Don't stay silent on this fire

Reflux, which can occasionally be seen in healthy people, may become a persistent problem if it persists for a long time and begins to significantly impair your daily life. However, with medical treatment without further delay, and if necessary, through easy and comfortable surgical methods, it is possible to completely get rid of this problem. You neither enjoy the food you eat nor the conversations in the environments you find yourself in. The "fire" within you has reached a point where it deprives you of all pleasure you could derive from your social life...

Days, months pass, but your complaints never change. Then it's time to consult a specialist. General Director of Medistate Kavacık Hospital and General Surgery Specialist Prof. Dr. Emin Ersoy and Gastroenterology Specialist Assoc. Dr. Ahmet Burak Toros states that reflux symptoms, which can occur once or twice a month in every healthy person, are normal. However, they also add the following; When these symptoms become persistent and begin to negatively impact your daily life, they may be indicative of a chronic reflux disease. When you read the information our experts share regarding reflux and its treatment, you will see that putting out the fire within you is actually not at all difficult.

Overview of Gastroesophageal Reflux

Reflux Disease (GERD) can be defined as the overflow (reflux) of acidic stomach contents back into the esophagus (Esophagus). It is the most common disease of the esophagus; it usually results from excessive acid production in the stomach, which frequently and intensely backs up into the esophagus, causing permanent or temporary acid-related damage there. Its prevalence in Western societies is close to 40%, and it significantly reduces quality of life. If left untreated and uncontrolled for many years, it can lead to the development of cancer (adenocarcinoma) at the lower end of the esophagus/stomach entrance.

As we mentioned, although the most common cause is excess stomach acid alone, structural problems in the valve that normally prevents this acid from backing up (such as a loose valve or a hiatal hernia) are facilitating factors in many patients. Mechanisms that have a role in GERD, but are more rare, can be listed as follows: Esophageal contraction (Esophageal Motility) disorders, delayed gastric emptying, bile reflux, impaired local defense mechanisms (for example, decreased salivary secretion, etc.)… In patients with impaired esophageal motility; more severe reflux, slowed acid removal, more severe tissue damage, an increase in the frequency of problems caused by GERD outside the esophagus; is observed. The best example of this condition is skin stiffness disease (Scleroderma). The accompanying Sicca (dryness of body secretions) syndrome causes a decrease in the acid-neutralizing capacity as a result of reduced salivary secretion.

Diagnostic Process

The primary symptom of GERD is chest pain (heartburn). If this is present, diagnosis is straightforward. In fact, the most common cause of non-cardiac (non-heart-related) chest pain is GERD (due to acid irritation). Chronic cough, asthma, sore throat, hoarseness, and a feeling of globus (lump in the throat) also often accompany the condition. Other symptoms caused by GERD can be listed as follows: acid regurgitation (bitter taste in the mouth), increased burping, dysphagia (painful swallowing), bad breath, and water brash (acid coming up into the mouth). Following the preliminary diagnosis, reflux-relieving treatment is usually initiated without the need for further diagnostic tests.

If there are alarm symptoms (dysphagia - difficulty swallowing, odynophagia - painful swallowing, anorexia, weight loss, history of GI bleeding); advanced diagnostic methods should be used. The endoscopic method (gastroscopy) performed by a specialist gastroenterologist is the gold standard in diagnosis. In terms of recognizing more serious problems caused by reflux (such as erosive esophagitis, ulceration, Barrett's esophagus, and stricture); its position is unique. In the presence of long-term GERD symptoms, when diagnostic uncertainty exists, or when improvement is incomplete despite treatment, endoscopy is indispensable. However, 24-hour pH monitoring in diagnosis is currently applied to a more limited patient group. Esophageal impedance and pH measurements are used in the investigation of non-acid reflux.

How Should It Be Treated?

For patients with mild symptoms, weight loss, smoking cessation, elevating the head of the bed, and the use of antacids (stomach syrups) if necessary may be recommended. In cases with more severe symptoms, more serious and long-term treatment is required. In severe reflux disease, PPIs (gastrointestinal medications-stomach protectors) are the backbone of treatment. The initial dose should be a double dose. Drug treatment can be extended for up to 6 months. Intensive antacid treatment added initially to PPIs accelerates the resolution of symptoms. The primary goal here is; The goals are to control reflux symptoms, heal reflux-induced esophageal ulcers (erosive esophagitis), and prevent potential problems (complications). In patients whose symptoms do not improve despite diet and adequate duration and dose of medical (drug-based) treatment, anti-reflux surgery (such as Nissen fundoplication, ) may be considered. However, the patient must be informed in advance about the risks and complications of surgery (e.g., gas-bloat syndrome). From a practical standpoint; Patients who present to the ENT clinic with recurrent complaints such as sore throat and dry cough may be started on a PPI (stomach medication) and monitored. If the patient improves with this treatment, it would be appropriate to consider GERD as the diagnosis and refer the patient to a gastroenterologist.

What Happens If It Is Left Untreated?

If reflux is left untreated, the lower part of the esophagus can narrow, leading to severe swallowing difficulties. Additionally, ulcers may develop due to excess acid and stomach contents. The presence of stomach lining cells at the lower end of the esophagus (Barrett's Esophagus) is the most dangerous effect of reflux. Because the most important cause of lower esophageal cancer is Barrett's Esophagus, which develops following reflux.

Rule 1. for Treatment: Abandon Your Bad Habits!

In current medical treatments, antacid medications that block stomach acid are used to reduce symptoms. However, if factors such as tobacco products, alcohol consumption, irregular lifestyle, and stress, which cause reflux, are present along with the medication, these must be eliminated for the treatment to be successful! Otherwise, the patient may become dependent on medications by having to use them long-term at increasingly higher doses, which can have serious side effects. Medications can also cause side effects such as bone loss and similar issues.

Who Can Be Treated with Laparoscopic (Minimally Invasive) Surgery for Reflux?

• Laparoscopic surgery performed under general anesthesia for reflux treatment is a comfortable and convenient method for patients whose medical treatment no longer provides adequate results. We can list the patient groups for whom this method can be applied as follows: Patients with hiatal hernia (stomach hernia) + reflux. Proton pump inhibitors – PPI (drugs that block acid) users whose symptoms disappeared but who relapsed after stopping the medication. Patients addicted to antacid medications. Those with symptoms similar to asthma, pharyngitis, cough, or middle ear infection (otitis) due to reflux disease.

Get Rid of Reflux with Laparoscopic (Minimally Invasive) Surgery!

Laparoscopic surgery performed under general anesthesia for reflux treatment is a procedure that takes approximately one hour. In this method, several small incisions are made on the abdominal skin; the image obtained through a camera inserted through these incisions is projected onto a television screen, and the procedure is performed. Patients can be discharged from the hospital after staying overnight following the surgery. Patients should consume liquid and jelly-like foods for the first two weeks, after which they can eat all types of food. Since the surgery is performed using the laparoscopic method, the pain is less compared to the open method, and the cosmetic results are much better from an aesthetic perspective. Patients can return to their daily routines and work life within a few days of leaving the hospital.

Pay Attention to These Complaints!

If you have been experiencing one or more of the following symptoms for a long time and frequently, consult a specialist! Bitter or sour water coming into the mouth Burning sensation behind the breastbone Chest pain Sore throat Nausea Dry cough Pharyngitis (sore throat and cough) Middle ear infections (otitis) Asthma attacks Difficulty swallowing Food getting stuck in the throat Hoarseness Indigestion and burping

References:

• National Institute for Health and Care Excellence. Gastro-oesophageal Reflux Disease and Dyspepsia in Adults: Investigation and Management (NICE Guideline).

• Society of American Gastrointestinal and Endoscopic Surgeons. Guidelines for Surgical Treatment of Gastroesophageal Reflux Disease (Fundoplication).

• American Society for Gastrointestinal Endoscopy. The Role of Endoscopy in the Management of GERD.

• Turkish Gastroenterology Association. Gastroesophageal Reflux Disease Diagnosis and Treatment Guidelines.