Gastroesophageal reflux disease (GERD) What is it?

The results of the study of GERD in the esophagus joins the stomach where the escape valve system is defined as a strong acid in the stomach to the esophagus. There are many reasons the operation of the valve system. Among the most important of these is to the upper right side of the stomach herniated into the chest cavity. Today, the increasing number of overweight people, a reflection of reduced physical effort and urbanization are among the factors that trigger the disease. It is known that our country had to use that 750 thousand people and drug reflux disease. In the most recent publications on the rising tide of deaths in the world GERD data it is presented.


What are the symptoms of GERD?

Dodge acid from the stomach to the esophagus gives many symptoms. Diseases of the heart behind the initial period pain, burning and heartburn, pain shot between two blades, symptoms such as shortness of breath occurs feeling. The persistent dry cough, sometimes accompanied by these findings. Coffee, cola, wine drinking is excessive increase seen in this complaint. pain in the upper abdomen and swelling usually not attached to reflux. These symptoms are signs of gastric disease in the majority of GERD patients who simultaneously. In the advanced stages of GERD, mouth pain water coming, hoarseness after you wake up, wake up at night with shortness of breath or choking feeling he may be accompanied by symptoms such as bad breath and asthma. as the cause of tooth decay and ear infections in children with GERD may occur.


What happens if treatment is GERD?

permanent damage may occur if left untreated GERD in the esophagus. esophagus called esophagitis with acid aseptic inflammation of the burning effects vary from mild to severe. ulcers in the esophagus formed, bleeding from these ulcers may occur. Acid peptic stricture in effect for a long time may develop esophageal strictures called persists. Today, the drugs stop acid secretion severe stages of the disease is very rare, we see frequent use.


GERD in the esophagus (esophageal) Does it cause cancer?

Esophageal cancer, GERD relationship is not proven in a definitive way. However, acid damage in cases where too much and it particularly shows an increased risk of esophageal cancer of adding ballast water. Acid and bile reflux in the esophagus when long züri Continue cells lining the inner surface of the lower end of some changes occur. These cells begin to resemble the esophagus to intestinal cells lost cell properties. We refer to this condition as Barrett’s esophagus. In case of severe GERD symptoms despite the use of drugs in people with complaints within 2-3 months reduction and alleviation of suspected development of Barrett’s esophagus. Because of the changing cells in people who develop Barrett’s esophagus begin to detect the burning acid. Barrett’s esophagus in people who develop esophageal cancer, the risk is about 1-2%. Although these risks appear small, the risk is 10-20% in 10 years.


Which surgery should be performed in patients?

only 2-3% of GERD patients require surgical treatment. The young age (before age 40), although not benefit from the drug use or drug use violent complaints when the day goes by, requiring an increase in the dose of the drug and the patient are ideal for patients treated with surgery. In addition to the abdominal cavity from the chest cavity and the muscles of the esophagus passes through the tunnel (hiatus) Where should normally be considered very large in the foreground for surgical treatment is an anatomical disorder. treatment with surgery in patients with Barrett’s esophagus should be kept in the forefront.


What are the surgical methods?

There are several surgical techniques for the treatment of GERD. Among the most frequently performed UnUdUr new laparoscopic Nissen fundoplication. This surgery can be done through 5 small incisions in the abdomen. Surgery profit in the creation of 2-4 cm of the esophagus should be included (this means lowering the abdominal hernia), hiatus for the prevention of herniated again, which narrowed and strengthening the upper part of the stomach valve at the lower end of the esophagus consists of three stages. First reflux surgery was performed in 1935, fleeing Nazi persecution in Turkey by prof.rudolf Nissan. Toupet outside Nissen surgery, Hill, other surgical techniques are rarely used they have discovered the Belsey is a doctor. Depending on the combustion acids present shortening of the esophagus in the vertical direction is carried Collis gastroplasty called lengthening the esophagus. In this procedure the stomach is very advanced stages of the disease, which means no new part of the esophagus, the stomach is required in cases where a large hernia.


Closed surgery (laparoscopic) or is there a difference between being open?

With much less pain than laparoscopic procedures, the patient’s length of stay in hospital is shorter (1-2 days) and increases quality of life. Patients return to work is 10-15 days. Open method of pain usually 15 days – it took 1 month. return to normal life is still close to 1 month. After open surgery have a higher risk of herniation out from the front wall of the abdomen and lung problems.


What is the success rate of the surgery?

The success rate of surgery in patients with proven GERD diagnosis is over 90%. What is meant by the success of the operation, leaving the everyday use of drugs, chest pain, symptoms such as burning and mouth brackish water it is not eliminated. The importance of this is that long-term success. This long-term success rather than short-term success of the surgery is more important. 30 years of success of the operation will last at least 40 years for a person with this surgery should be considered.


Which tests need surgery before?

Preoperative esophagus, stomach and duodenum endoscopy should be done to examine. See this operation, the surgeon who will do the surgery is very important. Also to be measured of the pressure valve in the esophagus and lower end. The name of this method is to gauge. In cases where the suspect GERD to measure leakage from the stomach into the esophagus for 24 hours, 24-hour pH monitoring should be performed. This method has been proven by acid reflux. This should be done in all patients, which will be operated three tests. In addition, the chest X-ray, electrocardiogram and blood tests are performed basically in individuals over the age of 40.


Have the risks of the surgery?

Laparoscopic Nissen fundoplication is a low-risk operation in medium size. The result is life-threatening surgery between 3-5 thousand. In laparoscopic surgery, which may be about 1-2 ten thousand gas embolism risk. Gas embolism as a result of air used to inflate the abdomen lung blood mingling, and can go to the heart and brain. This is can be a serious danger to life. There are other important risks of the surgery include tears may occur in the esophagus and stomach. They are 1-2% and is usually seen in a very long time with the patient and damage to persons around the esophagus. Also life threatening, but may have other problems that prolongs hospitalization. Among the most common is pneumothorax. The results of the chest cavity to escape the gas used to inflate the abdomen pneumothorax occurs and requires the placement of a chest drain. In this case, the length of stay in hospital for 1-2 days longer. Rarely bleeding. In addition, overweight people deemed too narrow or abdominal fat in the abdominal region may not be operated with closed method. This situation often occurs in 5-10% and must be passed to open method.


What are the side effects of surgery?

This surgery has some lasting side effects. This surgery, people with a lifelong kusamaz generated spittoon system because the lower end of the esophagus. Although not seen this first very important, as a result of our experience we can create some patients in distressed situations. For example, when food poisoning is missed or excess to induce vomiting in this case, you will need to apply for the quickest way to the hospital. Other side effects are usually transient and diarrhea, observed in 10% of patients (4-5 times a day to climb up the toilet) and bloating. These side effects are seldom permanent.


What should I do before surgery What should I do?

evening before the day of surgery should be glossed over with a light meal consisting of liquid food. The surgery is important to sleep at least 8-9 hours before lying down early night. K-blood clotting drugs (aspirin, if coumadin, etc.) used, must be left for at least 1 week before surgery. Surgery date should be set to come to the menstrual cycle in women, because in previous studies, the risk of infection after surgery performed in this case was shown to be slightly higher.


And what happens in the operating room at the hospital?

By preoperative intravenous needle will be opened and that leads to dry mouth and you will be made a needle that will allow you to relax. Do not remove all the clothes from your body before surgery and the nurse gave you that you need to wear the apron. Your Surgery usually starts in the morning. Operative time can vary between 1-4 hours. Short disease duration (2-3 years) in operation a short while people in the younger age, can be seen an excessive scar tissue around the esophagus in people who suffer from 20-30 years and can last 3-4 hours operation. After surgery, you will be taken to your room service except in special circumstances. a thin tube leading to the stomach exit from surgery on your nose (nasogastric tube) may be. This is placed in the image are decided by the stomach during surgery in some patients. After the surgery, the hospital will be admitted for 1 day. It will be fed with water you drink and eat or serum. Stand up and walk the evening of your surgery, we expect you to do deep breathing exercises. You will receive regular medications for pain and nausea. The next morning, accompanied by your doctor will drink water and eat food at noon consistency of porridge. In the afternoon you will discharge your pain is under control. During this time walking back and win the intestinal motility is very important. Removing gas from below the patient shows that the normal gut motility. 1 week after leaving the hospital for pain relief and nausea will need to use preventive medicine. There is no need to take off the blind stitch sewing operation is excreted. 1 week after the sutures can be in the open.


After surgery, what will change?

After surgery, smoking can all defeated. However, we recommend that our patients for 2 weeks eating everything puree consistency. Divide into two portions to eat two meals a day will reduce swelling complaints in the first period. 6 meals a day for 2 months after surgery and consume food is very important to thoroughly chew and swallow. As a result of the operations performed esophagus valve mechanism is formed in the lower end of a new temporary dysphagia may occur. This contractile function of the esophagus is more pronounced in patients with impaired person. Difficulty swallowing complaints usually pass within two months. Rice, bread, originally installed in foods such as salads can be seen very often. Installing it is felt to take a deep breath, walk around and drink warm water will allow the release of the esophagus. Are you satisfied more quickly because smaller stomach capacity and feel bloated. Therefore, reducing the portions will minimize these complaints. Your intestinal system will adapt to the new situation within 6 months. From the moment you leave you feel that reflux surgery now permanently linked to your complaint. For example, one will be able to go to bed pillows, which leads to problems beverages (tea, coffee, etc.) can easily inside.


Considered situations after surgery

6 months after the operation, attention has needed in situations. These include failing to lift a weight more than 5 kg. excessive abdominal pressure increases as pregnancy, you need to avoid situations such as constipation. In addition, violent coughing, vomiting and retching to such cases and the repairs made on hiatus surgery causes deterioration to go to waste. In case you feel you would have these types of complaints to inform your doctor and do not use recommended medications are recommended. In addition, consumption of carbonated drinks recommended not lead to an increase in the feeling of bloating the first 2 months after surgery.


When can I return to my normal life?

Usually 2 months after surgery, you will be able to eat three regular meals a day. You can do your daily work 1 week after surgery. After 15 days if you are off surgery, 1 month after open surgery can return to work. After 6 months you can start working in the exercise room. However, we recommend that you avoid weight training. 1 month at the end of your sex life can go back to not force your abdominal muscles.


How will I follow?

1 week after the operation will be examined by your surgeon. You will then be monitored by your surgeon 2.ay and 1 year. 1st year of follow-up by phone or email you will have a meeting on an annual basis. As long as you have any complaints or problems preoperative endoscopy If you do not have to follow Barrett’s esophagus.


Medical Terms

Barrett’s esophagus: the cells lining the esophagus refers to prolonged acid exposure, depending on the nature of the change and the transformation to intestinal cells predisposing to cancer development.

Collis gastroplasty: The esophagus is a tube extension of the acid from the stomach to the esophagus in which case shorter depending on the exposure is the name of the operation.

Gastritis: inflammation of the stomach with microbial and non-microbial reasons.

Gastroesophageal Reflux: The medical name for the escape of stomach contents into the esophagus.

Gas embolism: the escape of the gas used to inflate the abdomen blood circulation in laparoscopic surgery.

Hiatus: the tunnel through which the esophagus is the medical name of the diaphragm muscle.

Laparoscopic Nissen Fundoplication to: The name is most frequently performed surgery in the treatment of GERD disease.

Gauges: The esophagus is and method for measuring pressure valve at the lower end.

Nasogastric tube: thin tube is sent to the stomach from the nostrils name.

Esophagitis: the cause is usually non-infectious inflammation of the esophagus due to acid damage.

Esophagus is the medical name of the esophagus.

Peptic Stricture: The stenosis occurs when the acid gave excessive damage to the esophagus.

Pneumothorax: is the medical name for the escape of air between the chest wall and the lung.

Gall: This is the common name for the liquid produced by the alkaline nature of the gallbladder.

24-hour pH monitoring: placing a thin tube through the nose into the esophagus to show the pH and the nature of the escaping liquid is a method of taking a 24-hour pH recording.