Reflux Disease and Treatment

Reflux Disease and Treatment

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The esophagus allows the food to be eaten from mouth to the stomach and is about 35-40 cm long. Muscles acquire a special structure about 2 cm in length where they pass through the natural opening in the diaphragm called Hiatus where it is joined with the stomach, and it forms a kind of one-way valve mechanism called sphincter. On this count, the content of the stomach does not pass up to esophagus while the food goes down to the stomach. Corruption of this system for any reason results in reflux. Reflux is a complaint that stomach contents (acid, bile, nutrients, and stomach enzymes) escape to esophagus over the physiological limits. The most common cause of reflux is 70% sphincter insufficiency called as the valve colloquially on the lower extremity of esophagus. Along with the expansion of the place where the esophagus passes through the diaphragm, and upward movement of the stomach can also cause reflux.

[/bt_tabs_items][bt_tabs_items headline=”Symptoms Of Reflux “]

The most common symptom is burning in the esophagus and bitter water in the mouth. After eating again, especially when they lie down, what they eat come to the patient’s mouth. As a result of ascending of the long-term acid and irritation of the tissues, Laryngitis, damage to enamel, Asthma, Chronic cough and Bronchitis may occur. Depending on the destruction on the lower end of the esophagus, it may cause Esophagitis, ulceration, stenosis (stricture), Barrett’s esophagus depending on altered esophagus cell structure, lower esophageal cancer in later periods.

[/bt_tabs_items][bt_tabs_items headline=”Examination and Diagnosis”]

Endoscopy is the most basic diagnostic tool. Endoscopy can easily detect gastric hernia, esophagitis and Barret’s esophagus.

Sometimes it is necessary to perform an examination called 24-hour pH monitoring for the patient with normal endoscopy. After endoscopic examination, a thin catheter is inserted from the nose of the patient to the lower end of the esophagus, the catheter is connected to a device having the size of a wallet, and it records the pH changes at the lower end of esophagus when it is lying or standing, while eating or fasting, during the day or while sleeping. A special diet is not given before and after the procedure; the patient will continue his/her life as before. If there is stomach medication used, it is stopped 3 days before the procedure. At the end of 24 hours, the collected data are analyzed on the computer and the decision on the surgery is made based on the degree of acid reflux.

[/bt_tabs_items][bt_tabs_items headline=”Treatment of Reflux Disease”]

Not every reflux patient has surgery. First, nutrition and some lifestyle changes are recommended. These are:

Lying on a high pillow (while lying on, the body and head should be at high).

  • Avoid eating too much (Excess food increases gastric pressure and the possibility of reflux).
  • Eating frequent and regular meals in small quantities.
  • Eating slowly, chewing well.
  • Reduce oil (avoid fried food, fast food and margarine, stay of extremely fatty foods is high in the stomach, and more stomach acid is released).
  • Avoidance from chocolate (A substance called methylxanthine found in chocolates loosens the muscles in the esophagus and leads to relaxation in the sphincter).
  • Low consumption of coffee and dark tea (increases the possibility of caffeinated or coffee-free reflux).
  • Acidic drinks such as alcohol, cola, soda, canned fruit juices should not be consumed.
  • Very spicy foods, pickles and vinegar should not be consumed (Spices can increase the intensity of reflux and increase the burning in the stomach, so limit spicy ready-to-eat foods and use less spices for your meals).
  • Sit immediately after eating for at least 1 hour.
  • Avoid alcohol (alcohol increases stomach acidity).
  • Avoid smoking and other tobacco products (nicotine loosens the sphincter on the lower part of the esophagus).
  • Do not gain weight (Obesity increases reflux complaints).
  • Try to stay as far away from the stress as possible.
  • As the fluid consumption increases the stomach pressure, take it between meals, not during the meals.
  • Try not to wear narrow clothes especially after lunch, but wear more comfortable clothes.

SURGICAL TREATMENT OF REFLUX DISEASE:

Who should be treated surgically?

Patients who cannot receive medical treatment response

  • Progression of the disease under medical treatment and the need to continuously increase drug desire
  • Patients in need of long-term aggressive drug treatment
  • Patients who do not want long-term and aggressive drug treatment for reasons such as cost, discomfort, or fear of side effects
  • Patients who do not comply with medical treatment
  • Patients with a high risk of developing long-term complications (patients with Grade 3-4 esophagitis)
  • Patients who have Grade 1-2 esophagitis but detect defective CES
  • Patients with sliding hernia with medical treatment resistance
  • Patients with severe complications despite medical treatment
  • Barret’s esophagus, severe pulmonary symptoms

Reflux surgery was first introduced in 1936 by Prof. Dr. Rudolf Nissen from Germany with a surgery for a 28-year-old patient at the Istanbul University Faculty of Medicine and is still the golden standard of reflux surgery. If there is reflux surgery it is based on the principle of closing the opening in the hiatus and forming an artificial sphincter both by escaping into the thoracic cage and wrapping it like a sleeve on the lower end of the esophagus of the so-called fundus. The procedure is performed under general anesthesia with laparoscopically (closed) with special instruments inserted in 0.5 and 1 cm holes from the abdomen. If everything goes well, your surgery will take about 1 hour. Postoperative patients stay in hospital for 1 night.  For the first 2 weeks, it is recommended that liquid and soft food are main nutrition. There is no restriction with the condition of chewing well afterwards. Immediately after surgery, reflux will pass and patients will begin to live this comfort right after surgery. However, if there are complications (such as esophagitis) they will take time to recover. After reflux surgery, the person will continue to his/her normal life. Operation will not limit any activity.

 

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