Reflux: Symptoms get worse in one in four patients in hot weather

With scorching summer temperatures, it is not only the skin that burns, but also the stomach for 1 in 4 Italians. The heat, combined with a few exceptions to the rules made on vacation, can in fact cause a worsening of the symptoms of gastroesophageal reflux, a pathology that affects up to 20% of the Italian population (11.5 million people). In Campania, between 850 thousand and 1.1 million people suffer from it. Due to factors such as dehydration, changes in eating habits and slower digestion, the hottest months can transform gastroesophageal reflux into a real nightmare. However, for the most serious cases or those that are refractory to medical therapy, modern surgical techniques offer effective, personalized and potentially definitive solutions. The experts took stock during the second “Hot Topics in Functional Digestive Surgery Meeting” conference, promoted by the Buon Consiglio Fatebenefratelli Hospital in Naples and the Società Italiana Unitaria di Colon-Proctologia (SIUCP), currently underway in Naples.

What is gastroesophageal reflux?

This is an event dedicated to functional diseases of the digestive system, characterized by alterations in normal digestive functions without an immediately identifiable organic cause. “These dysfunctions can affect any segment of the digestive system, in particular the esophago-gastric and rectal-anal junctions, often presenting a prolonged course with symptoms that significantly impact the quality of life of patients - says Adolfo Renzi , head of the Operating Unit of Functional Diseases of the Esophagus and Colorectal at Buon Consiglio Fatebenefratelli Hospital in Naples -. In recent years, surgery has assumed a crucial role in the treatment of these conditions, including gastroesophageal reflux disease (GERD), obstructed defecation syndrome and GERD in patients eligible for bariatric surgery. However, determining the appropriate indications and limits for these interventions remains a topic of intense debate among specialists”.

Causes and symptoms of reflux

Particular attention will be paid to gastroesophageal reflux. “This disorder occurs in the presence of alterations in the functionality of the cardia (the valve between the esophagus and the stomach) and a hiatal hernia, a condition in which a part of the stomach rises through the diaphragm, a muscle that separates the thorax from the abdomen, into the space normally occupied only by the esophagus,” explains Renzi. “Even poor nutrition and obesity increase abdominal pressure, facilitating reflux.”

Summer heat can exacerbate reflux symptoms in several ways. “First of all by promoting dehydration,” the expert emphasizes. “An insufficient intake of water leads to a reduced dilution of gastric acids, increasing their acidity. Added to this are changes in eating habits: in summer we tend to consume more spicy, oily and cold foods, which can trigger acid reflux. High temperatures can also slow down digestion, causing bloating and acidity. Finally, increased sweating and loss of electrolytes can compromise the functionality of the stomach, causing an accumulation of acid.” Treatments Initial treatment involves reducing body weight and correcting eating habits, which exclude fatty or fried foods, tomatoes, citrus fruits, raw onions, garlic, chocolate, mint, coffee, black tea, carbonated drinks, alcohol, aged cheeses, sausages and spicy spices. It is advisable to eat small, frequent meals, slowly, and not to lie down immediately after eating.

The surgery

“It is crucial that people are aware of how summer habits can affect their digestive health,” says Renzi. “While hydration and a careful diet are crucial to managing seasonal acidity, for patients with chronic or severe reflux, surgery is an important and often curative treatment option.”

When symptoms are severe, refractory to medical therapy or when chronic medication is needed to control them, surgery becomes an effective alternative. “In this case, it is important to make an accurate diagnosis that can determine exactly the causes of the reflux and on which the choice of surgical technique depends,” says Renzi. “The accurate diagnosis of reflux uses tools such as upper digestive endoscopy (gastroscopy), 24-hour pH-metry (measurement of esophageal acidity), esophageal manometry (assessment of motility and tone of the lower esophageal sphincter).”

Surgical options

There are several surgical options available today against gastroesophageal reflux. The most traditional is the Nissen Fundoplication, in which the fundus of the stomach is wrapped around the esophagus to create an anti-reflux 'sleeve' effect. It offers good results in controlling symptoms and managing post-operative dysphagia, a frequent complication. In some Italian centers, the magnetic esophageal sphincter technology is adopted.

“A ring of titanium beads is placed laparoscopically around the lower esophageal sphincter,” explains Renzi. “Thanks to a magnetic attraction effect, a pressure zone is created that allows food to pass but blocks reflux. The advantages: greater standardization of the procedure, less post-operative dysphagia.” Among the most recent and innovative options is the Reflux Stop, a silicone device the size of a 1 euro coin, also implanted laparoscopically. “The device,” explains Renzi, “restores the normal function of the esophageal sphincter without compressing it, avoiding the side effects of standard surgical approaches, allowing for quicker discharge. All these surgical innovations offer patients personalized and long-lasting solutions, significantly improving their quality of life.”