Multiple Sclerosis (MS) is a disease that occurs after the degeneration of the “myelin” sheath surrounding nerve cells in the brain and spinal cord. MS is an autoimmune disease characterized by relapses (attacks) and remissions (periods without attacks), often progressing over time. Although MS is known to be autoimmune in nature, its exact cause has not been established. The disease arises when the body’s defense components, specifically “T lymphocytes,” attack the myelin sheaths in our nervous system, leading to demyelination. While the role of genetic factors is not definitive, familial occurrences have been observed. The disease is more frequently seen in women than men and usually starts between the ages of 20 and 40, often accompanied by gastrointestinal problems and other autoimmune diseases. It is more common in individuals of the white race and is observed less frequently in warmer climates compared to Northern Europe.

Common symptoms include balance disorders, double vision, numbness on one side of the body, and muscle weakness.

Diagnosis is made through examination and magnetic resonance imaging (MRI).

There is no definitive treatment for Multiple Sclerosis. All treatments aim to reduce the number and severity of relapses. Medications are used to suppress “autoimmunity.” However, while these drugs suppress autoimmunity, they also carry the risk of damaging the gut flora and potentially triggering autoimmunity through the resulting entry points.

What Is Autoimmunity?

Autoimmunity is defined as the loss of coordination in our immune system, leading it to perceive our own tissue and organ cells as “harmful” and “foreign,” ultimately attacking and causing tissue damage.

Why Does Our Immune System Lose Coordination?

One of the components of our immune system, known as white blood cells, includes “T lymphocytes.” T lymphocytes have the function of destroying harmful substances and microbes that enter our bloodstream from outside.

There are several barriers between the bloodstream and the external world. These include the digestive system mucosa, upper respiratory tract, skin, external ear canal, and eye mucosa. Nutrients, medications, toxins, and microbes can only reach the bloodstream after crossing one of these barriers. Once they enter the bloodstream, they can spread throughout the body.

All these barrier points have selective permeability. For various reasons, if the selective permeability of these barriers is partially or completely disrupted, harmful substances (such as microbes and macromolecules) that should not enter the bloodstream begin to cross over. If this transition is short-lived, the situation may resolve on its own without causing problems. However, if uncontrolled transition becomes chronic, our immune system will eventually become overwhelmed and lose coordination, perceiving harmful substances in the bloodstream as “foreign” and attacking the cells that make up our tissues and organs. Thus, an autoimmune process begins.

Why Is Early Intervention in Autoimmune Processes Important?

Autoimmune damage is often progressive and irreversible. Once an autoimmune disease has developed, it prepares the ground for the formation of other autoimmune diseases and accelerates the process.

How Can Autoimmune Processes Be Slowed or Stopped?

Restoring the barrier damage that causes autoimmunity can slow down or completely halt the autoimmune process. The most important entry point that initiates the autoimmune process is the disruption of selective permeability following damage to the gastrointestinal barrier.

How Does Damage to the Gastrointestinal Barrier Occur?

Our digestive system is lined with a single-layer “internal skin” known as mucosa. From the mouth to the end of the digestive system, the cells that make up the mucosal layer allow medications, water, minerals, vitamins, and digested food (carbohydrates, proteins, and fats) to pass through to the bloodstream. The fundamental characteristic of the mucosal layer is its “selective permeability.” Goblet cells that constitute the mucosal layer produce a gelatinous, slimy secretion known as “mucus,” which coats the mucosa like a film. Thanks to mucus, the substances we ingest through our digestive system and our digestive secretions are kept from direct contact with the mucosa, protecting it from their destructive effects.

To maintain the selective permeability of the entire gastrointestinal tract and the sustainable production of mucus, a diverse gut flora is essential.

What Is Flora?

Flora refers to the beneficial, diverse microbes that live with us in certain areas of our bodies, which do not harm us and form the first microbial defense line against external influences, directly or indirectly contributing to the area’s humidity, acidity, and biochemical functions. These mainly consist of bacteria, viruses, and yeasts. All of these are collectively referred to as flora. The areas of our body that harbor flora include the skin, digestive system, upper respiratory tract, external ear canal, eyes, and genital area.

What Is Gut Flora?

Gut flora refers to the microbiota residing throughout the digestive system.

What Happens If We Don’t Have Gut Flora?

Without gut flora, our digestive system becomes vulnerable to external factors, losing its resistance to microbial attacks. If there is no flora, each region cannot maintain its acidity, humidity, synthesis, and digestive functions. Flora is also crucial for mucus production. Without mucus, the mucosa becomes exposed to external factors, its integrity is compromised, and it loses its selective permeability. The disruption of selective permeability is the most critical step in the development of autoimmunity.

What Is the Fundamental Problem in the Disruption of Selective Permeability?

The critical stage in the disruption of selective permeability in the digestive system is the reduction or complete loss of the biodiversity of gut flora.

What Is Flora Biodiversity?

We can think of our digestive system as a factory, with each type of flora representing a specific branch of engineering. The more diverse engineering disciplines and technical classes a factory has, the higher quality products it can produce. Each type of flora that constitutes our microbiota has its own special functions. The richer and higher quality our flora biodiversity is, the better functions we will have. A high-quality and biodiverse gut flora is essential for a long, healthy life.

What Happens Without Flora?

Life cannot exist without flora.

How Can Flora Damage Be Corrected in Multiple Sclerosis?

If microbial analysis of the digestive system in patients with Multiple Sclerosis reveals flora damage and leaky gut syndrome, gut flora can be restored through flora transplantation. If the flora transplantation is successful and healthy flora re-establishes itself, selective permeability of the intestines can be restored, thereby slowing down or completely eliminating the autoimmune process.

What Is Flora Transplantation?

After examinations and laboratory analyses, healthy and highly biodiverse donor candidates are identified. After informing the identified donor candidates, their consent is obtained for the procedure. Under general anesthesia, flora samples are collected from 25-45 distinct anatomical areas using endoscopic and colonoscopic techniques, each rinsed with solutions suitable for the region’s characteristics and stored separately. After undergoing various processes, these flora samples are transplanted back into the patient’s equivalent anatomical areas under general anesthesia using endoscopic and colonoscopic techniques.

Success rates for the treatment are around 85% when the patient and donor are well-matched. If the procedure is not extraordinary, the results are lifelong.

Flora transplantation represents a significant advancement in halting autoimmune processes and treating Multiple Sclerosis.

We have published the results of our clinical studies on flora transplantation in the American medical journal CUREUS. You can access the article through the following link.

https://www.cureus.com/articles/115546-total-gastrointestinal-flora-transplantation-in-the-treatment-of-leaky-gut-syndrome-and-flora-loss#!/

What is Accelerated Aging and How Does It Happen?

Just as all the tissues and cells that make up our body need the necessary nutrients and oxygen to be nourished and perform optimal quality functions, waste and harmful substances must also be rapidly evacuated from the tissues. In addition, substances with the potential to cause harm (poisons, pathogenic microorganisms, incompletely digested macromolecules) must not reach the tissues. In all cases where these conditions are disrupted, the lifespan of the tissues is shortened and people AGED FASTER. All of these situations can be called RAPID AGING.

There are basically two factors that determine the life span of a cell, tissue and the entire organism. These can be summarized as factors that contribute to a long and high-quality life span and those that cause a short and low-quality life span.

Factors Contributing to Longevity and Quality of Life:

• Solid genetic infrastructure
• Being born spontaneously vaginally, without trauma and on time
• Breastfeeding for at least one year
• Growing up in a crowded family with quality flora
• Eating quality, balanced, natural nutrition and consuming clean water
• Minimal exposure to microbial trauma
• Minimal contact with antibiotics and corticosteroids
• Avoid long hospital stays and major surgery
• Living away from industrial pollutants (Radiation, heavy metals, polluted air, etc.)
• Doing sports and living an active life
• Not overeating and not being obese
• Avoiding agricultural chemicals (pesticides, herbicides, etc.)
• Staying away from cigarettes, alcohol and drugs
• Avoid intense stress

Factors that Cause Short and Poor Quality of Life:

• Having a bad genetic background
• Being born by Caesarean section, being born prematurely or having complications during birth
• Breastfeeding for six months or less
• Growing up in a family with poor quality flora or in a small family
• Eating inadequate, unbalanced and industrial food
• Not having access to clean and quality drinking water
• Passing on too many microbial diseases
• Using too much antibiotics or steroids for too long
• Long hospital stays and major surgery
• Experiencing periods where oral feeding stops for long periods of time
• Being exposed to industrial pollutants for a long time (Radiation, heavy metals, polluted air, etc.)
• Leading a sedentary life
• Overeating and being obese
• Long-term exposure to agricultural chemicals (pesticides, herbicides, etc.)
• Using cigarettes, alcohol and drugs
• Intense stress

Accelerated Aging is often confused with the disease we know as PREMATURE AGING . PROGERIA , also known as Hutchinson-Gilford or PREMATURE AGING disease , is a genetic disease that causes a child to age rapidly due to a mutation in the LMNA gene . However, there is no genetic disorder in RAPID AGING .

The foods necessary for humans are taken orally and digested, then mostly absorbed from the intestines and distributed to the bloodstream and the entire body through the bloodstream. The second most important need, apart from food, is OXYGEN. In cases where oxygen and necessary foods cannot reach the tissues in sufficient quantities, substances that should not reach reach the tissues or waste products cannot be effectively removed from the body, the life expectancy of the tissues and ultimately the entire organism is shortened and the quality of the shortened life also decreases.

Our topic here is to examine the effects of Leaky Gut Syndrome on ACCELERATED AGING.

To better understand the relationships between Leaky Gut Syndrome and ACCELERATED AGING, some definitions need to be made.

 What is Leaky Gut Syndrome?

The feature of the absorption surface of our intestines is that it absorbs foods that are fully digested. Not everything that is eaten or drunk is absorbed from the intestines and passes into the bloodstream. Nutrients that are necessary for our body, that will not harm our body, and that are fully digested can be absorbed from the intestines, we call this the SELECTIVE PERMEABILITY feature of our intestines. There are many diseases that cause damage to the intestinal absorption surface and cause our intestines to lose their selective permeability feature, the general name of these is LEAKABLE GUT SYNDROME .

 In What Situation Do Our Intestines Lose Their Selective Permeability?

The absorption surface of our intestines is covered with MUCOSA (inner skin) which has a single layer of cells. A gel-like secretion called MUCOUS secreted by the mucosa covers the entire mucosa like a film layer. In this way, direct contact with the intestinal substances (food, digestive enzymes etc.) is prevented and the mucosa is protected. When the mucus layer is absent or weakened, the mucosa is damaged after contact with the intestinal content and together with the absorption surface damage, SELECTIVE PERMEABILITY is partially or completely eliminated in the damaged areas of the intestines and unwanted substances that should not pass into the bloodstream (poisons, microbes, incompletely digested foods etc.) begin to pass and LEAKAGE GUT SYNDROME occurs.

What Happens If Selective Permeability Is Impaired in Our Intestines?

If the selective permeability of our intestines is disrupted, many things that normally should not pass from the intestines into the bloodstream begin to pass into the bloodstream. Our defense cells in the bloodstream, the “T lymphocytes”, perceive these as foreign and harmful and try to destroy them. However, when the passage becomes chronic and exceeds the level that our defense system can cope with, the perception of what is foreign and harmful in the T lymphocytes is disrupted and our body begins to perceive its own tissues as foreign and harmful and begins to attack our own tissues as well. The attack and destruction of our own tissues and organs by our defense system is called AUTOIMMUNE DISEASES . All diseases that occur in this way are called AUTOIMMUNE DISEASES . Things take on a different dimension after this stage.

 What is Autoimmunity?

All of the diseases that occur when our immune system gets tired and loses its coordination after external attacks, and mistakenly perceives some tissues of the body as foreign and harmful and chronically attacks them are called AUTOIMMUNE DISEASES, and this whole process is called AUTOIMMUNE.

What are Autoimmune Diseases?

There are thousands of autoimmune diseases. The most well-known of these are Rheumatoid Arthritis (joint rheumatism), GUT, Autoimmune Dermatitis, Behcet’s Disease, Hashimoto’s Thyroiditis, Autoimmune Ovarian Cysts, Psoriasis, Vitiligo, IBS, Crohn’s Disease, Ulcerative Colitis, Autoimmune Colitis, Diabetes, Food Allergies, Allergic Rhinitis, Allergic Asthma, Rosacea, etc.

Why Is Autoimmunity Treatment Important?

In people with any autoimmune disease, other autoimmune diseases develop much more easily. It’s like a chain reaction. Therefore, it is important to treat the autoimmune process as soon as possible.

What is Flora?

We live with single-celled organisms, mostly bacteria, viruses and yeasts, that live with us, do not harm us and also provide many benefits (defense, digestion, synthesis, humidity, acidity regulation, etc.). All of these are called FLORA. Some areas of our body (skin, digestive system, eyes, upper respiratory tract, etc.) contain FLORA. They are named according to the area they are located in (digestive system flora, genital area flora, etc.).

What is the Digestive System Flora?

The beneficial microorganisms located throughout the digestive system from mouth to anus are called DIGESTIVE SYSTEM FLORA. There are thousands of varieties. The more biodiversity we have, the more comfortable, effective and efficient the digestive system works.

We live together with single-celled organisms that are different for each region, in thousands of varieties, and in trillions in mass, in the protection and maintenance of the mucus produced by the mucosa, and that do not harm us, and that constitute our first defense mechanism against external microbial attacks, and that also have digestive, synthesis and nerve conduction functions. The general name of all of these is DIGESTIVE SYSTEM FLORA.

Our digestive system flora is renewed many times a day and the flora elements that have reached the end of their lifespan are naturally swept away and excreted as FEELS. 60-70% of our stool volume consists of dead or living flora waste.

What is the Function of the Digestive System Flora?

The function of the digestive system flora is to contribute to the humidity and acidity of the region in which it is located, to contribute to the production, protection and sustainability of mucus, to form the first line of defense against microbial attacks, to contribute to the enzymatic and chemical functions of the region, and to be an intermediary in the realization of the neural transmission functions of the digestive system.

Why is Flora Biodiversity Important?

If we compare our digestive system to a large and complicated factory, we can evaluate each flora biodiversity as an engineering-mastery field that requires special skills. The more engineers-masters a factory has with special skills, the higher the quality of the product will be. The BIODIVERSITY in our digestive system is exactly like that. The more biodiversity we have, the HEALTHY, HAPPY, QUALIFIED and LONGER we live.

How to Enrich Flora?

Our current flora can be enriched by close contact with people with rich flora, by eating a diet that protects and strengthens our flora (natural, free from pesticide residues, etc.), by not using unnecessary antibiotics, by staying away from industrial areas, and by consuming clean and healthy products (natural probiotics, etc.).

How to Get Flora?

Flora begins to be acquired in the womb. The next most important process is the method of birth. Those born by cesarean section will be born and live without the flora that they will never acquire throughout their lives. Many factors such as the size of the family the baby is born into, the flora of the people they are in close contact with, their nutritional culture and adequacy, past illnesses, treatments, etc. are effective in acquiring flora.

What Happens Without Flora?

Without flora, there would be no life.

Why Does Accelerated Aging Occur in Leaky Gut Syndrome?

The basic factor that triggers the onset of leaky gut syndrome is the weakening of the relevant region flora, the decrease in its biodiversity or its complete disappearance. The damage to the flora and the deterioration of the selective permeability of the intestine usually proceed in parallel. Due to the damage to the flora, an UNHEALTHY intestine emerges that is more open to microbial attacks, has impaired enzymatic functions, reduced synthetic ability, is inadequate in providing humidity, and has impaired acidity stability. As a result, digestive problems and consequently absorption problems of all nutrients will be observed together with more pathogenic microbial attacks. Due to the deprivation of the necessary nutrients by the tissues, they will not be able to perform their necessary functions and the tissue life will also decrease and the ACCELERATED AGING process will occur accordingly.

Is it possible to slow down or stop rapid ageing?

It may be possible to slow down or completely stop the RAPID AGING process that develops due to Leaky Gut Syndrome. Since all cases of Leaky Gut Syndrome are triggered by digestive system flora damage, it is first necessary to re-establish the digestive flora. Of course, if there are other additional factors that cause Leaky Gut Syndrome, they will also need to be eliminated or treated. If digestive system flora damage has been ongoing for more than 6 months, the only effective treatment at this stage is to re-establish healthy flora by performing FLORA TRANSPLANTATION.

What is Flora Transplantation?

After the examination and laboratory analyses, flora samples taken from at least one flora donor with high quality and biodiverse flora, under general anesthesia, endoscopically and colonoscopically, approximately 30-45 different anatomical areas, each with different solutions, are studied separately with the endoscopic lavage method and prepared through a series of processes, and then the flora is planted on the patient again under general anesthesia, endoscopically and colonoscopically, is called FLORA TRANSPLANTATION. Flora Transplantation is performed in a single session and is permanent for a lifetime.

We have compiled our clinical experiences on Flora Transplantation and published them in CUREUS, an academic, peer-reviewed, prestigious American medical journal, in 2022. Our article is the first and most comprehensive article in this field and is a reference. You can click the link below to access the article.

https://www.cureus.com/articles/115546-total-gastrointestinal-flora-transplantation-in-the-treatment-of-leaky-gut-syndrome-and-flora-loss#!/

Assoc. Prof. Dr. Murat Kanlıöz

General Surgery Specialist

What is Anemia?

Anemia, commonly known as “Anemia”, is defined as a decrease in the ratio of erythrocytes/red blood cells, which are components of blood, or a decrease in the amount of “Hemoglobulin”, which is the functional unit in erythrocytes.

What is Blood?

BLOOD is a fluid, red liquid containing many components that transports nutrients, medicines and oxygen that enter our body primarily through the digestive and respiratory systems to the areas where they are needed through the arterial network system, and transports waste products formed in the tissues to the area where they will be eliminated through the venous network system.

The basic shaped elements that make up the blood are; Red blood cells (erythrocytes), White blood cells (leukocytes) and Thrombocytes (platelets).

Red blood cells ensure that oxygen is carried from the lungs to the tissues and that carbon dioxide formed in the tissues is removed through the lungs.

White blood cells form our body’s defense system.

Platelets help stop bleeding.

Why Does Anemia Occur?

We can group the causes of anemia under three headings:

• Deficiencies of nutrients required for red blood cell production (Iron, Vitamin B12, Folic Acid, etc.)
• Short lifespan of red blood cells due to structural disorders (mostly genetic diseases, FMF, etc.)
• Anemias due to losses caused by bleeding.

The average lifespan of red blood cells is 120 days. Cells with structural disorders have a shorter lifespan.

Red blood cells are produced mainly in the bone marrow, spleen and liver. Red blood cells that have reached the end of their lifespan are removed from the system by the spleen.

The most effective treatable part of anemia disease is anemias that develop due to nutritional deficiencies. In anemias due to nutritional deficiencies, there are problems related to inadequate intake of substances necessary for hemoglobin production such as Iron, Folic Acid and Vitamin B12 or absorption from the intestines. If there is no deficiency in absorption or substances necessary for absorption, ANEMIA can be easily and permanently treated by supplementing the missing part. However, the treatment of ANEMIAs caused by the deficiency of substances necessary for absorption and absorption is not that easy. Anemias in this group are usually long-term and in other words CHRONIC ANEMIAs and their treatment is more difficult.

Why Is Anemia Important? What Happens If It Is Not Treated?

The only means of transporting OXYGEN, which all tissues and organs in our body need continuously, from the lungs to the tissues, and of transporting CARBON DIOXIDE, which is a waste product formed in the tissues, from the tissues to the lungs to be excreted, are RED CELLS and their functional unit, HEMOGLOBULIN.

If we have anemia, since insufficient oxygen will reach all the tissues in our body and the resulting waste product, carbon dioxide, will not be removed, this will cause deficiencies and disorders in the functions of the tissues and organs. This will affect all body functions. Due to the lack of oxygen in the body due to anemia, our HEART will try to compensate for the deficit by working harder. Accordingly, ANEMIA first and foremost increases the load on our HEART, causing tachycardia (increased pulse), cardiomegaly (enlargement of the heart) and many related heart diseases.

Anemia triggers many diseases in children, including growth and developmental delays, weakness of brain functions, and learning difficulties.

How is Anemia Related to Leaky Gut Syndrome?

Some definitions are needed to understand the relationship between anemia and Leaky Gut Syndrome.

What is Leaky Gut Syndrome (GBS)?

One of the most basic features of our intestines is that they have a selectively permeable feature. For many reasons, the selectively permeable feature of our intestines can be temporarily or permanently impaired. The things that the absorption surface of our intestines allows are absorbed from the intestines and transported to the bloodstream and thus to the organs and tissues. With the impairment of the selectively permeable feature of our intestines, intestinal contents that normally cannot pass from the intestines to the bloodstream begin to pass into the bloodstream (incompletely digested products, toxins, microbes, macromolecules, etc.). The general name given to all the diseases that create this picture is Leaky Gut Syndrome.

What are the diseases covered under the title of Leaky Gut Syndrome?

The main diseases examined under the title of Leaky Gut Syndrome are Ulcerative Colitis, Crohn’s Disease, Non-Specific Colitis, Irritable Bowel Syndrome (IBS), Celiac Disease, Lactose Intolerance, Celiac-Like Disease, Lactose Intolerance-Like Disease, Chronic Diarrhea, etc.

How is the Selective Permeability of the Intestines Impaired in Diseases Under the Title of GBS?

In all the diseases listed above and evaluated under the heading of GBS, permeability impairment occurs as a result of intestinal absorption surface damage.

The inner surface of our intestines has a curved ( villi and microvilli ) structure, and the surface facing the intestinal lumen is covered with a single-layered, inner skin called MUCOSA. All the cells that make up the mucosa are very tightly connected to each other. Digested foods pass through the cells on this absorption surface and reach the bloodstream. A protein called ZONULIN ensures the tight connection of these cells to each other. There is a gel-like secretion called MUCOSA, which is secreted from some special cell groups called GOBLET cells in the mucosa layer throughout the digestive system from the mouth to the anus, and covers the entire MUCOSA layer like a film layer, preventing direct contact between the intestinal content and the mucosa. Thanks to the MUCOSA, direct contact between the digestive secretions, foods, drugs, microbes and toxins in the intestine is PREVENTED. The most important component in the formation and maintenance of mucus is the DIGESTIVE SYSTEM FLORA, which consists of thousands of varieties with special functions for each region.

What is Flora?

We live with single-celled microorganisms, mostly bacteria, viruses and yeasts, in thousands of varieties, in trillions, that live with us in certain parts of our body (skin, genital area, digestive system, upper respiratory tract etc.), do not harm us, help us perform our vital functions (digestion, combating microbial attack, synthesis, humidity, acid balance, secretion, neural transmission etc.). The general name of all of these is FLORA.

What is the Digestive System Flora?

Throughout the entire digestive system, from mouth to anus, we live with thousands of single-celled beneficial microbes that are specific to each area and do not live in any other area. All of these are called digestive system flora . Our flora is constantly renewed and replaced by new ones, and those that have completed their lifespan are naturally excreted as STOOL (feces). Approximately 60-70% of the stool volume consists of dead and living flora waste.

Why is Digestive System Flora Important?

Thanks to the digestive system flora, defense, digestion, synthesis, humidity and regional acidity are provided against harmful microbial attacks in the area where they settle and live. The more biodiversity of our flora, the higher the quality of digestive system functions. If the relevant regional flora in the digestive system is disrupted for any reason or its biodiversity decreases, that area is invaded by PATHOGENIC MICROBES.

In addition, the regional flora must have sufficient biodiversity for the formation and maintenance of mucus. Damage to the flora affects mucus formation, causing the protective layer on the mucosa to weaken or disappear completely. As a result, the digestive system content will come into direct contact with the mucosa, causing damage to the mucosa and, accordingly, the selective permeability of the intestines will decrease or disappear completely.

How Does Leaky Gut Syndrome Cause Anemia?

For whatever reason, digestive system flora damage and accompanying GBS cases cause digestion and absorption problems. Accordingly, iron, folic acid and Vit B12 deficiency, which are necessary for hemoglobulin production, develop and ANEMIA occurs due to their deficiency. In addition, in some GBS cases, anemia occurs as a result of chronic bleeding due to ulcers in the intestine (ulcerative colitis etc.). It is not possible to create a healthy absorption surface in GBS without repairing the damage to the flora. Since sufficient enzymatic and chemical digestion will not occur without providing healthy and biodiverse flora, there will be difficulty in the transfer of the substances necessary for HEMOGLOBULIN production into the bloodstream.

What Findings Indicate Leaky Gut Syndrome?

• Food Allergy
• Abdominal bloating
• Excessive gas
• Appearance of mucus and blood in the stool
• Constant abdominal pain
• Intestinal discomfort
• Kronik ishal
• Chronic constipation
• Chronic fatigue
• Joint pain and swelling
• Fibromyalgia
• Persistent dermatitis
• Untimely and resistant acne
• Depression
• Mood disorder
• Manic attacks
• Vitiligo (areas of skin lacking pigment)
• Infertility
• Breast cysts
• Psoriasis
• Stagnation of education in autistic people
• Sudden declines in educational achievement
• Hasimato Troiditi
• All autoimmune diseases
• Recurrent oral sores
• Bad breath

Along with the above findings, it is necessary to evaluate in terms of ”Leaky Gut Syndrome” in cases of treatment-resistant ANAEMIA. Because it is not possible to correct ANAEMIA cases accompanying GBS cases without treating GBS.

In all GBS cases, there is damage to the digestive system flora. Palliative and chronic drug use in GBS treatment without correcting the digestive system flora damage will only provide temporary relief but will not correct the underlying FLORA DAMAGE.

Therefore, the only and permanent treatment for GBS cases is possible only with FLORA TRANSPLANTATION.

What is Flora Transplantation?

It is the process of obtaining flora samples from 30-45 different anatomical areas endoscopically and colonoscopically under general anesthesia from a DONOR candidate with high biodiversity, who has been approved by examination and necessary laboratory analyses, and then undergoing a series of procedures, and then cultivating the flora samples endoscopically and colonoscopically in the equivalent areas of the patient, again under general anesthesia.

In cases of Leaky Gut Syndrome, which develops due to digestive system flora damage, it is not possible to treat GBS without Flora Transplantation . In the vast majority of GBS cases, there is accompanying ANAEMIA. It is impossible to treat ANAEMIA without treating GBS.

Assoc. Prof. Dr. Murat KANLIÖZ

General Surgery Specialist

INFECTIOUS and PARASITIC DIARRHEA are the most common causes of diarrhea. Except for these, in hormanal disorders (hyperthyroidism, etc.), radiotherapy, chemotherapy, food allergies, food poisoning, IBS ( Irritable Bowel Syndrome), Ulcerative colitis, Crohn’s Disease, Celiac Disease, Lactose intolerance, Diabetes, some cancers (glucagonoma, unsilinoma, adrenal tumors, etc.), excessive alcohol consumption, drug addiction, enzymatic digestive disorders, genetic enzymatic diseases, pancreatic diseases, intestinal surgeries are also the main causes of DIARRHEA.
The vast majority of ACUTE DIARRHEA is caused by infectious and parasitic. But all of the above-mentioned causes can also cause CHRONIC DIARRHEA.

In all cases of diarrhea, deficiencies of all nutrients absorbed from the intestines (minerals, vitamins, proteins, fats, carbohydrates, etc.) are found.). October diarrhea-related absorption disorders are tolerable except in some cases in acute diarrhea and do not require additional treatment except fluid. In cases of acute diarrhea, such as cholera, serious mineral and fluid deficits may be life-threatening if not supported by treatment. But because CHRONIC DIARRHEA lasts much longer, developmental delays and permanent damage occur, especially in children. Because it will be very difficult to perform long-term travel and activities in chronic diarrhea, social isolation, depression, failures in school and business life are often observed along with it.

Diarrhea, for whatever reason, causes temporary or permanent damage to the entire digestive tract FLORA, especially the intestines. In cases of CHRONIC DIARRHEA, even if the flora damage resolves on its own, it can never access the microbial flora richness before diarrhea again. The duration, severity of CHRONIC DIARRHEA and associated additional diseases (diabetes, stopping oral nutrition, intensive antibiotic and steroid treatments, etc. Oct.) depending on it, it is impossible not to have damage to the flora of the digestive system. However, some of the damage caused may improve spontaneously to a level that can sustain life.

In case of damage to the flora of the digestive tract, that is, a decrease in microbial biodiversity, it will not be possible to treat diarrhea, even if the underlying cause of chronic diarrhea is eliminated.

Digestive, enzymatic, defense against microbial attacks, moisture, acidity, nerve conduction, intestinal motility, stool formation, etc., which have their own special functions in each region throughout the entire digestive system from the mouth to the anus, do not harm us, even have vital importance for us. we live together with thousands of different kinds of single-celled living species that have many more functions. Although our digestive system microbiota is thousands in biodiversity, we live peacefully together with the world of micro-creatures, which are numerically trillions, repeating themselves several times in a day. All of these are called the FLORA OF THE DIGESTIVE SYSTEM (Microbiota). Most of these micro-creatures in our digestive system are composed of bacteria, viruses and yeasts. There are more than 1000 types of bacteria that have been identified to date throughout our entire digestive system. The more variety of flora bacteria we can host in our digestive system, the healthier, happier, peaceful, disease-free and long-lasting we will live. There is a direct relationship between the biodiversity of the digestive system flora and long life. Dec. While biodiversity decreases as you go to metropolitan areas and industrial areas, it increases as you go to rural areas. However, the use of agricultural chemicals in rural areas is the most important factor that reduces biodiversity. The weaker the biodiversity of the digestive system flora, the more acute and chronic diarrhea is observed. Especially infectious and parasitic diarrhea is observed in people with limited flora biodiversity. Our flora is the most important defense mechanism that protects us against external microbial attacks.

The damage caused to the flora biodiversity along with CHRONIC DIARRHEA prepares the ground for the formation of ‘Permeable Bowel Syndrome’. Our intestines have a selective permeable property. The most important triggering factor in the degradation of the selective permeable property is FLORA DAMAGE. After Leaky Gut Syndrome occurs, an increasing number of AUTOIMMUNE DISEASES begin to occur (Rheumatoid Arthritis, GOUT Disease, Psoriasis, Vitiligo, Rose Disease, Behcet’s Disease, Autoimmune Vasculitis, Autoimmune Arthritis, Hashimoto’s Disease, Ovarian Cyst, Fibromyalgia, Chronic Fatigue, Depression, IBS, Food Allergies, Gluten Intolerance, Lactose Intolerance, etc.). After the formation of Permeable Bowel Syndrome, it is impossible to improve the picture without flora transplantation.

The most critical threshold in the emergence of CHRONIC DIARRHEA causes such as IBS, Celiac Disease, Ulcerative Colitis, food allergies and Crohn’s Disease is again the damage caused to the flora. Near the end of these cases, one or more of the causes that weaken the flora are observed before the disease occurs (intensive antibiotic therapy, steroid therapy, chemotherapy, radiotherapy, stopping oral nutrition, major surgical procedures, intensive care treatments or a serious infection that has been passed, etc.) For whatever reason, it is not possible to permanently treat chronic diarrhea in all diseases that are the cause or result of CHRONIC DIARRHEA without making the digestive system flora healthy again. In CHRONIC DIARRHEA, if our flora cannot return to health on its own or within 6 months despite all the treatments, it is necessary to restore the flora of the digestive system by transplanting the FLORA.

FLORA TRANSPLANTATION is the process of transferring flora samples taken from at least one healthy donor with high biodiversity, under general anesthesia, endoscopically and colonoscopically from 25-45 separate anatomical areas, each area washed with special solutions, after undergoing a number of procedures, endoscopically and colonoscopically to the equivalent anatomical area of the sick person, under general anesthesia.
It is not possible to treat CHRONIC DIARRHEA cases without restoring healthy flora.

We have turned our experience and clinical experiences related to Flora Transplantation into an article and published it in the American medical journal CUREUS. You can access the article from the link below

https://www.cureus.com/articles/115546-total-gastrointestinal-flora-transplantation-in-the-treatment-of-leaky-gut-syndrome-and-flora-loss#!/

Wishing you healthy days

MD, Murat KANLIÖZ
General Surgery Specialist

ANEMIA is a disease in which the blood level is low or commonly known as anemia . Anemia generally occurs for three reasons. These are;

• Insufficiency in blood production areas
• Rapid blood destruction
• Deficiencies of substances necessary for blood production (Iron, Folic Acid, Vit. B12, etc.)

Leaky Gut Syndrome is a general term that includes diseases that occur when our intestines lose their SELECTIVELY PERMEABLE feature. The main diseases evaluated under the title of Leaky Gut Syndrome are;

• Senior Sergeant Kolit
• Crohn’s Disease
• IBS (Irritable Bowel Syndrome/Irritable Bowel Disease)
• Kronik İshal
• Celiac Disease
• Gluten Allergy (Celiac-Like Syndrome)
• Lactose Intolerance
• Lactose Intolerance-Like Syndrome
• Chronic Non Specific Colitis

Our intestines have the largest surface area of ​​our body and are approximately 20,000 m2 ^, which is the size of three football fields. The inner surface of the intestines is covered with a single-layered inner skin layer called ENDOTHELIUM . After the food we eat is digested, it is absorbed through these cells and passes into the bloodstream. Nutrients and drugs absorbed from the intestines are carried by the blood and reach the areas of the body where they are needed. The most important feature in the absorption of food and other content in the intestines is SELECTIVE PERMEABILITY. Not everything can pass into the bloodstream from our intestines. However, the elements that our body needs and that will not harm our body can be absorbed into the bloodstream to the extent that our intestines allow. The two most important factors in the formation and maintenance of the selective permeability feature of our intestines are MUCUS and INTESTINAL FLORA .

MUCUS is secreted by GOBLET cells, which are specialized cells within the ENDOTHELIAL cells that line the inner surface of our intestines. MUCUS has a gelatinous structure and covers the ENDOTHELIAL layer like armor and protects the endothelium against the harmful effects of the intestinal content. The mucus shield is extremely important in maintaining and maintaining the selective permeability of the intestine. If there is no mucus or if it is insufficient, damage occurs to the endothelium, which is the inner surface of the intestine, and as a result, the intestine partially or completely loses its selective permeability. Our body makes an intense effort to repair the intestinal surface whose selective permeability is impaired, but if repair does not occur after a certain stage, the body permanently loses the absorption surface area by completely closing the area that has lost its selective permeability to absorption in order to protect itself. Areas covered with fibrotic tissue, which have lost their absorption and secretion functions, are dysfunctional and have no sensation, just like burn scars on the skin. The absorption surface area lost with fibrosis can never become functional again. Our body functions can tolerate the loss of absorption surface area up to a certain extent. However, after a certain stage, the remaining surface area will be insufficient to maintain vital functions.

Throughout our digestive system, we live with MICRO LIVING ENTITIES that are specialized for each region, do not normally live in any other region, perform digestion, secretion, detoxification, synthesis, intestinal motility, stool formation, nerve conduction and defense functions for us, live with us, consist of thousands of varieties, mostly bacteria, yeasts and viruses, expressed in trillions in number, renew themselves several times a day and continuously, and we call all of these DIGESTIVE SYSTEM FLORA. It is not possible for us to live healthily without FLORA. In addition, thanks to flora, it is possible to produce, protect and maintain MUCOUS secretion in every region of the digestive system. If there is regional or widespread damage to our flora, the mucous shield protection is eliminated and wounds occur in those regions due to the harmful effects of the digestive system content. When this process occurs in the intestines, LEAKAGE GUT SYNDROME occurs.

In cases of ”Leaky Gut Syndrome” where the intestines cannot perform healthy digestion, synthesis, detoxification and absorption, ANEMIA is frequently encountered due to the deficiency of fatty acids, carbohydrates, proteins, vitamins (especially Vit B12), minerals (especially iron) and folic acid required for BLOOD production. Sometimes ANEMIA appears as the first symptom of Leaky Gut Syndrome or as a symptom accompanying other symptoms.

Leaky gut syndrome is a condition that must be examined while investigating the causes of ANEMIA. Especially if there is ANEMIA together with Food Allergy, Ulcerative Colitis, Crohn’s disease, Lactose Intolerance, Celiac Disease, IBS and Autoimmune Diseases (Rheumatoid Arthritis, GUT Disease, Psoriasis, Vitiligo, Hashimoto’s Disease), Chronic Diarrhea, Mood Disorder, Autism, Chronic Fatigue, Eczema, Depression and Fibromyalgia, it is necessary to examine for ”Leaky Gut Syndrome”.

Wishing You Healthy Days

BAD ODOR is a condition that occurs as a result of many diseases originating from the mouth, upper respiratory tract and upper digestive system. Although bad breath is the result of hundreds of different diseases, the only thing they have in common is that they are all due to acute or chronic infection.

The main oral causes of bad breath are tooth decay, gum infections, oral wounds, trauma, burns and tumor formations.

Tonsillitis (tonsillitis), pharyngitis, laryngitis, sinusitis, tracheitis, bronchitis, esophagitis, esophageal diverticula, Achalasia Disease, esophagotracheal fistulas and gastritis are the main causes of bad breath.

All causes of bad breath include temporary or permanent disruption of the MICROBIAL structure of the relevant area, exposure to pathogen invasion, and tissue damage in that area.

Functions that are specialized for each region throughout the entire digestive system and upper respiratory tract, that do not normally live elsewhere, that are beneficial to us, such as digestion, defense against microbial attacks, synthesis, detoxification, nerve conduction, stool formation, intestinal motility and contribution to hormonal balance, etc. We live together with single-celled creatures, most of which are bacteria, yeast and viruses. All of these are called FLORA. Our FLORA, which has thousands of varieties, is numerically large enough to be expressed in trillions. The elements that make up FLORA diversity have a dynamic structure and continue their cycle in a healthy way by constantly replacing the old ones several times a day. Dead or expired flora elements are naturally excreted as feces. 60-70% of our fecal volume consists of dead and living flora waste. It is not possible to live a healthy, happy and long life without FLORA that is balanced and has sufficient biodiversity.

In all anatomical areas where we host FLORA, the first and most effective defense against pathogenic microbes coming from outside is carried out by flora elements. It is very difficult for pathogenic microbes to settle in areas with high and sufficient flora biodiversity, and even if they do, it will be in limited intensity and duration.

People with impaired oral flora often experience oral wounds, bleeding gums, gum infections, tooth decay, dry mouth, pain and difficulty swallowing. All of these cases involve infections caused by pathogenic microorganisms. If the oral flora cannot be restored, oral infections and bad breath become chronic. The most important reasons for the deterioration of the oral flora are;

• malnutrition
• Excessive carbohydrate consumption
• Very frequent and uncontrolled use of antibiotics
• immune system diseases
• Chemotherapy
• Radiotherapy
• Poor oral hygiene
• Burns (thermal, acid, base)
• traumas
• Intraoral surgeries
• Stopping oral feeding for a long time
• Cigarette
• Alcohol
• Frequent oral infections

If the oral flora is disrupted due to the reasons listed above and this situation becomes chronic, oral infections and BAD ODOR are an inevitable result.

Frequent infections such as tonsillitis, pharyngitis, laryngitis, tracheitis, esophagitis, sinusitis and gastritis are caused by the disruption of the flora of the relevant areas and are often accompanied by bad breath.

Gastro Esophageal Reflux (GER) and ALKALINE REFLUX GASTRITIS are diseases that should be evaluated separately regarding bad breath. In GER, acidic stomach contents rebound into the esophagus, larynx, and even the mouth. BAD ODOR occurs due to chemical burn in the esophagus, larynx and mouth due to stomach acid reflux, disruption of the flora and colonization of pathogenic microbes in the relevant areas.

Bad breath often occurs in cases of ALKALINE REFLUX GASTRITI, which develops due to chemical burn caused by basic bile after bile escapes into the stomach.

Bad breath can be eliminated with treatments aimed at the current cause. In GER, reflux should be prevented by medication, diet or surgical procedures. After reflux is prevented, the flora of the relevant region may recover spontaneously, but in cases that do not improve, FLORA TRANSPLANTATION is performed to re-establish healthy flora.

In cases of Alkaline Reflux Gastritis, duodenum contents (especially BILE) escape into the stomach due to dysfunction in the structure called PILOR, which is located at the stomach outlet and ensures controlled emptying of the stomach. In Alkaline Reflux Gastritis, bile reflux is prevented by endoscopic PYLOric REVISION or surgical intervention. If bad breath still persists after reflux is prevented, FLORA TRANSPLANTATION should be performed.

In cases of chronic gingivitis (gum inflammation), dental caries, tonsillitis, pharyngitis, laryngitis, sinusitis, tracheitis and esophagitis, treatment should be directed towards the cause first. If the damage to the flora cannot be resolved on its own after the condition causing bad breath is eliminated, FLORA TRANSPLANTATION should be performed.

The factor causing bad breath cannot be eliminated without re-establishing the flora of the relevant region by the Flora TRANSPLANT method.

FLORA TRANSPLANTATION, under general anesthesia from at least one healthy donor, each of 25-45 anatomical regions is washed endoscopically and colonoscopically by lavage with special solutions, and then the flora samples taken by aspiration are subjected to certain procedures. It is a method of transplantation under anesthesia.

We compiled the experiences regarding flora transplantation and published it as an article in a prestigious, academic, American medical journal. You can access relevant publications from the links below.

https://www.cureus.com/articles/115546-total-gastrointestinal-flora-transplantation-in-the-treatment-of-leaky-gut-syndrome-and-flora-loss#!/

https://www.cureus.com/articles/148649-a-new-and-effective-technique-in-the-endoscopic-treatment-of-obesity-and-regulation-of-diabetes-the-pyloric-revision#!/

BREATHODINE is not destiny. It can be completely eliminated with treatment directed towards the cause.

I wish you healthy days.

Unfortunately, since the health sector has entered into a product and service competition by standardizing everything, we encounter many unsuccessful results in obesity treatment. It is often ignored that each patient’s condition is unique and should be evaluated accordingly. Sleeve Gastrectomy, gastric balloon or gastric botox services are purchased like canned goods in the market by remote phone, text message or through sales representatives. Patients are often decided on OBESITY treatment without detailed examination and questioning by the physician, without evaluating laboratory results and without performing an endoscopy. The person who will perform this procedure (General Practitioner, Specialist Physician, Associate Professor or Professor or, even worse, none of these) is often not questioned. It is not taken into consideration whether they have had basic medical training and experience in these procedures in the past, and whether they have published their current experiences in an impartial, academic, peer-reviewed and prestigious journal (Because for a physician, the most important and most important reference is an academic publication).

Surgical techniques (Gastric Sleeve Surgery, By-Pass Surgery) and endoscopic techniques (Gastric Balloon, Gastric Botox) are frequently used in the treatment of obesity. In fact, when the right patient is selected and the applications are performed by experienced physicians, each technique is extremely successful. However, there are so many details that need to be considered when applying each technique that the possibility of encountering either bad results (reversible or irreversible), complications, or unsuccessful procedures that do not reach a result increases after the treatments that will be applied without knowing and/or taking them into consideration.

What are the main rules to consider before starting obesity treatment:

• Age of the patient
• Height, weight and body fat index
• Gender
• How many years has he been obese and at his current weight?
• Knowing the weight loss methods and diets used in the past, if any.
• Thyroid hormone values
• Blood sugar (hunger and fullness)
• Insulin resistance
• HbA1c value (blood sugar index of the last 6 months)
• Whether or not he/she has had digestive system surgery in the past
• Psychological background of the patient
• Social environment in which he lives
• Microbial structure of the digestive system
• Whether pregnant or breastfeeding
• Whether there is any active bleeding, tumor or suspicious lesion in the endoscopic examination (Endoscopy is definitely necessary for this)
• Whether there is a dysfunction in the stomach outlet (pylorus) in the endoscopic examination
• Medicines used
• Job
• Working conditions
• Whether or not she is planning a pregnancy in the near future

Applying the obesity treatment that the patient desires without taking the above issues into consideration and without technical guidance from the physician does not always yield the desired results.

In daily practice, the dialogues we often have with patients are exactly like this: “Doctor, I want to have a gastric balloon, how much does it cost and in which hospital do you perform it?” When I am faced with this question, I answer frankly so as not to be rude. In fact, the patient asking this question is not aware of the issues that need to be examined that I mentioned above and will act according to the cheapest price that will be given to that person. However, we try to explain as many technical details as possible to suitable patients and when we explain them, the patients understand the mistake they made and understand that the right method should be decided together. In fact, when we decide together, the most correct, fastest and cheapest method emerges on its own. In this way, the patient loses the weight they target without difficulty, and as a result, both the patient and the doctor are happy. It will always be more correct for the patient to consider doctors as a reliable health consultant rather than a person who sells a product or service.

As in all treatments, the thing that determines success in OBESITY treatment can be summarized as TOTAL QUALITY. If you ask what total quality is; we can count the experience of the doctor, the experience of the auxiliary health personnel, the physical conditions of the health facility, the standardization of the materials used, etc.

In our clinical studies, we observed that if the structure called PYLORES, which controls the stomach outlet, is functional, the results are successful regardless of which obesity treatment is applied considering the patient’s condition. In other words, I can say that the most important technical secret in the success of all OBESITY treatments is whether the PYLORES function is taken into consideration .

We definitely evaluate the PYLORS function in all patients as a result of the endoscopic examination we perform, in addition to all other details. If the pylorus is functioning normally (fully closing / Normotonic), there is no problem in applying the selected treatment. However, if the pylorus is hypotonic (partially closing) or does not close at all (Atonic), we first perform endoscopic PYLORS REVISION in these patients, restore function to the pylorus, and then apply the obesity treatment that has been decided. When we do this, the results are seriously pleasing.

(Note: You can access our articles published in international medical journals on the importance of pyloric function in obesity treatment by clicking the links below)

https://www.cureus.com/articles/148649-a-new-and-effective-technique-in-the-endoscopic-treatment-of-obesity-and-regulation-of-diabetes-the-pyloric-revision#!/

https://journals.lww.com/surgical-laparoscopy/abstract/2020/12000/efficacy_of_intragastric_balloon_placement_and.3.aspx

https://link.springer.com/article/10.1007/s11695-020-04556-7

Assoc. Prof. Dr. Murat KANLIÖZ

General surgery specialist

In all areas where our body comes into contact with the external environment, we live with thousands of varieties of single-celled organisms that live with us, do not harm us and at the same time benefit us. We call all of these single-celled organisms FLORA or Microbiota . Depending on the area they are located in, they are called digestive system FLORA , upper respiratory tract FLORA , skin FLORA . The regions are also evaluated in subgroups. For example, digestive system flora is examined in subgroups such as oral, pharynx, esophagus, small intestine and colon flora.

Every part of our body that has flora cannot perform HEALTHY and FUNCTIONAL functions without having high quality and biodiversity flora . For example, healthy skin is only possible with high quality and biodiversity flora.

What Does Microbiota Biodiversity Mean?

In the parts of our body where we have FLORA , the greater the variety of flora elements, each with different functions, the better the functions of the relevant region will be performed, which will in turn ensure that the region in particular and our body in general are healthier .

If we consider our body as a FACTORY , we can evaluate each member that constitutes the microbiota biodiversity as an engineering branch. The more functional technical personnel diversity (richness) there is in a factory, the higher quality production is expected from the factory. The same applies to the human body. Each type of flora element has its own special functions. Many single-celled microorganism types constitute the microbiota.

What Types of Microorganisms Make Up the Microbiota?

The members that make up the microbiota are mostly bacteria, fungi, viruses, archaea and protists , but the dominant group is bacteria.

What is the Digestive System Flora?

The mouth and throat, which we call the upper digestive system, also form part of the upper respiratory tract.

The area from the mouth to the anus is called the digestive system.

There are 1054 different types of flora bacteria that have been identified throughout the digestive system. Each of these is specific to the area where it settles and lives, and it is not possible for it to settle and live in any other area in a healthy person. If it settles in another area or if it grows excessively in certain areas, it brings with it some diseases ( SIBO, Obesity, IBS, etc. ).

The more varieties of flora bacteria that have been identified so far, out of the 1054, we have in our digestive system, the more HEALTHY, DISEASE-FREE, HAPPY and LONGER we will live. However, life and living conditions are not always so generous to us.

What are the Factors Affecting Flora Biodiversity ?

Of the 1054 different species identified in the digestive system to date, we host an average of 100-125 in our body. This number increases as we go to rural areas and decreases as we go to metropolitan areas. The most important factors in the decrease of biodiversity are intensive use of antibiotics, malnutrition, malnutrition, prolonged cessation of oral feeding, use of corticosteroids, chemotherapy, radiotherapy, agricultural chemicals (pesticides and herbicides), environmental pollutants (industrial facilities, etc.), air and water pollution, consumption of GMO foods, food preservatives and supplements, hormone treatments, etc.

How to Recover Flora and Increase Biodiversity?

It has been shown in many studies that microbiota ( FLORA ) acquisition begins in the womb. Whether the birth is normal or cesarean is effective in flora acquisition. Those born by cesarean will be deprived of some flora elements that they will feel the lack of throughout their lives. After birth, babies acquire flora from their mothers and family members with whom they are in closest contact. In addition, eating and drinking habits and regional diversity are important in flora acquisition. In particular, the flora biodiversity and quality of the mother, the family and the close environment they are in contact with are one of the most important factors in determining the flora diversity to be acquired.

The duration of breastfeeding is one of the main factors that determine the formation of our flora. Hereditary and congenital diseases that occur at birth, nutritional adequacy during infancy, past diseases, and antibiotics used are also effective in the formation of the flora.

In addition, there are changes in the diversity of our flora with age (infancy, adolescence, pregnancy, breastfeeding and menopause, etc.).

We can both protect and enrich our flora by eating natural foods, not using unnecessary antibiotics, breastfeeding for at least one year after birth, staying away from environmental pollutants as much as possible, and prioritizing natural foods when eating.

Extended family, street friendships, nursery, school, team sports, boarding school, student dormitories, and collective social activities are extremely valuable for gaining FLORA.

Changes in Flora with Aging

As in all our cells, tissues and organs , FLORA quality and biodiversity also decrease due to aging . This effect is most evident in women around the age of 50, usually with menopause, and in men after the age of 55-60, serious losses in FLORA quality are observed. The speed of these losses is one of the most important parameters that determines quality of life, eating and drinking habits, the emergence and speed of autoimmune diseases, and with these, quality of life.

Damage to our floss impairs our overall mental, psychological and physical performance.

In What Way Does Flora Damage Cause These Effects?

Our digestive system flora forms the first defense barrier against harmful microbes coming from external sources through eating and drinking. For example, if our throat flora is damaged, we often experience tonsillitis (tonsillitis) and pharyngitis. Similarly, damage to our oral flora causes sores in the mouth, tooth decay and bad breath.

Our intestines have a SELECTIVELY PERMEABLE feature. The nutrients that have been fully digested and that we need are absorbed from our intestines and pass into the bloodstream. Thanks to selective permeability, macromolecules, toxins and microbes that have not been digested CANNOT pass into the bloodstream. One of the most important elements in ensuring the selective permeability of our intestines is that our intestinal flora is healthy and has a high biodiversity. In case of intestinal flora damage or loss, weaknesses occur in the selective permeability feature of our intestines. With the disruption of selective permeability, food allergies and related nutritional disorders, autoimmune diseases are triggered and many chronic diseases are prepared.

Is it possible to delay the effects of aging if we protect our flora well?

There is a direct relationship between microbiota quality and quality of life and longevity . The decrease in biodiversity in the microbiota and the deterioration of its configuration ( dysbiosis, SIBO, etc. ), nutritional disorders, mandatory food restrictions, intestinal movement disorders ( constipation, diarrhea, IBS, etc. ), abdominal pain, intestinal restlessness and autoimmune diseases that develop together ( articular rheumatism, gout, MS, vitiligo, psoriasis, Hashimoto’s disease, fibromyalgia, etc. ) directly affect the quality and duration of life, and also reduce the resistance to many diseases ( cancer, epidemics, etc. ).

We often come across these in our environment; Generally, there are patients who are elderly, have eating and drinking problems, weight loss, general debility, allergies, suddenly become bedridden, but after medical examination and examination, NO DIAGNOSIS CAN BE MADE and it is considered as a SIGN OF AGING. Patients in this situation are mostly left to their FATE with simple vitamin supplements. Such patients should definitely be evaluated in terms of DIGESTIVE SYSTEM FLORA . It will mostly be seen that there are serious flora damages.

As a result, if we can protect our “digestive system flora” well and increase its biodiversity and treat the resulting flora damage with the FLORA TRANSPLANTATION method , it is possible to “DELAY THE EFFECTS OF AGING, LIVE LONGER, HAPPIER AND HEALTHIER” .

What is Flora Transplantation?

Flora Transplantation is a procedure performed to re-establish biodiversity in areas where permanent flora damage has occurred for any reason.

Flora Transplantation is the process of taking flora samples from at least one healthy donor (flora donor) under general anesthesia by washing 25-45 different anatomical regions with special washing solutions, each of which is subjected to special processes and the regional floras are transferred to the patient under general anesthesia, endoscopically and colonoscopically. Treatment success rates are around 85%. The flora obtained is permanent for life. Flora transplantation is done in a single session.

What to Expect After Flora Transplant?

The effect begins to be seen within hours after the flora transplantation procedure, and three weeks are required for maximum effectiveness.

If healthy flora can be created with flora transplantation, selective permeability of the intestine is re-established and effects related to autoimmune process are reversed. As the flora becomes healthy again, a defense is formed against pathogenic microbes. Enzymatic, chemical and biological digestive processes start to work healthily. As a result, foods that were previously difficult to digest will be digested more easily. Food allergies due to flora damage are eliminated. Since the fight against harmful microbes will be carried out, cases such as bad breath, tonsillitis, pharyngitis, gastritis and chronic diarrhea that develop due to pathogen colonization will be minimized. Due to the healthy functioning of the intestines, complaints such as diarrhea, constipation, excessive gas and abdominal pain will significantly regress and mostly return to normal. By closing the gate that triggers autoimmunity with flora transplantation, significant improvements are observed in all developing autoimmune processes and even some clinical conditions return to normal dramatically (Rheumatoid arthritis, Gout, Vitiligo, Psoriasis, MS, Ulcerative Colitis, Crohn’s Disease, IBS etc.).

A FLORA TRANSPLANT to be performed on a patient with flora damage will be extremely beneficial. In many patients, the effect is so dramatic that the patient and their relatives cannot hide their astonishment at the picture they see. The patient begins to eat more comfortably after the flora transplant. Along with this, a noticeable increase is observed in the patient’s physical, mental and psychological performance.

As a result, it is possible to say that one of the most important parameters affecting AGING is the quality of our MICROBIOTAE (OUR FLOOR).

We compiled the results of our clinical studies on flora transplantation into an article and published it in the academic, peer-reviewed, prestigious American Medical journal CUREUS. You can access the article from the link below.

https://www.cureus.com/articles/115546-total-gastrointestinal-flora-transplantation-in-the-treatment-of-leaky-gut-syndrome-and-flora-loss#!/

Assoc. Prof. Dr. Murat KANLIÖZ

General surgery specialist

WHAT IS SAFRA?

Bile is a secretion produced by the liver.

WHAT ARE THE FUNCTIONS OF SAFRA?

Bile has two functions. First, it ensures that substances that undergo decomposition in the liver are eliminated from the body. Its second function is the digestion of fats and the absorption of fat-soluble vitamins (vitamins A, D, E and K) from the intestine.

WHAT IS GALLBLADDER?

The gallbladder is a pear-shaped, hollow, bag-like organ attached to the right lobe of the liver, 7-8 cm long and 3-4 cm wide at its widest point.

WHAT ARE THE BILE TRAINS?

Bile ducts are the name given to the channel system that ensures the flow of bile produced in the liver to the gallbladder and/or intestine, which is an intermediate station.

WHERE DOES Bile FLOW IN THE INTESTINE?

Bile flows through the bile ducts to the region called the duodenum 2nd continent (12 finger intestines), 10-12 cm ahead of the stomach exit.

WHAT IS THE VOLUME OF THE GALLBLADDER?

The volume of the gallbladder varies between 35-65 cc.

WHAT IS THE USE OF GALLBLADDER?

The gallbladder is the preliminary storage and concentration area of ​​the bile produced in the liver, approximately 1500-2000 cc per day, before flowing into the intestine. bile, bile produced by the liverIt is stored by concentrating approximately 10 times (5-20 times) in its sac. In proportion to the fat content of the foods we eat, bile, concentrated enough for fats to be digested, flows into the second continent of the duodenum with the contraction of the gallbladder.

WHAT HAPPENS AFTER THE GALLBLADDER IS SURGICALLY REMOVED?

In cases where the gallbladder is surgically removed due to any reason (gallbladder stone, gallbladder polyp, gallbladder tumor, etc.), bile flows into the intestine (duodenum) continuously in proportion to the rate of production in the liver. While 150-200 cc of concentrated bile flows into the duodenum when it is needed, in the amount needed, when the gallbladder is present, 150-2000 cc of concentrated bile flows into the duodenum continuously, regardless of need, and at the same density as it is produced in the liver, unconcentrated, after the gallbladder is removed. Due to the flow of bile at a volume ten times normal into the duodenum, in cases where the PILOR, which is located at the exit of the stomach and acts as a kind of valve, is poorly functional or dysfunctional, some of the bile leaks into the stomach (BILE REFLUX). As a result, stomach disorders may develop. Due to surgical removal of the gallbladder, problems occur in the digestion and absorption of fats and fat-soluble vitamins.

WHAT IS BILE REFLUX?

Bile Reflux means bile leaking into the stomach. In every person, some bile may leak into the stomach at certain periods and this situation is called Physiological Bile Reflux. However, as the amount of reflux increases, a condition called Alkaline Reflux Gastritis occurs, which is considered a disease.

WHO HAS BILE REFLUX MORE?

Bile Reflux is seen in people whose valve system called PILOR, located at the exit of the stomach, is weak. Normally, the direction of flow of contents in the digestive system is always forward, and backward movement is a pathological process. In cases where the gallbladder is removed or the internal volume of the gallbladder is occupied by a stone or mass, since the gallbladder cannot fulfill its adequate storage function, the bile produced by the liver flows into the duodenum in high volume without being concentrated or less concentrated, and some of the bile is produced by a mechanism that can be called the overflow effect. Stomach leakage occurs in these people with PYLORIC DYSFUNCTION. Complaints occur depending on the amount of bile escaping and the duration.

WHAT IS PYLOOR?

PYLOOR is a muscle bundle located at the exit of the stomach. The pylorus works like a VALVE at the exit of the stomach, thus performing the functions of storing the food we eat in the stomach, controlling the flow of pre-digested food in the stomach to the duodenum, and preventing the duodenal content from flowing back into the stomach.

WHAT IS PYLORIC INSUFFICIENCY (DYSFUNCTION)?

PYLORIC INSUFFICIENCY is the condition in which the pylorus cannot perform its VALVE function at all or partially. If the pylorus is in normal function, it is called NORMOTONIC PYLOR, if there is partial leakage, it is called HYPOTONIC PYLOOR, and if it is completely dysfunctional, it is called ATONIC PYLOR.

WHAT CAUSES BILE REFLUX?

Bile Reflux, Alkaline Reflux can cause gastritis, heartburn, intestinal infections, frequent diarrhea, digestive system flora disorder, flora dysbiosis, Helicobacter Pylori infection in the stomach, intestinal discomfort, excessive gas, belching, abdominal pain, bad breath, sleep disorder, malnutrition, etc. . why could it be.

WHAT ARE THE SYMPTOMS OF BILE REFLUX?

Bile Reflux Symptoms; Abdominal pain, constant burning sensation in the stomach, decreased complaints after meals, increased complaints during hunger, weight loss, bad breath, excessive gas, burping, intestinal discomfort, malnutrition, frequent diarrhea, etc.

HOW IS Bile Reflux Diagnosed?

Bile Reflux is diagnosed by endoscopic examination. During endoscopy, bilious green content is observed in the stomach. Alkaline Reflux Gastritis is observed due to the effect of bile entering the stomach (redness, edema, sometimes bleeding areas, ulcers, etc. on the inner surface of the stomach). In the endoscopic examination, when light mechanical stimulation is applied to the stomach outlet with the tip of the endoscopy device, the PILOR normally closes, this is called the normal pyloric structure (NORMOTONIC PYLORO). However, in patients with bile reflux, in endoscopic examination, the pylorus is observed either not closing completely (HYPOTONIC PYLOOR) or not closing at all (ATONIC PYLOOR).

BY WHICH MECHANISM DOES BILE REFLUX DAMAGE THE STOMACH?

The stomach is an acidic environment and the pH is 1.5-2. Bile is basic and its pH is 8-8.5. Bile escaping into the stomach erodes the structure called MUCUS, which protects the inner surface of the stomach from external influences, and creates a CHEMICAL BASIC BURN on the inner surface of the stomach. Due to this basic burn, ALKALINE REFLUX GASTRITIS occurs.

HOW IS BILE REFLUX TREATED?

In Bile Reflux, the stomach surface is tried to be protected by giving surface coating drugs to prevent bile from coming into contact with the stomach surface. However, bile reflux cannot be treated permanently without eliminating the main problem. To treat bile reflux, it is necessary to either restore the function of the pylorus or perform surgeries that change the anatomical structure that will prevent bile from flowing back into the stomach. We clinically apply the technique we call PYLOOR REVISION, which restores function to the pylorus by endoscopically injecting filler around the pylorus without disturbing the existing anatomy. If the pylorus cannot be restored to function, the other treatment to be performed is Duodenal Switch surgery.

WHAT IS PYLORIC REVISION?

PYLORA REVISION is an endoscopic interventional procedure performed to prevent pyloric leakage in patients whose pylorus does not close completely or at all.

HOW IS PYLORIC REVISION DONE?

Pyloric Revision is the process of closing the opening causing leakage in the pylorus by performing filler injections around the pylorus of patients with HYPOTONIC and ATONIC pylorus by entering endoscopically under sedation anesthesia. In this way, bile content is prevented from flowing back into the stomach. The process is completed in 15 minutes in total. The patient can return to daily life on the same day. No hospitalization is required. He is discharged from the hospital 2 hours after the procedure.

IS PYLORIC REVISION PERMANENT AND HOW LONG IS THE EFFECT DURATION?

In our clinical study, the effectiveness of the “Pyloric Revision” performed in the control endoscopy of the patients to whom we performed “Pyloric Revision” during an average follow-up period of 32 months still continues in 92% of the patients.

BY WHOM WAS PYLORIC REVISION FIRST DEFINED AND APPLIED?

PYLOric REVISION was defined and applied for the first time by “Assoc. Prof. Murat KANLIÖZ”. It has been proven by scientific academic publications that bile reflux can be prevented with Pyloric Revision. Clinical study results and description of the technique were published in 2023 in the peer-reviewed American Medical journal CUREUS. The name PYLOric REVISION was given to the procedure by Associate Professor Murat KANLIÖZ, who discovered and defined the technique.

https://www.cureus.com/articles/148649-a-new-and-effective-technique-in-the-endoscopic-treatment-of-obesity-and-regulation-of-diabetes-the-pyloric-revision# !/

HOW IS DUODENAL SWITCH SURGERY PERFORMED IN BILE REFLUX?

In Duodenal Switch surgery, the passage between the stomach and small intestine is closed from the immediate exit of the stomach. 150 cm from the stomach exit, the small intestine is cut in full thickness and divided into two ends, one incoming and one outgoing. The separated end of the outgoing intestinal segment is brought into the stomach (anastomosis is performed). The other end of the intestine, which is reserved for the 75th cm of the intestinal segment that is mouthed to the stomach, is mouthed to ensure the flow of both bile and stomach contents. In this way, bile flow is removed from the stomach, preventing bile from flowing back into the stomach.

WHAT ARE THE POSSIBLE COMPLICATIONS OF DUODENAL SWITCH SURGERY?

Depending on the surgery performed, anastomotic leakage and bleeding may occur at a rate of 1-2%. Depending on the surgery performed, the first point of contact of the stomach contents with the intestine will be at the 150th cm of the intestine, so severe pain, bloating and excessive gas may occur in the abdomen after meals. This table is called DUMPING SYNDROME. Dumping Syndrome occurs at a rate of 10-15% after DUODENAL SWITCH surgery, and these complaints may continue for life. Digestion and absorption of carbohydrates occurs in the first 100 cm after the stomach exit. Carbohydrate absorption disorders are observed after Duodenal Switch. The most important factor accused in the formation of dumping syndrome is expressed as the contact of dense carbohydrate content with the intestine after the 150th cm.

WHEN SHOULD DUODENAL SWITCH SURGERY BE PERFORMED IN BILE REFLUX?

Duodenal Switch surgery should be performed when the quality of life is severely impaired due to bile reflux and cannot be treated with any other method. Duodenal Switch is a surgery that should be considered as the last option in Alkaline Reflux Gastritis.

WHAT ARE THE ADVANTAGES OF PYLORIC REVISION OVER DUODENAL SWITCH SURGERY?

• There are no surgical risks in Duodenal Switch surgery
•  Anatomical structure is not damaged
•  Does not require hospitalization
•  No loss of workforce
•  Does not cause malnutrition
•  Dumping syndrome is not observed
•  It is cheap
•  It is not an invasive procedure
•  Does not cause loss of labor
•  It is extremely effective

WHAT ARE THE DISADVANTAGES OF PYLORIC REVISION COMPARED TO DUODENAL SWITCH SURGERY?

Pyloric Revision does NOT have any disadvantages compared to Duodenal Switch surgery.

Assoc. Prof. Murat KANLIÖZ
General surgery specialist

Before answering the question of what PANGASTRITIS is, it would be better to define what GASTRITIS is. Because PANGASTRIT is only one of the titles that define gastritis cases. GASTRITIS is a condition in which the inner layer of the stomach becomes inflamed due to many reasons. Gastritis also depends on its duration; if it develops in the last three weeks, it is called ACUTE GASTRITIS , and if it continues for six weeks or longer,it is called CHRONIC GASTRITIS . There is alsoa condition defined as SUBACUTE GASTRITIS , which describes the period in which the exacerbation period of acute gastritis has passed and is moving towards recovery.

Definitions are made according to the depth of erosion caused by gastritis on the stomach wall. Superficial Gastritis is a definition used for mild superficial involvements. Edematous Gastritis presents a slightly more serious picture and accompanying edema has also been added to the picture. Hemorrhagic Gastritis means that there is bleeding along with gastritis. Erosive Gastritis is a condition of gastritis with tissue loss on the stomach surface. Ulcerous Gastritis is a severe condition that describes the formation of wounds in the stomach along with gastritis.

Gastritis is also named according to which part or part of the stomach it affects. DISTAL Gastritis affects the parts of the stomach close to the exit area and is also called ANTRAL Gastritis . PROXIMAL Gastritis affects the upper parts of the stomach. DIFFUSE Gastritis is a term indicating that gastritis affects a large area. PANGASTRITI , on the other hand, indicates involvement of the entire stomach and is sometimes called Total Gastritis . SUBTOTAL Gastritis is used to describe gastritis that affects the majority of the stomach.

WHAT ARE THE SUBTYPES OF PANGASTRITIS?

Pangastritis is called ACUTE PANGASTRITIS, SUBACUTE PANGASTRITIS and CHRONIC PANGASTRITIS depending on its duration .

Pangastritis, depending on the damage it causes on the stomach surface, is called SUPERFISCAL PANGASTRIT, EDEMATOUS PANGASTRIT, HEMORRHAGIC PANGASTRITIS, EROUSIVE PANGASTRITIS and ULCEROUS PANGASTRITIS .

HOW DOES PANGASTRITIS OCCUR?

There is a gel-like, slimy secretion that coats the inner surface of the stomach like an armor, this secretion is called mucus. Thanks to mucus, the inner surface of the stomach prevents both digestive system secretions and food from direct contact with the stomach surface. In this way, the inner surface of the stomach is protected from the damaging effects of digestive secretions and food.

Erosion of the mucus layer is an important triggering factor in cases of pangastritis. In addition, the increase in gastric acid secretion and the reflux of bile-containing small intestine contents into the stomach ( ALKALINE REFLUX ) also cause erosion in the mucus layer. Apart from these, disruption or decrease in the diversity (flora) of beneficial microorganisms in the stomach may also initiate the inflammatory process (Helicobacter Pylori colonization in the stomach, etc.). The acid content of the stomach and the stomach flora are one of the most important defense mechanisms against pathogens coming from outside. Disruption of these mechanisms causes damage to the stomach and intestinal flora.

WHAT ARE THE CAUSES THAT CAUSE PANGASTRITIS?

The main causes of pangastritis are:

• Decreased mucus secretion or deterioration of mucus quality due to dysfunction in the mucus-secreting cells in the stomach.
• Reasons that increase stomach acid secretion (Stress, Gastrinoma, etc.)
• Foods that contain excessive acid and cause acid secretion (dark chocolate, orange, lemon, etc.)
• excessive alcohol consumption
• Stomach surface burns caused by chronic exposure or intentional consumption of some chemicals
• Disruption of stomach flora (Helicobacter Pylorus infection etc.)
• Long-term hunger (Hunger strike, death fasts, fasting, inability to feed orally)
• Deep nutritional deficiencies
• ALKALINE REFLUX GASTRITIS DUE TO PYLOOR DYSFUNCTION, which is the valve mechanism at the stomach outlet
• Especially high doses or long-term use of painkillers known as Non-Steroid Anti-Inflammatory (Apranax, Aprol, Dicloron, etc.)
• Chemotherapy
• Radiotherapy

WHAT ARE THE SYMPTOMS OF PANGASTRITIS?

Stomach pain, nausea, weakness, insomnia, depression, attention disorders, anemia, indigestion, excessive gas, burping, bad breath, bloating, loss of appetite, weight loss.

HOW IS PANGASTRITIS DIAGNOSED?

The most important and diagnostic method with the highest diagnostic value is endoscopic examination. In all endoscopic examinations, pathological examination is also performed by taking multi-point biopsy in order to detect Helicobacter pylori and tumoral development.

WHAT CAN CAUSE PANGASTRITIS?

• Unrest
• Depression
• Sleeping disorder
• bad breath
• Anemia
• stomach bleeding
• Stomach and intestinal discomfort
• stomach perforation
• Chronic wounds in the stomach
• STOMACH TUMOR

WHAT HAPPENS IF PANGASTRITIS IS NOT TREATED?

Pangastritis cases become chronic if left untreated. It is not possible for chronic cases to heal on their own. Acute Pangastritis causes stomach perforation and bleeding. Chronic cases pave the way for stomach cancer. In addition, anemia often accompanies chronic Pangastritis.

HOW IS PANGASTRITIS TREATED?

The factor that causes pangastritis is determined and treatment programs are applied based on the cause.

Acute Pangastritis cases are easier to treat than chronic cases. However, acute cases usually present to healthcare institutions in a very dramatic and noisy manner and are extremely agitated. However, they usually respond quickly and positively to treatment. The situation is a little more difficult in chronic pangastritis and treatment may take a long time.

The most important element in treatment is to eliminate the underlying cause. While this is sometimes an intense painkiller used and it is possible to prevent it, sometimes there may be situations where it is not possible to stop it, such as chemotherapy or radiotherapy.

If the cause is Helicobacter Pylori, it can be treated with FLORA TRANSPLANTATION. Helicobacter Pylori is most often treated with multiple antibiotics for 3-4 weeks. However, antibiotic treatment is a double-edged sword as it kills the remaining flora.

A significant portion of pangastritis cases are caused by increased gastric acid secretion. In these cases, PPI (proton pump inhibitor) drugs (Panto, etc.) that reduce acid secretion and acid-neutralizing antacid drugs (talcid, rennie, etc.) are used.

Since pangastritis mostly damages the inner surface of the stomach due to direct contact of gastric secretions and food due to a decrease in mucus secretion, drugs that form a mucus-like coating on the inner surface of the stomach are given four times a day on an empty stomach (Antepsin, etc.).

TREATMENT OF PANGASTRITIS COMPLICATIONS

Pangastritis is accompanied by serious complications and these often require treatment. The most common complication treatment is the treatment of the factors that cause anemia. These come in the form of iron preparations and Vit B12 supplements.

It may be necessary to give supportive treatment due to excessive gas.

Sedating drug supplements may be required for insomnia.

Stomach bleeding requires hospitalization and treatment.

One of the most serious conditions is stomach perforation. The only treatment for these is surgery.

It should also be monitored at regular intervals for stomach cancer.

WHAT IS SIBO DISEASE?

SIBO is a disease caused by excessive bacterial growth in the small intestines. SIBO, as pronounced in English, consists of the initials of the words “Small Intestinal Bacterial Overgrowth”.

HOW DOES SIBO OCCUR?

It occurs after the biodiversity of the digestive system FLORA (MICROBIOTA) decreases and/or is permanently damaged for many reasons.

WHAT IS THE FLORA (MICROBIOTA) OF THE DIGESTIVE SYSTEM?

It lives with us throughout the digestive system from the mouth to the anus, does not harm us, at the same time contributes to the physiological functions of the region (acidity, humidity, etc.), performs digestion and synthesis functions, and constitutes the first defense mechanism against pathogenic microbial attacks coming from outside, We live together with dozens or even hundreds of beneficial microorganisms that contribute to the nerve conduction of the intestines, mostly consisting of bacteria, and numerically much greater than the number of all the cells in our body. All of these are called DIGESTIVE SYSTEM FLORA or MICROBIOTA.

WHAT ARE THE FACTORS THAT CAUSE DIGESTIVE SYSTEM FLORA DAMAGE?

-High dose and/or long-term use of antibiotics
-Long-term corticosteroid treatments
-Use of protein powder (especially in fitness people) (It contains high doses of steroids)
-Anabolizing additive products used for muscle development
-Cancer treatments (chemotherapy, radiotherapy, immunotherapy, etc.). )
-Stopping oral feeding for 10 days or more
-Inappropriate diet programs
-Serious digestive system surgeries
-Heavy metal poisonings (Lead, mercury, cadmium, etc.)
-Long-term contact with agricultural pesticides (herbicides, pesticides)
-Ionizing radiation
-Environmental pollution
-Inadequate nutrition
– Long-term hunger
– Unbalanced nutrition
– etc.

WHAT ARE THE SYMPTOMS OF SIBO?

SIBO is a disease evaluated under the umbrella of leaky gut syndrome. Nutritional and absorption disorders occur due to excessive bacterial growth in the small intestines. Since the consumed foods are used by increased bacterial density, nutritional deficiencies are observed in patients. It manifests itself with symptoms such as excessive gas in the intestines, abdominal pain, restlessness, skin allergies, sleep disorders, constipation, diarrhea and indigestion.

HOW IS SIBO DIAGNOSED?

First of all, the examination and questioning of the patient’s complaints brings us closer to the diagnosis. SIBO is diagnosed by breath test or analysis of intestinal content samples taken endoscopically. Another method is microbial analysis of stool.

WHICH DEPARTMENT SHOULD THOSE WITH SIBO DISEASE GO?

If you have such complaints, it would be appropriate to consult physicians who specifically work on SIBO disease. If you cannot reach a physician specifically working in the field of SIBO, you can get support from gastroenterology, internal medicine or general surgery specialists.

WHAT HAPPENS IF SIBO IS NOT TREATED?

If SIBO disease is not treated, it paves the way for hundreds of diseases to occur due to the deficiency of many nutrients. If SIBO disease, which develops due to leaky gut syndrome, is left untreated, the number of autoimmune diseases may increase and irreversible damage may occur. Decrease in quality of life, chronic fatigue and unhappiness develop due to SIBO symptoms.

WHAT DOES LEAKY GUT SYNDROME MEAN?

Our intestines are selectively permeable. With the onset of flora damage, the selective permeability of our intestines is disrupted and as a result, harmful substances, toxins, macro molecules and microbes that should not be absorbed from the intestines are absorbed into the bloodstream. The general umbrella definition of the diseases that make up this picture is LEAKY GUT SYNDROME , and SIBO disease is also evaluated under this group. With the formation of leaky gut syndrome, the process of autoimmune diseases begins.

WHAT IS AUTOIMMUNISM?

It is caused by the fatigue and loss of coordination of the defense system after long-term, high concentration and chronic entry of substances perceived as harmful and foreign by our defense system into the blood circulation, especially through the digestive system, upper respiratory tract, external auditory canal, eye socket mucosa and skin. All diseases that develop after the patient mistakenly perceives his own tissues and organs as harmful and foreign and causes damage by attacking these places are called AUTOIMMUNE diseases. The most well-known autoimmune diseases are Rheumatoid Arthritis, GUT disease, Psoriasis, Behçet’s disease, Vitiligo disease, Crohn’s disease, Ulcerative Colitis, IBS, SIBO, Ankylosing Spondylitis, Fibromyalgia, Hashimoto’s Disease, etc.

HOW IS SIBO TREATED?

The main reason for SIBO disease is the decrease in the biodiversity of the digestive system flora (microbiota) and the complete extinction of some species. With the decrease in biodiversity, SIBO occurs due to the inappropriate settlement and proliferation of flora elements. When the configuration, adequacy and diversity of the microbiota in the digestive system are disrupted, SIBO occurs with the excessive colonization of the small intestine by the inappropriate number of flora bacteria and pathogenic bacteria.
Currently, in the treatment of SIBO, attempts are made to reduce the increasing bacterial density in the intestines by giving long-term (at least 3 weeks), high doses and multiple antibiotic treatments. The treatment can provide significant relief to patients in the short term. However, as an unintended and undesirable side effect of this treatment, the healthy flora bacteria remaining in our body are also damaged. Therefore, we do not think that antibiotic treatment for SIBO is an appropriate form of treatment today. Because although antibiotic treatment provides short-term relief, the disease often reoccurs and the flora damage caused by the antibiotic aggravates the situation even further. Since the main problem in the development of SIBO disease is flora damage, the most correct treatment should be the re-establishment of the digestive system flora. It is possible to achieve this goal only with FLORA TRANSPLANTATION.
We treat SIBO disease by establishing healthy and highly biodiverse flora with TOTAL GASTROINTESTINAL FLOARA TRANSPLANTATION treatment.

IS IT POSSIBLE TO PREVENT SIBO FROM OCCURING?

It is possible to prevent the occurrence of SIBO disease by avoiding effects that may harm our digestive system flora.

IS IT POSSIBLE TO COMPLETELY GET RID OF SIBO DISEASE?

It is possible to treat SIBO disease completely and permanently with TOTAL GASTROINTESTINAL FLOARA TRANSPLANTATION treatment.

TOTAL GASTROİNTESTİNAL FLOARA NAKLİ NEDİR?

Flora samples are taken from at least one healthy donor with high biodiversity, under general anesthesia, endoscopically and colonoscopically, by washing each of approximately 25-45 different anatomical regions with special solutions, and are prepared by going through a number of processes. It is the process of implanting the prepared flora samples into the patient under general anesthesia, endoscopically and colonoscopically, and the flora samples taken from the same area of ​​the donor as the same area of ​​the patient.
Once healthy flora is established, the flora of each region prevents the formation of pathogenic microorganisms and excessive invasions outside the scope in the relevant region. The real power to fight against SIBO is our FLORA. Once a healthy and biodiverse flora is established, the flora of each region creates healthy physiological conditions by eliminating inappropriate invasion and settlement of pathogenic microorganisms.

Flora Transplantation is performed in a single session and is permanent for life unless there are extraordinary circumstances. No additional treatment or medication is required after Flora Transplantation.
We compiled our clinical study results on flora transplantation, which have been going on for many years, into an article and published them in CUREUS, a REVIEWED, RESPECTED, ACADEMIC, American Medical Journal. You can access the relevant article from the link below.

https://www.cureus.com/articles/115546-total-gastrointestinal-flora-transplantation-in-the-treatment-of-leaky-gut-syndrome-and-flora-loss#!/

Associate Professor Murat KANLIÖZ
General Surgery Specialist

• Autism: It is a complex behavioral syndrome characterized by speech and language disorders, mental impairment, and learning and motor dysfunctions.
• Gastro Intestinal System (GIS): It describes the entire digestive system from the mouth to the anus.
• Microbiota: Microbiota is “ecological communities formed by commensal, symbiotic and pathogenic microorganisms” and are found on the inner and outer surfaces of all multicellular organisms that have been studied, from plants to animals. The microbiota includes bacteria, archaea, protists, fungi and viruses. Depending on their location, they are named as “Intestinal Microbiota” or “Intraoral Microbiota”. Where they are found and settled is not a coincidence. Each of them has functions specific to the region in which it is located. Briefly, we can define it as the sum of microorganisms (bacteria, fungi, virus and protozoa families) that live in our body and are not human cells. It is also called FLORA.
• Micromyoma: It defines the genome structure that forms the microbiota.
• Leaky Gut Syndrome (GBS) / Leaky Gut Syndrome (LGS): Our intestines have selective permeability, thanks to the barriers on the intestinal absorption surface. As a result of the decrease in microbiota biodiversity, the increase in pathogenic microorganisms (Dysbiosis), the excessive increase in bacteria in the small intestines (SIBO DISEASE) and the inability to maintain quality mucus secretion, our intestines lose their “SELECTIVE PERMEABLE” feature. The umbrella definition of diseases presenting with this picture is LEAKY GUT SYNDROME.
• Dysbiosis: It describes the increase of pathogenic microorganisms instead of beneficial microorganisms (FLORA) in the intestines.
• Trimester: It is the name given to each 3-month period of the 9-month gestation period in humans.
• Fetus: 9-40 days of pregnancy. It is the name given to the living thing in the womb between weeks and weeks. The first eight weeks are called the embryonal period.
• Commensalism: It is a type of life in which two organisms live together, where one organism benefits and the other is not affected by this partnership.
• Symbiosis: Two organisms living together by helping each other as a single organism.
• Pathogen: Any organism or substance that causes disease.

AUTISM is a disease characterized by unusual behaviors, difficulties in communicating and establishing relationships with the environment, and indifference or hypersensitivity responses to sensory signals from the environment (1). The diagnosis of autism is usually made at the age of 2-3, after the child is taken to the doctor due to lack of communication and skills. Both genetic and environmental factors play a role in autism, but most cases of autism are idiopathic (cause unknown) (2). Autism is observed more in men than women (3). In large-scale studies, it is known that one in every 46 live births is autistic (4). There are many factors blamed for the development of autism. A significant portion of these are associated with situations encountered in embryonal and fetal life, some are related to the type of birth, and some are associated with postnatal processes. Maternal infection during pregnancy can lead to changes in the microbial composition as well as an increased risk of autism. It was determined that women who were hospitalized due to infection during pregnancy had a higher risk of giving birth to autistic children. Viral infections in the first trimester of pregnancy and bacterial infections in the second trimester are associated with a higher risk of giving birth to an autistic child (5).

In their study, Kang et al. reported that autistic children experienced significantly shorter breastfeeding duration (6). In the study conducted by Swedish scientists Urran et al., using information obtained from a population-based registry including approximately 2.6 million children, they reported that the risk of autism development in the child is 20% higher in cesarean births compared to natural vaginal birth (7). It is also known that many autistic children receive high doses of oral antibiotics in the first years of their lives(2). Premature birth, mode of delivery, and breastfeeding affect the intestinal microbial composition of newborns. Vaginally born babies who are breastfed have the healthiest microbiota composition. (8). Taken together, it has been observed that the risk of developing autism is higher in children born prematurely with very low birth weight, born by cesarean section, and not breastfed ( 9 ). Autism is diagnosed at a much higher rate in those who have been hospitalized for a long time, in those who have been treated with antibiotics for a long time, or in those whose mothers had an infection during pregnancy (5, 10). In a broad-based epigenetic study conducted by Alam et al., it was reported that infections during pregnancy may cause changes in myelination in the brain and possibly behavioral changes as observed in autism (11).

The relationship between autism and microbiota has been demonstrated by many studies. Our intestines have selective permeability and thanks to this barrier, we are protected from many harmful factors. The intestinal barrier consists of commensal intestinal microbiota, mucus layer, and epithelial cells connected by tight junctions (12). It has been shown in many clinical studies that this barrier is more impaired in autistic individuals than in non-autistic individuals, microbiota (FLORA) biodiversity is reduced, and dysbiosis and SIBO are more common. It has also been shown that decreased microbiota diversity in the mother, SIBO and Dysbiosis are directly related to the development of autism in the child.

Microbiota has an important role in maintaining the physiological (healthy) structure in the Gastro Intestinal System (GIS), that is, throughout the digestive system from the mouth to the anus, and some digestive systems (Food Allergy, IBS, Celiac Disease, Gluten Sensitivity, Ulcerative Colitis, Crohn’s Disease, etc.) .) and non-digestive diseases (Autism, Autoimmune Arthritis, Autoimmune Vasculitis, Psoriasis, Dermatitis, Vitiligo, Depression, Type 2 Diabetes, etc.) have been shown in the clinical study conducted by Mangiola et al. that there are qualitative and quantitative changes in the INTESTINAL FLORA (microbiota). (13). In the research conducted by Mangiola and his colleagues, they revealed that disruption of the intestinal microbiota is extremely important in the formation of autism and in the management and treatment of existing autism. Available evidence shows that disruption of the gut microbiota plays a key role in the development of autism and mood disorders (13). Accumulating evidence has demonstrated a link between changes in the composition of the gut microbiota and both gastrointestinal and neurobehavioral symptoms in children with autism. Gut dysbiosis in autism has been widely demonstrated. (14). Many children with autism have abnormalities in GI physiology, including increased intestinal permeability, general microbiota changes, and intestinal infection. Moreover, autistics are described as “picky eaters” and the presence of certain sensory patterns in autistic patients may represent one of the main elements that inhibit feeding. GI disorders are associated with the altered composition of the gut microbiota. The gut microbiome can communicate with brain activities through microbiota-derived signaling molecules, immune system elements and gut hormones, as well as vagal and spinal afferent neurons (15).

Microbiota is a group of microorganisms that colonize the human body, and the composition of this group is not accidental; The term microbiome covers the genomes of all microorganisms in a particular environment. This complex ecosystem is characterized by a network of positive and negative relationships that significantly influence the health of the host ( 16 ). Each member of the microbiota biodiversity has special functions. So far, 1054 different types of FLORA (microbiota) bacteria have been identified throughout the digestive system. No member settles or lives outside the localization to which it belongs (17). Microbial composition varies with age, diet, diseases, geography, and shared environment ( 18 ).

The Gastro Intestinal System (GIS), the largest surface of the body, contains trillions of microorganisms separated by the intestinal barrier. The number of FLORA bacteria living in our intestines alone is 10 times greater than all the cells in our body (19). 90% of all microorganisms in the GIT colonize the initial parts of the small and large intestines (20).

Many eating habits and food-related aggressive behaviors in autism are directly related to FLORA. In addition to dysbiosis, GI symptoms are four times more common in children with ASD compared to the normal population. It was determined that the most common gastrointestinal symptom in children with autism was constipation. The same authors also found a link between rigid persistent behavior and the occurrence of constipation ( 21 ). It has been reported that GI problems in autistic children cause more tantrums, aggressive behavior and sleep disorders, and worsen the behavior compared to autistic individuals without GI symptoms (22). A study suggests that behavioral changes such as aggression, self-harm or sleep disturbance observed in autistic children may be an expression of abdominal discomfort (23).

The intestinal microbiota performs many important functions in our body. First, it maintains the proper functioning of the intestines, ensuring proper pH, proper intestinal peristalsis, and regular bowel movement rhythm. Microorganisms colonizing the intestines not only participate in the digestion of food by secreting digestive enzymes or converting complex nutrients into simpler organic compounds and fat metabolism, but also contribute to the absorption of digested food. In addition to the functions mentioned above, the intestinal microbiota is also responsible for synthesizing some vitamins, especially the B group (24). Through anaerobic fermentation of indigestible carbohydrates (mostly dietary fiber), intestinal microorganisms produce short-chain fatty acids, which are the primary energy source for the epithelial cell of the colon (colonocytes) (25). Another important role of the intestinal microbiota is the neutralization of toxins and carcinogenic compounds (26). In addition, intestinal microorganisms protect our body against the penetration of pathogenic factors by creating the intestinal barrier (27). According to Azouz et al., it was reported that 82.5% of a group of 40 autistic children aged between 3 and 12 had gastrointestinal symptoms (28). Children with autism have a wide range of gastrointestinal symptoms, including constipation, diarrhea, bloating, abdominal pain, reflux, vomiting, excessive intestinal gas, foul-smelling stools, and food allergies (29). In the study conducted by Kang et al., it was determined that the low bacterial diversity found in autistic children was associated with the severity of gastrointestinal symptoms (2).

Otizmli hastaların sindirim sistemi problemlerini tedavi etmenin en etkin ve kalıcı yöntemi FLORA NAKLİDİR (30). Sağlıklı ve biyoçeşitliliği yüksek en az bir donörden yapılacak flora nakli ile hastanın sindirim sistemi mikrobiyotası yeniden tesis edilmiş olur. Flora nakli hakkındaki tüm teknik detaylara https://www.docdrmuratkanlioz.com/flora-nakli/ linki tıklayarak ulaşabilirsiniz.

Assoc. Prof. Murat KANLIÖZ

General surgery specialist

SOURCE:

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2. Kang D.W., Park J.G., Ilhan Z.E., Wallstrom G., Labaer J., Adams J.B., Krajmalnik-Brown R. Reduced incidence of Prevotella and other fermenters in intestinal microflora of autistic children. PLoS ONE. 2013;8:e68322. doi: 10.1371/journal.pone.0068322.
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30. Kanlioz M, Ekici U, Ferhatoğlu MF. Total Gastrointestinal Flora Transplantation in the Treatment of Leaky Gut Syndrome and Flora Loss. Cureus. 2022 Nov 3;14(11):e31071. doi: 10.7759/cureus.31071. PMID: 36475195; PMCID: PMC9720094.

It is an abbreviation consisting of the initials of the words Small Intestinal Bacterial Overgrowth. In Turkish, it means Excessive Proliferation of Bacteria in the Small Intestines.

What are the symptoms of SIBO?

• bloating in the abdomen
• cramps
• Diarrhea
• Constipation
• Sleeping disorder
• eating disorders
• Tension
• chronic fatigue
• excessive gas in the abdomen
• Burp
• Food intolerances (dairy, gluten, etc.)

How to Diagnose SIBO?

• SIBO breath test
• Microbial Analysis of Stool

What causes SIBO?

Due to SIBO, there are deteriorations in the functions of the intestines due to the colonization of more flora bacteria and pathogenic bacteria than should be in the small intestines. Deficiencies of many nutrients occur due to digestive and absorption disorders. The most common of these are chronic anemia due to vitamin and mineral deficiency, bone disorders (osteoporosis, etc.), joint and muscle pain. Nutritional disorders are observed because the food we eat is consumed by excessively increasing bacteria. It increases the tendency to diabetes. Since SIBO is an autoimmune disorder that develops secondary to the disruption of the digestive system flora, it paves the way for the formation of other autoimmune diseases (dermatitis, psoriasis, vitiligo, depression, autoimmune arthritis, food allergies, etc.).

How is SIBO treated?

In order to reduce the excessive bacterial load in the small intestines due to SIBO, long-term and multiple antibiotic treatments are applied to reduce bacterial colonization in the small intestines. In these treatments, patients feel good for a short period after the treatment. But the disease soon becomes the same or even more disturbing than before. The vicious circle created by continuous antibiotic treatment deepens further.

The underlying pathological process of SIBO disease is the decrease in biodiversity in the digestive system flora, the replacement of flora bacteria by pathogens (DYSBIOSIS), and the dominance of some flora members, disrupting the flora balance. It is not possible to restore these damages to the digestive system flora with antibiotic treatment. With each antibiotic treatment, the beneficial flora bacteria that overgrow and remain behind along with the pathogenic bacteria are also damaged, and SIBO becomes more insoluble.

The use of probiotics is recommended as another option in the treatment of SIBO. In recent years, the amounts of probiotics used by SIBO patients have reached the level of addiction. Probiotics relieve patients’ symptoms to the extent that they can mimic flora bacteria. The difference between flora bacteria and probiotics is that while FLORA BACTERIA resides in a certain region of the digestive system and lives by constantly renewing itself throughout life, PROBIOTICS are limited to the benefit they provide during their passage through the similar region in the digestive system and do not cling to the region they benefit from and colonize there. In short, PROBIOTIC can provide relief as long as it is used. In addition, PROBIOTICS contain steroids and steroid-like substances, although they are not stated in the package inserts. Therefore, it is controversial whether the benefit of probiotics is due to their microbial content or steroids. Another point is that almost all patients who use probiotics for a long time state that when they stop using probiotics, they are in worse shape than when they started. This situation is also called probiotic addiction.

Since SIBO is the result of damage to the digestive system flora, which is the beginning and gateway to an autoimmune process, and the accompanying “LEAKY GUT SYNDROME”, other autoimmune diseases are expected to develop after SIBO. The GOLD STANDARD treatment for flora damage, which is the source of SIBO disease, is “TOTAL GASTROINTESTINAL FLORA TRANSPLANTATION”

For TOTAL GASTROINTESTINAL FLORA TRANSPLANTATION, there must be at least one healthy donor. Flora samples are taken from a healthy donor under general anesthesia from 25-45 different anatomical regions by lavage method performed with endoscopy and colonoscopy. After the flora samples taken are subjected to certain procedures, endoscopy and colonoscopy are performed on the patient under general anesthesia, and flora is transplanted to the equivalent area of ​​the patient from whichever part of the donor the flora sample was taken.

Successful treatment rates with TOTAL GASTROINTESTINAL FLORA TRANSPLANTATION in SIBO disease are around 90%.

https://www.docdrmuratkanlioz.com/flora-nakli/

Assoc. Prof. Murat KANLIÖZ

General surgery specialist

We call the structure PILOR, which consists of a muscle bundle at the exit of the stomach, controls gastric emptying, prevents back leakage, is a kind of valve (valve), and is functionally a sphincter (contraction-relaxation). Our stomach is a preliminary storage area for the food we eat and drink. Food stored in the stomach undergoes chemical, physical and enzymatic digestion and is sent to the small intestines. After the digestion process of the food in the stomach, the stomach content becomes ready to be discharged into the small intestine. This pre-digested content of the stomach is called chyme. After chyme is formed, a warning goes from the stomach to the brain. This warning is the message that I have completed my pre-digestion, you can now empty the stomach slowly. Thereupon, with the signals coming from the brain, the stomach transfers approximately 50-75 cc of CHIMUS to the duodenum at 3-5 minute intervals with periodic movements of the stomach muscles, which we call milking contraction. Milking contractions of the stomach and simultaneous opening of the pylorus continue at rhythmic intervals until the stomach is emptied. After eating, the time that food spends in these processes in the stomach is 2-4 hours. Food is completely emptied from the stomach four hours after eating.

Storing, digesting and evacuating its contents at regular intervals in the stomach, as described above, is possible with the functional PILOR. Normally, simultaneously with the excretory (milking) contractions of the stomach, the pylorus relaxes and opens, and the stomach contents are transferred to the duodenum. However, the pylorus does not function functionally to the same extent in every person. During the endoscopy examination, if the pylorus is completely closed and there is no bile (green liquid) in the stomach, we define it as NORMOTONIC PYLORIS (normal structure). In people with normotonic pylorus, when the tip of the endoscope lightly touches the pylorus surroundings during endoscopic examination, the pylorus closes completely. During endoscopic observation, if the pylorus closes upon stimulation with the endoscope tip but remains partially open, we define this situation as HYPOTONIC (Partially Closing) PYLOOR. In cases of hypotonic pylorus, partially bilious content can be observed in the stomach. In the endoscopic examination, if the pylorus is completely open and does not contract or close at all with the mechanical stimulation made around the pylorus with the endoscope tip, this situation is called ATONIC (non-functional) PYLOOR. In cases of atonic pylorus, bilious content is often found in the stomach.

In order to understand the mechanism of Alkaline Reflux Gastritis formation, we need to briefly talk about bile and gallbladder functions. Approximately 1000-1500 cc (1-1.5 liters) of bile is produced by the liver per day. The bile produced flows into the duodenum through the bile ducts. The place where it flows into the duodenum is approximately 10-12 cm ahead of the stomach exit. Bile, which is normally produced and flowed into the duodenum through the bile ducts, does not pass directly into the duodenum. There is a GALLBLADDER on the bile duct, which is the primary storage site for bile. Bile is produced continuously from the liver, regardless of the foods we eat, but bile flow to the duodenum increases or decreases depending on the need for bile from the foods we eat. Normally, the bile produced during the day first comes to the GALLBLADDER and is concentrated tenfold (1/10) and stored there. After this concentration, 1000-1500 cc of bile turns into 100-150 cc of concentrated bile and as a result, the amount of bile flowing into the duodenum is 100-150 cc. In cases where the volume to concentrate and store bile from the liver decreases due to stones or other formations in the gallbladder, the volume of bile flowing into the duodenum increases. In people with gallstones, a higher volume of bile (150 cc ↑) will flow into the duodenum compared to normal people, and accordingly, more ALKALINE REFLUX GASTRITIS will be observed in these people than normal. In people whose gallbladder has been removed in some way, bile flows directly into the duodenum without any concentration, independently and uncontrolled from our eating and drinking periods. Thanks to the gallbladder, the speed of passage of stomach contents into the duodenum and the need for bile of the stomach contents passing into the duodenum are determined and concentrated bile is transferred to the duodenum as much as necessary. After the gallbladder is removed, 1000-1500 cc of bile, 10 times the normal volume, continuously flows into the duodenum without any perception of need. That’s why people with hypotonic and atonic pylorus typically state that their complaints ease when they eat and increase when they starve. However, in advanced cases, complaints become persistent regardless of hunger and satiety.

When most of the volume of the gallbladder is occupied by stones and cannot provide adequate storage and concentration, or when the gallbladder is removed for any reason, due to the increase in the volume of bile flowing into the duodenum, bile leaks back into the stomach more intensely in people with HYPOTONIC and ATONIC pylorus, and they experience ALKALINE REFLUX GASTRITIS. emerges or the existing situation becomes even more severe. The biochemistry of the stomach is an acidic environment (pH: 1.5-2), while the duodenum is basic (alkaline) (pH: 8). If duodenal contents leak into the stomach, which is used to an acidic environment, it will cause BASIC CHEMICAL BURN in the stomach. Basic burn is the same type of damage and burn caused by bleach. This situation occurs as a result of PILOR function deficiency.

In people with ATONIC pylorus, bile leakage into the stomach occurs even if there are no stones in the gallbladder or if the gallbladder is not removed. The rate of ATONIC pylorus in the society is 3-5%. Bile leakage is also observed in people with HYPOTONIC pylorus, although less frequently than atonic ones, under normal conditions. The rate of HYPOTONIC pylorus in the society is about 8-10%. However, in patients with ATONIC and HYPOTONIC pylorus, severe ALKALINE REFLUX GASTRITIS due to bile leakage occurs after the gallbladder is removed and this rate is approximately 15%. In these cases, an attempt is often made to reduce the complaints by giving medication. However, in cases where drug treatment is insufficient, surgeries are performed to prevent duodenal content from leaking into the stomach. With the surgery called “Duodenal Switch”, bile leakage into the stomach is prevented. However, this surgery is an extremely complex, anatomically disruptive and risky procedure. It should be used as a last resort.

As a surgeon who has performed “Duodenal Switch” surgery on ALKALINE REFLUX GASTRITI patients for years, I developed the method I call “PYLOOR REVISION” after my clinical research on whether there could be a simpler method for this. I published my clinical research results in peer-reviewed American Medical Journals.

https://link.springer.com/article/10.1007/s11695-020-04556-7

https://www.cureus.com/articles/148649-a-new-and-effective-technique-in-the-endoscopic-treatment-of-obesity-and-regulation-of-diabetes-the-pyloric-revision#!/

With “PYLORIC REVISION”, leakage in the pylorus is prevented by endoscopically filling injections around the pylorus in cases with atonic and hypotonic pylorus. The procedure is completed in approximately 20 minutes under sedation, without the patient feeling anything. 2 hours after Pyloric Revision, people can continue their daily lives without any restrictions. Maximum effectiveness occurs 24-48 hours after the procedure is applied. The injection filling material does not cause any temporary or permanent harm to the patient.

In our academic clinical studies, the effectiveness of the “Pyloric Revision” performed in the control endoscopy of the patients to whom we performed “Pyloric Revision” during an average follow-up period of 32 months still continues in 92% of the patients.

If no longer effective cases are detected, repeat endoscopic pyloric revision does not have any side effects.

“PYLORIC REVISION” is a very important development in the treatment of ALKALINE REFLUX GASTRITIS in that it is fast, simple, cheap, risk-free, repeatable and non-surgical.

Assoc. Prof. Murat KANLIÖZ

General surgery specialist

The most basic feature of our intestines is that they do not allow all the food we eat and drink to be absorbed from the intestines and pass into the bloodstream. This feature of our intestines is called SELECTIVE PERMEABILITY. Healthy intestines absorb the elements we need and will not harm us. The foods we eat are broken down and separated into basic building blocks by going through a number of enzymatic, mechanical, biological and chemical processes. Only after food is digested in this way, it is absorbed from the intestines and mixed into the bloodstream, and reaches the relevant areas needed by the body through the bloodstream. Each digested food is absorbed from its own specific parts of the intestine. The intestinal surface where absorption takes place is called MICROVILLUS. There are a number of basic requirements for the microvilli, where selective permeability takes place, to function fully and completely. Microvilli are covered with a gel-like structure secreted from the intestines and this is called MUCUS. Thanks to mucus, microvilli are protected from direct contact with intestinal contents. Just as our digestive system secretions digest the food we eat, without the protection of mucus, it begins to damage its own tissue.If there is no mucus secretion or if it is unhealthy, damage (ulcer, wound) occurs in the microvilli after direct contact with intestinal secretions and the foods we eat, and sometimes if this damage is long-term, the damage to the microvilli areas results in irreversible loss of absorption surface. The average length of our small intestines is 8-10 meters, and its internal surface area (absorption surface) is 18000-22000 square meters. The fact that the inner surface of our small intestines has an area as large as a giant Olympic stadium is extremely important for intestinal functions. This entire area is covered with microvilli. If the microvilli structure comes into contact with the intestinal content, it begins to lose its absorption and selective permeability properties. If the contact is prolonged, the microvilli structure in these areas turns into dysfunctional fibrotic structures, this is called VILLUS ATROPHY and is an irreversible process. For the microvilli to be functional, FLORA bacteria (beneficial microbes) that are specific to every part of the intestine, except for the mucus secretion, are needed. FLORA is indispensable for the mucus that covers the microvilli as a protective layer to be healthy, functional and sustainable.

The combination of microvilli, mucus and flora bacteria are the basic building blocks in protecting the intestinal absorption surface and ensuring SELECTIVE PERMEABILITY. The triggering factor in the disruption of selective permeability often begins with the disruption of the intestinal flora. In the absence of flora or when pathogens take its place, healthy mucus production cannot occur, and as a result, selective permeability is disrupted after damage to the microvilli. After selective permeability is impaired, products that should not pass from the intestines to the bloodstream (macro molecules, toxins, microbes, etc.) begin to pass. Therefore, the general name of these diseases is called LEAKY GUT SYNDROME.

Some of the diseases evaluated under the title of Leaky Gut Syndrome are; Celiac Disease, Gluten Allergy (Celiac Like Syndrome), Lactose Intolerance, Food Allergies, Ulcerative Colitis, Crohn’s Disease, Chronic Diarrhea, Chronic Nonspecific Colitis, SIBO, Dysbiosis etc. All of these diseases cause damage to the digestive system flora. Most often, the main factor that triggers the emergence of the disease is the weakening or complete or partial disappearance of the digestive system flora.

As a result of Leaky Gut Syndrome, after the intestine loses its selective permeability, many things that should not pass into the bloodstream begin to pass. Our body’s defense system cells make an intense effort to clear them from the bloodstream. As permeability increases and the duration of the event becomes longer (chronic), our defense system begins to tire and lose coordination, after a while, the perception of what it needs to destroy is impaired and it perceives the body’s own tissue as foreign and harmful and begins to attack those places, this situation is called AUTOIMMUNITY.

Leaky Gut Syndrome and other AUTOIMMUNE diseases that develop together seriously affect the quality and duration of life. One of the most important gateways to the onset of autoimmunity is the intestines and the Leaky Gut Syndrome that develops together. After Leaky Gut Syndrome occurs, autoimmune diseases begin to emerge one by one. An autoimmune disease prepares the ground for the occurrence of other autoimmune diseases, that is, makes it easier. The main autoimmune diseases involved in the process are; Hashimoto’s Disease; Fibromyalgia, Autoimmune Arthritis; GUT Disease, Psoriasis, Rose Disease, Behcet’s Disease, IBS, Depression, Vitiligo, Dermatitis etc.

The first and basic treatment in the treatment of Leaky Gut Syndrome is the restoration of the damaged intestinal flora. The most definitive and permanent treatment for the restoration of the digestive system flora is TOTAL GASTROINTESTINAL FLORA TRANSPLANTATION.

TOTAL GASTROINTESTINAL FLORA TRANSPLANTATION is performed by taking donors with healthy digestive system flora. Flora transplantation is performed by performing endoscopy and colonoscopy under general anesthesia from at least one healthy FLORA DONOR, from approximately 25-45 different anatomical regions of the digestive system, washed with serum suitable for the habitat of each region, the washing liquid is taken back and flora samples taken from each region are obtained after special processing. It is the process of transferring healthy FLORA colonizations from whichever part of the donor they were taken to the equivalent anatomical parts of the patient, endoscopically and colonoscopically, under general anesthesia.

The earlier Leaky Gut Syndrome is treated with the FLORA Transplantation method, the higher the treatment success rate will be. Because microvilli atrophy (absorption surface loss) that develops due to the disease is irreversible. Even if treatment is performed with Flora Transplantation, for example, if the intestinal absorption surface area of ​​22000 square meters has decreased to 14000 square meters, no treatment can increase the surface area even by 1 square meter. The aim is to protect the remaining reserves. Because if this area falls below a certain threshold value, the benefit from the treatment will be limited.

Assoc. Dr. Murat KANLIÖZ

Flora Transplantation Institute

Throughout our digestive system, from the mouth to the anus, there are dozens or even hundreds of varieties, each with very specific functions (digestion, metabolism, defense, etc.), where we host them, and where we face serious health problems if they are not present or their biodiversity decreases. We live in harmony and balance with BENEFICIAL MICROBES. All of these are called “DIGESTIVE SYSTEM FLORA”. The more diversity of our flora, the healthier we are, but if it decreases or its proportional balance is disrupted (SIBO, GBS, Dysbiosis, etc.), we will experience serious health problems. It is not possible to live if there is no flora.

The formation of our flora begins with birth and gradually becomes richer. However, while the flora of some may be very rich, some may not be so lucky. Because each of us has our own special conditions regarding the factors that play a role in the formation of flora biodiversity. The main ones are; Our genetic background, the conditions we are exposed to during pregnancy, the mother’s diseases and nutrition, the type of birth (normal birth – caesarean section), the flora quality of the people you are in close contact with and the environment, nutrition, environmental factors, the diseases you have experienced, the duration of breastfeeding, long-term hospitalization. There are many factors such as our condition, antibiotic use, cancer treatment, etc.

From time to time, infectious diseases, antibiotic use, temporary cessation of oral nutrition (intensive care, surgery, etc.), cancer treatments, etc. occur in all of our flora. In such cases, damage may occur to our flora. However, these damages usually resolve spontaneously. The remaining flora reproduces and continues to maintain its old functions. The emergence of our complaints is directly proportional to how much our biodiversity decreases after the damage to our flora. The decrease in biodiversity means the complete and permanent extinction of some of the FLORA members that were in our digestive system in the past. The functions of this vanished FLORA element will no longer be realized, and it will be compensated as much as possible by other remaining flora elements. As a result, there will be deterioration in digestive system functions and quality of life. The findings of the decrease in biodiversity and our awareness of this depend on our threshold of tolerance. But there comes a point when biodiversity decline is neither tolerable nor sustainable for any human being.

In the light of this information, the answer to the question of how to improve the intestinal flora is:

• First of all, we must protect our flora well. For this:
• We should not use uncontrolled drugs (especially antibiotics)
• We should breastfeed for at least a year after birth
• We should have a balanced and regular diet
• We should avoid processed foods
• We should not use medicines or additives upon recommendations.
• We should avoid cesarean birth except in cases of necessity.
• We must be protected from environmental pollutants (chemical, biological and physical)
• We must avoid contact with agricultural pesticides.
• We should avoid long periods of fasting (more than 24 hours)
• We must take actions that will enrich our flora. These:
• We must strengthen our flora with PREBIOTIC (fibrous foods, garlic, celery, etc.)
• By feeding natural probiotics (yoghurt, pickles, vinegar, kefir, etc.), we should relieve our flora and prepare an environment for its enrichment.
• We must ensure that babies and children are together with their healthy peers for a long time. Because we enrich our flora with close contact with healthy flora.
• We should eat natural minerals, vitamins and proteins.

However, despite all the enrichment efforts, the critical threshold was exceeded and FLORA BIODIVERSITY decreased, the proportional balance was disrupted, Leaky Gut Syndrome occurred, food allergies started (Gluten, Lactose, spices, nuts, etc.), additional autoimmune diseases occurred (autoimmune joint disorders, Psoriasis, Vitiligo). If one or more of the symptoms such as , Hashimoto, etc.), chronic fatigue, fibromyalgia, depression, emotional disorder, etc. occur, the only thing to do in the next step is FLORA TRANSPLANTATION.

For Flora Transplantation, with the flora transplantation from a healthy, high-quality, high-biodiversity DONOR or DONORS, healthy flora is regained and accompanying diseases are treated. The most important element in flora transplantation is to perform FLORA TRANSPLANTATION before the remaining intestinal reserve reaches the irreversible stage.

If the damage to the flora is not restored spontaneously or by flora transplantation, SIBO and Dysbiosis will inevitably occur. SIBO or Dysbiosis does not occur in people who have a healthy and high biodiversity flora. Healthy FLORA is the most important barrier to disrupting the flora balance and changing it in favor of pathogens.

Assoc. Dr. Murat KANLIÖZ

Flora Transplantation Institute

*What is Flora?

*What is Flora Biodiversity and Why is it Important?

*How is our flora formed from birth?

*What is the Life Cycle of Our Flora?

*What are the factors that harm our flora?

*How Can We Protect and Enrich Our Flora?

*Our “Genetic Memory” in Increasing Flora Biodiversity

WHAT IS FLORA?

They live with us in certain parts of our body (skin, external ear canal, mouth, nose, intestines, etc.), where we host them, which contribute to the humidity, acid balance, biochemical and enzymatic functions of the region where they are located, and at the same time protect the areas where they are located from pathogenic microorganisms. The common name for all USEFUL MICROORGANISMS (Microbes) that protect against diseases is FLORA. Our flora in the area from the mouth to the anus is called DIGESTIVE SYSTEM FLORA.

 WHAT IS FLORA BIODIVERSITY AND WHY IS IT IMPORTANT?

More than 1000 different flora bacteria have been identified throughout the entire digestive system, from the mouth to the anus. The region where each flora bacteria settles and lives in the system is different. At the same time, the function of each flora element is unique and vital. Having more than 1000 species of biodiversity in a human digestive tract is wonderful, but not even utopianly possible. On average, in Türkiye’s geography, this biodiversity is 100-120 in rural areas, while it is around 50-60 in metropolises. Biodiversity should not be confused with the number of flora and bacteria. The number of flora bacteria we have throughout our entire digestive system is approximately 100 times greater than the number of all cells in our body. I think the importance of flora is better understood with these numbers. We contain millions of each type of flora in our intestines. We can think of our digestive system as a FACTORY and the flora as specialized WORKERS or ENGINEERS. There is no doubt that the more different specialized departments a factory has, the more quality products will come out of that factory. In other words, the better the quality and sufficient number of our flora biodiversity, the HEALTHIER, COMFORTABLE, HAPPY, PRODUCTIVE, SUCCESSFUL and LONGER we live.

HOW IS OUR FLORA FORMED FROM BIRTH?

Flora follows a process that begins before birth and enriches with birth. The mother’s health status, especially the medications used during pregnancy (antibiotics, corticosteroids, chemotherapeutic agents, etc.), nutritional status, radiation, existing diseases, habits (alcohol, drugs, smoking, etc.) are important factors that affect the baby’s flora before and after birth. The type of birth is an important factor in the acquisition of flora. Normal birth (vaginal birth) is an extremely important process in the baby’s flora acquisition. Birth takes approximately 2-8 hours, and the entire process allows the baby to come into contact with and gain new flora. Births by cesarean section do not benefit from this flora acquisition process, and this deficiency continues throughout life. In the postnatal period, the family in which he was born and lived, especially his mother, are the most important sources for him to gain flora. Being born into a family with a large and high-quality flora is an invaluable asset for acquiring flora. The diversity of flora we acquire, especially in the first two years after birth and until the age of seven, is extremely important in our lives. The people we come into contact with outside the family, the animals, nature, the quality of our diet, and the diversity of our diet help shape our flora.

WHAT IS THE LIFE CYCLE OF OUR FLORA?

Our flora goes through a dynamic process. It is alive, it constantly renews itself, and like us, it needs certain conditions to survive. During the day, old and dead members of our flora naturally pass through the digestive system and are excreted through feces. Approximately 60% of our stool volume consists of dead and living flora waste. Since Flora constantly renews itself, no deficiency is felt. This cycle continues throughout life and we wake up every day with new, vibrant and healthy flora. While almost all of our previous flora is excreted through the feces, we have a renewed flora every day, and this non-stop process continues throughout our lives. OUR FLORA is both protected and nourished by the secretions of the region where it is located. In addition, the foods we consume are also a source of nutrition for our flora.

WHAT ARE THE FACTORS THAT DAMAGE OUR FLORA?

The most important factor that harms our flora is our failure to provide adequate nutrition. Like us, our flora also has a limit to how it can withstand hunger. Other factors that harm our flora can be listed as poor nutrition, alcohol, smoking, food quality, etc.

Stopping oral feeding for a long time for some reasons may cause flora damage and sometimes this damage may be permanent. The most typical examples of this situation are chronic hunger due to inability to access food, inability to take oral nutrition during intensive care treatments, and long-term cessation of oral nutrition due to surgical procedures.

While the antibiotics we use for disease destroy the disease-causing microbes, they also harm our flora. Although many factors damage our flora, the greatest proportional damage is caused by the antibiotics used.

Drugs under the title CORTICOSTEROIDs, which are used for many diseases, also have a serious role in causing flora damage. In addition, this group of drugs is generally used for a long time and the damage to the flora is irreversible.

Chemotherapy drugs and radiation used in cancer treatment also cause irreversible damage to the flora.

Another topic is AGRICULTURAL DRUGS (Pesticides), which, although not brought to the agenda as much as the ones mentioned above, are at least as harmful and to which we are exposed most of the time without even realizing it.

Apart from this, water and air pollution, industrial pollution, smoking, ionizing radiation, biological and chemical pollution, which we can evaluate under the heading of environmental pollution, are also important factors in causing flora damage.

Another important factor in the deterioration of the intestinal flora is CHRONIC DIARRHEA.

HOW CAN WE PROTECT AND ENRICH OUR FLORA?

How We Protect:

• By not using antibiotics and corticosteroids without the supervision of a physician.
• By eating as natural as possible.
• By purifying the food we consume from pesticide residues
• By eating a balanced and quality diet.
• With less exposure to environmental pollution.
• By avoiding ionizing radiation.
• By exercising regularly.
• By staying away from cigarettes and alcohol.
• By taking protective measures in the environments where we work or live.

How can we enrich:

• By breastfeeding for at least one year from birth.
• By ensuring close contact with as many healthy peers as possible in the first seven years of age.
• By encouraging normal birth (vaginal).
• By traveling to many different geographies and getting acquainted with the nutrition culture.
• By consuming natural foods that will give us new flora (sourdough products, vinegar, pickles, kefir, yoghurt, cheese, tarhana, sausage, etc.)
• When necessary, by performing “FLORA TRANSPLANT” from healthy people.

“OUR GENETIC MEMORY” IN INCREASING FLORA BIODIVERSITY

Our genetic memory recognizes the FLORA BACTERIA, which has been identified in the digestive system to date but has never been hosted in our body before, and when it reaches a localization where it can survive, it clings to that region, multiplies and colonizes there, and enables it to function for life as a new flora member of the digestive system. As long as we come into contact with a new flora bacterium, our genetic memory somehow takes care of the rest and increases our flora biodiversity.

Assoc. Dr. Murat KANLIÖZ

Flora Transplantation Institute

Irritable Bowel Syndrome, also known as IBS (Irritable Bowel Syndrome), is a common disease that we encounter with a rate of up to 20% in the adult age group. Irritable Bowel Syndrome is evaluated in the literature as an IDIOPATHIC (cause unknown) disease group. It is more common in women.

What are the Symptoms of Irritable Bowel Syndrome?

The most common findings in Irritable Bowel Syndrome are excessive intestinal gas, abdominal pain, intestinal discomfort, constipation, diarrhea, occasional periods of alternating constipation and diarrhea, and defecation in the form of goat dung (like olive grains). A significant portion of patients are described as having partial relief after defecation.

What is the Treatment for Irritable Bowel Syndrome?

Definitive treatment of Irritable Bowel Syndrome with medications has not been defined. Additionally, there is no specific diet for Irritable Bowel Syndrome. Not every diet provides relief for every patient. However, it is observed that fennel, mint and chamomile teas relieve patients. In Irritable Bowel Syndrome, it is observed that gluten (wheat, barley, etc.) and lactose (milk, cheese, etc.) products, as well as eggs, orange, lemon and black tea, trigger or increase complaints in many patients. All kinds of stress increases the symptoms of “Irritable Bowel Syndrome”. Sometimes, due to psychological disorders that we cannot resolve, it is important to get support from psychologists and/or psychiatrists, who are experts on the subject, in the treatment of the disease.

Why Are People With Irritable Bowel Syndrome “Always Unhappy”?

Abdominal pain, gas, diarrhea, constipation, insomnia, malnutrition, which are the symptoms of Irritable Bowel Syndrome, are the causes of tension and unhappiness. Another reason that is as important as these is that the protein called “ZONULIN” is consumed intensively to repair the uncontrolled passage from the intestine to the bloodstream in “Leaky Gut Syndrome”, which develops due to flora damage. Normally, 95% of the protein called Zonulin is used in the establishment and replacement of nerve conduction networks in our body. However, as too much zonulin is consumed in the intestines due to the “Leaky Gut Syndrome” that develops in the intestines, the needs of our nervous system cannot be met and accordingly, “PSYCHOLOGICAL DISORDERS” occur. In addition, our intestines are the areas where 70% of “ENDORPHINS”, the hormones that make us happy, are produced. Another source of UNHAPPINESS is the intestines that do not work properly and cannot produce enough endorphins.

What Causes Irritable Bowel Syndrome?

Irritable Bowel Syndrome disrupts sleep quality, causes chronic fatigue, tension, unhappiness, and decreases in work and academic success. Along with chronic fatigue, muscle-joint disorders and fibromyalgia are the inevitable result. Accordingly, if patients with “Irritable Bowel Syndrome” are not treated, they will live an UNHAPPY, UNRESTABLE, LOW WORK AND ACADEMIC SUCCESS, and a poor quality life.

Are There Factors That Trigger Irritable Bowel Syndrome?

In clinical studies, the majority of patients suffering from “Irritable Bowel Syndrome” live under stressful living conditions in cities and metropolises, are more exposed to environmental pollutants, consume more industrial foods (ready and processed foods), consume more genetically modified foods (especially milk). products (wheat and corn) and consume more products exposed to pesticides. We encounter “Irritable Bowel Syndrome” at a much lower rate in rural areas, where traditional agricultural methods are used, and in places far from industrial areas.

What is the “Relationship of Irritable Bowel Syndrome with Our Intestinal Flora”?

The environmental pollutants (air, water and food pollution) we are exposed to in the metropolises where we live in Irritable Bowel Syndrome are extremely harmful to intestinal FLORA health. In many studies, digestive system flora biodiversity has been observed to decrease in cities and metropolises. The richer our digestive system FLORA BIODIVERSITY is, the better the quality of digestive system functions. In the “Microbial Analysis of Stool” performed in Irritable Bowel Syndrome, it is observed that there are serious decreases in the biodiversity of the digestive system flora and selective permeability is impaired. Therefore, we recommend enriching the digestive system flora in cases of Irritable Bowel Syndrome. This enrichment can be possible by consuming natural foods, staying away from environmental pollutants as much as possible, not using unnecessary drugs (especially antibiotics, steroids, etc.), and staying away from alcohol and cigarettes. In addition to these, we also make a PROBIOTIC contribution by consuming foods such as yoghurt, kefir, pickles, vinegar, etc., which can be made at home using natural products.

What is “Flora Transplant” in Irritable Bowel Syndrome?

In patients with Irritable Bowel Syndrome, “Total Gastrointestinal Flora Transplantation” from at least one healthy donor in cases where a decrease in flora biodiversity is detected by performing “Microbial Analysis of Stool”, reduces the complaints significantly. Since the aim of “Total Gastrointestinal Flora Transplantation” is to increase the biodiversity of the digestive system, the more quality and multiple donor transplants are made, the more success will be achieved. If Flora Transplantation is performed from a quality donor pool, success rates are over 85%. FLORA TRANSPLANTATION performed in a single session does not require any additional treatment and can be a permanent solution for life, unless there are extraordinary circumstances.

WHAT ARE THE SYMPTOMS?

HOW IS IT DIAGNOSED?

HOW IS IT TREATED?

The disease, in its current sense, was first described in 1932 by American “Dr. It was named CROHN’S DISEASE because it was defined by Bernard Burrill CROHN and introduced into the medical literature.

CROHN’S DISEASE is a disease considered in the inflammatory bowel diseases group. This inflammation is an AUTOIMMUNE reaction, where our defense system perceives the body’s own tissues as foreign-harmful and attacks them. IN CROHN’S DISEASE, regional thickening and narrowing occur in the areas involved with the involvement of the inner surface of the digestive system, sometimes ulceration (wound) and granuloma (mass) may also be added to these. Involvements are skip areas and tend to involve more than one area, and these affected areas can vary from a few centimeters to a meter. In CROHN’S DISEASE, involvements can occur in every region from the mouth to the anus, but they are mostly observed in the last parts of the small intestines (distal ileum) and the beginning of the large intestine (colon) (cecum), and this region is called the ileocecal region. Along with thickening and stenosis due to inflammation in the involved area, swelling due to inflammation may also be observed in the regional LYMPH NODES.

CROHN’S DISEASE mostly occurs between the ages of 35-40. There is no obvious gender difference. However, it can also be encountered in earlier and later periods. In the medical literature, it is evaluated in the IDIOPATHIC disease group (cause unknown). However, in CROHN’S DISEASE, family accumulation, that is, genetics, is an important factor. There is a consensus that hereditary and environmental factors play a role in CROHN’S DISEASE. In addition, although the disease is often observed after a triggering traumatic process (severe infection, severe depression, cancer treatment, chemotherapy, etc.), it can sometimes occur even when there is no obvious reason.

CROHN’S DISEASE progresses with recovery (remission) and exacerbations (active disease). Providing long remission is extremely vital in the treatment of CROHN’S DISEASE. Because in each exacerbation period, the thickening and narrowing in the previous affected areas increases, and more importantly, new areas of involvement are formed.

In CROHN’S DISEASE, complete or near-complete obstruction in the intestines may be observed due to stenosis in the affected area. In this case, the only treatment is to surgically remove the narrowed area and restore intestinal fluidity. Due to the stenosis in the retained intestinal segment and the complication we call FISTULA (tunnel), there may be problems between the intestines (entero-enteral fistula), between the intestine and the anus (perianal fistula), between the intestine and the abdominal wall (entero-cutaneous fistula), between the intestine and the vagina (entero-vaginal fistula). etc. may develop. Due to this fistula, the intestine flows into the area where the fistula opens through a tube and causes complications. FISTULA cases in CROHN’S DISEASE are extremely resistant to treatment and tend to fistulize again from the same place or another place after treatment.

Another possible complication in CROHN’S DISEASE is FISSURE (crack) around the anus and ANAL ABSCESS. Fissure and anal abscess, just like fistula, are extremely resistant to treatment and their recurrence rate is extremely high.

WHAT FINDINGS SHOULD WE SUSPECT CROHN’S DISEASE?

• Long-standing abdominal pain, intestinal irritability and nausea
• FIRE that has not decreased for a long time and whose reason cannot be explained
• Persistent oral sores
• BLOOD in the stool
• MUCUS (slimy) appearance in the stool
• Resistant DIARRHEA
• Sometimes constipation in older ages
• Feeling of frequent defecation (tenesmus) and feeling of incomplete evacuation after defecation
• Anemia
• chronic fatigue
• Loss of appetite and weight loss
• Resistant anal fissure (anal fissure)
• Anal fistula (discharge of feces and/or gas from the side passage other than the anus)
• Anal abscess (anal abscess)
• Those who have had other autoimmune diseases in the past have these findings

HOW IS CROHN’S DISEASE DIAGNOSED?

The patient’s complaints should be listened to very carefully by a physician experienced in his field. The detailed questioning that follows is extremely valuable for diagnosis. With the physical examination, it is evaluated whether there are wounds in the mouth, anal fissure, anal fistula, anal abscess, any skin lesions, nail and skin findings, anemia, swelling in the regional lymph nodes, abdominal tenderness, etc. Then blood tests are performed to monitor the AUTOIMMUNE reaction, blood table and other parameters. Endoscopy and colonoscopy are extremely valuable in diagnosis and are the most important in making the diagnosis. In the endoscopic-colonoscopic examination, finding regional stenosis, tissue thickening, and occasionally ulceration and granuloma formations are specific findings for diagnosis. In addition, BIOPSY (small sample taking) from the areas where findings are detected allows the diagnosis to be confirmed. Contrast-enhanced MRI (magnetic resonance imaging) is important in making the diagnosis and especially in identifying fistulas.

HOW IS CROHN’S DISEASE TREATED?

In CROHN’S DISEASE, treatment is evaluated in two parts: suppression of inflammation during exacerbation periods and treatment of complications (intestinal obstruction, fistula, fissure, abscess, etc.).

Many immunosuppressive drugs are used to suppress the AUTOIMMUNE reaction during the exacerbation (attack) period. While these drugs suppress the autoimmune reaction, they also cause irreversible damage to the FLORA structure of the digestive system.

The only treatment for FISTULA, FISSURE, ANAL ABSCESS AND INTESTINAL OBSTRUCTION, which are complications of CROHN’S DISEASE, is SURGERY.

The most important and critical thing in CROHN’S DISEASE is to diagnose the disease early and start treatment as soon as possible. The longer and more severely people suffer from the disease, the more irreversible complications occur.

For these reasons, providing the longest possible REMISSION (well-being, disease-free period) periods and the least EXCREASE (attack) periods constitute the basis of the treatment. Because each attack means new areas of involvement and increased complications of existing areas.

Due to the current treatment methods and the medications given to suppress the disease, our digestive system FLORA is further damaged. All research shows that the weakening of the digestive system flora is an important triggering factor in the emergence of CROHN’S DISEASE. OUR FLORA, which has been weakened by suppression treatments, suffers further damage (its biodiversity decreases and sometimes disappears partially or completely), resulting in a vicious circle.

Disruption of the DIGESTIVE SYSTEM FLORA and decrease in biodiversity disrupts the selective permeability of the digestive system and causes LEAKY GUT SYNDROME. Leaky Gut Syndrome is one of the most important factors for the onset of AUTOIMMUNISM. The occurrence of any autoimmune disease accelerates and facilitates the occurrence of other autoimmune diseases. CROHN’S DISEASE is also an autoimmune disease.

According to the examinations, if the damage to the digestive system flora is treated with TOTAL GASTROINTESTINAL FLORA TRANSPLANT from a healthy donor and healthy flora with high biodiversity is introduced, TRAYY GUT SYNDROME can be treated.

Clinical research shows that patients diagnosed with CROHN’S DISEASE often have moderate to severe damage to their digestive system flora. TOTAL GASTROINTESTINAL FLORA TRANSPLANTATION performed on these patients provides serious remission (improvement) and long remission periods. Therefore, complications arising from CROHN’S DISEASE (intestinal obstruction, fistula, fissure, abscess, etc.) are reduced in patients with fewer attacks.

Another currently popular treatment for CROHN’S DISEASE is the method known as GAITA TRANSPLANTATION or FECAL MICROBIAL TRANSPLANTATION (FMT). Stool (stool) taken from a healthy donor and subjected to certain procedures is colonoscopically transplanted to the large intestine of the patient. FMT procedure is also an effective method in the treatment of CROHN’S DISEASE. However, TOTAL GASTROINTESTINAL FLORA TRANSPLANTATION is the GOLD STANDARD treatment for Crohn’s Disease.

Spastic Colitis, also known as Irritable Bowel Syndrome (IBS) or Irritable Bowel Disease, is defined as a functional disease for which no organic cause can be identified. The most important symptoms in patients are abdominal pain, especially after meals, but most of the day, intestinal discomfort, excessive bloating, excessive intestinal gas, defecation disorders (diarrhea, constipation, defecation like goat dung, normal defecation from time to time), and indigestion.

Spastic Colitis is seen in approximately 15-20% of the population. This disease is more common in women than men. Spastic Colitis is becoming more common all over the world every year. Stress is shown to be the most important triggering factor in Spastic Colitis cases. At the same time, since the disease itself produces serious stress, it is controversial whether the disease is caused by stress or whether stress is the source of the disease. It is observed more frequently in sensitive people. It causes significant workforce loss and disrupts social life.

Our digestive system, and especially our intestines, have a very serious nerve network. The first organ that is affected by any physical, psychological or social stress we experience is our intestines. We all know very well that; If we feel a little upset, the first thing we lose is our appetite, and sometimes nausea and abdominal pain are added to this. Even in a simple flu infection, the first thing we lose is our appetite and we experience intestinal discomfort. Our intestines are the most important production site of endorphins (happiness hormones), which are the hormones that make us feel happy. Therefore, any negativity in the intestines will affect endorphin production, triggering restlessness, unhappiness and depression.

Chronic fatigue is very common as the symptoms experienced due to spastic colitis not only reduce work and school success, but also reduce quality sleep time. Stomach ulcer, reflux esophagitis, dyspepsia, headache, fibromyalgia, chronic headache, migraine, attention disorder, learning disability, diabetes, sexual dysfunction, tendency to inflammation, hemorrhoids, anal fissure, tinnitus, malignancy due to increased stress due to spastic colitis. and many other diseases are more common in people with spastic colitis.

The most important finding detected in spastic colitis patients in our clinical research is the decrease in the biodiversity of the digestive system flora. There is a significant relationship between the decrease in biodiversity and the increase in spastic colitis. Significant regressions are achieved in spastic colitis cases with treatments aimed at increasing biodiversity.

With industrial development, the disease has increased like an avalanche and still continues to increase. As the majority of the world’s population began to live in cities and metros, especially in the second half of the twentieth century, exposure to environmental pollutants (air, food and water pollution), genetically modified food consumption, agricultural chemicals and the increase in ready-made food consumption primarily cause damage to our digestive system flora. All studies show that the greater the biodiversity of our digestive system flora, the more resistant we are to digestive system disorders. Spastic Colitis is much less common in people with high flora biodiversity.

There are more than a thousand flora bacteria identified in the human digestive system to date. We observe that the diversity of digestive system flora increases as we move to rural and areas far from industrial production, and the flora biodiversity decreases as we move to industrial zones and metropolises.

There are different flora elements in every region of the digestive system, from the mouth to the anus. These have many functions such as combating pathogenic microbes in the region where they are located, acid-base balance of the region, humidity, biosynthesis, detoxification, digestion, etc. We contain dozens or even hundreds of types of flora bacteria throughout the digestive system. Each flora element is specific to its own region and does not survive or survive in another region. Like hundreds of departments in a very complex factory, there are hundreds of regions where different functions occur throughout the digestive system. Each type of flora is a colonization of millions of members in the region where it lives. FLORA renews itself many times during the day, and the flora members that have expired are naturally excreted as feces. 60-70% of the fecal volume consists of dead and living flora waste.

Since a serious decrease in flora biodiversity is often observed in the disease called spastic colitis, IBS or irritable bowel syndrome, the most permanent and effective solution in the treatment is FLORA TRANSPLANTATION…

Total gastrointestinal flora transplantation from a healthy donor with high biodiversity provides serious regressions in SPASTIC COLITI cases.

• What is the digestive system flora?
• What is the diversity and importance of digestive system flora?
• How is our flora formed?
• How does our flora deteriorate?
• How can we enrich and/or protect our flora?
• What does SELECTIVE PERMEABILITY of our intestines mean?
• What happens when the SELECTIVE PERMEABILITY of our intestines is disrupted?
• What does Leaky Gut Syndrome mean?
• WHAT CAUSES Leaky Gut Syndrome?
• WHY SHOULD Leaky Gut Syndrome be treated as soon as possible?
• What are the symptoms of Leaky Gut Syndrome?
• How is LEAKY GUT SYNDROME diagnosed?

WHAT IS THE DIGESTIVE SYSTEM FLORA?

Throughout the entire digestive system of humans (from mouth to anus), all of them have special functions in their own fields (digestion, synthesis, disinfection, elimination of harmful substances, fight against pathogenic microbes, etc.), produce benefits for us, live with us, and we can express dozens and hundreds of them in diversity. In biodiversity, we live together with BENEFICIAL MICROBES, the majority of which are BACTERIA and YEAST, which are hundreds of times more numerous than the cells in our entire body. Their general name is DIGESTIVE SYSTEM FLORA.

WHAT IS DIGESTIVE SYSTEM FLORA DIVERSITY AND ITS IMPORTANCE?

If we think of our body as a complex factory, each FLORA type can be thought of as a technician-engineer. The quality of products a factory produces depends on how many specialized technicians and engineers it has. To date, 1054 different FLORA elements have been identified in the entire digestive system. The more diversity of FLORA we have in our digestive system, the more HEALTHY, HAPPY, QUALITY and LONG we live.

HOW IS OUR FLORA FORMED?

We start gaining flora at birth. During normal birth, the baby receives its first flora from the mother’s birth canal and it is extremely valuable. Cesarean births leave you deprived of this fluoride for life. After birth, the baby is shaped by the flora it receives from its surroundings, especially its mother. Breast milk, eating habits, everything in contact with the family and the environment diversifies the flora. The flora structure undergoes partial changes with age (infancy, adolescence, birth, menopause, etc.).

HOW CAN OUR FLORA BE DISTURBED?

FLORA, which we house in the digestive system, is nourished by what we eat and digestive system secretions. Not being fed orally for a long time (intensive care processes, surgical interventions), using too many antibiotics, having frequent throat infections, malnutrition, environmental pollutants (especially agricultural pesticides), radiation, immunosuppressive drugs, long-term use of corticosteroids, chemotherapy, immunity Many factors, especially diseases that disrupt the immune system, cause FLORA DAMAGE.

HOW CAN WE ENRICH AND/OR PROTECT OUR FLORA?

What is meant by enriching the flora is to increase the biodiversity of the flora. First of all, if there is no medical necessity, normal birth should be encouraged. It is important to have a quality and balanced diet. Industrial food products should be avoided as much as possible. It should not be forgotten that there are intensive pesticides on foods. We should produce and consume natural probiotics ourselves at home (pickles, tarhana, dried fruit, yoghurt, kefir, tomato paste, vinegar, pickles, etc.). FLORA BIODIVERSITY will be increased if our children are provided with long-term close contact, eating, drinking and spending time together with their healthy peers in various geographies, especially during the developmental period. It is extremely important that as many healthy breastfeeding mothers breastfeed at least once during infancy. Unnecessary use of medications, especially antibiotics, should be avoided, and alcohol and cigarettes should not be used.

What does SELECTIVE PERMEABILITY of our intestines mean?

All the foods we eat are cleared of microbes, thanks to our FLORA and digestive system secretions (saliva, stomach secretions, bile, pancreatic secretions, etc.), and are broken down and made suitable for absorption by our intestines. Each region of our intestines has different biochemical functions, and the region where each type of food is absorbed and enters the bloodstream is also different. Foods are absorbed from the intestines and pass into the bloodstream and meet the body’s needs. Our intestines have selective permeability, so it is not possible for everything to pass into the bloodstream. This SELECTIVE PERMEABILITY is vital and protects us. The selective permeability of our intestines is possible by protecting the absorption surface from external factors thanks to the flora required in each part of the digestive system and the mucus secreted from the intestine. Thanks to the mucus covering the inner surface of the intestine, the absorption surface does not come into direct contact with our digestive secretions and food. When the mucus structure is disrupted and contact occurs, irritation (ulcer) occurs on the inner surface of the digestive system and this surface loses its selective permeability.

What happens when the SELECTIVE PERMEABILITY of our intestines is disrupted?

When our intestines lose their selective permeability, many things that normally should not pass from the intestines to the bloodstream (undigested foods, toxins, microbes, etc.) begin to pass into the bloodstream in an uncontrolled way.

What does Leaky Gut Syndrome mean?

Our defense system detects elements that should not pass into the bloodstream (undigested foods, toxins, microbes, etc.) and strives to destroy them. After a certain stage, as a result of our defense system getting tired and losing coordination, it perceives our body’s tissues as “foreign-harmful” and begins to attack them. This is the most important breaking point. Our defense system’s attack on its own tissues is called AUTOIMMUNISM and the entire process after that is AUTOIMMUNE PROCESSES. Why is this important? Because once an autoimmune disease occurs, it invites or facilitates the formation of other autoimmune diseases. One of the most important triggering factors in AUTOIMMUNE diseases, and most importantly, is the loss of the selective permeability of the intestines. The general name of the diseases that occur when the intestines lose their selective permeability is “LEAKY GUT SYNDROME”. Some of the main diseases evaluated under the title of Leaky Gut Syndrome are as follows. Celiac Disease, Celiac-like Disease (Gluten Allergy), Lactose Intolerance (Breast Milk Allergy), Lactose Allergy-Like Syndrome (Advanced Milk Allergy), Ulcerative Colitis, Crohn’s Disease, Food Allergy, SIBO, Dysbiosis, etc.

WHAT CAUSES Leaky Gut Syndrome?

Our small intestines are approximately 6-8 meters long from the stomach exit to the large intestines. Our large intestines are 180-220 cm long. The inner surface of our small intestines is not a straight pipe; it creates many folds within itself, increasing the absorption surface area. In an adult human, the inner surface of the small intestines is 16,000-20,000 m2, which is the size of a large Olympic stadium. Thanks to this large surface, absorption, synthesis, digestion, secretion and detoxification processes occur in a healthy way. One of the most important health criteria for people is the width of the small intestine absorption surface area. Because if we compare our intestines to the borders of a country, our intestines are just as vital as the control of these places is for a country. This large intestinal absorption surface does not come into direct contact with the intestinal contents (digestive secretions and foods we ingest from outside). If it does, the same thing will happen to our intestines as the food we eat is digested in the intestines, and wounds will form on the surface. The entire inner surface of our intestines is protected from external influences by being covered with a slimy secretion called MUCUS. The structures we call FLORA, which are beneficial microorganisms that are specialized for each region of the digestive system and live with us, are of vital importance in the formation and maintenance of MUCUS. The higher the FLORA biodiversity, the better quality intestinal functions are provided.

One of the most critical factors that disrupts mucus formation and makes our intestines open to external factors, and most importantly, is FLORA DAMAGE. If the flora of the relevant area is weakened or completely eliminated for any reason, mucus production in those areas is disrupted and the intestine is exposed to external factors. The most important feature of our intestines is that they are SELECTIVELY PERMEABLE. Selective permeability is disrupted in the intestinal surface areas where the mucus protection shield is eliminated, the flora of which is disrupted, and the intestinal contents pass into the bloodstream uncontrollably and the AUTOIMMUNE process begins. This situation is called LEAKY GUT SYNDROME.

All conditions that cause damage to the digestive system flora play a role in the formation of Leaky Gut Syndrome.

WHY SHOULD Leaky Gut Syndrome be treated as soon as possible?

Due to ulceration that begins when our intestines are exposed to external factors, their absorption surface areas begin to disappear, that is, to decrease, irreversibly. The longer people suffer from leaky bowel disease and the more severe the disease progresses, the greater the loss of intestinal absorption surface area (villus atrophy) occurs, and these losses cannot be regained with treatment. To give an example, if the small intestine absorption surface has decreased from 20,000 m2 to 12,000 m2 due to Leaky Gut Syndrome, we cannot increase the surface area above 12,000 m2 again with any treatment method. The treatment to be performed is only aimed at protecting what is left behind after the damage. Treatment time is extremely important because it is not possible to restore many vital functions after the intestinal absorption surface area falls below 4,000 m2.

Was sind die Symptome des Leaky-Gut-Syndroms?

• Bloating after meals
• Increase in intestinal gas
• foul-smelling stools
• bloody defecation
• Mucusy defecation
• Feeling of defecation immediately after eating
• Indigestion
• The onset of food allergies (floury, sugary, dairy foods, nuts, spices, eggs, etc.)
• Changes in defecation habits
• chronic diarrhea
• developmental delays
• Decline in educational achievement
• Deepening or emergence of autism
• Mental state disorders (Depression etc.)
• skin allergies
• The emergence of the following autoimmune diseases:

*Psoriasis

*Fibromyalgia

*Hashimoto Thyroiditis

*Rheumatic Joint Diseases

*Behcet ‘s disease

*Gout

*Acne outside puberty

*Vitiligo Disease

*Weakening of the immune system

*Kidney, ovarian and breast cysts

*Chronic Fatigue

*Unhappiness for no reason

*etc

How is LEAKY GUT SYNDROME diagnosed?

First of all, a detailed physical examination and questioning is performed on the patient who presents with the symptoms of leaky gut syndrome listed below. These symptoms are:

– Bloating after meals

– Increased intestinal gas

–  Foul smelling defecation

– Bloody stools

– Mucusy defecation

– Feeling of defecation immediately after eating

– Indigestion

– The onset of food allergies (floury, sugary, dairy foods, nuts, spices, eggs, etc.)

– Changes in defecation habits

– Chronic diarrhea

– Developmental delays

– Decline in educational success

– Deepening or emergence of autism

– Mental state disorders (Depression etc.)

– Skin allergies

-Emergence of the following autoimmune diseases

*Psoriasis

*Fibromyalgia

*Hashimoto Thyroiditis

*Rheumatic Joint Diseases

*Behcet ‘s disease

*Gout

*Acne outside puberty

*Vitiligo Disease

*Weakening of the immune system

*Kidney, ovarian and breast cysts

*Chronic Fatigue

*Unhappiness for no reason

*etc

An examination by a physician experienced in Leaky Gut Syndrome will usually be sufficient to make a diagnosis. After the diagnosis is made, some laboratory tests are performed to see the technical details.

These tests:

• Zonulin Test in Stool
• Microbial Analysis of Stool (Microbiata Test)

Apart from these, necessary tests may also be performed. Diagnosis of Leaky Gut Syndrome is made primarily by listening to the patient well, answers to the right questions, observations, physical examination and physician experience.

Above all, we should provide clear definitions of concepts so that they are clearly understood, and no questions are left unanswered.

No more than 5% of those with GLUTEN intolerance have CELIAC DISEASE. The remaining 95% are the cases that we may refer to as CELIAC-LIKE SYNDROME. Let’s take a look at what these concepts mean, one by one:

Why is it important to make an accurate definition?

Making an accurate definition is important as 95% of all cases of CELIAC-LIKE SYNDROME are definitively and permanently treatable. Whether it is CELIAC DISEASE or CELIAC-LIKE SYNDROME, all patients in both groups are considered to have “Leaky Gut Syndrome”, which is characterized by damage to the flora of the digestive tract and impaired selective permeability of the intestines. Even so, the disease processes and mechanisms in both groups are different.

CELIAC DISEASE is a genetically inherited intolerance to “GLIADIN”, one of the proteins that make up “GLUTEN” contained in floury foods such as barley and wheat. These patients can be diagnosed at any stage of their lives. The main critical process in the onset of clinical symptoms is the emergence of intestinal FLORA DAMAGE. CELIAC DISEASE is diagnosed upon microscopic examination in a pathology laboratory of the tissue samples collected from the small intestine by biopsy (endoscopic dissection) during an endoscopy.

CELIAC-LIKE SYNDROME is the name given to all cases with intolerance to gluten-containing products, which cannot be diagnosed as having CELIAC DISEASE by endoscopic biopsy. Intestinal flora damage is a contributing factor to the intolerance of floury foods in both CELIAC DISEASE and CELIAC-LIKE SYNDROME.

In CELIAC-LIKE SYNDROME, the selective permeability of the intestines is impaired due to damage to the flora of the digestive tract, and accordingly, intestinal contents that should not normally pass through the intestines into the bloodstream pass into the bloodstream, thereby triggering the allergic process. The body’s defense system perceives substances that should not pass into the bloodstream as foreign and tries to destroy them. Eventually, the defense system loses its control over what it should attack and destroy, and begins to attack the body’s own tissues, which it perceives as foreign. This is where the most important process begins and this is called “AUTOIMMUNITY”, that is, the body’s attempt to destroy itself and the diseases that develop at the end of this process are called “AUTOIMMUNE DISEASES”. Regardless of which one it is, autoimmune diseases facilitate the development of other autoimmune diseases. These autoimmune diseases include atopic dermatitis, vitiligo, rosacea, autoimmune arthritis (rheumatism), autoimmune vasculitis (Behcet’s disease, etc.), psoriasis, MS, allergic rhinitis, allergic asthma, ulcerative colitis, IBS, fibromyalgia, chronic fatigue, etc.

The following is a question that both patients with CELIAC DISEASE and CELIAC-LIKE SYNDROME always wonder about: These foods didn’t cause me any discomfort, allergies or bloating in the past, so why do they cause me discomfort now? The answer is simple. You had an intact digestive flora in the past, but now you don’t.

In cases with CELIAC-LIKE SYNDROME, one of the most important factors in the onset of complaints and clinical findings is the GENETICALLY MODIFIED grains we eat (GM products). We cannot distinguish between natural and GMO products with the naked eye. Yet, our intestines are able to instantly distinguish between natural wheat and GM wheat thanks to our genetic memory that has been passed down through generations for thousands of years. With the damage to our digestive flora, the selective permeability of the intestine is disrupted and GM products passing into the bloodstream trigger the allergic reaction process.

Both patients with gluten intolerance and patients with CELIAC DISEASE and CELIAC-LIKE SYNDROME can be treated with the FLORA TRANSPLANTATION. FLORA TRANSPLANTATION can achieve a complete and permanent recovery in cases with CELIAC-LIKE SYNDROME. In CELIAC DISEASE, however, it is possible to achieve long-term (3-5 years) remissions after treatment with the FLORA TRANSPLANTATION and partial or complete relief of complaints. At this point, it would be helpful to briefly describe WHAT FLORA IS, WHAT IS THE FUNCTION OF FLORA and WHAT FLORA TRANSPLANTATION IS.

WHAT IS FLORA?

Certain parts of the human body are inhabited by microorganisms which peacefully live with us, do not harm us, contribute to the vital functions of the region in which they live, cause health problems when not present, whose functions cannot be compensated in any other way, which constantly renew themselves, whose diversity increases under favorable living conditions, and whose number and biodiversity decrease in some unfavorable conditions.  Their generic name is FLORA.

WHAT IS THE FUNCTION OF FLORA? WHY DOES IT MATTER TO US?

Each part of our body has its own flora, which are the most crucial structures that fight against pathogens coming from outside. In cases where the flora of a given site is reduced, destroyed or extinct, the site gets invaded by pathogenic microorganisms. A disturbed flora in our throat, for example, leads to chronic tonsillitis and chronic pharyngitis. A disturbed oral flora, on the other hand, may result in bad breath, dental caries, canker sores and dry mouth. The flora of the digestive tract is of critical importance in the formation of a gel-like secretion called mucus, which coats the entire lining of the digestive tract, in the site they inhabit. In the absence of mucus, what we eat and drink as well as all the secretions of the digestive system come into direct contact with the surface of the digestive system (mucosa) and cause erosion in the parts they come into contact with. The flora is indispensable for the acid-base balance, enzymatic function, synthesis function and digestive activities of the site they inhabit. Without flora, these functions get impaired. Any disruption of the flora in any given site not only disrupts the function of that site, but also causes disruptions in the functions ahead and behind it.

WHAT IS A FLORA TRANSPLANT?

Flora transplantation is the process consisting of collecting flora samples from at least one healthy FLORA DONOR under general anesthesia through endoscopy and colonoscopy from approximately 30 different anatomical regions of the digestive system, with each region being washed with serums suitable for its own characteristics and aspirated back, subjecting these samples to some series of specific procedures, and then transplanting them endoscopically and colonoscopically to the equivalent anatomical regions of the patient under general anesthesia.

Fecal transplantation is usually considered as a treatment option in the following cases:

DISEASES TREATED WITH FECAL TRANSPLANTATION:

• Impaired Small and Large Intestinal Flora
• Leaky gut syndrome
• IBS
• Food allergies
• Autoimmune Diseases
• Dementia
• Alzheimer’s Disease
• Chronic Diarrhea
• Chronic Constipation
• SIBO
• Dysbiosis

Despite the fact that fecal transplants have already yielded promising results in the treatment of numerous diseases, this treatment modality is still being studied extensively and is only considered standard treatment in certain cases. Medical treatments, as usual, may yield different results for each person, and each treatment method should be administered under the supervision and advice of a medical practitioner.

No. In fact, the underlying principle is the same. Flora transplantation involves transplanting flora from a donor with healthy flora into a patient whose digestive tract flora is weakened, deformed or impaired.

As I realized that the process I started with fecal transplantation proved to be inadequate over time, I conducted several studies to find an answer to the question of how to perform a more effective and inclusive flora transplantation. My research led me to develop TOTAL GASTROINTESTINAL FLORA TRANSPLANTATION (TGFN). TGFN offers a much higher treatment coverage, treatment success and long-term persistence. Unlike fecal transplantation, TGFN involves the transplantation of specific live flora members from each site (from the same site in the donor to the corresponding site in the patient).

WHAT IS TRANSPLANTED BY FECAL TRANSPLANTATION and HOW IS IT PERFORMED?

Inhabiting the entire digestive tract, our flora replenishes itself many times a day. The waste of living and dead flora that has reached the end of its lifespan travels naturally through the digestive tract and is excreted in the FECES. Of the volume of feces, 60-70% is made up of flora residues. Actually, fecal transplantation involves the transplantation of not the feces, but the flora bacteria in it. The full term is indeed “Fecal Microbial Transplantation”, i.e. “Transplantation of Microbiota in Feces” (Hedef kitle İngilizce bilen kitle olduğundan cümle şu şekilde çevrilmiştir: Terimin tam karşılığı aslında “Fecal Microbial Transplantation”, yani “Gaita içindeki Mikrobiyotanın Nakli”dir.). The flora of the upper segments of the digestive tract is often deformed in the course of natural progression. Therefore, fecal transplantation usually involves the transplantation of the flora of the segments following the small intestine of the digestive tract. Therefore, fecal transplantation is based on the transplantation of non-selective flora.

HOW IS FECAL TRANSPLANTATION (i.e. Fecal Microbial Transplantation) IS PERFORMED?

Fecal transplantation is the process of collecting fecal material from at least one healthy fecal donor, subjecting the collected material to a number of procedures, and transplanting it into the patient’s digestive system through endoscopy and colonoscopy. Fecal transplantation is performed in the endoscopy ward of the hospital, under sedation (mild anesthesia) supervised by an anesthesiologist, while the patient is asleep and breathing normally. The patient feels neither pain nor remembers the procedure. After the procedure, the patient wakes up spontaneously.

Fecal transplants by type are listed below:

• Fecal transplants from a single donor to a single anatomical site
• Fecal transplant from multiple donors to a single anatomical site
• Fecal transplant from one donor to multiple anatomical sites
• Fecal transplant from multiple donors to multiple anatomical sites

WHAT IS FLORA?

Certain parts of the human body are inhabited by microorganisms which peacefully live with us, do not harm us, contribute to the vital functions of the region in which they live, cause health problems when not present, whose functions cannot be compensated in any other way, which constantly renew themselves, whose diversity increases under favorable living conditions, and whose number and biodiversity decrease in some unfavorable conditions. Their generic name is FLORA.

HOW MANY TYPES OF FLORA BACTERIA HAVE BEEN IDENTIFIED IN THE DIGESTIVE SYSTEM?

The number of flora bacteria identified in the human digestive tract to date is 1054.

HOW MANY TYPES OF FLORA BACTERIA DO HUMANS HARBOR IN THE ENTIRE DIGESTIVE SYSTEM?

The most important factor in this is the environmental conditions.  Whereas the diversity of flora in those living in large metropolitan areas is as low as 50-60, this figure tends to increase in rural areas. This figure is around 100 to 110 on average in Turkey.

WHAT IS A FLORA TRANSPLANT?

Flora transplantation is the process consisting of collecting flora samples from at least one healthy FLORA DONOR under general anesthesia through endoscopy and colonoscopy from approximately 30 different anatomical regions of the digestive system, with each region being washed with serums suitable for its own characteristics and aspirated back, subjecting these samples to some series of specific procedures, and then transplanting them endoscopically and colonoscopically to the equivalent anatomical regions of the patient under general anesthesia.

First of all, you should consider the possible effects of the surgery on your state of health. Sleeve gastrectomy often leads to significant weight loss, which can help improve Type 2 diabetes, high blood pressure, sleep apnea and other obesity-related conditions. You are unlikely to regret undergoing the surgery taking into account these benefits if you have such health problems and your attempts to lose weight in other ways have been unsuccessful.

Gastric sleeve surgery, however, is also associated with serious risks and side effects. Among these can be post-operative infections, blood clots, nutritional deficiencies and stomach acid escaping back into the esophagus. Besides, this surgery requires a significant change in diet and lifestyle. In the aftermath of your surgery, you will need to change your eating habits significantly to be able to tolerate small portions. This may be challenging for some people and may lead to a feeling of regret after surgery.

Gastric sleeve surgery usually has a high success rate, but in some cases weight loss may be lower than expected or the patient may regain weight over time. The success of the surgery depends largely on whether the patient changes his or her lifestyle and adheres to his or her doctor’s recommendations. This constitutes another cause of regret for those who are dissatisfied with the results of the surgery and regret undergoing it.

Lastly, you should also consider the cost of having gastric sleeve surgery. The procedure is usually very costly, even if your insurance policy covers this type of surgery. Moreover, additional costs may arise due to post-operative lifestyle changes, dietary supplements and regular medical follow-up.

All in all, whether or not to regret undergoing gastric sleeve surgery would depend on your personal state and the way you consider the potential benefits and risks of the surgery. Before making such a decision, consulting with your doctor is important to thoroughly explore all options, possible complications and expected lifestyle changes. This would minimize any possible feelings of regret about the surgery and allow you to achieve your overall health goals.

1. Banana & Oatmeal Purée: This recipe, which you can enjoy for breakfast, is rich in both protein and fibers. The recipe contains 1 x ripe banana, 2 tbsp of oatmeal and 1 tsp of cinnamon. Put all ingredients in a blender and blend until smooth. Finally, add 1 tablespoon of protein powder and mix again.
2. Pureed Chicken Soup: This recipe, which can be preferred for lunch, is perfect for meeting protein needs. After boiling the chicken breast, add 1 tbsp of chicken broth and a little salt and blend.
3. Broccoli & Carrot Purée: Perfect for dinner, this recipe is rich in vitamins A and C. After boiling 1 x carrot and 1 x broccoli, put them in a blender. Then add 1 tbsp of olive oil and a little salt and blend.
4. Apple & Cinnamon Purée: Suitable as a snack, this recipe is rich in fibers and satisfies the need for dessert. After boiling 1 x apple, put it in a blender. Add 1 tsp of cinnamon and a little water and blend.
5. Yogurt & Banana Smoothie: This recipe, which you can increase the protein content by adding protein powder, can be preferred at any time of the day. Add 1 x banana, 1 cup of yogurt, 1 tbsp of honey and 1 tbsp of protein powder and blend in a blender.

These recipes are usually tolerated by everyone, however, you should check in with yourself when consuming the recipes, as each individual’s tolerance may be different. If you experience symptoms such as stomach pain, nausea or vomiting after a certain recipe, stop consuming it and consult your doctor.

Always keep in mind that after gastric sleeve surgery, the capacity of your stomach is considerably reduced. It is therefore important to eat slowly and in small portions. It is also essential to drink enough water during and between meals. However, since drinking too much water during meals can overload the stomach, make sure to drink water before and after meals.

Here is an example of how BMI is calculated: Let’s consider a person who is 1.75 meters tall and weighs 80 kilograms. To calculate the BMI of that person, we first square the height (1.75*1.75=3.0625). Then we divide the weight by this value (80/3.0625=26.12). In this example, the person’s BMI is around 26.

The BMIs indicate the following according to the World Health Organization: A BMI between 25-29.9 indicates overweight, while a BMI of 30 and above indicates obesity. Since the person in this example has a BMI of 26, he/she can be said to be overweight.

However, BMI may not prove to be the most accurate way to measure body fat as it does not distinguish between muscle mass and fat mass. In view of the limitations associated with BMI, other methods, such as measuring body fat percentage or waist circumference, can also be used to identify obesity.

The body fat percentage tells you how much of your total body weight is made up of fat. This can be measured using a variety of instruments and methods but is usually done by bioelectrical impedance analysis (BIA) or skinfold thickness measurement. Such measurements are usually performed by a health professional.

Measuring waist circumference actually involves measuring the circumference of the widest point of the waist. Excessive waist fat, especially in the abdomen, can be a sign of a number of health problems, including Type 2 diabetes, high blood pressure and heart disease. A waist circumference of 102 cm (40 inches) or more for men and 88 cm (35 inches) or more for women can increase health risks.

Whilst these instruments and measurements can help to identify obesity, it is also important to take stock of your overall health and lifestyle. To achieve and maintain a healthy weight, it is important to eat a balanced and nutritious diet, exercise regularly, get enough sleep and manage stress.

Lastly, if you are concerned about your weight, it is best to consult a health professional. Health professionals can help decide the best approach and create a custom plan for you, where necessary.

1. Severe abdominal pain: This usually manifests as severe pain at the site of the surgery. The pain is usually constant and cannot be relieved using ordinary painkillers.
2. Fever and Chills: As the body tries to fight the infection caused by the leaks, fever may develop. This may usually cause chills and sweating.
3. Malaise and Fatigue: As the body uses its energy to fight infection, this often results in malaise and fatigue.
4. Shortness of Breath: This condition appears in particularly serious cases and requires immediate medical attention.
5. Accelerated Heartbeat: Body fluid levels drop due to infection, causing the heart to beat faster.
6. Nausea and Vomiting: The impaired functioning of the digestive system can lead to nausea and vomiting.
7. Loss of Appetite: The impaired functioning of the digestive system often leads to a reduced appetite.

You should seek medical attention immediately if any of the above symptoms are present after gastric sleeve surgery. Besides, as these symptoms can also be signs of other medical conditions, consulting a health professional to properly assess the symptoms is of utmost importance.

What should I do in case of leaks following Gastric Sleeve Surgery?

A leak that may develop following Gastric Sleeve Surgery is a serious complication and requires urgent medical intervention. When signs of leaks appear, you should take the following steps:

1. Promptly Consult Your Doctor: In the case of a suspected leak, you should first consult your doctor or healthcare provider immediately.
2. Seek Urgent Medical Attention: Go to an emergency room immediately if symptoms are serious or getting worse rapidly.

The way how the leak should be treated usually depends on the condition. In mild cases, the patient may be prescribed antibiotics and a diet restricted to liquid food. Severe cases, however, may require surgical intervention.

Surgical intervention is usually performed by endoscopic procedure, during which the specialist “repairs” the stomach by sealing the leak or inserting a stent. In rarer cases, an open surgery may be required.

Each of the above conditions should be handled under the supervision of medical professionals. Never attempt treatment on your own, as this can lead to more serious health problems. Depending on the patient’s condition and the severity of the leak, all these treatment options should be considered by the specialist. It is therefore of paramount importance to contact a health professional in case of any symptoms and suspicions.