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REFLUX


Reflex is chronic symptom of mucosal damage caused by stomach acid coming up from the stomach into the esophagus. Reflux is a physiological condition. It can be seen from infancy. For example, it is known by everyone that the babies vomit a little during degasification when they are breastfed more than needed. This is a type of reflux and physiological. Due to nutrition mistakes in adult humans, gastric content may come up to esophagus. This case occurs during belching or hiccups or without rhyme or reason. When this coming up occurs in sporadic occasions, it is not considered and is seen as "physiological reflux". 

When more than 2 times reflux is encountered in a week, "pathological reflux", namely reflux disease can be mentioned. There are some factors triggering reflux disease. These foods might be listed as (bitter, sour pickles, spices, very greasy and gravy dishes, roast, raw onions, chocolate, syrup sweets, acidic and carbonated drinks, alcohol), nutrition errors (fast food, excessive amounts of food), lifestyle errors (sit leaning forward after eating or going to bed after dinner, compression of abdomen and stomach with tight clothes, life style without sport and activity).

As well as these factors, some diseases that are not in the hands of the humans may also contribute to the formation of reflux formation. These can be listed as laxity or expansion in stomach valve, stomach hernia, slowing in stomach discharge, narrowing or clogging at the exit of stomach. 

One or several of these factors come together and reveal reflux disease. Reflux disease has fundamental two reasons. First one is burning in the stomach or esophagus and second one is sour water coming up to esophagus and mouth. In addition to fundamental symptoms, chronic coughing, voice hoarseness, permanent irritation in the throat and pharyngitis, chest pains and burning in the chest may occur. 

When to consult to the doctor?
The patient with the above complaints should immediately consult to the doctor and it is diagnosed after performing required analyses and its treatment should be arranged. If case of complaints despite the treatment in the persons diagnosed and with ongoing diet and treatment, once paint, swallowing difficulty or blocking feeling is experienced in esophagus during swallowing of liquid or solid food, it should be consulted to the doctor immediately. 

Who are potential victims of reflux?
Reflux disease can be seen women or men, elderly or young people. Incidence rate increases day by day. Diet style and life conditions play a highly important role in this increase. Reflux is seen in the persons frequently and excessively consuming reflux induced foods (acidic-fizzy drinks, brewed tea, coffee, frying, fatty-bitter-spicy-tomato paste dishes, onion, sour, pickles, chocolate, alcohol) and not having regular meal times). Still, the persons who are overweight are at higher increased risk in terms of reflux disease. 

How reflux is diagnosed?
For diagnosis of reflux disease, many data are used. Firstly, complaints of the patient are listened and the disease is examined in detailed with further questions. Following this, it is investigated whether there is an examination finding pertaining to any case which will cause these complaints with physical examination. 

Once preliminary diagnosed is placed, X-ray examinations or endoscopic examinations are required for supporting this diagnosis.  Importance of X-ray examinations in reflux diagnosis has dropped as a result of ease experienced by the help of development, spread and sedation of endoscopic examinations. 

Once endoscopy is conducted, esophagus, stomach valve, stomach and structures at the exit of stomach are in detailed evaluated. In this way, information is obtained regarding diagnosis, reason, potential damaging and severity of disease of reflux disease. 

There are methods measuring acid volume coming up to esophagus and determining reflux severity parametrically. These are called "esophageal pH meters" (which measure the pH in the esophagus). This measurement is conducted with two methods. The first one is the method conducting acid measurement with the help of thin tubes called "catheter" and lowering into the stomach from the nose and this is an old method. Here, the patient spends time as intubated to the device with a thin tube lowering to his/her stomach from the nose. The second one is "BRAVO capsule pH metric" method. This method is new. In this method that is available in our hospital, a chip is placed with an endoscopic method to the lower end of esophagus and acid measurement can be conducted during 48 hours thanks to this chip. There is no catheter on the nose in this method. This transmits the chip measurements in esophagus to the receiving device fitted to the belt with wireless frequency. The data collected during 48 hours in the receiving device are collated and evaluated in breakdown in the computer. There is no cable or catheter rather than the receiving device fitted to the belt within this period of 48 hours. This process enables the person to maintain their routines in the same way such as nutrition, bath, wandering, sleeping, work, shopping etc. 

How reflux is treated? 
Reflux disease treatment is associated due to the disease. The treatment should be initiated by disciplining diet program before the treatment in the person using uncontrolled and disproportionate diet and consuming reflux-induced foods in frequent manner. Diet life style arrangements are the primary and the most important step in the treatment because the most common reasons in reflux disease are the diseases in this regard. Losing weight of those having problem with obesity in a controlled way will contribute considerably to decreasing reflux complaints.

Unless this acid coming up cannot be reduced or prevented with diet and life style arrangements since what matters in reflux disease is coming up of stomach acid to esophagus, the complaints will not be eliminated. In this case, stomach acid reducing drugs come to the fore. These drugs can reduce the severity of acid coming up to esophagus and ensures reducing or eliminating the complaints. Rather than reducing the complaints, the drugs are intended for recovering the damages in esophagus. Regular drug use also reduces the risk of recurrence of such damage. In addition, if the patient has stomach hernia or expanded stomach valve state, performing a surgery and correcting this anatomic deformation is among the treatment options. Surgery can be performed with laparoscopy method (closed method).

In brief, diet is a requirement. In addition to the diet, drug should be used if needed. If the problem persists despite the diet and drug and if there is a pathology to be fixed with surgery, operation should be among the options.

What should be considered following treatment and recovery process?
As understood, reflux disease is not a disease treated once and getting comfortable for a life time. Reflux patients should always pay attention to their weights, diet styles, life styles and clothing styles. While this diet-oriented life is going on, these patients will have to use drugs in addition to the diet in periods where the disease becomes specific or in case of reflux complaints. This period of drug use varies from patient to patient. If the diet is proper and smooth, the requirement of using the drug will be less in that extent.