh its harm. By using PPI continuously, this feature of the gastric juice, which should be acidic, is eliminated. Some scientific studies show that when PPI is taken continuously, the acidity of the stomach increases. It shows that calcium absorption is impaired as the environment disappears, resulting in the risk of osteoporosis and hip fracture. It is also claimed that it causes frequent lung infections, especially in elderly patients.
HOW IS REFLUX DIAGNOSIS?
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With endoscopic examination, the inside of the esophagus and the junction of the stomach and esophagus are evaluated directly. During endoscopy, wounds and ulcers caused by acid and bile coming from the stomach may be seen in the esophagus. In some cases of reflux, although the patient has complaints, endoscopic findings may be insufficient. In such cases, the esophagus may need to be evaluated with a catheter that measures acid for 24 hours. Reflux patients can apply to the Ear, Nose and Throat, Chest Diseases and Cardiology (heart diseases) departments due to their complaints.
HOW IS PERMANENT TREATMENT FOR REFLUX?
Reflux. The only permanent treatment method for the disease, whose long-term results are known today, is laparoscopic surgery. In cases where a wound is opened in the esophagus, when a hiatal hernia is diagnosed by endoscopy, and in cases of valve insufficiency, the patient may need to take medication for life. Especially in patients in this position, laparoscopic surgery is required. Surgery is an option that provides permanent healing, saves the patient from constant medication use and increases the quality of life.
In the USA, laparoscopic reflux surgery is the third most frequently performed operation after gallbladder and obesity surgeries.
After laparoscopic surgery, the patient stays in the hospital for one day. is fed orally the next day. deeds of patients After surgery, there is no need for food regimes and social measures. There is a success rate of over 90% in the long term after surgeries performed by experienced surgeons.
DOES CANCER DEVELOP WITH REFLUX?
There is a relationship between reflux disease and lower end cancers of the esophagus. However, the probability of developing cancer is extremely low and it appears after some preliminary findings. Acid and especially bile constantly escaping from the stomach into the esophagus causes changes in the inner lining of the esophagus.
The cells of the esophagus try to be like the acid and bile resistant cells of the stomach and imitate them in order to protect themselves from the damage caused by acid and bile. These imitation cells are called "Barret". After changes in Barrett's cells, pre-cancerous "dysplasia" cells appear. Barrett's Esophagus develops in 10% of reflux patients. Dysplasia development can be seen in 3-7% of these patients. Patients with Barrett's Esophagus need to be followed up with biopsy annually or at least every 3 years. Continuous medication use does not prevent cancer development by 100% in cases of Barrett's Esophagus. The most important reason for this is that although acid leakage is prevented by drug treatment, contact with bile cannot be prevented. Surgical treatment provides a more protective treatment by preventing the escape of both acid and bile from the stomach to the esophagus.
TO WHOM IS LAPAROSCOPIC SURGERY RECOMMENDED?
Laparoscopic surgery for gastric reflux requires constant medication. It is recommended for those who remain in the esophagus, those whose complaints recur after stopping the medication, those whose wounds in the esophagus do not heal despite the medication, or those whose wounds in the esophagus reopen immediately after stopping the medication, those who have wounds that cause bleeding in the esophagus, those who develop advanced cellular changes in the esophagus, especially those in the young age group. It is also recommended for nausea. Laparoscopic surgical treatment is effective for pain, persistent cough and hoarseness.
IS THERE A REVERSE AFTER SURGERY?
The most important factor that ensures success in laparoscopic surgery is the experience of the surgeon. Recurrence after surgery is less than 5% in the series of experienced surgeons. In fact, most of the patients who use acid-reducing medications after surgery due to their complaints There is no reflux. These patients are those who use uncontrolled medication to relieve digestion or due to dyspepsia. In recent years, the recurrence rate has decreased even more with the use of patches (polypropylene grafts). The most important causes of recurrence are severe trauma and compulsive vomiting in the early postoperative period. In patients where a patch is applied, the possibility of recurrence is eliminated in these cases.
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