Dr. Ertan Beyatlı

What does KÖS mean? What is LES Looseness?

(Update: ) - Digestive System Diseases

Under normal circumstances, after food and drinks are swallowed, they are advanced to the stomach through the esophagus (esophagus, esophagus).

Depending on the position of our body, food and drinks in the stomach can be displaced but do not go back to the esophagus.

The system that provides this mechanism is called LES in Latin and KÖS and AÖS in Turkish. In the last phase of the swallowing reflex, this mechanism allows passage as a one-way valve.

LES - Lower Esophageal Sphincter (lower esophageal valve)
COS - Cardio-Esophageal Sphincter (Stomach and Esophageal Valve)
LES - Lower Esophageal Sphincter

How does LES Looseness develop?

There are many complicating factors that provide this mechanism of LES. Among them

  • membrane between the abdominal and thoracic cavity (diaphragm, diaphragm = diaphragm)
  • circular muscles and some ligaments in the lower part of the esophagus
Kös regurgitation mechanism
Kös regurgitation mechanism

Some factors play a role in the breakdown of this mechanism, such as increased intra-abdominal pressure, excess weight, smoking, alcohol, etc.

Ertan Beyatlı, MD, PhD

Disruption of the COC mechanism causes looseness and, rarely, tightening of the lid between the stomach and esophagus.

Gastric lid laxity is named in many different ways; eg LES laxity, CSS insufficiency, LES insufficiency, LES dysfunction, LES insufficiency, etc. The tightening and excessive closure of the valve is called LES Hypertonicity or Contraction.

In case of LES Loss, the acid in the stomach moves towards the esophagus and causes irritation and scarring there Esophagitis). This condition is also known as Gastro-Esophageal Reflux Disease (GERD).

Risk factors

Some factors that increase the chances of Gastroesophageal Reflux Disease (GERD) include:

  • Obesity, Overweight
  • Pregnancy
  • Stomach Hernia (Hiatal hernia)
  • Connective tissue diseases, eg Scleroderma (Systemic sclerosis)
  • Delayed gastric emptying time and stenosis of the gastric outlet, such as pyloric stenosis
  • Alcohol, coffee, cigarettes
  • Eating too much at a single meal or eating late at night.
  • Certain medications, eg aspirin

LES Flaccidity Symptoms

The following symptoms may be seen in patients who experience CSF looseness:

  • burning in the stomach, rancidity
  • burning in the esophagus, chest burning and pain
  • bitter water in the mouth
  • in the following cases nauseavomiting, weight loss
  • painful swallowing, odynophagia
  • a tingly feeling in the neck or throat
  • Chronic cough with unknown cause
  • pharyngitis, laryngitis
  • Asthma-like complaints
  • Sleeping disorder

Diagnosing LES Loss or GERD

The doctor who follows you can make a diagnosis after a physical examination in line with your complaints and history.

To support the diagnosis and check for complications, your doctor may order some tests, such as:

  • Endoscopy (Gastorscopy) (see: How is endoscopy done while being put to sleep?)
  • Ambulatory acid (24 hour pH) probe test. In this test, a probe is placed in the lower part of the esophagus. Thus, the time and amount of acid reflux are measured within 24 hours. There are two types of probes. In the first one, the probe is connected with a very thin cable to a receiver you will carry on you. In the second, the probe is wireless and is automatically dropped within 1-2 days and expelled with feces.
  • Esophageal manometry. This test measures rhythmic muscle contractions in your esophagus when swallowed. Esophageal manometry also measures the coordination and strength exerted by the esophageal muscles (esophageal barometric measurement).
  • X-ray (X-ray) of your upper digestive system. ÖMD-Barium radiography


Left untreated, ongoing esophageal inflammation can lead to some problems over time:

  • Narrowing of the esophagus (esophageal stricture). Stomach acid damages the lower esophagus, causing scar tissue to form. Scar tissue narrows the food path, causing swallowing problems.
  • An open wound in the esophagus (esophageal ulcer). Stomach acid can erode the tissue in the esophagus and cause an open wound. An esophageal ulcer can cause bleeding and pain and make it difficult to swallow (dysphagia, odynophagia)
  • Pre-cancerous changes in the esophagus (Barrett's esophagus mucosa). Acid damage can cause changes in the tissue lining the lower esophagus as time progresses. These changes are associated with an increased risk of esophageal cancer.

In addition, asthma, chronic cough and respiratory complaints may develop in the long term. Problems with teeth, gums and mouth may also occur.

LES Loss Treatment

LES Loss treatment

There are many treatment and surgical options available for LES Loss. The main goal of treatment is to reduce the acid flow to the esophagus and to repair the valve mechanism (Anti-Reflux Methods, eg fundoplication). It's possible that your doctor will likely recommend that you try lifestyle changes and over-the-counter medications first. If you do not experience relief within a few weeks, your doctor may recommend prescription medication or surgery.

Mechanism of Drugs

  • Antacids that neutralize stomach acid.
  • Medicines that reduce acid production. (H2 receptor blockers)
  • Medicines that block acid production and improve the esophagus. (Proton Pump Inhibitors)

Diet - Some foods can trigger complaints in some patients and they should avoid these foods. For example: fatty and spicy foods, chocolate, citrus fruits, Pineapple, tomato, onion, Garlic, mint, alcohol, Coffee, Tea and soda.

Some measures can be taken at home to reduce complaints. For example:

  • Quitting smoking
  • getting rid of excess weight
  • eating less often
  • chewing gum after eating, avoiding lying down
  • avoiding foods and drinks that trigger your symptoms
  • avoiding wearing tight clothing
  • practicing relaxation exercises

Some herbal remedies can also provide relief. Herbs commonly used for GERD include:

  • yellow daisy
  • licorice root
  • marshmallow root
  • slippery elm

Surgery and other procedures

GERD and LES Loss can usually be controlled with medication. However, if medications do not help or if you want to avoid long-term medication use, your doctor may recommend some surgical procedures:

Fundoplication surgery

partial (Toupet) or complete (Nissen) Fundoplication

During this surgery, the upper part of the stomach is wrapped around the LES to strengthen the sphincter mechanism, prevent acid reflux, and repair hiatal hernia. Fundoplication is usually done through a minimally invasive (laparoscopic) procedure. The wrapping of the upper part of the stomach can be partial (Toupet) or complete (Nissen).

Magnetic Sphincter Strengthening Device (LINX device)

magnetic bead ring - Linx
magnetic bead ring - Linx

A small magnetic bead ring is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to acid in reflux, but weak enough to allow food to pass through. The Linx device can be placed using minimally invasive surgery (laparoscopy).

Pregnancy and GERD

Pregnancy can increase your chances of experiencing acid reflux. Hormonal changes during pregnancy can cause the muscles in your esophagus to relax more often. A growing fetus can also put pressure on your stomach. This can increase the risk of stomach acid entering your esophagus. Many drugs used to treat acid reflux are safe during pregnancy. However, in some cases, your doctor may recommend that you avoid certain antacids or other treatments. Learn more about strategies you can use to manage acid reflux during pregnancy.


Irritable bowel syndrome (IBS) is a condition that can affect your large intestine. Common symptoms: abdominal pain, bloating, constipation, diarrhea. According to a recent review, symptoms associated with GERD are more common in people with IBS than in the general population.

Drinking alcohol and GERD

In some people with GERD, certain foods and drinks can make symptoms worse. These dietary triggers can include alcoholic beverages.

Depending on your specific triggers, you may be able to drink alcohol in moderation. But for some people, even a small amount of alcohol triggers GERD symptoms.

These mixers can also trigger symptoms if you combine alcohol with juices or other blenders. Discover how alcohol and mixers can trigger GERD symptoms.

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