What is Reflux?
Many people have complaints of indigestion, rancidity and burning in the esophagus after eating. This disturbing condition is marked by food and stomach acid reaching the esophagus and even the mouth. This situation is temporary in some people and disappears over a period of time. However, in some people, it becomes a very disturbing, frequently occurring and very painful disease. This disease was called “Gastroesophageal reflux”. It is a disease that is observed quite frequently (15-20%) in the society. Although it is more common in women, serious esophageal damage is more common in men. It can cause very serious conditions in the elderly and children.
What are the Symptoms of Reflux?
The most common symptom is heartburn. Some people may feel this burning in their stomach, neck, shoulders, or even their back and arms. It is sometimes indistinguishable from heart pain. They usually consult a doctor for this reason.
Reflux esophagitis was detected in 50% of patients who underwent coronary angiography due to chest pain and found it negative. Pain in esophagitis often has an acute onset and lasts for hours, wakes you up from sleep, is relieved with antacids and food, is related to food and meals, is felt when lying on your back or bending forward, is accompanied by symptoms such as pyrosis, regurgitation and dysphagia in 50% of cases, is unrelated to effort, is often under the sternum or under the sternum. It is felt in the back area and does not spread.
In addition to pain, sour water in the mouth, "regurgitation" is another common symptom. It leaves a bad taste in the throat and mouth, usually occurs after meals and rarely during meals. Symptoms often occur while lying down and sleeping. Abdominal bloating, burping, hiccups, tickling sensation, chronic cough, bad breath, hoarseness, nodules on the vocal cords and asthma attacks are other symptoms.
How is reflux treated?
Reflux disease is diagnosed today. It is a disease that can be prevented and treated once diagnosed. With the meal, acid secretion begins in the stomach for the grinding process. At the end of the meal, some of this secreted acid overflows from the stomach and irritates the esophagus. We call this backward overflow Reflux. Acid reflux, food It may cause temporary and permanent damage to the pipe. We use the definition of "heartburn" for the pain that occurs as a result of this irritation, and "Esophagitis" for the damage to the esophagus.
The stomach surface is accustomed to acid and has mechanisms to eliminate the destructive effect of acid. However, there are no such protective mechanisms against acid in the esophagus. Normally, there is a mechanism that acts as a gate between the stomach and the esophagus, which we call the "lower esophageal sphincter". This gate allows swallowed food to pass from the esophagus to the stomach, but it works with a mechanism that prevents the stomach contents from escaping back. Looseness or disorders in this gate (stomach hernia-hiatal hernia) are the causes of reflux disease.
The frequency of reflux occurs in cases where the pressure in the stomach increases (eating too much food, lying down after eating, etc.).
Which Patients Require Surgery?
• Age (the younger the patient, the more priority surgery is).
• Severity, frequency and type of complaints.
• Severity of damage to the esophagus
• Recurrence rate of the disease despite drug treatment
• If there is a stomach hernia (Hiatal Hernia) along with reflux, the patient's treatment is surgery.
What Can Be Corrected with Surgery?
Nowadays, we also benefit from the advantages of less pain and shorter recovery time that laparoscopic surgeries provide to the patient in the treatment of reflux disease.
The damaged area is Laparoscopic fundoplication surgeries, which aim to reconstruct the lower esophageal sphincter, in other words the door between the stomach and the esophagus, and prevent the stomach contents from leaking into the esophagus, are widely used all over the world. The surgery is a laparoscopic procedure performed using the latest technical developments. It is a procedure that takes approximately 1-1.5 hours, and the patient can start oral feeding the next day and be sent home the same day or the next day, and can return to work within 7 days. All the advantages of laparoscopic surgeries (such as less pain, shorter hospital stay and no post-operative risk) are utilized.
Thus, the elimination of taking medication every day for years and the elimination of inflammation in the esophagus. With the regression of inflammatory events and the elimination of cancer risks associated with them, the patient is provided with a better quality of life. The side effects of these laparoscopic fundoplication procedures performed by experienced surgeons are minimal and the success rate is between 95-100%.
It is a type of surgery recommended with appropriate patient selection as a result of joint evaluation of gastroenterologists and surgeons.
What are the symptoms of reflux (GER disease)?
The most important symptom of GER is burning in the chest that spreads upwards. Burning may be felt in the stomach, throat or neck. Especially alcohol, pickles, chocolate, sour, bitter and spicy foods are among the foods that aggravate inflammation. Another important symptom is the involuntary discharge of gastric fluid into the mouth without nausea. With this feature, it is distinguished from vomiting.
Once a week or more frequently, a burning sensation in the chest rising towards the throat and bitter-sour water coming to the mouth is sufficient for the diagnosis of the disease. Apart from these two important symptoms, the symptoms that occur due to reflux irritation of other organs are also important in recognizing GER.
Persistent nagging cough
Hoarseness
Voice polyp or nodule in the strings
Throat infections such as untreatable laryngitis and pharyngitis
Feeling of fullness in the throat
Need for frequent throat clearing
Good for treatment unresponsive asthma
Recurrent pneumonia
Reflux should be suspected as the underlying disease in short-term pauses in breathing during sleep.
Constant need to clear the throat, hoarseness, frequent pharyngitis. The main cause of most people with laryngitis is reflux. It has also been shown that half of those with chronic cough have reflux disease. There are even patients who cough for years and go from doctor to doctor without getting a diagnosis. When asthma and reflux occur together, one worsens the other. In some patients with suspected reflux, chest pain that cannot be distinguished from heart pain occurs. In such cases, it is best to suspect reflux after a heart examination.
Difficulty in swallowing, painful swallowing, stomach bleeding or weight loss may be symptoms of reflux, or they may be completely symptomatic. These are conditions that may indicate a different disease. Reflux disease in children is in the form of simple vomiting, but it can be responsible for the "sudden infant death" syndrome, especially in infancy. Poor posture in childhood, growth and development retardation, anemia, pneumonia attacks, respiratory diseases, and suffocation attacks in newborns are also among the reasons for GER. Reflux is the underlying cause of one-third of childhood asthma.
What are the diseases caused by reflux?
Growth-developmental retardation in children
Pneumonia due to gastric fluid leaking into the lungs,
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Respiratory diseases such as laryngitis, pharyngitis, bronchitis, asthma,
Inflammation of the esophagus (esophagitis),
Peptic stenosis (narrowing of a part of the stomach),
>It may cause digestive tract bleeding,
Anemia,
Barret's disease, which predisposes to esophageal cancer
Cancer.
Reflux. Treatment
There are two methods: drug treatment and surgical treatment. In the treatment of reflux, if there is no underlying organic cause, the patient is given drugs that prevent acid formation and drugs that neutralize the existing acid. In surgical treatment, the sphincter muscle between the stomach and esophagus is strengthened by surgery. It is generally used if there is a hiatal hernia and sometimes when drug treatment does not yield results. For patients who do not want to use medication for a long time, surgical treatment can be applied if it is appropriate and the patient wishes. The patient must be informed about the side effects and complications of surgical treatment.
Reflux disease is a chronic disease and complaints may increase, decrease, disappear and recur from time to time. For this reason, there are rules that the patient must follow to prevent reflux.
Ways to Prevent Reflux
- Lie on a high pillow (The upper body and head should be high while lying down).
- Avoid eating large amounts (overeating increases stomach pressure and increases the possibility of reflux).
- Eat small amounts of food frequently and regularly.
- Eat food slowly and chew well. >
- Reduce fat (Avoid fried foods, fast foods and margarine. Excessively fatty foods also have a high retention time in the stomach and more stomach acid is released).
- Avoid chocolate (The substance called methylxanthine found in chocolate relaxes the muscles in the esophagus, causing relaxation in the syncope).
- Avoid coffee, consume tea less (Caffeinated or decaffeinated coffee increases the possibility of reflux).
- Food. Avoid substances that irritate the pipe.
- Do not drink alcohol, acidic drinks such as cola, soda, canned fruit juices.
- Avoid very spicy foods, pickles and vinegar (Spices increase the severity of reflux and cause burning in the stomach. For this reason, limit spicy ready-made foods and use less spices in your meals.
- Do not lie down immediately after the meal, sit for at least 1 hour.
- Avoid alcohol (Alcohol increases stomach acid). >
- Avoid cigarettes and other tobacco products (Nicotine relaxes the sphincter in the lower part of the esophagus).
- Do not gain weight (Obesity increases reflux complaints).
- Try to stay away from stress as much as possible.
- Since fluid consumption increases stomach pressure, drink it between meals, not during meals.
- Try to avoid tight clothes and wear more comfortable clothes, especially after meals.
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