What is reflux?
At this point, a very famous saying in medicine “There is no disease, there is patient” is true. Although the name of the disease is the same, the symptoms and treatment modality vary greatly from person to person.
How does reflux occur?
What are the symptoms?
- Burn in the upper middle part of the abdomen and the spread of this burn to the chest. (these patients may even be exposed to long-term examinations and tests, considering as a cardiac patient)
- Bitter taste in the mouth, especially after meals
- Dry cough (sometimes so severe to wake you up at night)
- Hoarseness and sore throat (meaning that the acidic fluid risen up has reached the vocal cords)
- Polyp or nodule on the vocal cords
- Persistent laryngitis and pharyngitis despite treatment
- Recurrent pneumonia
- Painful and difficult swallowing
The abovementioned complaints may vary in frequency and severity.
What are the risk factors?
What are the foods that increase reflux?
How is it diagnosed?
- Endoscopy (Gastroscopy): This method visualizes the inner surfaces of the esophagus, stomach, and duodenum utilizing a device that has a camera at the tip. In the presence of reflux, it is important in terms of observing changes that may occur in the esophagus and diagnosing gastric hernia.
- 24-hour esophageal pH monitoring: This method aims to measure the times when the esophagus is exposed to acid over a 24-hour period with a very fine small probe placed in the esophagus. The information that is decisive in the treatment, such as a number of reflux episodes in the course of a day, the level it rises up, duration, are recorded throughout the day.
- Barium-contrast imaging of the stomach (barium swallow test): In this method, a substance called barium is swallowed by the patient and a series of x-rays are then taken from the patient. During this study, the movement of the barium visualized in a bright color on the images is followed. The amount of reflux can be seen during or immediately after swallowing.
- Esophageal Manometry: It is a device that measures the motility of esophagus. If esophageal motility disorder is detected, the treatment of reflux may be completely changed.
NOTE: Not all of these tests are required for each patient. The philosophy of medicine is based on “administration of the most effective treatment with the fewest tests possible”. However, in the case of suspicion, even additional tests may be necessary.
What is the treatment?
- Obese individuals must regain their normal weights to prevent reflux.
- There should be a minimum of 4 hours between dinner time and bedtime.
- Lying on the left side with the head slightly elevated during sleep may partially prevent the stomach content from rising up. For this purpose, a large variety of wedge pillows for reflux are available in the market. (figure)
- Smaller, more frequent meals should be eaten.
- Tight clothes that tighten the waist region should be avoided.
- Smoking is known to increase reflux. Smoking should be discontinued.
Patients whose symptoms do not resolve with these measures need drug therapy in the second step. Drug therapies cannot prevent the stomach content from rising up into the esophagus, but prevent this reflux from damaging the esophagus by reducing the amount of acid in the stomach. Therefore, in order to benefit from drug therapy, it is necessary to use it for life. Unfortunately, the use of these drugs for many years increases the risk of occurrence of some dangerous side effects.
The best treatment method is surgery for patients who cannot achieve the expected benefit from drug therapy or who benefit from drug therapy but do not want to use gastroprotective drugs for life. In reflux surgery, the space in which the esophagus passes through the diaphragm is narrowed and the stomach is rotated around itself by giving an inkwell shape, thus reflux is prevented. The surgery is entirely performed laparoscopically (closed). In this method, special instruments inserted into the abdomen through incisions smaller than 1 cm are used.