REFLUX - STOMACH ACID LEAK
One of the most common complaints of patients admitted to outpatient clinics of Otorhinolaryngology (ENT) is the feeling of stuck in the throat or sore throat. In most cases, treatments are inadequate and diseases are persistent. It has been determined that reflux alone or in combination with other factors plays a role in the etiology of most of these.
What is Reflux?
It is a discomfort caused by acid leakage in the stomach exceeding the connection point that prevents backward escape between the stomach and esophagus. This acid leakage causes swelling, tenderness and sometimes ulcers in the lower part of the esophagus. Sometimes acid can go up and affect the upper part of the esophagus, throat, nasal, larynx and vocal cords, even the trachea. It creates different complaints according to the affected region. These are usually burning or discomfort in the chest, burning and pain in the throat, voice changes, frequent throat cleaning, throat knotting and dry cough.
Most patients with reflux disease have recently undergone chronic pharyngitis treatment, and even some patients have undergone surgery, due to the difficulty in proper examination of the reflux, and in some cases, the lack of clear findings in the throat. However, with the development of examination facilities and test methods with endoscopic cameras, reflux is an important factor in these diseases in recent years.
In spite of drug therapies, there should be suspicion of reflux in hoarseness, cough and sore throat which is not fully healed or repeated after a short time.
Gastroesophageal Reflux Disease (GER): Excessive amount of gastric acid and other stomach contents escaping towards the esophagus causing serious heartburn, heartburn and pain.
Laryngopharyngeal Reflux (LFR): Gastric acid and other stomach contents up the esophagus, throat (pharynx) and larynx (larynx) back to escape. These patients do not usually suffer from classic reflux symptoms such as heartburn and heartburn. Therefore, the name 'Silent Reflux' is also used. Throat, larynx and vocal cords are much more sensitive to gastric acid and digestive enzymes than the esophagus. Reflux plays a role in pharyngitis, laryngitis, voice disorders, persistent cough, nodules and polyps, as well as sinusitis and ear infections in the pharynx and larynx. It can rarely lead to asthma, chronic bronchitis and pneumonia. It has also been shown to cause chest pain, sleep apnea and even dental problems.
Complaints of the Reflün:
Feeling there's something in the throat,
Excessive throat cleaning,
Long-lasting cough-like cough,
Feeling something stuck in the throat,
Hoarseness,
Heartburn,
Pain or tenderness in the throat,
A bad, bitter taste in the mouth (especially in the morning),
Discharge from the back of the nose,
Asthma-like respiratory complaints,
Difficulty with high notes when singing
In FLR, the patient's complaint may be a feeling of stuck in the throat, hoarseness, cough or sore throat. However, these complaints may vary from patient to patient. On the other hand, in sound artists, it can be caused by fatigue, difficulty in giving subtle sounds and a sensation of curtain in sound.
Is Reflux a Serious Disease?
It is a long-lasting, disturbing disease. If left untreated, it is prone to permanent damage to the mucosa and chronicity. Bleeding, narrowing and blockage of the esophagus may occur.
It should be kept in mind that irritation of gastric acid in the throat and larynx can lead to edema, nodules and flesh growth in vocal cords and even cancer in the future.
How does reflux occur, what is the burning sensation?
The acid, which is already present in the stomach, increases with the secretion of acid by the special cells producing acid in the stomach after eating. While standing, with the help of gravity, acid can hardly come up. However, gastric acid is easier to reach the esophagus in the lying position. This causes the complaint to increase at night. The longer the acid remains in the esophagus and throat, the more damage it will do. There is a burning and discomfort feeling spreading from the back of the chest towards the throat. In addition to symptoms such as belching and bloating, a bitter or sour acid taste can be felt behind the throat.
How Common is this Discomfort?
This is quite common. Depending on the food habits, there is an average of one in every 10-15 people. More than 60 million people in the United States suffer from heartburn once a month; another study found more than 15 million Americans complaining of heartburn every day.
Laringo pharyngeal reflux is seen in 10% of all otolaryngology diseases. The frequency of reflux in patients with voice disorders or people with chronic throat disease reaches 60%.
Diagnosis of reflux: The information obtained from the patient and the endoscopic examination of the otorhinolaryngology are often sufficient for diagnosis. Some changes seen in the vocal cords are very important in diagnosis.
24-hour acid measurement (Ph monitoring) provides important information in the diagnosis of reflux. Monitoring is also useful for the assessment of alkali reflux as well as acid reflux.
Complaints and regression of symptoms with reflux therapy are also valuable in the diagnosis.
Reflux is also important in pediatric patients, but the diagnosis is more difficult. It is normal to have some reflux until the age of two, but reflux should be investigated for persistent cough, hoarseness, bronchitis and weight loss.
In the presence of reflux, food allergies and other gastrointestinal diseases should also be investigated if necessary.
How can complaints be reduced in reflux?
Alteration of eating and lifestyle habits and the correct use of drugs such as antacids may be sufficient for those who do not have advanced disease. Some suggestions that can be applied in daily life can help reduce complaints:
Nutrients that increase reflux and stomach burning:
Chocolate, dried fruits, mint
Fatty foods
Coffee, caffeinated and cola drinks
Alcohol
Gassing foods such as beans, chickpeas and corn
Foods fried in oil
Citrus fruits and juices
Tomato products
Pickles and pickle juice
Hot and sour foods
Other Lifestyle Changes in Reflux Treatment:
Reducing the amount of meals eaten, more frequent meals with smaller meals
Excess weight should be reduced. In overweight people, stomach contents are more easily escaped because of the high pressure in the abdomen.
No smoking and alcohol
The head of the bed should be high when lying
3 hours after eating or drinking should not be lied, if necessary, lighter and low-fat foods should be taken.
Try to reduce stress and stress
Tightly wrapped clothing should not be worn after meals, excessive bending, heavy work should not be done
Recently after meals 10–15 min. It was determined that the saliva increased by chewing gum containing bicarbonate content, neutralized the acid remaining in the larynx or esophagus and decreased the complaint of reflux. Chewing gums should be preferred.
What Medications Are Available for Reflux and Heartburn Complaints?
In the early stages of the disease, deacidifying drugs in the form of tablets called syrups or chewed in the mouth may be sufficient. Drugs called proton pampa inhibitors that prevent gastric acid secretion should be used regularly in later stages of the disease. Treatment with these drugs usually lasts 2-3 months, and some patients even need to use it longer.
How long should reflux therapy continue?
Reflux is a long-term (chronic) but intermittent disease. For this reason, reflux may reappear for a number of reasons (eg stress, fatigue and diet, etc.) after the symptoms and signs of reflux have disappeared and treatment is discontinued completely. Therefore, in general, reflux patients need intermittent treatment. The duration of reflux treatment varies from person to person, but lasts for an average of 3-6 months.
Reflux Therapy
In the treatment of patients with pharyngolarengeal reflux, social precautions should be applied first. In cases that cannot be treated with social measures, medication or surgical treatments may be necessary.
First, foods that increase reflux should be avoided. Coffee, starchy carbonated beverages and canned fruit juices, fries, fried meat or chicken, offal, sausage salami, as well as beans, chickpeas, corn-making foods, such as increased reflux. Chocolate, nuts, dough desserts, tahini halva, margarine, tail oil, hot spices, pickles, vinegar, garlic and lemon salt should be banned.
Excess food should not be taken at a time, less amount and should be taken regularly. Food should not be too cold or hot and should be chewed thoroughly.
It is recommended to raise the head when lying down. In addition, in order to increase intra-abdominal pressure, it is useful not to gain weight and not to wear clothes that tighten the waist. After eating, care should be taken for 2-3 hours and not to eat especially at night.
Drinks and cigarettes should not be used.
Drug Treatment in Gastroesophageal Reflux
Single dose treatment is preferred in gastroesophageal reflux, whereas pharyngolarengeal reflux should be administered twice daily to fasting abdomen before breakfast and dinner for effective treatment. In case of excessive night reflux, additional medication may be recommended at night.
Although the treatment of diseases such as acid irritation and reflective polyp nodule in the vocal cords passes with treatments, hoarseness may persist in some patients. These patients may require voice therapy.
Surgical Treatment of Gastroesophageal Reflux
In cases where medication fails, surgery may be necessary if the valve between the esophagus and the stomach is loosened. Surgical treatment may be recommended in patients with severe reflux and who do not respond to medication. Here, the esophagus sphincter is tightened by surgery.
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