Reflux Treatment in Ankara

What is Reflux?

Gastroesophageal reflux disease (GERD) occurs when stomach acid flows back into the esophagus in greater amounts or for longer periods than normal, causing a burning sensation in the center of the chest (heartburn). Patients may also experience complaints such as a bitter taste in the mouth or regurgitation of food. It is a common condition in the population, with a prevalence of 15-20% in Turkey. In some people with an overly sensitive esophagus (hypersensitive esophagus),even normal amounts and durations of stomach acid reflux can cause chest burning symptoms similar to reflux.

What are the symptoms of reflux?

Reflux-related symptoms usually occur after meals. They are often triggered by consumption of foods such as very fatty and fried dishes, highly spicy foods, alcohol, chocolate, coffee, fresh mint, and fruit juices. The burning sensation, which typically spreads from the stomach to the throat after eating, is frequently accompanied by regurgitation of food and/or sour-bitter liquid into the mouth and, over time, difficulty swallowing. Reflux disease can also cause coughing (especially at night),hoarseness, tooth decay, and sore throat.

Symptoms of reflux include:

• Burning sensation in the center of the chest (heartburn)
• Regurgitation of food and drinks from the stomach into the mouth
• Sour taste in the stomach, especially at night or when lying down after meals
• Sore throat (pharyngitis) and hoarseness
• Feeling of something stuck in the throat or difficulty swallowing
• Coughing (more frequent at night or when lying on the back after meals)
• Bloating is a common accompanying complaint in reflux patients
• Belching (which may be accompanied by regurgitation of food or sour-bitter liquid)
• Bad breath (due to reflux-related tooth decay, gum disease, and pharyngitis)
• Sometimes hiccups may occur

What Triggers Reflux?

In people predisposed to reflux disease, certain foods, lifestyle mistakes, and stress can cause reflux symptoms to appear. Nowadays, the increasing consumption of fast food, packaged ready-made products, and additives used to extend the shelf life of foods contribute to the development of reflux.

Eating close to bedtime is one of the important factors that trigger reflux. When lying down, stomach emptying slows down, causing more acid to be produced. Also, lying on the back makes it easier for stomach contents to flow back into the esophagus.

Some foods and drinks can relax the lower esophageal sphincter and trigger reflux symptoms. These include:

• Alcohol
• Smoking
• Coffee
• Mint (especially fresh mint)
• Fried and fatty foods
• Acidic fruits, acidic drinks, and fruit juices
• Chocolate

Besides these, individual sensitivity to foods may vary. A food that does not trigger reflux in one person may cause symptoms in another. This is something individuals can notice through their own observations.

What Should Be Done to Prevent Reflux?

To prevent and reduce reflux symptoms, the first step is to make changes in diet and lifestyle. Making these changes can significantly reduce or eliminate symptoms in many patients. Additionally, these changes can reduce the need for medication or the amount of medication required to control symptoms.

To prevent and reduce reflux symptoms:

• Avoid the foods and drinks mentioned above that trigger reflux
• Avoid foods that you personally identify as reflux triggers
• Do not eat close to bedtime (at least 3 hours before) and avoid lying down immediately after eating
• Reduce the quantity of evening meals and avoid trigger foods especially at dinner
• For patients with severe symptoms, increase the number of meals but eat smaller portions each time
• Avoid excessive weight gain, and lose weight if overweight
• Choose clothing and accessories that do not compress the abdomen or waist
• Elevate the head of the bed (especially for patients with frequent nighttime reflux)
• Avoid smoking and alcohol
• For patients with abdominal bloating caused by excessive gas, diagnose and treat to reduce or eliminate the bloating
• Avoid activities that increase intra-abdominal pressure immediately after eating (such as heavy lifting or strenuous exercise)

How Should Nutrition Be for Reflux?

Dietary habits and changes are very important for controlling reflux symptoms and also help reduce the need for medication. In addition to avoiding the foods and drinks mentioned earlier, a Mediterranean-type diet that is rich in fiber, low in spices, and not very fatty should be preferred.

Foods such as raw garlic and onions, which cause excessive acid production in the stomach, should be avoided. The habit of eating late at night should be stopped, and food intake (including fruits and snacks) should end at least 3 hours before going to bed. Great effort should be made to avoid consuming alcohol, coffee, and acidic beverages especially after the evening. It is not harmful to consume non-acidic drinks that do not cause relaxation of the lower esophageal sphincter during the period before bedtime.

What Is Good for Reflux Disease?

Diet and lifestyle changes, along with stress reduction, are very important factors for reducing reflux symptoms, preventing chronic complications related to reflux, and decreasing the need for medication.

Avoiding or minimizing foods and drinks that trigger and increase reflux will help relieve reflux symptoms. Especially, avoiding late-night eating is necessary. Losing weight in overweight patients can reduce or even eliminate symptoms.

Light physical activity such as walking after meals increases stomach and intestinal movements, which has a reflux-reducing effect. Consuming fiber-rich foods (apple, banana, broccoli, cauliflower, cabbage, carrot) and plenty of water is beneficial for reflux.

How Is Reflux Diagnosed?

Clinical diagnostic criteria for reflux include mild symptoms of burning sensation spreading from the center of the chest toward the throat, bitter-sour stomach contents coming up into the mouth, sometimes accompanied by difficulty swallowing, and bothersome belching occurring at least twice a week, or severe symptoms at least once a week or more frequently. However, most reflux patients do not have clear symptoms. In some patients, complications (especially asthma-like cough attacks at night, strictures and ulcers in the lower esophagus with associated bleeding, difficulty swallowing) may develop without typical reflux symptoms.

Reflux diagnosis can be made by evaluating the patient’s symptoms, detailed medical history, and physical findings. Endoscopy is required to confirm the diagnosis or to check if damage due to reflux has occurred, especially in patients with long-standing symptoms. Most reflux patients do not develop significant damage to the esophagus, so in patients without clear endoscopic findings, 24-hour acid monitoring (pH monitoring) and manometric tests may be performed. Although rarely used nowadays, barium swallow X-ray examination is another supportive diagnostic test.

Endoscopy, described in detail under a separate heading, is important not only for diagnosis but also for detecting conditions that may cause reflux, such as a hiatal hernia or relaxation of the lower esophageal sphincter (often described as valve relaxation).

The 24-hour acid measurement is a test performed by placing a catheter through the nose to the lower end of the esophagus connected to a portable recording device that does not restrict daily activities. Manometric examination, which evaluates esophageal motility, is usually performed alongside this test.

Reflux Treatment in Ankara

The most important factor in the treatment of reflux disease is making changes in lifestyle and dietary habits. Simply changing lifestyle and eating habits can lead to a reduction or complete disappearance of symptoms. Additionally, medication plays a faster and more effective role in preventing reflux. In patients where endoscopic evaluation shows loosening of the lower esophageal sphincter, and symptoms persist despite lifestyle and dietary changes along with medication, and reflux continues as confirmed by 24-hour acid monitoring, endoscopic treatment methods can be applied. If endoscopic and manometric examinations confirm the diagnosis of a hiatal hernia, treatment with endoscopic or surgical methods may be necessary.

Avoiding foods and drinks that relax the lower esophageal sphincter and trigger reflux is very important for controlling symptoms. Quitting smoking, if applicable, will significantly help. Tight clothing around the abdomen and a tight belt can increase reflux symptoms by putting pressure on the stomach and should be avoided. Eating foods, including fruits or snacks, drinking coffee, lying down after meals, or lying flat on the back especially close to bedtime can cause reflux.

Alcohol consumption is an important factor that causes reflux, especially when consumed late at night before lying down, which leads to nighttime reflux. Fatty and fried foods, raw garlic and onions, mint, sesame, and heavily spiced foods—known to trigger reflux—should particularly be avoided at dinner and near bedtime. Apart from these highlighted foods and drinks, individual patients may have different trigger foods. It is recommended that patients keep a food diary if necessary to identify their personal triggers.

Lying flat on the back facilitates stomach contents flowing back into the esophagus, so raising the head of the bed by about 35 degrees is effective in preventing reflux. Simply using extra pillows is not sufficient and may cause neck problems, especially in patients with cervical disc issues. Therefore, using a reflux pillow or adjusting the bed to an inclined position is a more appropriate method.

Obesity increases intra-abdominal pressure, putting pressure on the stomach and causing or worsening reflux symptoms. Losing an adequate amount of weight can reduce or eliminate symptoms in such patients.

Reflux Medication Treatment

Medications used include acid secretion suppressants (proton pump inhibitors, H2 receptor blockers),drugs that increase esophageal motility, alginates that form an acid barrier over stomach contents, and partly antacid drugs. Medications that facilitate gastric emptying are also used in reflux treatment.

Is reflux treated with surgery?

Surgery is recommended for patients whose reflux symptoms do not improve despite lifestyle and dietary changes combined with medication, or for those who do not want to use medication long-term, especially when a hiatal hernia is present. The most commonly performed surgery is Nissen fundoplication. In this procedure, the upper part of the stomach is wrapped circularly around the lower part of the esophagus to close the opening, usually reinforced with a material called mesh. During this operation, the hiatal hernia is also repaired. Nissen fundoplication is the most common and effective surgery and can be performed laparoscopically (minimally invasive).

Is there endoscopic treatment for reflux?

Endoscopic treatments consist of different techniques mainly preferred for patients with looseness of the lower esophageal sphincter. The choice of method depends on the experience of the endoscopist performing the treatment and cost-effectiveness considerations. As experience and scientific data about these recently introduced endoscopic methods increase, their role in treatment will become clearer.

What complications can reflux cause?

In patients with untreated reflux or those with undiagnosed reflux that does not cause significant symptoms, over the years acid-induced damage to the esophagus (esophagitis) can lead to ulcers that may cause bleeding, strictures (narrowing) in the lower esophagus called Schatzki rings, resulting in difficulty swallowing and painful swallowing, and tissue changes known as “Barrett’s esophagus” which are considered at risk for developing cancer.

Furthermore, especially nighttime reflux can cause stomach contents to reach up into the upper esophagus and lungs, leading to asthma-like cough and lung problems. Such patients may be mistakenly treated for asthma for years.

Acidic stomach contents reaching the upper parts of the esophagus can also cause chronic pharyngitis, tooth decay, and even middle ear problems.