Reflux
General SurgeryReflux is the problem of stomach contents leaking back into the esophagus. There is a valve between the stomach and the esophagus, which we call the lower esophageal sphincter. This valve, made of muscle, prevents acid from flowing back into the esophagus and ensures that it remains in the stomach. Loosening in this area and disruption of the clamp results in reflux.
Generally, since the contents of the stomach are acidic, acid, and sometimes alkaline liquids, due to bile-pancreatic fluid escaping from the duodenum to the stomach, can leak back into the esophagus. As a result of long-term contact with these liquids, it causes irritation of the esophagus to varying degrees. In this case, chest pain, feeling of a lump in the lower part of the chest, eating food and gastric fluid coming to the mouth like bitter water, a burning sensation in the throat and painful swallowing may occur.
Although the problem primarily concerns the esophagus, in advanced cases, symptoms such as chest pain, cough, asthma, recurrent sinusitis, bad breath, erosion of teeth, upper respiratory tract infections, hoarseness, and hiccup attacks may also accompany the picture. Patients can apply to ear, nose, throat and chest diseases clinics with these findings.
The most important reason that triggers reflux is nutrition. Some foods trigger reflux and the consumption of these foods should be kept under control. Fatty foods directly trigger reflux. Foods that are easy to digest should be preferred instead of fatty and heavy foods. Tomatoes, raw garlic and onions, spicy foods, mint, coffee, tea, cigarettes, alcohol, vinegar, fried foods, carbonated drinks, canned foods, oranges and lemons can also be counted among the main foods that cause reflux. Among the reasons may be the expansion of the space where the esophagus passes into the abdomen and the herniation of the stomach from there (hiatal hernia).
Diagnosis of Reflux Disease
The basic diagnostic method is endoscopic examination of the esophagus and stomach. With this examination, the condition of the esophagus and the clamp between the stomach and esophagus can be evaluated. In cases of prolonged and severe irritation, biopsies may be taken to evaluate tumor transformation. Apart from endoscopy, pH meter can be used to evaluate the amount and frequency of acid leaking into the esophagus, and manometer measurements can be made to evaluate the clamp pressure between the stomach and the esophagus.
How is reflux treated?
Life changes are among the primary treatment methods. It is necessary to reduce obesity, reduce high-carbohydrate nutrition and eat a protein-rich diet, cut down on carbonated, alcoholic and caffeinated foods, stop smoking, stop eating at least two hours before bedtime, eat small amounts frequently, raise the head of the bed according to the foot end, and avoid tight clothing. .
Treatment usually begins with oral medication. Here, medications that reduce stomach acidity, increase gastric pincer pressure and accelerate gastric emptying can be used.
Surgical treatment is necessary for those who do not benefit from treatment using medication for a long time, have significant hiatal hernia, and have tissue deterioration that is progressing towards cancer due to irritation in the esophagus.
The gold standard for surgical treatment is laparoscopic hiatal hernia repair and, most commonly, Nissen fundoplication. In this operation, the enlarged hiatus defect is repaired and the fundus part of the stomach is used as a 360-degree bandage to try to control the leakage at the stomach entrance. Different modifications of fundoplication can also be chosen depending on the case (such as Toupet, Dor methods). The most common problem after surgery is temporary swallowing difficulty. It usually resolves itself within a few months.