What is Reflux?
Reflux is the movement of stomach content back into the esophagus (food pipe). This reverse action can cause heartburn, vomiting, and pain. Additionally, it can lead to breathing difficulties, coughing, worsened asthma symptoms, and wheezing. This phenomenon is relatively common among both children and adults.
Reflux is a normal physiological occurrence in small infants due to an immature digestive system. In the vast majority of cases, there is no need for treatment during this age period, as reflux tends to resolve on its own by the age of one to two years in over 90% of cases. Rare cases that require treatment include inadequate weight gain, extreme fussiness that may indicate esophagitis and acute or persistent breathing difficulties.
Why Does It Happen?
The stomach produces acid and other gastric juices that aid in digestion. Normally, the lower esophageal sphincter muscle prevents the backflow of stomach content into the esophagus. When this muscle doesn't function properly, it allows acidic juices from the stomach to flow back into the upper part of the esophagus, leading to reflux. The muscle may not perform its function fully in cases where there is an anatomical issue in the area (such as a hiatal hernia or after surgery in the region) or due to the influence of substances like sex hormones (a reason for reflux during pregnancy), smoking, and certain foods. Pressure on the stomach, such as obesity, pregnancy, or frequent coughing, can exacerbate the condition through mechanical mechanisms.
How is Reflux Diagnosed?
In most cases, specialized tests are not necessary to diagnose reflux, and the clinical history is sufficient for diagnosis and initial treatment planning. In situations where there is a poor response to initial treatment or when atypical symptoms are present, the physician may opt for diagnostic tests. These tests may include one or more of the following:
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Gastroscopy: Inserting a thin tube with a camera at the end into the esophagus and stomach to confirm reflux and rule out other conditions that might mimic reflux. Biopsy samples may also be taken for microscopic examination.
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pH-Metry: This test measures the presence of acid in the esophagus and requires a 24-hour hospital stay. A small tube is inserted into the esophagus, monitoring the presence of acid over the day. The results are analyzed based on a clinical diary.
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Contrast Radiography: By consuming contrast material in a radiology center and obtaining X-ray images, anatomical issues like hiatal hernias and strictures can be identified. This test is not intended to confirm or rule out reflux but rather to identify anatomical causes that could lead to reflux.
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Gastric Emptying Time Test: At a nuclear medicine center, marked food can be ingested and the rate of its emptying from the stomach can be measured. Slow gastric emptying may exacerbate reflux and suggest the need for medications promoting gastrointestinal motility.
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Milk Scintigraphy: Rarely performed at a nuclear medicine center, this test involves drinking marked milk and tracking its flow back into the esophagus and potentially reaching the lungs.
What Can Be Done to Manage Reflux?
Your doctor will advise you on possible treatments for reflux, which may also include medications. Symptoms of reflux can be improved by making changes to your lifestyle:
- Elevating the head of the bed can help alleviate nighttime complaints. Ensure the entire bed is elevated, not just the mattress or pillow.
- Avoid eating while lying down and sit upright.
- Frequent small meals are better tolerated than larger meals.
- Avoid going to bed with a full stomach. Refrain from eating for about two hours before sleeping.
- Weight loss, in cases of excess weight, can significantly alleviate symptoms.
- Tight-fitting clothes should be avoided.
- Avoid smoking and exposure to smoke.
What About Diet?
In any case, maintaining a balanced and healthy diet is essential. Certain types of foods are known to worsen reflux and should be avoided as much as possible:
- Fatty foods (fast food, processed meats, creamy sauces, etc.)
- Acidic foods and beverages (including fruit juices)
- Tomato-based products like ketchup and pizza sauce
- Caffeine (sodas, chocolate, tea, coffee, and caffeine-containing products)
- Mint-flavored products
And If It Doesn't Improve?
For significant reflux cases, medical treatment is necessary. The explanation provided here is very concise and partial, and no treatment should be initiated without clear medical guidance.
Treatment is divided into three parts:
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Acid Suppression Medications: a. Antacids: Medications that directly neutralize acid through chemical reactions. These are used for mild cases of heartburn that require immediate and temporary relief and are not suitable for significant clinical reflux in children. b. H2 Receptor Antagonists: These medications (such as Zantac) reduce stomach acid secretion but do not entirely prevent it. Additionally, some patients develop tolerance within a week or two and may require dose escalation for clinical effectiveness. c. Proton Pump Inhibitors (PPIs): These medications (such as Losec and Pantoloc) strongly inhibit stomach acid secretion and do not lead to long-term tolerance. While they are more expensive, they have a high safety profile and proven efficacy. However, giving these medications in syrup form is problematic since the active substance is destroyed by stomach acidity. The required dosage varies, and sometimes high doses are needed to achieve the desired effect.
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Thicken the Food in the Stomach: Increasing the thickness of stomach contents reduces the likelihood of reflux. This can be achieved by adding rice cereal to infant diets or by using a formula that thickens in the stomach (such as Infamil AR). Alternatively, there are safe medications that achieve the same effect (such as Gaviscon or Algicon).
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Medications Promoting Gastrointestinal Motility: This treatment is not routine and is used in exceptional cases where the physician suspects slow stomach emptying.