Gastroesophageal reflux disease (GERD) is a very common disease in the society, characterized by inflammation in the lower end of the esophagus and the resulting pain and burning, which occurs as a result of the acid, enzymes and bile in the stomach leaking into the esophagus. It can be seen at any age and in both genders.

The inner surface of the stomach is protected against acid and digestive enzymes. Since there is no similar protection in the esophagus, stomach contents leaking into the esophagus causes chemical damage and inflammation there after a point.

 

The reason for this leakage is very diverse, it may be due to more than one reason, and different reasons may facilitate the formation of reflux from time to time:

1. Temporary loosening in the connection at the lower end of the esophagus,

2. Structural differences in the lower end of the esophagus,

3. Stomach hernia,

4. Delay in gastric emptying,

5. Medicines,

6. Cigarettes and alcohol,

7. Obesity,

8. Like eating habits.

 

The most common complaint is burning and pain that starts from the entrance of the stomach and spreads towards the middle of the chest. This pain is sometimes severe and can mimic pain originating from the heart. Another common complaint is bitter water in the mouth, which occurs as a result of ingested food or stomach contents coming into the mouth. These complaints may sometimes be accompanied by difficulty in swallowing and pain when swallowing. Additionally, hoarseness, cough, asthma-like complaints, sore throat and deterioration in dental health may also occur. Rarely, the development of stenosis in the esophagus or the development of cancer in the lower end of the esophagus (Barret's esophagus) may cause persistent difficulty in swallowing, inability to feed, and weight loss.

 

The diagnosis of gastroesophageal reflux disease can often be made by evaluating the patient's complaints, clinical findings and response to treatment. Imaging techniques and some advanced tests may be necessary to make a differential diagnosis and to evaluate or monitor the severity and degree of the disease.

Imaging can usually be done with medicated stomach x-ray and/or endoscopic examination (examination of the esophagus and stomach by swallowing a light and camera system through the mouth). Advanced tests include 24-hour pH meter (evaluation of acid leakage with the help of a catheter advanced from the nose to the esophagus), manometric studies (evaluation of esophageal and stomach movements and contractions), scintigraphic studies and histopathological evaluations (further evaluation of tissue samples taken with a microscope). .

 

In the differential diagnosis, other benign or malignant diseases of the esophagus, heart, stomach and gallbladder diseases and irritable bowel disease (Chron's Disease, Ulcerative Colitis) that may cause similar complaints should be prioritized.

 

Medication and diet and lifestyle changes are recommended for treatment. In some patients, endoscopic treatments or surgical intervention may be necessary with the recommendation of specialist doctors.

 

In drug treatment, drugs that reduce stomach acid, proton pump inhibitors (PPI): omeprazole, lansoprazole, pantoprazole, esomeprazole, rabeprazole) constitute the basic treatment.

 

In addition, antacid drugs and alginic acid may be recommended to reduce complaints, and some patients may additionally benefit from drugs that regulate esophageal and stomach movements.

Patients are advised to stay away from foods (such as chocolate), drinks and medications that will facilitate escape into the esophagus, and to reduce smoking and alcohol.

 

Patients are informed about body positions, nutrition and sleeping habits that facilitate reflux. It would be appropriate to go on a diet to reach the ideal weight.

 

Surgical interventions with endoscopic treatments are necessary in some patients, and they are performed to strengthen the mechanisms that prevent reflux at the lower end of the esophagus and the entrance to the stomach. These treatments must be performed on appropriate patients and by expert teams.

 

The most important undesirable consequences of gastroesophageal reflux disease are the development of stenosis at the lower end of the esophagus and the observation of changes at the cellular level (Barret's esophagus) due to long-term injury at the lower end. Barrett's esophagus may cause esophageal cancer if it involves changes that predispose to tumor development. These complications can be diagnosed especially by endoscopic examination and biopsy. They require regular treatment and follow-up and may require surgical intervention in some patients.

 

Gastroesophageal reflux disease is usually controlled with recommended diet and lifestyle changes and medication. In some patients, the disease may reoccur after discontinuation of medications or may worsen under treatment. Therefore, patients may need to use medication for a long time. Endoscopic treatments and surgical intervention are required in very few patients. Rarely, stenosis and esophageal cancer may develop, and the risk of their development can be reduced with regular follow-up and treatment, or the developing tumor can be detected in the early stages. However, otherwise, it should be known that there is an increased risk of esophageal cancer, especially in patients who are at risk and come in late periods.