Gastroesophageal reflux is the pathological escape of stomach contents (acid) from the stomach to the esophagus (esophagus). Patients may present with the complaint of burning of the chest (heartburn). Reflux is sometimes the burning of food behind the esophagus, as well as the introduction of food and brackish water into the mouth. Reflux occurs after prepared meals. Gastroesophageal reflux disease is a common disease in our country as well as all over the world. Reflux disease in 20% of the middle of the food taken into the mouth of the esophagus (esophagus) makes. At the lower end of the connecting tube in the middle of the esophagus which is similar in shape, there is a sphincter which is closed in the open air only where the food is open. This sphincter prevents gastric acid and food entering the stomach back into the esophagus. Although ‘stomach burn’ at the lower end of the esophagus can identify various digestive problems, the medical can identify the gastroesophageal reflux patient stool there, so that the secreted acids for digestion and spread into the neck. An adult can experience this irritating burning sensation at least once a month.

Other symptoms in GERD are; vomiting, difficulty swallowing, chronic coughing, wheezing.

Why do we get GERD?

When we eat, food moves from mouth to stomach through the esophagus. At the lower end of the esophagus, there is a small muscle structure called the esophagus sphincter. This muscle acts as a one-way valve, allowing food to pass into the stomach. Normally, what we eat closes immediately after being held and prevents gastric juices with a high acid content from returning to the esophagus. However, when this sphincter does not work properly, it may come into contact with the stomach acid content coming back into the esophagus and burning sensation. This may irritate the esophagus and cause inflammation. It can also cause heartburn or even damage the esophagus. Having this condition may increase the risk of esophageal cancer.

 

What are the symptoms of reflux disease?

When the sphincter at the lower end of the esophagus loosens, gastric acid escapes back into the esophagus;

Heartburn – Heartburn

Burning in the chest

Eating back to the mouth

Weight Loss

Pain ‐ sour water in the mouth

Bad breath

Bulge-belching

Chronic pharyngitis

Chronic sinusitis

It causes allergic asthma and tooth decay.

If Gastric Acid Leaks into the Breathing Tube;

It can lead to hoarseness, sore throat, cough, feeling of obsession in the throat, asthma manifested by night-time crises, excessive snoring, and sleep disturbances.

Why GERD occurs?

Some people are born with a weak esophageal lower sphincter. In addition, fatty and spicy foods, some types of medication, tight clothing, smoking, drinking alcohol, exercising strongly, and sudden changes in body position (such as sudden bending) can cause the sphincter to relax and cause reflux. A hiatal hernia occurs in most GERD patients. This refers to the situation in which the upper part of the stomach enters the diaphragm and into the chest cavity. This case is thought to contribute to the development of acid reflux.

How is GERD treated?

You can start by changing your lifestyle first. Changing your eating habits, and taking antacids that are sold over the counter, can reduce symptoms. It can also help to lose weight, reduce or eliminate smoking and alcohol consumption, and change eating and sleeping patterns. Antacids neutralize gastric acids and over-the-counter medications reduce the amount of gastric acid produced. Both may be more effective in relieving symptoms. Prescription drugs can be effective in improving esophageal irritation and relieving symptoms. The part of determining this treatment should be decided in consultation with your surgeon.

If lifestyle changes and drug use do not go away, surgery may be decided. Surgery is very effective in the treatment of GERD. The most common operation for GERD is called fundoplication. Fundoplication involves fixing your hiatal hernia, if any, and wrapping the upper part of the stomach to the end of the esophagus to strengthen the lower esophageal sphincter. This is done to prevent acid reflux. It is mostly performed with minimally invasive techniques using several small incisions performed by laparoscopic surgery.

There is almost no postoperative pain after this operation. The duration of hospitalization is short. Shortens the time to return to daily life. Whether you are eligible for this surgery is decided by endoscopy.

1- SURGERY: The most commonly used permanent treatment method today is laparoscopic surgery. When the wound is opened in the esophagus, a gastric hernia is diagnosed by endoscopy and in patients with valve failure, the patient may need to drink medicine for life.

After laparoscopic surgery, the patient stays in the hospital for one day and is fed orally the next day. There is no need for food regimens and social precautions after the operation of the patients. There is more than 90% success in the long term after the operations of experienced surgeons.

Who is recommended for laparoscopic surgery?

Those who have to take medicine continuously,

Those who repeat the complaint when the drug is stopped,

Those who did not pass the esophagus sores despite the medication or the sores in the esophagus were reopened immediately after the drug was stopped,

Those with bleeding injuries to the esophagus,

Those with advanced cellular changes in the esophagus, especially those in the young age group

Nausea, continuous cough and hoarseness in patients with severe,

Process after GERD surgery

Patients are encouraged to engage in mild activity at home after surgery and should avoid heavy lifting or strenuous activities for a short period of time determined by your surgeon.

Postoperative pain is usually mild, but some patients may require prescription pain medication for a short period of time.

Anti-reflux medicine is usually not required after surgery.

Most surgeons temporarily change the patient’s diet after starting with fluids and then progressively progressing to solid foods. You should ask your surgeon about dietary restrictions immediately after surgery.

You will probably be able to return to your normal activities in a short time. These activities include taking a shower, driving a car, walking up stairs, lifting, working and having sexual intercourse.

Control is required within 2 weeks after surgery.

 

Does GERD have any side effects?

Studies have shown that the majority of patients undergoing the procedure are either asymptomatic or have significant improvement in GERD symptoms.

Long-term side effects of this procedure are usually rare.

Some patients experience temporary difficulties in swallowing immediately after surgery. This usually occurs one to three months after surgery.

Rarely, patients may require a procedure to stretch or rarely re-operate the esophagus (endoscopic enlargement).

The ability to burp and vomit after this procedure may be limited. Some patients report abdominal distension.

Rarely, some patients did not report improvement in their symptoms. Reflux symptoms may return months or years after the procedure.

Complications of GERD

Although the operation is considered safe, complications can occur as can be seen in any operation.

Rarely, the following complications may occur;

Adverse reaction to general anesthesia

Bleeding

Injury to esophagus, spleen, liver, stomach or internal organs

Wound, abdominal or blood infection.

Other less common complications may also occur.

Your surgeon will discuss these with you. It will also help you decide whether the risks of laparoscopic anti-reflux surgery are less than non-operative management.

When will you call your doctor

Make sure you call your doctor or surgeon if you develop any of the following:

Continuous fever, above 101 degrees F (39 C)

Bleeding

Increasing abdominal distension

Uncomfortable pain in your medication

Persistent nausea or vomiting

Shake

Persistent cough or shortness of breath

Purulent drainage from any incision (pus)

Redness surrounding any of your worsening or larger cuts

You cannot eat or drink liquids

The most common cause of surgery is heartburn, which does not go with medications and lifestyle changes. Surgery may also be an option if:

Severe inflammation in your esophagus, your tube works in your mouth for your stomach

Contraction of your esophagus caused by cancer

Barrett’s esophagus, a change in cells due to acid reflux

Before surgery, you will probably take tests to check how well the muscles in your esophagus are working, including esophageal manometry and esophageal motility studies.

Because you are at risk in any operation, you should consider acid reflux or GERD (gastroesophageal reflux disease) surgery only when other treatments do not work and are likely to result in good results.

GERD surgery

The main surgery for persistent heartburn is called fundoplication. The surgeon can touch the parts directly (open fundoplication) while you can open your medication, or in a special location, including a thin tube with light and camera called laparoscope to operate you outdoors.

Your surgeon cuts your abdomen: a large cut for open surgery or a few small cuts for laparoscopic surgery. They will then wrap around the lower part of your esophagus at the beginning or somewhere in the upper part of your stomach and sew it into place. This can cause the esophagus to tighten, which prevents the acid from being drawn back into the aside.

Also, a laparoscope out of your lower esophagus to put a titanium bead ring for girls. This strengthens the valve between the esophagus and the stomach. Food and liquids can still pass.

 

IS RECURRENCE AFTER SURGERY?

Recurrence after surgery is less than 5% in the series of experienced surgeons. In recent years, the incidence of recurrence has decreased with the use of burning (polypropylene graft). The most important conditions of relapse are severe traumas and compulsive vomiting in the early postoperative period. This is the patch cleaning.

 

AFTER GERD SURGERY

With laparoscopy, you get a shorter recovery time and less pain. It also doesn’t leave a big mark. it can be considered minimally invasive.

Conclude surgical surgeries and satisfied with the results. But surgery will not get rid of all your symptoms. The drug may need to be continued to be taken. 1 out of 10 people may need to have surgery again. These are rare display cases.

It is very safe specific to the device and does not cause other problems to the device. If it happens,

Difficulty swallowing after surgery and

May be gas swelling syndrome

Decide if surgery is a good choice for you and talk to your doctor about the pros and cons of your condition.

 

WHAT SHOULD REFLUX PATIENTS PAY ATTENTION TO?

You should avoid acidic beverages, alcohol, coffee, spicy foods, pickles, vinegar, chocolate, food, garlic, and foods. These are foods and drinks that increase stomach acid,

Aspirin or pain medication should be used as little as possible,

It should not be slept immediately after eating. At least two hours pass,

There must be a head and neck area when lying down. Reflux pads

If you increase the amount of acid in the stomach should not smoke

Alcohol and fermented beverages should refrain from alcohol and fermented beverages by delaying gastric emptying and increasing stomach heat, disrupting acid balance and lowering the initiator of the occlusive muscle of the esophagus,

Less but frequent food, slow eating, good chewing should take care,

The ideal weight should be paid attention. Because weight increases reflux complaints,

Do not tighten the belt too much, avoid escaping, avoid being narrow,

Avoid work that requires a lot of power,

Liquids are consumed in the search for meals, not cooking.