Reflux disease

What is reflux disease?

In reflux disease, acidic and non-acidic stomach contents flow back into the esophagus – and not just occasionally, but the reflux is pathologically increased. Typical symptoms are: Heartburn, acid regurgitation, burning and pain behind the breastbone. The symptoms are particularly pronounced after sumptuous meals. In medical terms, the disease is also known as gastroesophageal reflux disease, or GERD for short. The word “gastroesophageal” means that both the stomach and the esophagus are affected.

Heartburn or reflux disease

Many people are familiar with occasional heartburn. Although it is annoying and painful, it is considered normal and harmless because the contents of the stomach only come into contact with the mucous membrane of the esophagus for a short time. With reflux disease, however, acidic stomach contents often flow back into the esophagus and cause unpleasant symptoms. The aggressive digestive juices repeatedly come into contact with the mucous membrane of the esophagus and irritate it. If the acidic gastric juice acts on it for a longer period of time, it can become inflamed and damaged. Possible consequences in addition to the unpleasant symptoms: Inflammation, ulcers, chronic mucosal remodeling, narrowing or, in the worst, fortunately rare case, esophageal cancer.

Reflux disease – frequency and age

Heartburn is a very common problem. In the western population, between 10 and 20 percent of the population suffer from acid reflux at least once a week. Men and women are equally affected. Pregnant women in particular often suffer from heartburn. Around 10 percent of the population suffer from pathological reflux. In principle, reflux disease can occur at any age. Even babies can be affected if the esophageal sphincter is not yet fully developed at birth. Infants, children and adolescents also sometimes suffer from reflux.

Reflux disease: causes and risk factors

Reflux disease usually occurs when the pressure in or on the stomach is high and the lower sphincter between the stomach and oesophagus no longer closes sufficiently or is altered, or the stomach becomes overfilled. This muscle normally prevents stomach acid from returning to the esophagus. When swallowing, it relaxes and ensures that the chyme only “slides” in one direction – namely into the stomach. The sphincter muscle therefore functions like a kind of valve. The following causes and risk factors are possible for gastroesophageal reflux:

• 
  Diaphragmatic hernia
  The esophagus extends through a narrow gap in the diaphragm into the stomach. In the case of a diaphragmatic hernia, the stomach slides a little upwards into the chest cavity due to the hernia. The diaphragm is then no longer able to support the closure of the sphincter. Many people with reflux disease have a hiatal hernia, but the reverse is not true: very few people with a hiatal hernia suffer from reflux disease.
• Esophageal motility disorders: The movement (motility) of the esophagus is restricted. It is not able to quickly transport the refluxed stomach contents back down again. A sensitive oesophagus or a lack of neutralizing saliva can also be a possible cause – in this case it reacts particularly strongly to contact with small amounts of digestive juices (the reflux does not necessarily have to be increased, for example scleroderma).
• Overweight and obesity(adiposity): The higher the body weight, the higher the risk of reflux disease. The reason is the increased pressure in or on the stomach, which strains the esophageal muscle.
• Pregnancy: Here too, the pressure in the abdomen is increased, which favors reflux disease. In addition, there are hormonal factors that reduce the mobility of the esophagus.
• Diseases that are associated with increased production of stomach acid (very rare) or that impede gastric outflow (gastroparesis).
• Previous operations on the esophagus or stomach.
• Premature babies: The sphincter muscle between the esophagus and stomach is not yet properly developed.
• Certain foods: chocolate, fatty foods, hot spices, coffee, alcohol, peppermint, hot peppers.
• Smoking increases the risk of heartburn and reflux disease.
• Stress, hectic, anger.
• Many medications, for example antihypertensives, benzodiazepines, calcium channel blockers, nitrates or hormonal contraceptives such as the pill.

The more food is ingested, the more reflux can flow back. In addition, physical exertion and certain postures appear to promote reflux disease. Heartburn is often worse when lying down or leaning forward, which is why patients with severe reflux benefit from an early and rather small evening meal (around 6 p.m.), after which the stomach can empty itself to a large extent before lying down.

Symptoms: Reflux disease usually causes pain and a burning sensation

Reflux disease causes typical symptoms that can be very unpleasant. These include:

• Heartburn when acidic gastric juice comes into contact with the mucous membrane in the esophagus
• Pain or burning behind the breastbone – many describe a feeling as if a “fire” is burning in the esophagus (also known as “heartburn”)
• Acid regurgitation from the stomach
• Burning sensation in the throat

Atypical symptoms are

• Bad taste in the mouth
• Hoarseness
• Upper abdominal pain
• Chronic cough and lung diseases
• Acid-induced tooth damage or hoarseness

Consult a doctor if you suffer from symptoms such as heartburn or acid reflux. This can primarily be the general practitioner, who may consult specialists in gastroenterology who can then carry out examinations. In this way, it is possible to find out what is behind the symptoms.

Reflux disease: Diagnosis with us

First of all, we will ask you about your medical history (anamnesis). The following are important for the diagnosis of reflux disease:

• Your symptoms – especially heartburn or acid regurgitation
• How often do the complaints occur?
• When do you experience the symptoms, for example after eating or on an empty stomach?
• Does the discomfort increase when lying down or bending forward?
• Do you have any other known illnesses?
• Are you taking any medications? If yes: Which ones and since when?
• Do you smoke? If yes: How much and since when?
• How much alcohol do you drink and when?
• What kind of food do you eat?
• Do you have a lot of stress and worries?

Answer all questions as honestly and accurately as possible. We can usually diagnose reflux disease on the basis of the symptoms described. Frequent heartburn is particularly significant. We usually suggest a trial treatment: You take a medication that slows down the production of stomach acid (proton pump inhibitor) for about two weeks. If you then have fewer or no more symptoms, it is most likely due to reflux disease. Then continue to take the medication.

If the treatment does not work or if other symptoms such as difficulty swallowing or unexplained weight loss occur, further examinations are carried out by the gastroenterology department. The same applies if the symptoms are very unspecific or if the reflux disease has been present for a long time. The following tests are used:

• Endoscopy of the oesophagus and stomach: This endoscopic method can visualize the inside of the oesophagus and the condition of the stomach. This allows inflammation, narrowing or a Barrett’s esophagus to be detected. An endoscope is used – a thin, flexible tube with a light source and camera. The images are then displayed on a monitor. We advance the endoscope through the mouth or nose into the esophagus up to the stomach. We can also take tissue samples (biopsies) from suspicious areas.
• Impedance pH metry: Specialized gastroenterologists (functional diagnosticians) use this method to measure the acidity (pH value) in the oesophagus for at least 24 hours. The pH-metry works via a thin probe that leads through the nose into the stomach. It is connected to a small measuring device. This makes it possible to determine whether and how much acidic and non-acidic stomach content enters the esophagus. Very important: By entering symptoms, it is possible to assess whether the reported complaints are actually caused by reflux episodes measured by the device. This examination is therefore the most accurate, the so-called “gold standard”. Alternatively, in specialized centers such as ours, a small wireless sensor can be implanted in the esophagus of sedated patients during a gastroscopy to measure acid reflux. This examination has the advantage that no probe has to be passed out through the nose. The sensor falls off by itself after a few days and is usually excreted unnoticed with the stool.

Reflux disease: prevention, early detection, prognosis

There are a number of known risk factors for reflux disease that are based on lifestyle. And you can start with this yourself. Prevention is therefore possible, but only to a certain extent. Even if you already suffer from reflux disease, you can alleviate the symptoms and avoid health consequences through your lifestyle. The following tips will help:

• Watch your alcohol consumption: don’t drink too much alcohol and take frequent alcohol breaks.
• If you are a smoker: Try to stop smoking. Sometimes you have to make several attempts.
• Achieve and maintain a normal body weight: If you are overweight, try to lose a few kilos. Just a few pounds less often helps a lot. The best recipe for losing weight is a healthy, balanced diet and plenty of exercise.
• Don’t eat too much before you go to bed – the symptoms often get worse at night. It is better to eat small, easily digestible meals before going to bed.
• A raised head section, ideally a sloping of the entire bed, also reduces gastroesophageal reflux.

Course and prognosis of reflux disease

In addition to a healthy lifestyle, you should treat reflux disease adequately. Regular check-ups with us are also important in order to avoid complications as far as possible. Then the course and prognosis are good in most cases. However, because drug therapy cannot eliminate the cause of reflux disease – namely the weakening of the sphincter muscle – it can flare up again and again.

In the long term, reflux disease can lead to a number of complications. These include, for example:

• Ulcers in the esophagus due to inflammation
• Scarring in the gullet
• Narrowing of the esophagus – food intake is difficult or restricted
• Bleeding, sometimes vomiting blood
• Barrett’s esophagus: Only rarely does reflux disease become more severe and Barrett’s esophagus, a precursor of esophageal cancer, develops. You should therefore have your reflux checked by a doctor at regular intervals. This enables them to diagnose and treat the disease in good time.
• Respiratory diseases: Irritable cough, asthma attacks or laryngitis
• Tooth damage

Reflux disease: treatment alleviates the symptoms

Overall, reflux disease can be treated well. The most important strategies are medication and a change in lifestyle. But surgery can also help some people.