REFLUX GERD - REFLUX

Gastroesophageal reflux disease occurs when the lower esophageal sphincter opens spontaneously or does not close properly (basically a dysfunction of the muscle ring between the esophagus and the stomach) and the stomach contents rise to the esophagus and cause irritation (such as in the case of diaphragmatic hernia), acid reflux, heartburn and other serious conditions including the risk of cancer in the long term. The prevalence of reflux disease has increased in direct proportion to the obesity epidemic, and now affects about 10% of Israelis on a daily basis. Reflux is usually treated with acid reducers, which help relieve symptoms but do not cure the disease. Reflux symptoms can also be alleviated through changes in diet and lifestyle.

Historically, a major surgery called fundoplication has been recommended to patients who have not responded to medication, but the operation involves many complications and is performed only in difficult cases.

Endoscopic treatments for reflux disease include minimally invasive techniques that fill the gap between medical and surgical treatment.

Endoscopic treatment may not only improve symptoms but in many cases take the patient off regular drug therapy altogether.

Endoscopic treatments are based on reducing the diameter of the passage between the esophagus and the stomach by tightening it, using a special device that uses special pins or stitches. A second approach is an electrical burn to the lower esophageal sphincter or a radio frequency energy supply for example by the Stretta device which is available in the country.

At the beginning of 2023, advanced endoscopic equipment arrived in Israel, which helps us provide a solution for a wide population suffering from reflux (you can watch a demonstration of the technology in the attached video at the top of the page).

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What is the cause of reflux?

Reflux means to flow back or forth. Gastroesophageal reflux is a condition in which what is in the stomach returns to the esophagus.

In proper digestion, the lower sphincter of the esophagus opens to allow food to enter the stomach. It is then closed to prevent food and acidic gastric juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the lower sphincter of the esophagus is weak or loosened when it should not occur.

This condition allows the contents of the stomach to flow up into the esophagus.

Risk factors for reflux

MORE THAN 25% OF THE POPULATION IN ISRAEL SUFFERS FROM HEARTBURN AT LEAST ONCE A MONTH, AND MORE THAN 5% OF ADULTS SUFFER FROM HEARTBURN EVERY DAY, INCLUDING MANY PREGNANT WOMEN. RECENT STUDIES SHOW THAT GERD IN INFANTS AND CHILDREN IS MORE COMMON THAN DOCTORS THOUGHT. THIS CAN CAUSE VOMITING THAT HAPPENS AGAIN AND AGAIN. IT CAN ALSO CAUSE COUGHING AND OTHER BREATHING PROBLEMS.

Some doctors believe that a diaphragmatic hernia may weaken the lower sphincter of the esophagus and increase the chances of gastroesophageal reflux. A diaphragmatic hernia occurs when the upper part of the stomach ascends to the chest through a small opening in the diaphragm (diaphragmatic break). The diaphragm is the muscle that separates the abdomen from the chest.

Recent studies show that the opening in the diaphragm helps to support the lower end of the esophagus.

Importantly, there are many people with diaphragmatic hernia who will not suffer from heartburn or reflux. But a diaphragmatic hernia may allow the contents of the stomach to leak more easily into the esophagus.

Coughing, vomiting, exertion or sudden physical exertion can increase the pressure in the abdomen and lead to a diaphragmatic hernia. Many healthy people aged 50 and over have a small diaphragmatic hernia,y although it is usually a condition of middle age, hiatal hernias affect people of all ages.

Diaphragmatic hernias usually do not need treatment. But this may be necessary if the hernia is in danger of suffocation, or deformed in a way that cuts off the blood supply. It may be necessary to treat the hernia if you additionally have severe reflux or inflammation

A number of additional things can increase the likelihood of having reflux

Overweight or obesity Pregnancy Late emptying of the stomach, connective tissue diseases such as rheumatoid arthritis, scleroderma or lupus choices in diet and lifestyle can worsen acid reflux if you already have it: Smoking certain foods and drinks, including chocolate and fatty or fried foods, coffee and alcohol large meals eating before bedtime, certain medications, including aspirin  

The most common symptom of reflux is heartburn. It usually feels like a burning pain in the chest that starts behind your sternum and moves upwards to your neck and throat. Many people say that it feels like the food is coming back here, leaving an acidic or bitter taste.

The burn, stress or pain of heartburn can last up to two hours. Often it is worse after eating. Lying down or bending down can also cause heartburn. Many people feel better if they stand upright or take an antacid that cleans acid out of the esophagus. People sometimes mistake heartburn pains for the pain of heart disease or heart attack, but there are differences. Exercise can aggravate the pain in heart disease, and rest may relieve it. Heartburn pain is less likely to go along with exercise. But you may not notice the difference, so immediately seek medical help if you have chest pain. Besides pain, you may also have nausea Bad breath Difficulty breathing Difficulty swallowing vomiting Tooth enamel erosion Lump in the throat If you have acid reflux at night, you may also have: Persistent cough Inflammation of the throat Asthma that occurs suddenly or worsens sleep problems

In addition to heartburn you may suffer from:

• Nausea
• Bad breath
• Difficulty breathing
• Difficulty swallowing
• Vomiting
• Tooth enamel erosion
• A lump in the throat
• Persistent cough
• Strep throat
• Asthma that occurs suddenly or worsens
• Sleep problems

An innovative treatment for reflux!
Transoral Incisionless Fundoplication (TIF)

Gastroesophageal reflux disease is a very common condition among the large population. Symptoms of heartburn or regurgitation (increase in gastric contents to the esophagus and pharynx) were reported in 25% of patients in developed countries each year. Although drug therapy provides a solution for a significant number of patients, a significant number of people (ranging from 10% to 40% of patients) may fail to achieve a complete resolution of the symptoms.

Given the significant impact of symptomatic reflux disease on the quality of life, alongside the high costs and growing awareness of the possible negative effects of long-term pill therapy.

Now, after years of waiting, we are proud to be at the forefront of medical technological innovation and to bring to patients in Israel the message of Transoral Incisionless Fundoplication (TIF)

TIF IS A MINIMALLY INVASIVE, ENDOSCOPIC PROCEDURE, MUCH SAFER COMPARED TO SURGERY, WITH FASTER RECOVERY TIME FOR PATIENTS, AND ALL THIS WITH AMAZING CLINICAL RESULTS.

MULTIPLE INTERNATIONAL STUDIES HAVE SHOWN THAT THE TIF PROCEDURE IS SUCCESSFULLY PERFORMED IN UP TO 99% OF PATIENTS, WITH ONLY 2% EXPERIENCING PROBLEMS DURING OR AFTER THE PROCEDURE, SUCH AS RUPTURE OR INTERNAL BLEEDING. FOR A LARGE NUMBER OF PATIENTS, TIF PROVIDES SIGNIFICANT RELIEF FROM REFLUX SYMPTOMS AND IMPROVED QUALITY OF LIFE. MOST PATIENTS (91%) ALSO EXPERIENCE A REDUCTION IN DIAPHRAGMATIC HERNIA AND MANY (89%) ARE ABLE TO STOP TAKING MEDICATION. RELIEF OF SYMPTOMS AFTER TIF USUALLY LASTS BETWEEN EIGHT TO 10 YEARS, WHICH IS SIMILAR TO RELIEF IN MOST CASES OF SURGICAL TREATMENT. WHEN REFLUX SYMPTOMS RETURN.

IF WE COMPARE THE NUMBERS TO ISRAEL, WE CAN SAY THAT ABOUT 250,000 TO 500,000 PEOPLE ARE POTENTIAL CANDIDATES FOR TIF ENDOSCOPIC TREATMENT FOR REFLUX, A TREATMENT THAT CAN SIGNIFICANTLY IMPROVE THEIR QUALITY OF LIFE, AND WEAN THEMSELVES OFF REGULAR DRUG TREATMENT.

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Recommended food for reflux sufferers in general

* The information presented on the site regarding recommended foods is an enrichment and is not a substitute for consultation with a clinical doctor / dietitian.

It can be said that most patients suffering from reflux are advised to eat the following foods:

Low-acid fruits: these include bananas, melon and apples.

Vegetables: leafy greens, broccoli and potatoes.

Lean proteins: chicken, fish and tofu.

Whole grains: oats, quinoa and whole wheat bread.

Nonfat or skimmed dairy products: milk, yogurt and cheese.

Healthy fats: avocado, olive oil and nuts.

IT IS ALSO IMPORTANT FOR PEOPLE WITH REFLUX GERD TO AVOID SPICY, FATTY OR ACIDIC FOODS, AS WELL AS CARBONATED DRINKS AND CAFFEINE. EATING SMALLER, MORE FREQUENT MEALS MAY PROVE BENEFICIAL, AND YOU SHOULD AVOID EATING CLOSE TO BEDTIME.

IT IS IMPORTANT TO NOTE THAT EACH PERSON IS DIFFERENT AND WHAT MAY TRIGGER SYMPTOMS IN ONE PERSON MAY NOT TRIGGER ANYTHING IN ANOTHER PERSON. IT IS RECOMMENDED TO KEEP A FOOD DIARY TO KEEP TRACK OF THE FOODS THAT AGGRAVATE YOUR SYMPTOMS. IF YOU ARE NOT SURE WHICH FOODS MAY TRIGGER YOUR REFLUX GERD SYMPTOMS, IT IS RECOMMENDED TO CONSULT A HEALTH PROFESSIONAL.