reflux disease is the most common cause of heartburn. Heartburn only a symptom of reflux disease. More about other symptoms, causes and treatment of reflux disease.
Synonyms
gastroesophageal reflux disease, reflux esophagitis
Reflux disease is often confused with the most common symptom of this condition, heartburn. Reflux, the rising of stomach acid into the esophagus, causes heartburn. Occasional heartburn, however, is not a disease, but usually the result of sumptuous meals or excessive drinking.
If heartburn occurs regularly, reflux disease may be the cause. This cause is usually a malfunction of the lower esophageal muscle. This lower esophageal sphincter separates the esophagus from the stomach. Ensures the closure between the two organs. In reflux disease, stomach contents easily enter the esophagus through the weakened sphincter muscle – and cause discomfort there.
Two forms of reflux disease: NERD and ERD
Physicians usually speak of reflux esophagitis. They distinguish reflux disease mainly in two subgroups:
– NERD stands for Non-Erosive Gastroesophageal Reflux Disease. In this form, the mucous membrane of the esophagus is not (yet) demonstrably damaged by the rise of stomach acid. – ERD is the abbreviation for Erosive Reflux Disease. In this form of progression, the protective mucosa of the esophagus is visibly injured and changed like an ulcer. The incidence of reflux disease in Germany is estimated to be between 10. Reported in up to 25 percent of the total adult population. However, studies do not always distinguish precisely between occasional or recurrent heartburn (pyrosis) and actual reflux esophagitis, i.e. reflux disease. Experts estimate that about 10 percent of adults chronically suffer from reflux disease requiring treatment.
Symptoms
For more on the symptoms and complications of reflux disease: see heartburn
Causes
The most common cause of reflux disease is a weak lower esophageal muscle. The so-called lower esophageal sphincter separates the esophagus from the stomach. If the muscle is too weak, acidic gastric contents can easily pass from the stomach into the esophagus and damage the mucosa.
The cause of esophageal sphincter weakness cannot be determined in most cases. Doctors then speak of a primary reflux disease. This form is by far the most common.
A secondary reflux disease on the other hand, is caused by a change in the physical structure or. Function. In half of the cases, the secondary form is caused by the spatial shifts during pregnancy. Another common cause is diseases of the stomach, such as a narrowed gastric outlet (pyloric stenosis). Congenital or acquired changes in the esophagus, excessive stomach acid production, weakness of the stomach mouth (cardia insufficiency) or diaphragmatic weakness (hiatal hernia) are further causes of secondary reflux disease.
Drugs can also irritate the esophageal mucosa. So-called pill esophagitis is caused, for example, by antibiotics (z.B. Tetracyclines, clindamycin, and penicillin) or bisphosphonates for osteoporosis (z.B. Alendronate, etidronate and pamidronate) if they are taken lying down and swallowed with too little water.
Furthermore, antiviral drugs such as zidovudine and zalzitabine, non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen, cardiovascular drugs such as alprenolol, captopril and nifedipine, cortisone preparations, ascorbic acid as well as ferrous sulfate and potassium chloride can cause esophageal mucosal damage.
Treatment
Complaints due to primary reflux disease can be reliably alleviated mainly by changing the diet. The main thing is, on the one hand, not to overfill the stomach. On the other hand, avoiding substances that irritate the stomach has a positive effect. This applies, for example, to carbonated beverages, high-fat and high-carbohydrate foods, alcohol and coffee. Nicotine is also one of the substances that irritate the stomach. Too many pounds in the form of excess weight also have a negative effect on the esophageal sphincter muscle. Detailed information can be found here: Diet for reflux disease and heartburn. For drug treatment of primary reflux disease. Heartburn is treated with a number of active ingredients. Read more here: Heartburn.
In the case of secondary reflux disease, the therapy is aimed at treating the triggering disease or. To change medication. After pregnancies, esophageal sphincter closure strength normalizes within weeks or months in most cases.
Gastric acid blockers carry risks
Proton pump inhibitors such as esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole are among the best-selling drugs in Germany. According to the Barmer Krankenkasse drug report, almost 12 million Germans were prescribed proton pump inhibitors in 2018. In addition, the active ingredients omeprazole, pantoprazole or esomeprazole are also available over the counter.
In the public perception, gastric acid blockers from the group of active substances known as proton pump inhibitors are considered to be a simple and safe drug. However, this leaves out 2 aspects: the side effects and the fact that proton pump inhibitors can be addictive.
Kidney damage as a side effect
The most common side effects of proton pump inhibitors include bone loss (osteoporosis) and magnesium deficiency with an increased risk of cardiac arrhythmias and seizures. These side effects have now been proven by a whole series of studies. Sometimes even more serious is the fact that the medication permanently disrupts the natural regulatory cycle of gastric acid production. After prolonged use, between 14 to 64 percent of patients remain permanently dependent on the medication.
Connection between proton pump inhibitors and allergies possible
Proton pump inhibitors may increase the risk of allergic diseases. Scientists from the University of Vienna published in the journal "Nature Communications" (August 2019) a study (see Sources) that establishes at least a striking statistical association between long-term use of proton pump inhibitors and allergic diseases. The scientists had evaluated data from Austrian health insurance companies. They found that the likelihood of prescribing anti-allergic medications increased by up to 300 percent when stomach acid blockers had previously been prescribed. This does not necessarily mean that proton pump inhibitors actually trigger or promote allergies. According to the authors of the study, however, the connection cannot be dismissed out of hand and suggests that gastric acid blockers should only be used in very small doses.
The German Society for Gastroenterology, Digestive and Metabolic Diseases evaluates the study result differently. According to the press release, the professional society sees no "evident connection between gastric acid blockers and allergies". The design of the Austrian study does not allow for a corresponding evaluation.
