Prof. Dr. İsmail Hakkı Kalkan | İç Hastalıkları ve Gastroenteroloji Uzmanı

Biofeedback therapy is a drug-free, non-surgical muscle rehabilitation program that displays pelvic floor muscle activity on a computer screen using specialized sensors, teaching patients how to coordinate and relax these muscles correctly.

Dyssynergic defecation is a coordination disorder where the pelvic floor and anal sphincter muscles contract instead of relaxing during a bowel movement. It is a major cause of chronic, drug-resistant constipation.

No, biofeedback sessions are completely painless, non-invasive, and have no side effects. Each session lasts about 30 to 45 minutes, with a typical plan of 6 to 12 sessions depending on the patient's condition.

Yes, biofeedback therapy, which strengthens the anal sphincters and improves coordination, is one of the most effective non-surgical and drug-free treatments for gas and fecal incontinence (anal incontinence).

Resistant reflux refers to GERD symptoms that persist despite standard proton pump inhibitor (PPI) medications. It is diagnosed using 24-hour pH-impedance monitoring and esophageal manometry to measure acid/non-acid reflux events and muscle pressures.

Atypical reflux symptoms include chronic dry cough, hoarseness, throat clearing, and a lump-in-the-throat sensation (globus). These symptoms are often mistaken for pharyngitis or asthma and missed during routine ENT examinations.

Barrett's esophagus is a condition where the normal lining of the esophagus changes into tissue resembling the intestinal lining due to chronic acid exposure. Because it carries a cancer risk, these areas should be removed using endoscopic ablation techniques.

At our clinic in Cankaya, Ankara, we perform the 24-hour pH-impedance test by placing a very thin, flexible catheter through the nose into the esophagus. It painlessly records all acid, non-acid, liquid, and gas reflux events over 24 hours.

Using PPIs for years without supervision can lead to malabsorption of B12, iron, and calcium, increasing osteoporosis risks. Therefore, a definitive diagnosis must be made, and the duration and dosage of medication must be determined accordingly under supervision.

Dysphagia is categorized into 'oropharyngeal dysphagia' (difficulty initiating swallowing, of neurological/muscular origin) and 'esophageal dysphagia' (the sensation of food getting stuck in the chest/esophagus, of structural or motility origin).

Achalasia is a motility disorder where the esophagus loses its ability to contract and the lower sphincter fails to relax during swallowing. It is successfully treated non-surgically via endoscopic balloon dilation, POEM (endoscopic division of the non-relaxing muscle), or surgery.

Esophageal manometry is requested for patients with swallowing difficulties, non-cardiac chest pain, and suspected motility disorders (like achalasia, diffuse spasm, or EGJOO) to analyze the pressures of the esophageal muscles.

EGJOO is a motility disorder characterized by incomplete relaxation of the lower esophageal sphincter during swallowing, while esophageal body peristalsis is partially preserved. It is similar to achalasia but managed differently.

Since swallowing difficulty (dysphagia) is an alarm symptom, a gastroenterologist must be consulted immediately as soon as it appears.

Ulcerative colitis continuously affects only the mucosal layer of the colon and rectum. Crohn's disease can affect any part of the gastrointestinal tract from mouth to anus, typically in a patchy (skip) pattern, involving the full thickness of the bowel wall.

Mucosal healing refers to the complete resolution of inflammation and ulcers on the bowel lining, confirmed by colonoscopy. It represents a deeper, more stable state of remission than just symptom improvement.

Fecal calprotectin is a highly sensitive stool marker that indicates active bowel inflammation. Normal levels, along with a normal bowel wall on ultrasound, suggest that there is no active flare-up in the bowel, preventing the need for unnecessary, invasive colonoscopic evaluations.

Yes. Because biological agents target specific inflammatory molecules in the gut, they are highly safe under strict medical supervision and regular screenings, preventing disease progression and reducing surgical risks.

'Treat-to-target' means adjusting medication doses and types not just based on how the patient feels, but until objective goals—such as normal fecal calprotectin levels, normal blood markers, and complete mucosal healing—are achieved.

Our clinic provides advanced diagnostic and treatment services at third-level academic medical standards for complex digestive system issues such as resistant reflux, chronic constipation (especially dyssynergic defecation), dysphagia (like achalasia), and Inflammatory Bowel Diseases (Ulcerative Colitis, Crohn). We are particularly preferred for cases that have not been resolved in other centers or have not responded to standard treatments. We personally apply physiological tests like esophageal manometry, 24-hour pH-impedance, and anorectal manometry to offer personalized solutions, including drug-free biofeedback and interventional endoscopic treatments.

Anorektal manometri, ince ve esnek bir kateter yardımıyla dışkılama kaslarının basınçlarını ve sinirsel reflekslerini ölçen kısa süreli bir testtir. Test sonucunda pelvik taban kas koordinasyon bozukluğu (dissinerji) saptanan uygun hastalarda, özel bilgisayarlı görsel geri bildirim cihazları eşliğinde kasların doğru gevşeme paternini yeniden öğrenmesi için biofeedback seansları planlanır.

İnflamatuvar Bağırsak Hastalıklarında (İBH) temel hedef, yalnızca şikâyetlerin geçmesi (klinik remisyon) değil; bağırsak duvarındaki iltihabın tamamen gerilemesi (mukozal iyileşme) ve alevlenmelerin önlenmesidir. Takipte düzenli aralıklarla dışkıda kalprotektin düzeyi, bağırsak ultrasonu ve seçilmiş olgularda biyolojik ilaç düzeyi/antikor izlemi uygulanır.

Standart mide koruyucu tedavilere rağmen göğüste yanma, ağza acı su gelmesi veya inatçı öksürüğü süren hastalarda; yemek borusundaki asitli ve asit dışı (safra/gaz) kaçakları kaydetmek için 24 saatlik pH-empedans incelemesi yapılır. Yutma güçlüğü veya lokma takılması eşlik ediyorsa yemek borusu hareket bozukluklarını dışlamak için yüksek çözünürlüklü özofagus manometrisi eklenir.