Reflux Disease and Its Treatment

General Information

The esophagus allows food to be delivered from the mouth to the stomach and is approximately 35-40 cm long. At the point where it joins with the stomach, the muscles up to 2 cm in length pass through the natural opening in the diaphragm called the Hiatus, gaining a special structure and forming a kind of one-way valve mechanism called the sphincter. In this way, the stomach contents do not pass up into the esophagus while the food goes down to the stomach. Reflux occurs as a result of the malfunction of this system. Reflux is when stomach contents (acid, bile, food and gastric enzymes) escape into the esophagus above the physiological limits and cause complaints. The most common cause of reflux is the sphincter deficiency, which is called the valve at the lower end of the esophagus at a rate of 70%. Again, with the enlargement of the place where the esophagus passes through the diaphragm, the stomach slipping upwards can also cause reflux.

Symptoms of Reflux

There may be chronic cough and Bronchitis. BARRET can cause esophageal cancer and lower esophageal cancer in the later stages due to varying degrees of inflammation (esophagitis), ulceration, stricture (stricture) in the esophagus due to the damage it has made in the lower end of the esophagus.

Examination and Diagnosis

The most basic diagnostic tool is endoscopy. Stomach hernia, esophagitis (esophagitis), Barret esophagus are easily detected with endoscopy.

Sometimes, patients with normal endoscopy should perform an examination called 24-hour pH monitoring. After the endoscopic examination, a thin catheter is inserted from the nose of the patient to the lower end of the esophagus and the catheter is connected to a wallet-sized device and records the pH changes in the lower end of the esophagus that occur when the patient is lying or standing, eating or hungry, during the day or while sleeping for 24 hours. A special diet is not given before and after the procedure; the patient continues exactly as he lived before. If there is any stomach medication used 3 days before the procedure, it is discontinued. The data collected at the end of 24 hours are analyzed on the computer and the decision is made for surgery by looking at the degree of acid reflux.

Treatment

Surgery is not performed for every reflux patient. Nutrition and some lifestyle changes are recommended first.

These:

• Lying on a high pillow (When lying down, the upper part of the body and head should be high).
• Avoiding large amounts of food (Too much food increases stomach pressure and the possibility of reflux increases).
• Eating small amounts of frequent and regular meals.
• Eating food slowly and chewing well.
• Reduce fat (Avoid fries, fast food and margarine. Fatty foods also have a longer duration of stomach and release more stomach acid).
• Avoiding chocolate (The substance called methylxanthine found in chocolate causes relaxation in the sinker by relaxing the muscles in the esophagus).
• Consuming less coffee and dark tea (with or without caffeine increases the likelihood of reflux).
• Acidic beverages such as alcohol, cola, soda, and canned fruit juices should not be consumed.
• Pickles and vinegar should not be consumed from very spicy foods (Spices may increase the intensity of reflux and increase the burning in the stomach. Therefore, limit spicy ready-made foods and use less spice in your meals).
• Do not lie down immediately after eating, sit for at least 1 hour.
• Avoid drinking (Alcohol increases stomach acid).
• Avoid cigarettes and other tobacco products (Nicotine loosens the grommet in the lower esophagus).
• Do not gain weight (Obesity increases reflux complaints).
• Try to avoid stress as much as possible.
• As fluid consumption increases stomach pressure, take it between meals, not during meals.
• Try not to wear tight-fitting clothes, especially after meals, and try to wear more comfortable clothes.

SURGICAL TREATMENT OF REFLUX DISEASE

Who should have surgical treatment?

• Patients who do not respond to medical treatment
• Disease progression under medical treatment and the need for continuous drug dose increase
• Patients requiring long-term aggressive medication
• Patients who do not want long-term and aggressive medication due to reasons such as cost, discomfort of use or fear of side effects.
• Patients who do not comply with medical treatment
• Patients at high risk of complications in the long term (Grade 3-4 esophagitis patients)
• Patients with Grade 1-2 esophagitis but with defective CSS
• Patients with medical therapy-resistant sliding hernia
• Patients with serious complications despite medical treatment
• Hard hat esophagus, severe pulmonary symptoms

Reflux surgery was first performed by Prof. Dr. It was started by Rudolf Nissen with the surgery he performed on a 28-year-old patient at Istanbul University Faculty of Medicine and is still the gold standard of reflux surgery.

Reflux surgery; It is based on the principle of closing the opening in the hiatus, if any, and the escape of the part of the stomach called the fundus, like a sleeve at the lower end of the esophagus, into the rib cage and creating an artificial sphincter.

The procedure is performed laparoscopically (closed) under general anesthesia with special tools entered through 0.5 and 1 cm holes in the abdomen. When everything goes well, your surgery will take approximately 1 hour. After the surgery, patients stay in the hospital for 1 night. For the first 2 weeks, a liquid and soft food-based diet is recommended. There is no restriction afterwards, provided that you chew the foods well.

Reflux complaints will disappear immediately after the surgery and patients will start to experience this comfort immediately after the operation. However, if there are complications (such as esophagitis), it will take time to resolve them. After reflux surgery, the person will continue his normal life from where he left off. The surgery will not restrict any of its activities.