Gastroesophageal Reflux
The incidence of gastroesophageal reflux disease (GERD) in our country varies between 19-25%. Studies show that one in five people have reflux. Gastroesophageal reflux (GER), commonly known as reflux, is the escape of gastric contents (gastric acid, pepsin, pancreatic enzymes and bile) back into the esophagus. Physiological reflux may also occur in healthy individuals. Physiological reflux is usually not recognized because of its short duration and no damage to the esophagus.
Reflux; When repeated frequently during the day, lasts longer and occurs during sleep, there is now pathological reflux. A typical symptom is burning sensation behind the breast bone and is accompanied by varying degrees of damage to the esophagus. In this case, ‘gastroesophageal reflux disease GÖR (GERD) or şekl reflux disease iyle as it is common among people is mentioned. Almost half of the people living in the West have identified this complaint at least once a year, 25% at least once a month, 15% at least once a week, and 5% to 10% at least once a day. The findings obtained in epidemiological studies in our country are not very different from these results.
Foods normally found in the stomach, and especially fasting acid and bile do not escape the esophagus. The valve system at the junction of the esophagus and the stomach (lower esophageal sphincter - LES) prevents this. This system allows food from the esophagus to pass into the stomach, while preventing gastric contents from escaping back into the esophagus. Thus, the mucosa of the esophagus, which is resistant to acid and bile, is saved from destruction. The most important reason of the reflux system is that the valve system is inadequate for various reasons. It is not always necessary to have valve failure for reflux. Reflux may also occur in some diseases of the esophagus and in the case of gastric emptying.
Gastric hernia is another important cause of GER. Gastric hernia, separating the chest and abdominal cavity and the diaphragm called as a result of excessive expansion of the hole in the membrane, the upper part of the stomach joins the esophagus through this hole to shift into the chest cavity. In the presence of gastric hernia, the structure and function of LES deteriorates and the escape of stomach contents to the esophagus is facilitated. Gastric hernia is present in almost half of the patients with severe reflux, while reflux complaints occur in 1/3 of cases of gastric hernia.
Symptoms of gastroesophageal reflux disease:
Typical symptoms of reflux disease are a burning sensation from the bottom of the chest to the throat (heartburn) and the return of edible food to the mouth or esophagus (regurgitation). This burning sensation can spread to the back and throat, usually starts 30 minutes after meals, and increases with exercise and leaning forward.
In patients with severe reflux, the contents of the stomach back to the mouth as a result of bad breath, sore throat, difficulty swallowing, hoarseness, abdominal distension, burping, hiccups, tickling and chronic cough may be seen as complaints. Reflux was detected in 2/3 of coughs with unknown cause. In addition, some studies have shown a close relationship between reflux and asthma.
Another atypical symptom in GERD is chest pain (chest pain due to non-cardiac causes). Since pain can sometimes be confused with coronary heart disease, these patients are usually first examined for heart disease. As a result of examinations performed in 25-30% of these patients who seem to be heart-shaped, there is no reason to explain chest pain and reflux disease was found in half of these patients.
Diagnostic methods in gastroesophageal reflux disease:
The diagnosis of reflux can be easily diagnosed by an experienced physician in patients with typical complaints by careful listening of the patient's complaints. The improvement of the patient's complaints in a short time with a treatment for reflux is another method that can be used in the diagnosis.
Endoscopic examination (gastroscopy) is the most common method for the diagnosis of reflux because it allows direct examination of the esophagus, esophageal-gastric junction and stomach, and, if necessary, tissue samples for histopathological examination. Gastroscopic examination of the esophagus from the stomach and acid-induced sores and ulcers can be seen.
Endoscopic examination should be performed especially in patients whose complaints last for more than 5 years, who are over 40 years of age, who have esophageal or gastric cancer in their first degree relatives (mother, father and siblings) and who have symptoms of swallowing difficulty, painful swallowing, weight loss and anemia.
In patients with atypical findings, undiagnosed or unresponsive treatment, some additional tests are required. In such cases, the esophagus may need to be evaluated with a catheter (PH meter) measuring acid for 24 hours, or esophageal manometry, which measures the food repulsion of the esophagus.
Complications of gastroesophageal reflux disease:
Long-term and inadequately treated patients may develop stenosis in the lower end of the esophagus. The main symptom is difficulty in swallowing. Balloon dilation is used for the treatment of stenosis and surgical treatment may be required in cases that do not improve. Another complication that may occur in reflux disease is deep ulcers in the esophagus. These ulcers can be painful and sometimes cause severe bleeding. Chronic laryngitis, asthma and more serious problems that may occur as a result of gastric contents entering the airways are other complications that may occur in reflux disease. A serious and silent complication of gastroesophageal reflux disease is known as Barrett's esophagus or barrett's metaplasia. The importance of Barrett's esophagus is the development of cancer. The incidence of esophageal cancer in Barrett's esophagus is about 0.5% per year. Patients with Barrett's esophagus should be followed up periodically by gastroscopy and tissue sampling, and patients with early signs of cancer should be treated with surgery.
Treatment of gastroesophageal reflux disease:
GERD significantly reduces the comfort of life with problems caused by esophagus and outside the esophagus. Therefore, the aim of the treatment is to relieve the symptoms and prevent the development of complications. First of all, non-drug treatments that regulate lifestyle are applied in addition to medical treatment.
These:
Raising the bed head,
Avoid eating three hours before bedtime,
To reduce the amount of food and fat content,
Decrease caffeine and chocolate intake,
Smoking cessation, alcohol cessation,
Ideal is to come to weight.
It is recommended to reduce the consumption of fatty and fried foods, tomato paste and spicy foods, especially sweets, coffee, acidic fruit juices and cola drinks, and to consume such foods mostly at lunch times.
Increasing the intra-abdominal pressure corset, tight belt and leaning forward to push forward to increase the reflux. Any kind of stress increases stomach problems. Mucosa-damaging aspirin and other analgesics and drugs that lower the lower esophageal sphincter pressure, such as theophylline, anticholinergics and calcium antagonists, should not be used during treatment.
Medication:
Proton pump inhibitors and H2 receptor blockers to be used in the period of symptoms have an effect by lowering the gastric acid level. Long-term treatment is required in patients whose symptoms do not resolve despite lifestyle-regulating measures and who relapse frequently despite short-term treatment. Although antacids provide a rapid symptomatic improvement, they should generally be used in large quantities and at frequent intervals and have no therapeutic effect.
The most effective agents in treatment are proton pump inhibitors. These drugs may require lifelong use in patients with reflux hernia who have gastric hernia or esophageal ulcers. These drugs provide an effective treatment by strongly suppressing gastric acid secretion. An effective dose of these medications can improve the majority of patients (85-100%) after 8-10 weeks of treatment.
A major problem in the treatment of reflux disease is the relapse of symptoms in the majority of patients after discontinuation of treatment. Sudden discontinuation of treatment increases this possibility. In some patients, it may be sufficient to take the medication every other day or intermittently twice a week, or to use it during complaints.
According to our current knowledge, it can be said that there is no harm in long-term use of these drugs. Vitamin B12 deficiency and infrequently reduced bone density may be seen in elderly patients for more than 6-8 years. No iron deficiency development was observed. Long-term use, especially in the elderly, may lead to an increased incidence of gastrointestinal infections and pneumonia. Long-term use of the drug may result in increased serum gastrin levels and neuroendocrine cell hyperplasia in the stomach. Gastric cancer formation due to the use of these drugs has not been reported.
Endoscopic treatment:
Stretta procedure is endoscopic gastroplication and suture.
Surgical treatment:
Nowadays, the most commonly used permanent treatment method is laparoscopic surgery. Surgical treatment is an alternative if it responds to PPI treatment but cannot tolerate the drug. Surgical treatment may be recommended especially for GERD with severe regurgitation despite PPI treatment.
GERD is a common disease in the community, impairing quality of life, can cause esophageal and extraesophageal symptoms, and has serious complications. They respond well to PPI treatment, but often require long-term maintenance therapy. The drugs used in the treatment of reflux are known to be safe. A small number of patients require surgical treatment. Surgical treatment should not be rushed and the patient should be examined in detail to see if it is suitable for this treatment.
11AXX
Basic Care Lansoprazole Delayed Release Capsules, 15 Mg, 42Count
