Repeated backflow of stomach contents into the esophagus is called gastroesophageal reflux disease (GERD). The leading symptom of reflux disease is heartburn; other symptoms include belching, sore throat, cough and chest pain. If left untreated, severe complications such as inflammation, mucosal changes ("Barrett's mucosa") and narrowing of the esophagus can occur. At the Diako Mannheim, the clinics involved have therefore developed. The external cooperation partners an interdisciplinary reflux center founded. This was discovered in 2016 by the Fa. InterCert certified according to ISO 9001: 2015.
Specialists from the various specialist areas work hand in hand under one roof with the aim of providing each patient with the best possible therapy at the highest medical level. For this reason, an individual treatment concept is developed and implemented for each patient in reflux boards that meet on a regular basis. This means that we at the Diakonissenkrankenhaus have optimal conditions for the diagnosis. created a therapy for reflux disease with all its facets.
Advantages of the reflux center for patients
– Interdisciplinary care – High level of expertise in the field – All modern diagnostic and therapeutic procedures are used – Follow-up care guaranteed – Close cooperation with referring physicians – Involvement of referring physicians in the reflux board
In order to achieve a high quality of treatment and outcome, we have standardized diagnostics and therapy. In order to enable an external, independent assessment of our approach, our reflux center was certified in 2016 by the Fa. InterCert certified according to ISO 9001: 2015.
As the Clinic for General and Visceral Surgery is one of only 12 clinics in Germany to be designated as a "Reference Center for Minimally Invasive Surgery" by the German Society for General and Visceral Surgery (DGAV), we are able to offer a wide range of services All reflux surgical operations are performed at a technically high level.
Gastroesophageal reflux disease (GERD)
The cause of heartburn and other reflux symptoms is a weakness of the sphincter muscle at the junction of the esophagus and the stomach. This works like a valve through which food and liquid pass from the esophagus into the stomach. Normally this closes after swallowing. Prevents stomach contents from flowing back into the esophagus.
According to epidemiological studies, 8-26% of all Europeans suffer from reflux symptoms. One cause seems to be increasing obesity ("adiposity"), also an accompanying diaphragmatic hernia ("hiatal hernia") may increase the muscle weakness.
By using the so-called proton pump blockers or inhibitors (PPI), the majority of all patients with reflux symptoms can certainly be treated successfully over long periods of time.
If optimization of drug therapy does not lead to success, or if there are side effects from taking the drugs, surgical measures may also be indicated. The patient's wish not to have to constantly take medication over many years can also lead to surgery. Large diaphragmatic hernias up to complete displacement of the stomach into the thorax can only be treated surgically.
If conservative therapy fails, there is widespread consensus that surgery should be performed only after guideline-based comprehensive diagnostics and after joint indication by the gastroenterologist and the surgeon.
First of all, the patient's medical history is taken and individual advice is given on all questions relating to prevention, diagnosis and treatment of reflux symptoms.
There is no diagnostic gold standard for the diagnosis of reflux disease, because the symptoms are not always clearly assignable and the reflux does not always lead to visible changes in the esophagus.
In order to enable a competent diagnosis, the complex reflux clarification is carried out during a 3-day inpatient stay. Afterwards, in our interdisciplinary reflux board, the best possible individual therapy recommendation is made based on a synopsis of all findings.
The first examination method of choice is endoscopy.
During endoscopy of the esophagus, typical reflux-related changes in the mucosa can be detected as well as other, non-reflux-related findings can be diffentially diagnosed.
For this purpose, it is necessary to take samples ("biopsy") during the endoscopy, which are then sent to specialized pathologists. Endoscopy can also detect diseases that are associated with an increased risk of cancer.
pH-metry and impedance measurement
This examination determines the frequency, duration and temporal occurrence of the reflux.
Even in the case of an inconspicuous endoscopic examination, both acid and non-acid reflux from the stomach into the esophagus can be detected by means of impedance pH-metry. This measurement is made by a probe that is inserted through the nose into the esophagus and comes to rest in the lower esophagus.
The measurement is taken over 24 hours. This essential examination method can be used to determine the severity of the reflux disease ("DeMeester score"), which is the basis for considerations regarding individual therapy of the reflux disease.
Sometimes the complaints are not caused by reflux but by mobility disorders of the esophagus ("motility disorder of the esophagus").
For this purpose, the high-resolution prere measurement of the esophagus ("High resolution esophageal manometry") is available in our reflux center. Here, prere changes are registered simultaneously at several points in the esophagus during the swallowing act.
If motility disorders are present, this must be taken into account, above all, when determining the indication for surgery and when selecting the therapeutic procedure.
X-ray – pap swallow
This radiological procedure is used in some patients, also to better assess movement and anatomical features or postoperative changes.
– In the case of complex clinical pictures, measurements of the Gastric emptying sonography, scintigraphy or even magnetic resonance imaging is used. – Reflux-related impairments of the lungs are determined by measuring the Lung function determined. – In the case of reflux-related hoarseness, the Laryngoscopy.
Once the reflux patient has undergone the guideline-based inpatient diagnostics in our reflux center, the case is discussed in our interdisciplinary reflux board in the presence of all treatment partners.
After demonstration and discussion of all findings, it is decided whether a convervative or surgical therapy concept should be considered.
If the indication for surgery has been made after comprehensive external diagnostics, the patient can go to an Second Opinion contact the reflux board.
Optimization of the drug therapy: The change or. Adjustment of the life habits is first a measure, which surely already many humans, who turn to a reflux center, accomplished.
Drug therapy usually consists of therapy with the so-called proton pump inhibitors. If this is well tolerated, it sometimes only needs to be adjusted a little or modified or supplemented by other preparations to make the reflux patient symptom-free.
It has been proven that reflux complaints are often associated with obesity.
Therefore, all patients of our reflux center receive individual nutritional counseling.
In the case of intolerance and side effects of drug therapy, diminishing effect after prolonged use or simply the desire not to be permanently dependent on these drugs, the indication for surgery can be made, which is nowadays usually performed minimally invasive ("keyhole surgery").
Based on the results of the examination, the most suitable surgical procedure will be selected for you.
Patients with a large diaphragmatic hernia ("hiatal hernia") or complete displacement of the stomach into the thorax ("thoracic stomach") should be operated on independently of the classic reflux symptoms in order to determine complaints (z.B. prere behind the sternum after eating, swallowing difficulties, cardiac arrhythmias) and to avoid complications due to the incorrect position of the stomach.