Yenidoğandan Ergenliğe: Gastroözofageal Reflü

Gastroözofageal reflü (GÖR), gastrik içeriğin istemsiz olarak özofagusa geçmesidir. Mide içeriğinin özofagusa aralıklı ve sürekli geçişin yol açtığı klinik belirti ve bulgular ile birlikte yaşam kalitesinde düşmenin görüldüğü durumlar gastroözofageal reflü hastalığı (GÖRH) olarak tanımlanmaktadır. GÖR, çocukluk çağının sık görülen ve iyi klinik seyir gösteren bir sorunudur. Süt çocukluğu reflüsü hayatın 1. ayından itibaren görülmeye başlamaktadır. Dördüncü ay civarında görülme sıklığı doruk noktaya ulaşırken, bir yaşından sonra giderek azalarak yaklaşık iki yaşında tamama yakını düzelmektedir. GÖR, fizyolojik olarak günlük yaşantıda yutmadan bağımsız olarak sıklıkla alt özofagus sfinkterinin geçici gevşemesi sonucu ortaya çıkmaktadır. Fizyolojik şartlarda reflü oluşumunu 4 temel mekanizma önlemektedir. Bunlar; 1. Alt özofagus sfinkteri yetersizliği, 2. Özofagusun temizleyici rolü, 3. Özofagus mukoza bütünlüğü, 4. Mide boşalmasıdır. GÖR fizyopatolojisi henüz yeterince anlaşılamamıştır. Genetik, çevresel, anatomik, hormonal ve nörojenik mekanizmaların sorumlu olduğu ileri sürülmektedir. Günümüzde alt özofagus sfinkterinin geçici gevşemeleri en başta sorumlu mekanizma olarak kabul görmektedir. Gastroözofageal reflü hastalığının belirtileri yaşla birlikte değişkenlik göstermekle birlikte gastrointestinal ve solunum sorunları ile ortaya çıkmaktadır. Gastroözofageal reflü hastalığı tanısında anemnez ve fizik muayane, özofageal PH monitörizasyon, çoklu kanal intraluminal impedance (MII) ve PH monitörizasyon; motilite çalışmaları, endoskopik inceleme ve biyopsi, baryumlu inceleme ve nükleer sintigrafi kullanılmaktadır. Tedavide non-farmakolojik ve farmakolojik tedavi yöntemleri uygulanmaktadır. Farmakolojik tedavi prokinetik ajanlar ve asit baskılayıcılardan oluşmaktadır. Cerrahi tedavi endikasyonları ise oldukça sınırlıdır.

From Newborn to Teenage: Gastroesophageal Reflux

Gastroesophageal reflux (GER) is characterized by the involuntary passage of gastric contents into the esophagus. GER disease is defined as a persistent or intermittent passage of gastric contents into the esophagus, which often results in overt clinical signs and symptoms and affects the quality of life. GER is a common disorder in childhood and has a good prognosis. GER in infancy begins within the first month of life, peaks at the 4th month, and after the first year, it steadily decreases and finally resolves at the age of 2 years. GER physiologically occurs due to the relaxation of the lower esophageal sphincter, independent of swallowing. The mechanisms against GER include the following; 1. Lower esophageal sphincter dysfunction, 2. Clearance effect of esophagus, 3. Esophageal mucosal integrity, and 4. Gastric emptying, which prevent the development of GER disease. Although the physiopathology of GER is still not clearly established, proposed factors are genetic, environmental, anatomic, hormonal, and neurogenic. The most responsible factor is lower esophageal sphincter relaxations. The clinical signs of GER varies with age but commonly appear with gastrointestinal and respiratory symptoms. The diagnosis of GER disease is based on history, physical examination, esophageal pH monitoring, multichannel intraluminal impedance and esophageal manometry, motility examinations, endoscopy, biopsy, examinations with barium, and nuclear scintigraphy. Treatment of GER includes non-pharmacological and pharmacological therapies, such as prokinetic agents and acid suppressors. Surgical treatment indications are relatively limited.

Kaynakça

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