What is reflux disease? The escape of stomach contents into the esophagus is called gastroesophageal reflux, or simply reflux. This situation may occur in normal/healthy individuals in small amounts after meals. However, if this situation causes complaints and affects the quality of life, then reflux disease is in question.
What are the symptoms of reflux disease? The most common symptom is burning. It is a burning sensation that is expressed by burning, especially after meals, from the upper part of the stomach upwards to the esophagus. Another important symptom is the ingestion of food or bitter, sour liquids. In the presence of any of these two symptoms, reflux disease can be diagnosed. Sometimes these complaints may occur at night and may wake the patient from sleep. There may also be difficulty swallowing and painful swallowing. Apart from these typical symptoms for reflux disease, there may also be symptoms that we call atypical. If atypical symptoms are present without typical symptoms then it may be difficult to diagnose.
What are the atypical symptoms of reflux disease? Chest pain, hoarseness especially in the morning, dry-irritating cough, tickling sensation in the throat are atypical symptoms of reflux disease. However, other conditions that may cause these complaints in patients should be excluded. For example, heart diseases should be investigated first in a patient with chest pain, and ENT examination should be performed in patients with hoarseness and irritation cough.
What are the conditions that facilitate reflux? Eating habits, overweight, wearing a corset, pregnancy, some drugs, alcohol, smoking and stress can be counted. Regarding food; Eating in haste, overfilling the stomach, greasy-fried meals, foods with excessive tomato paste-sauce, coffee, sleeping with a full stomach can be counted as factors that facilitate reflux.
How is the diagnosis made in reflux disease? The diagnosis of the disease is usually made easily by complaints. No testing may be required. However, if the complaints occur above the middle age, if the complaints continue for a long time, if there are complaints that we call atypical, or if there are serious symptoms such as weight loss, difficulty in swallowing, painful swallowing, bleeding, anemia, absolute examination is required in these patients.
What do you mean by examination in reflux disease? In reflux disease, the first examination to be performed when necessary is gastroscopy, and endoscopy, as it is commonly said among the people. However, not every patient with reflux may have a finding on endoscopy that diagnoses the disease. In these cases, advanced diagnostic methods can be applied if necessary.
What is endoscopy? We understand the examination of tubular organs with soft tubular instruments with a video camera at the endoscopy tip. The endoscopic examination used in reflux disease is called gastroscopy. In gastroscopy, the esophagus, stomach and duoenum (double-finger intestine) are examined with a soft tubular instrument of approximately 9 mm width. This examination should be done by an experienced physician who has a certificate of expertise approved by the Ministry of Health in this regard. Today, with the opportunities provided by technology, this examination can be performed in about 5 minutes and without any discomfort to the patient.
How is reflux disease treated? Chewable tablets and syrups, which we call antacids, are useful in relieving complaints in patients. It provides instant relief, but has no effect on the healing of wounds developed under the esophagus due to the disease. If patients feel the need to use these drugs constantly, it means there is a problem, physician control is required. Today, the most effective drugs used in the treatment of reflux disease are drugs called proton pump inhibitors (PPI). These drugs are usually used once a day, in the morning, half an hour before breakfast. These drugs do not have significant side effects.
Are there non-drug treatment methods in reflux disease? Yes. Today, surgical treatments based on the tightening of the stomach entrance with the laparoscopy method are applied. Successful results of up to 90% are obtained with this treatment called fundoplication. However, the physician who will perform this treatment must have experience in this field. Although very successful results are obtained with the surgeries, patients may have complaints such as difficulty in swallowing, inability to burp and excessive flatulence, which are usually temporary after the surgery. In addition, some of the patients who have long-term surgery may still need medication. For these reasons, the decision to operate should be made jointly by the patient, the gastroenterologist and the surgeon. Patients who will benefit from surgical treatment are generally those who benefit from PPI treatment. If the patient does not benefit from PPI treatment, the patient will most likely not benefit from surgical treatment, except in exceptional circumstances. If the patient does not benefit from drug therapy, the diagnosis of reflux may not be correct. For this reason, it is necessary to make sure that the preoperative diagnosis and the patient will benefit from the surgical treatment. When necessary, examination methods called manometry and 24-hour pH-meter should be applied to patients before surgery.
In recent years, endoscopic treatments have been developed as a treatment method other than drug therapy and surgery in reflux patients. The purpose of these methods is to tighten the area where the esophagus and stomach meet and to prevent the escape of stomach contents into the esophagus, similar to surgery. However, these treatment methods are new and their long-term results are unknown, so they are not recommended for every patient.
Does reflux disease cause cancer? Theoretically yes, but in practice, it is a rare situation, especially in our country. Long-term reflux causes cellular changes in the lower part of the esophagus and the surface of the esophagus is covered with different cells called Barrett’s metaplasia. 10% of patients with Barrett’s metaplasia have a risk of developing cancer over many years. However, this risk should not be exaggerated. The chance of developing cancer in a patient with Barrett’s metaplasia is 0.5% per year. If patients diagnosed with Barrett by endoscopy and biopsy have endoscopic examination at regular intervals according to biopsy results, it is possible to detect cancer before it develops fully or at a very early stage.
What are the characteristics of reflux disease in our country? Reflux disease is a common condition in our country as well as in all western societies. About half of the people living in our country experience complaints related to this disease frequently or infrequently. About one in five people experience symptoms of this disease 1-2 times a week. However, in our country, the disease usually has a mild course and can be treated easily. Barrett’s metaplasia, which can progress to cancer, is rare.
How long can drugs called proton pump inhibitors be used, are they safe to use? Long-term use of these drugs is considered safe. Today, we know that these drugs can be used safely for 16 years. However, their use must be within the knowledge of the physician. It should not be used for a long time without being sure of the diagnosis. The patient who will use it for a long time should definitely have a gastroscopic examination. As with any drug, these drugs should be used effectively but in the lowest possible dose.
