What Is Reflux Disease? Reflux Symptoms, Causes and Treatment

What Is Reflux?

Reflux is the passive, involuntary rise of stomach contents (acid, bile) into the esophagus and/or higher, causing complaints such as heartburn and/or regurgitation (sour water). Less commonly, reflux may also present with atypical symptoms such as chronic cough, persistent pharyngitis, hoarseness, bad breath and tooth decay. Based on how frequently symptoms occur, reflux is described as mild, moderate or severe. Reflux is a very common condition affecting nearly all of society, with a prevalence of approximately 20–35%. Although many factors contribute to the development of reflux, the most important is laxity of the sphincter (gastric valve) located between the esophagus and the stomach. This sphincter is the main structure that prevents stomach contents from flowing back into the esophagus. Endoscopic and surgical treatments for reflux are based on structurally restoring this valve mechanism.

What Are the Symptoms of Reflux Disease?

Symptoms of reflux disease can be examined under 2 headings: typical and atypical.

Typical symptoms:

The most common symptoms of reflux are burning in the chest (heartburn) and regurgitation (sour water coming up).

Atypical symptoms:

Hoarseness, frequently recurring or persistent pharyngitis, laryngitis, sinusitis, tooth decay, bad breath, asthma and COPD (chronic obstructive pulmonary disease) attacks, recurrent pneumonia attacks.

Who Is Reflux Commonly Seen In?

The frequency of reflux may increase in the following people:

Smoking, alcohol consumption

Obesity

Consumption of fatty foods (fried or high-fat foods – “chocolate, dried nuts” –)

Caffeine (coffee, tea, cola, chocolate)

Pregnancy

Hiatal hernia

Certain medications (muscle relaxants that affect the function of the gastric valve)

Consumption of foods that increase stomach acid (acidic fruit juices, pickles, spicy foods)

How Is Reflux Diagnosed?

The first test a patient with reflux symptoms should undergo is “endoscopy”. Endoscopy is used to evaluate the function of the gastric valve, determine the severity of reflux and create a permanent treatment plan. In patients with no typical reflux symptoms or no signs of reflux on endoscopy, the presence or absence of reflux can be scientifically demonstrated using:

24-hour pH monitoring (conventional or wireless (Bravo pH monitoring)

Impedance

Motility study (HRM – high-resolution manometry)

With these methods, the presence or absence of reflux can be scientifically demonstrated. In patients with obvious reflux on endoscopy, these methods are usually not needed.

Is Reflux a Serious Disease?

Reflux is a chronic disease; if left untreated, it can lead to tissue changes in the esophagus caused by persistent acid reflux (Barrett’s esophagitis), esophageal stricture (peptic stricture), difficulty swallowing and even esophageal cancer. Untreated reflux disease can also cause recurrent pneumonia, persistent pharyngitis, laryngitis and asthma attacks in older adults. Long-term use (more than 1 year continuously) of stomach-protecting medications (proton pump inhibitors), taken to reduce reflux symptoms, may also cause anemia, vitamin deficiencies and bone loss, and in some patients there is a possibility of developing stomach cancer. For this reason, a permanent solution to the reflux problem must definitely be sought and implemented.

How Is Reflux Treated?

Reflux is a chronic disease. The goal of treatment is to relieve reflux complaints, heal any damage that has occurred in the esophagus, and prevent possible complications. For this purpose, 3 types of treatment are applied:

Lifestyle changes;

Lose excess weight

Do not smoke or drink alcohol

Pay attention to eating smaller meals more frequently.

Fatty, fried foods

Nuts

Hot, sour and spicy foods

Chocolate,

Avoid acidic drinks.

Do not use medications that may cause reflux

Avoid wearing belts, corsets and tight clothing that squeeze your waist

Raise the head of your bed by about 15 cm

Finish eating and drinking at least 3 hours before bedtime

Drug Treatment

In drug treatment applied alongside lifestyle changes, the aim is to reduce the stomach acid that flows back into the esophagus and causes reflux symptoms. Medications that reduce stomach acid are called proton pump inhibitors (PPIs). Today, with these highly effective drugs, disease symptoms can be completely treated. However, many side effects may occur with long-term use (more than 1–3 years) of these drugs. The most notable side effects include: vitamin B12 and iron deficiency, bone loss, susceptibility to infections, reduced effectiveness of other medications taken concurrently, formation of precancerous lesions in the stomach, and even an increased risk of stomach cancer. Whether the benefits or the harms of long-term use of these drugs outweigh the other is still a matter of debate.

Endoscopic Treatments

Endoscopic treatment of reflux has become a very popular topic in recent years, because well over 80% of patients with reflux problems in the population have mild or moderate reflux and do not meet the criteria requiring surgical procedures. Therefore, since long-term diet and medication use is both difficult and carries certain side-effect risks for patients with mild and moderate reflux, endoscopic treatments specifically for this patient group have come to the forefront. The most popular and effective of these are:

Anti-Reflux Mucosal Ablation (ARMA): Endoscopic reconstruction of the gastric valve region. This procedure is performed in the endoscopy room under sedation. It is based on cauterizing the gastric valve region with an argon gas coagulator, followed by healing and narrowing of the gastric valve region. The procedure takes 15–20 minutes. It has an efficacy of 80% and is a procedure with extremely few side effects. No hospital stay is required.

GERDx: Endoscopic suturing of the gastric valve region (Endoscopic Fundoplication) iş This procedure can be briefly summarized as performing surgical reflux surgery endoscopically. The procedure is performed under general anesthesia and lasts 30 minutes. During the procedure, 1 or 2 sutures (stitches) are placed in the gastric valve region under endoscopic guidance. It is a permanent treatment, with efficacy above 90% in appropriate indications. A possible side effect is mild pain after the procedure, which can generally be relieved with painkillers.

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Surgical Treatment

The aim of surgical treatment for reflux is to prevent stomach acid from flowing back by compressing the lower end of the esophagus. However, it is the treatment method to be used when necessary, after the above treatment methods have been tried. The operation performed is called Nissen Fundoplication. It is generally a method applied to patients with markedly loose gastric valves and hiatal hernia.