Continued use of reflux medication increases the risk of kidney disorders, dementia and hip fractures.
When we eat, food goes from the mouth to the stomach through a tube called the oesophagus, which has a small muscle ring on the lower end, acting as a valve; gastric reflux occurs when the lower oesophageal sphincter (LOS) does not work as it should, and allows acid to flow back and burn the lower part of the oesophagus. ‘This irritates and inflames the oesophagus, causes a sensation of acidity, and in time may even damage the oesophagus. It is often accompanied by the existence of a hiatal hernia, in other words, the stomach rises to the thoracic cavity in differing degrees, though this is not always the case,’ states Doctor Pedro Bretcha, President of the Sociedad Española de Oncología Quirúrgica (SEOQ, Spanish acronym for the Spanish Society for Surgical Oncology) and surgical oncology specialist at Hospital Quirónsalud Torrevieja.
Among its multiple symptoms, Doctor Blas Flor, Head of the Digestive Surgery Service and surgical oncology specialist at Hospital Quirónsalud Valencia, highlights pyrosis or heartburn, which is the sensation of retrosternal stinging or burning; regurgitations, which are the reflow of content from the stomach to the mouth; and others, such as epigastric abdominal pain, thoracic pain, aphonia, cough with no apparent cause, and sleep problems. This disease is benign and, in most patients, has no complications, ‘though at times,’ warns the specialist, ‘the persistence and intensity of the symptoms may negatively affect patient’s quality of life and interfere with the activities of daily life,’ in fact, ‘chronic reflux may develop a pre-malign condition called “Barrett’s Oesophagus,” which in turn evolves into cancer. The vast majority of lower oesophageal cancers originate in chronic reflux.’
Gastro-oesophageal reflux is usually treated in three progressive steps. In the first place, a lifestyle change is considered, with a change in diet and use of over-the-counter antacids to reduce the frequency and severity of symptoms. ‘Weight loss, reduction or elimination of smoking and alcohol consumption, and the modification of eating and sleep habits can also be helpful,’ Doctor Bretcha points out.
In case the symptoms persist after these lifestyle changes, it is possible that patients may need pharmacological treatment. Antacids neutralise gastric acids, and over-the-counter medications reduce the amount of gastric acid produced. ‘Both may be effective in resolving the symptoms. Prescribed medications are more effective in healing oesophageal irritation and alleviating the symptoms, though before starting treatment, patients must consult their surgeon,’ warns the laparoscopic surgery is highly effective in treating gastro-oesophageal reflux, and definitively eliminates the need for medications that, in the long term, cause side effects. As Doctor Blas Flor explains, ‘the surgery is performed under general anaesthesia, and consists of building a full or partial cuff, using the stomach, around the oesophagus, placing it below the diaphragm. In order to do this, we make small incisions, only millimetres in size, in order to access the abdomen through the laparoscope, which connects to a small video camera to fully view the abdominal cavity.’ Among the advantages of the laparoscopic approach, we can include a reduction in post-operatory pain, minimal scarring and quick reincorporation to work.
‘Thanks to this intervention, patients find relief for their symptoms in nine out of ten cases, and only 15% have a recurrence of the symptoms after five years. To these benefits, we must add suspension of the medication, which has been proven, with continued use over time, to be associated to a greater risk of kidney disorders, dementia and hip fractures,’ concludes Doctor Bretcha.