Gastroözofageal Reflü Hastalığı
Özet
Gastroözofageal reflü hastalığı (GÖRH), mide içeriğinin patolojik şekilde distal özofagusa geri kaçmasıyla oluşan, dünya genelinde %7-25 sıklıkta görülen önemli bir sağlık sorunudur. İleri yaş, yüksek vücut kitle indeksi, sigara ve sedanter yaşam gibi risk faktörleri bulunan hastalık, temel olarak alt özofagus sfinkterinin (AÖS) fonksiyonel bozukluğundan kaynaklanır. En yaygın klasik semptomları mide ekşimesi, disfaji ve göğüs ağrısıyken; ses kısıklığı, kronik öksürük ve astım gibi özofagus dışı belirtiler de gösterebilir. Tanısında ampirik proton pompa inhibitörü (PPİ) tedavisine yanıt ve üst gastrointestinal endoskopi (EGD) yaygın olarak kullanılırken, altın standart test pH monitorizasyonudur. Tedavi edilmediğinde özofajit, striktür, kanama ve özofagus adenokarsinomuna ilerleme riski taşıyan Barrett özofagusu gibi ciddi komplikasyonlara yol açabilir. Hastalığın yönetiminde ilk adım yatak başının yükseltilmesi, kilo kontrolü ve diyet değişikliklerini içeren yaşam tarzı modifikasyonlarıdır. Medikal tedavide antiasitler, H2 reseptör antagonistleri ve yüksek iyileşme sağlayan PPİ'lar tercih edilir. İlaç bağımlılığından kaçınmak isteyen veya medikal tedaviye dirençli seçilmiş vakalarda ise Laparoskopik Nissen fundoplikasyonu gibi cerrahi seçenekler ile endoskopik anti-reflü yöntemleri %80-90 oranında uzun vadeli başarı sunan etkili birer alternatiftir.
Gastroesophageal reflux disease (GERD) is a major global health issue with a prevalence ranging from 7% to 25%, characterized by the pathological retrograde movement of gastric contents into the distal esophagus. Associated with risk factors such as advanced age, high body mass index, smoking, and a sedentary lifestyle, the disease primarily stems from the dysfunction of the lower esophageal sphincter (LES). While its most common classic symptoms are heartburn, dysphagia, and chest pain, it can also manifest through extraesophageal signs like hoarseness, chronic cough, and asthma. Diagnosis frequently relies on response to empirical proton pump inhibitor (PPI) therapy and upper gastrointestinal endoscopy (EGD), whereas ambulatory pH monitoring remains the gold standard. If left untreated, GERD can lead to severe complications, including esophagitis, strictures, bleeding, and Barrett's esophagus, which carries a risk of progression to esophageal adenocarcinoma. The initial step in management focuses on lifestyle modifications, including elevating the head of the bed, weight loss, and dietary adjustments. Medical management incorporates antacids, H2 receptor antagonists, and PPIs, which achieve high healing rates. For selected patients seeking to avoid lifelong medication or showing resistance to medical therapy, endoscopic anti-reflux procedures and surgical options, such as laparoscopic Nissen fundoplication, serve as highly effective alternatives, providing long-term symptom control in 80% to 90% of cases.
Referanslar
Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900-20
El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiyology of gastrooesophageal reflux disease: a systematic review. Gut 2014;63:871-80
Revicki DA, Wood M, Maton PN, Sorensen S. The impact of gastroesophageal reflux disease on health-related quality of life. Am J Med. 1998;104:252–258.
Van Soest EM, Dieleman JP, Siersema PD, Schoof L, Sturkenboom MC, Kuipers EJ. Tricyclic antidepressants and the risk of reflux esophagitis. Am J Gastroenterol. 2007;102:1870–1877.
Zheng Z, Nordenstedt H, Pedersen NL, Lagergren J, Ye W. Lifestyle factors and risk for symptomatic gastroesophageal reflux in monozygotic twins. Gastroenterology. 2007;132:87–95.
Ferriolli E, Oliveira RB, Matsuda NM, Braga FJ, Dantas RO. Aging, esophageal motility, and gastroesophageal reflux. J Am Geriatr Soc. 1998;46:1534–1537.
Ciriza-de-los-Ríos C, Canga-Rodríguez-Valcárcel F, Castel-de-Lucas I, Lora-Pablos D, de-la-Cruz-Bértolo J, Castellano-Tortajada G. How useful is esophageal high resolution manometry in diagnosing gastroesophageal junction disruption: causes affecting this disruption and its relationship with manometric alterations and gastroesophageal reflux. Rev Esp Enferm Dig. 2014;106:22–29
Van Herwaarden MA, Samsom M, Smout AJ. Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Gastroenterology. 2000;119:1439–1446.
Gastal OL, Castell JA, Castell DO. Frequency and site of gastroesophageal reflux in patients with chest symptoms. Studies using proximal and distal pH monitoring. Chest. 1994;106:1793–1796.
Tokashiki R, Funato N, Suzuki M. Globus sensation and increased upper esophageal sphincter pressure with distal esophageal acid perfusion. Eur Arch Otorhinolaryngol. 2010;267:737–741.
Irwin RS, Fransız CL, Curley FJ, Zawacki JK, Bennett FM. Gastroözofageal reflüye bağlı kronik öksürük. Klinik, tanısal ve patojenetik yönler. Göğüs. 1993; 104 :1511–1517.
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–328.
Dent J, Armstrong D, Delaney B, Moayyedi P, Talley NJ, Vakil N. Symptom evaluation in reflux disease: workshop background, processes, terminology, recommendations, and discussion outputs. Gut. 2004;53(Suppl 4):iv1–24.
Ronkainen J, Aro P, Storskrubb T, Johansson SE, Lind T, Bolling-Sternevald E, et al. High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report. Scand J Gastroenterol. 2005;40:275–285.
Richter JE. Gastroesophageal reflux disease in the older patient: presentation, treatment, and complications. Am J Gastroenterol. 2000;95:368–373.
Shaheen NJ, Richter JE. Barrett’s oesophagus. Lancet. 2009;373:850–861.
Khademi H, Radmard AR, Malekzadeh F, Kamangar F, Nasseri-Moghaddam S, Johansson M, et al. Diagnostic accuracy of age and alarm symptoms for upper GI malignancy in patients with dyspepsia in a GI clinic: a 7-year cross-sectional study. PLoS One. 2012;7:e39173.
Wang WH, Huang JQ, Zheng GF, Wong WM, Lam SK, Karlberg J, et al. Is proton pump inhibitor testing an effective approach to diagnose gastroesophageal reflux disease in patients with noncardiac chest pain?: a meta-analysis. Arch Intern Med. 2005;165:1222–1228.
Pandit S, Boktor M, Alexander JS, Becker F, Morris J. Gastroesophageal reflux disease: A clinical overview for primary care physicians. Pathophysiology. 2018 Mar;25(1):1-11.
Locke GR, Talley NJ, Fett SL, et al. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 1997;112:1448-56.
Department of Gastroenterology and Hepatology, Center for Swallowing and Esophageal Disorders, Cleveland Clinic Foundation, Cleveland, Ohio Available online 23 February 2005.
Clarrett DM, Hachem C. Gastroesophageal Reflux Disease (GERD). Mo Med. 2018 May-Jun;115(3):214-218.
Wiener GJ, Morgan TM, Copper JB, Wu WC, Castell DO, Sinclair JW, et al. Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters. Dig Dis Sci. 1988;33:1127–1133.
Thompson JK, Koehler RE, Richter JE. Detection of gastroesophageal reflux: value of barium studies compared with 24-hr pH monitoring. AJR Am J Roentgenol. 1994;162:621–626.
Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? Arch Intern Med. 2006;166:965–971
Khan BA, Sodhi JS, Zargar SA, Javid G, Yattoo GN, Shah A, et al. Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux. J Gastroenterol Hepatol. 2012;27:1078–1082.
Meining A, Classen M. The role of diet and lifestyle measures in the pathogenesis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2000;95:2692–2697.
Festi D, Scaioli E, Baldi F, et al. Body weight, dietary habits and gastroeosophageal reflux disease. World J Gastroenterol 2009;15:1690-701.
Bujanda L. The effects of alcohol consumption upon the gastrointestinal tract. Am J Gastroenterol 2000;95:3374-82.
Collings KL, Rodriguez-Stanley S, Proskin HM, et al. Clinical effectiveness of a new antiacid chewing gum on heartburn and oesophageal ph control. Aliment Pharmacol Ther 2012;16:2029-35.
Rohof WO1, Bennink RJ, Smout AJ, et al. An alginate-antacid formuation localizes to the acid pocket to reduce acid reflux in patients with gastrroesophageal reflux disease. Clin Gastroenterol Hepatol 2013;11:1585- 91.
Khoury RM, Katz PO, Castell DO. Post-prandial ranitidine is superior to post-prandial omeprazol in control of gastric acidity in healthy volunteer. Aliment Pharmacol Ther 1999;13:1211-4.
Gralnek IM, Dulai GS, Fennerty MG, Spiegel BM. Esomeprazole versus other proton pump inhibitörs in erosive esophagitis: a meta-analysis of randomized clinical trials. Clin Gastroenterol Hepatol 2006;4:1452-8.
Lidums I, Lehmann A, Checklin H, et al. Control of transient lower esophageal sphincter relaxations and reflux by the GABA (B) agonist baclofen in normal subjects. Gastroenterology 2000;118:7-13.
Yew KC, Chuah SK. Antireflux endoluminal therapies: past and present. Gastroenterol Res Pract. 2013;2013:481417.
Nissen R (1956) Eine einfache Operation zur Beeinflussung der Refluxösophagitis. Schweiz Med Wochenschr 86(Suppl 20):590–2
Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R (1991) Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc 1(3):138–43
Lundell L (2010) Surgical therapy of gastro-oesophageal reflux disease. Best Pract Res Clin Gastroenterol 24(6):947–59
Galmiche JP, Hatlebakk J, Attwood S, Ell C, Fiocca R, Eklund S, Långström G, Lind T, Lundell L (2011) LOTUS Trial Collaborators. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. JAMA 305(19):1969–77
Yang H, Meun C, Sun X, Watson DI (2012) Outcome following management of dysphagia after laparoscopic anti-reflux surgery. World J Surg. Feb 1. (in press)
Toupet A (1963) Technique d’oesophago-gastroplastie avec phrenogastropexie appliquée dans la cure radicale des hernies hiatales et comme complément de l’opération de Heller dans les cardiospasmes. Mem Acad Chir 11:394–8
Dor J, Humbet P, Dor V et al (1962) L’intéret de la technique de Nissen modifée dans la prévention du reflux après cardiomyotomie extra-muqueuse de Heller. M Acad Chir 88:877–84
Varin O, Velstra B, De Sutter S, Ceelen W (2009) Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis. Arch Surg 144(3):273–8
Herbella FAM, Patti MG, Del Grande JC (2011) Hiatal mesh repair—current status. Surg Laparosc Endosc Percutan Tech 21:61–66
Pointner R, Granderath FA (2008) Hiatushernie und Rezidive. Die Achillessehne der Antirefluxchirurgie? Chirurg 79:974–981
Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Michael Brunt L, Hunter JG, Demeester TR, Swanstrom LL, Daniel Smith C, Filipi CJ (2009) Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 23(6):1219–26
Symons NR, Purkayastha S, Dillemans B, Athanasiou T, Hanna GB, Darzi A, Zacharakis E (2011) Laparoscopic revision of failed antireflux surgery: a systematic review. Am J Surg 202(3):336–43
