“It often coexists with a septal hernia, in which part or all of the stomach enters from the esophagus or other septal defects into the chest, causing chronic or acute problems.”
Apart from septal hernia, other etiological factors known today are:
• Obesity
• Smoking
• Consumption of specific foods (fatty foods, fried foods, spicy foods) and drinks
• Increased intra-abdominal pressure
• Consumption of large meals in combination with bedtime immediately after eating
Taking certain medications (eg anticholinergics, β-receptor antagonists, bronchodilators, calcium channel blockers, dopaminergic drugs, progesterone, etc.).
Symptoms
These include:
• Posterior sternal burn
• Acid reductions
• Stomach or posterior pain
• Severe sore throat, hoarseness or laryngitis
• Chronic cough, asthma starting in old age, asthma mainly in the evening and frequent respiratory infections
• Foreign body sensation in the throat
• Poor oral hygiene
• Dysphagia or edema, pain when swallowing food.
Complications
Gastroesophageal reflux shows serious complications that may concern only the esophagus itself or neighboring organs such as e.g. the heart (heart problems). Common complications are:
• Inflammation (esophagitis) and ulcers in the esophagus
• Creation of esophageal strictures due to the healing of ulcers
Laryngitis Inflammation of the larynx due to swelling of the vocal cords
• Chronic lung lesions up to pulmonary fibrosis or bronchiectasis
• Barrett esophageal development
• Development of esophageal cancer.
Barrett’s esophagus
It is the condition in which the inner lining of the esophagus undergoes changes. Specifically, it is transformed in order to protect itself from the attack of the acidic gastric fluid that regresses. But any hasty change in the tissues of the human body can lead to dysplasia.
Thus, this condition increases the risk of developing cancer. Patients with Barrett’s esophagus should follow a strict schedule of regular endoscopy and biopsy and long-term medication. If a high degree of dysplasia is found, there is evidence of either total esophagectomy without lymphadenectomy or endoscopic laser removal of the lesion, lifelong PPIs (proton pump inhibitors) or Nissen vaulting. In addition, regular endoscopic examination is necessary according to the instructions of the treating gastroenterologist.
Diagnosis
The patient’s history and symptoms lead to a very accurate diagnosis of the disease. Further diagnostic testing aims to rule out other problems that may mimic reflux (eg heart problems that cause chest pain) and to determine the extent and severity of the disease. May include:
• Esophagogastroscopy: for the examination of lesions in the esophagus and the immediate examination of the lower esophageal sphincter
• Esophageal manometry: for the study of lower esophageal sphincter pressures
Esophageal pH: is the test of choice, the one that will confirm the reflux of the acidic contents of the stomach to the esophagus
• Computed tomography for any coexisting septal hernia.
Treatment
Mild symptoms:
In mild symptoms and if the coexistence of septal hernia is not proven, the treatment lies in conservative measures, ie measures related to changes in the lifestyle of the patient. What are recommended are:
• Weight loss
• Lifting the pillow or headrest on the bed
• Avoid foods that cause acid reflux (eg coffee, chocolate, alcohol, fatty foods, etc.)
• Avoid eating large amounts of food before going to bed.
• Quitting smoking
• Avoid tight pants or excessive tightening of the belt.
Moderate-severe symptoms
• Taking medications: antacids, antihistamines, proton pump inhibitors.
• Surgical treatment: if the diagnostic test reveals the presence of a septal hernia or the symptoms do not disappear. With chronic medication, the doctor must proceed with surgery.
The restoration, surgically, of the correct anatomy of the area leads to the disappearance of the symptoms and the final relief of the patient. The most common anti-reflux surgery is Nissen vaulting.
Nissen surgery schematic illustration
During this operation, which is now performed laparoscopically or robotically, the stomach canopy is used to create a new sphincter. The duration of postoperative hospitalization is one to two 24 hours and follows a short period of careful nutrition. The patient quickly returns to his daily routine by following a careful diet for a short period.
Writes:
Dr. Ioannis K. Kozadinos, Director of the Robotic Surgery Clinic of the Metropolitan Hospital
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