Gastroesophageal reflux disease or GERD is a pathology that up to 20% of Spaniards can suffer from. If it is not treated in time, it can not only affect our quality of life, but also end up seriously damaging our health. It occurs when the contents of the stomach return to the esophagus, causing heartburn, a burning sensation that usually manifests below the sternum and rises to the larynx, but also cough, hoarseness, dysphonia, or difficulty passing food. the food.
“Reflux is the rise of the contents of the stomach upwards, which happens physiologically at specific times, and we speak of GERD when this rise produces annoying symptoms that alter our quality of life or consequences at the mucosal level (wounds in the stomach). esophagus, stenosis, Barrett-type premalignant lesions…). Typical symptoms are heartburn, a burning sensation that can reach the throat, even regurgitation; while the atypical ones are cough, chest pain, hoarseness, lung infections, or sore throat,” explains Dr. Rocío Temiño López-Jurado, assistant of the Digestive Service at the Teknon Medical Center in Barcelona.
It is a multifactorial pathology, according to this expert. On the one hand, she states that there are anatomical factors, such as an alteration at the level of the valve that separates the esophagus from the stomach, such as a hiatus hernia, where that valve relaxes; or a lax cardia, where the muscles of the gastroesophageal junction have relaxed.
“Other causes that predispose to GERD are certain foods or drugs that can promote the relaxation of this valve or make it difficult to empty the stomach; situations that increase abdominal pressure such as some kidney or liver diseases (for example polycystic disease), situations of bloating and constipation, where the microbiota of each patient has a lot to do with it; overweight and obesity, as well as physiological situations such as pregnancy, and other factors such as diet, alcohol or caffeine,” details this expert endoscopist.
Dr. Temiño maintains that diet has a lot to do with the development of GERD because there are foods that have a direct action on the cardia, and that can relax it, such as chocolate or coffee, alcohol, or fats. On the other hand, she mentions that fats and raw vegetables especially delay gastric emptying and slow digestion.
At the same time, he mentions that there are foods that promote bloating, produce an increase in pressure and encourage the contents of the stomach to rise upwards: “The digestive tube is a continuum, with valves that prevent its contents from rising upwards, But with an increase in pressure, GERD can occur.”
In this sense, the doctor warns that there is no miracle diet against reflux, but she does advise that patients follow diets low in fat, toxic, without alcohol, without tobacco, or without processed foods, because all of them, as As the Teknon specialist defends, they produce greater acidity in the stomach, while relaxing the cardia.
Furthermore, he says that there are patients who respond to certain diets, and others who do not because there are people with alterations at the level of different microbiota and some foods make them bloated, while others do not. For this reason, this digestive system specialist insists that the diets of patients with GERD must always be personalized.
Among the general recommendations provided by Dr. Rocío Temiño López-Jurado would be to eat several meals a day, preferably in small quantities, well chewed and slowly eating low-fat foods thanks to techniques such as boiling, grilling, or papillote, accompany each meal with vegetables and avoid raw foods at dinner time. “Raising the head of the bed, following a diet and moderate physical exercise that allows us to be at a normal weight, and a Mediterranean diet rich in fruits, vegetables and antioxidants can greatly improve reflux,” she points out.
If, despite the diet and pharmacological treatment (which fails in 30% of patients, according to claims), the GERD is not corrected, this expert from the Teknon Medical Center maintains that it is possible to perform several endoscopic techniques, which allow the correction of alterations. anatomical, such as hiatus hernia or lax cardia, for example.
Precisely, in 2020, the Teknon Medical Center performed an endoscopic fundoplication for the first time in Spain with the EsophyX-Z endoscopic device for the treatment of gastroesophageal reflux, a new internationally endorsed technique that achieves the reconstruction of the anti-reflux valve without the need for external scars, which means a faster recovery for patients. Until then, in Spain, achieving this was only possible through the laparoscopic route.
In recent years, several endoscopic devices have been developed for the treatment of reflux, but the EsophyX-Z 2.0 is the only one that allows fundoplication to be performed endoscopically without incisions. “Incisions are no longer necessary. The intervention is performed through the patient’s esophagus, which is reached through the mouth, and the intervention is performed from within the stomach itself. Once inside and thanks to the EsophyX-Z and the direct vision that the endoscope offers us, it is possible to release some polypropylene points that help us join the layers of esophageal tissue and the bottom of the stomach, creating a new semicircumferential valve,” he comments. Dr. Temiño.
To perform this intervention, it is necessary to subject the patient to general anesthesia and it lasts approximately one hour. But, because it is not necessary to make incisions in the abdomen, it only requires one day of admission for the patient and very short recovery times. “With this new technique we can offer our patients a treatment from an endoscopic point of view with excellent results and safety profile, and with a great advantage, the very low incidence of “dysphagia”, that is, difficulty swallowing, after surgery. intervention”.
Ideal candidates for this technique are patients with a lax cardia or small hernia (2cm), with chronic reflux, that is, lasting more than six months, confirmed either because they have esophagitis or impedance tests that confirm this reflux and who respond to pharmacological and dietary treatment, at least partially according to this specialist.
