Reflux disease (heartburn)Stomach acid normally remains in the stomach, but can enter the esophagus. Reflux of stomach acid into the esophagus is technically referred to as reflux or gastroesophageal reflux disease (GERD). Typical are burning pains behind the breastbone (heartburn).
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What is reflux disease (heartburn)??
Stomach with reflux problem
Food makes its way from the oral cavity down the esophagus to the stomach. For digestion, stomach acid (hydrochloric acid, HCl) is released in the stomach, the mucous membrane of the stomach is protected against the acid in healthy people. Normally, the lower sphincter of the esophagus closes well so that acid cannot pass from the stomach into the esophagus. However, for some people or in certain situations, this does not work: gastric acid then flows out of the stomach into the esophagus, occasionally also into the respiratory tract. Because this occurs in the opposite direction to the usual direction of food (backwards), it is referred to as reflux. When disturbing symptoms and/or complications develop due to reflux of stomach contents, gastroesophageal reflux disease, or GERD for short, exists. The acid can cause irritation in the esophagus. cause mucosal inflammation. The condition causes heartburn and sometimes a burning or pain in the upper stomach area that can radiate behind the breastbone and high in the neck. In addition, those affected often have a sour reaction to.
Most people suffer from reflux symptoms at one time or another. Heartburn, z. B. after an extended meal; many then temporarily take appropriate medication. Frequent symptoms, i.e. reflux disease, occur in about 10-25% of all adults. The symptoms are often so pronounced that they affect the quality of life. In about half of those affected, however, no inflammation of the esophageal mucosa is visible.
The dominant symptom is heartburn. It typically occurs in the first few hours after meals. Acid regurgitation is equally common, as is a burning pain in the upper part of the stomach, which often radiates to behind the breastbone. The symptoms typically worsen when bending forward or lying down. They can be so pronounced that they limit the quality of life. This depends on how severe and frequent the pain is and whether or not there is inflammation in the esophagus.
Some sufferers also report a persistent irritating cough and hoarseness . The pain associated with reflux disease can be similar to the chest pain associated with a heart attack; therefore, this should always be considered as a possible cause as well.
Reflux of stomach acid can lead to other symptoms such as difficulty swallowing, tooth damage, sleep disturbances, etc. lead.
The cause is usually a dysfunction in the upper gastric orifice (a muscle), as it does not properly perform its backward closing function to the esophagus. A stomach that is too full or a slower emptying of the stomach can also lead to a malfunction of the sphincter. This allows acid to flow from the stomach back into the esophagus. The acid leads to an unpleasant burning sensation. Can lead to mucosal inflammation of the esophagus in some people. However, some patients suffer very strongly from heartburn even without inflammation of the esophagus, while others with clear inflammation hardly complain at all.
Certain factors favor the development of reflux disease:
– older age and smoking – overweight – little physical activity – mental illness, z. B. Anxiety disorders, depression – Pregnancy – Dietary habits ( z. B. Acidity, quantity, large meals just before bedtime) – Certain medications can weaken the function of the sphincter muscle in the esophagus and promote reflux. – Hiatal hernia: In this condition, the stomach bulges through the muscles of the diaphragm. This muscle, together with the sphincter of the lower esophagus, helps to close the stomach and prevent reflux of stomach contents. The hernia contributes to the worsening of the closure mechanism, but is a rather rare cause of reflux disease overall.
In most cases, the diagnosis is made based on the typical medical history of frequent heartburn and acid regurgitation. Medical examinations often show no abnormal findings. Laboratory tests usually provide little information.
In uncomplicated cases, the typical symptoms can be treated, for example, with acid-inhibiting agents (proton pump inhibitors [PPI]) without the need for further examinations. If the symptoms subside under medication, this is a clear indication that the suspected diagnosis was correct.
If patients have clear risk factors (alcohol, smoking), complain of additional atypical complaints, suffer from concomitant diseases or have complained of heartburn for a very long time, an endoscopy of the esophagus and stomach (gastroscopy), if necessary, will be performed. Further examinations also recommended.
With the help of gastroscopy, doctors can find out if there is inflammation of the esophagus (esophagitis). Esophagitis may be accompanied by a more marked change in the mucosal cells in the esophagus, a so-called. Barrett's esophagus . this disease can lead to esophageal cancer over a longer period of time, therefore regular check-ups are advisable.
Gastroscopy is performed v. a. Performed in patients* for whom proton pump inhibitors are unsuccessful, and in patients* with dysphagia or other symptoms that should be carefully clarified. During gastroscopy, it is important to assess the extent of mucosal damage in the esophagus, identify any complications, and rule out cancers in the stomach or esophagus. In certain cases, this involves taking a tie sample for microscopic examination (biopsy).
Some patients with severe inflammation may be completely asymptomatic. At the same time, only about half of all patients with gastroesophageal reflux disease have mucosal changes in the esophagus.
Measurement of pH and prere in the esophagus is performed only in certain cases:
– For reflux symptoms without mucosal changes in the esophagus – When surgery (such as sphincter surgery) is being considered. – When patients do not respond to proton pump inhibitors. – To detect reflux of gastric contents in individuals with chest pain or other atypical symptoms when the cause is unclear.
Treatment is aimed at relieving symptoms and preventing inflammation of the esophagus or curing inflammation.
What you can do yourself?
There are some things you can do yourself to improve the situation:
– Tilt the head of the bed slightly upwards to reduce reflux problems at night. – Avoid overweight . – Avoid late and rich dinners, as this increases acid production at night. – Avoid foods and drinks that increase discomfort. This is especially true of carbonated drinks, citrus fruits, spicy or fatty foods, peppermint, chocolate, coffee and alcohol. ! Nicotine is thought to weaken the lower sphincter of the esophagus. should be treated. – Avoid e ng sedentary clothing and work positions that involve standing or sitting bent over for long periods of time. – The use of certain painkillers (NSAIDs) should be avoided.
Medications are often used. For many people, the occasional use of acid reducers (so called "acid reducers") is sufficient. Antacids), possibly also regularly after meals. Occasionally, medications that form a protective film (with alginic acid) around the mucous membrane also help. The most effective drugs are those that reduce or completely stop acid production, known as proton pump inhibitors (PPI). Should be taken 30 minutes before a meal. H2 receptor blockers are rarely used anymore.
The disadvantage of these drugs is that their effect lasts only as long as they are taken. Some patients are therefore bound to a long-term treatment of the reflux disease.
If patients do not improve with counseling and medication, surgery may be performed in some cases. Surgery is performed to modify the lower portion of the esophagus with the sphincter and/or the upper portion of the stomach to prevent reflux of stomach acid as much as possible. Nowadays, this is usually done in a low-invasive way and leads to good results, but often does not surpass the effect of medications. Surgery is mainly considered in younger individuals with very severe symptoms.
The disease is chronic, with good periods alternating with bad periods. Medications are effective as long as you take them. In most cases, reflux disease is completely harmless.
However, certain complications are possible as a result of the condition:
– Inflammation of the esophagus (see above) – Narrowing of the esophagus due to chronic inflammation (very rare) – Asthmatic symptoms when stomach acid passes from the stomach into the esophagus and on to the trachea. – Damage to enamel – Barrett's esophagus can be a precursor to esophageal cancer in isolated cases; however, this is rare. – Bleeding in the upper gastrointestinal tract, which can lead to anemia.
– Martina Bujard, science journalist, Wiesbaden, Germany
This article is based on the article Gastroesophageal Reflux Disease. The following is the literature list from this document.
1. Lohnstein M, Eras J, Hammerbacher C. The Exam Guide to General Practice – Updated and Expanded 3. Support. Augsburg: Wibner-Verlag, 2018. 2. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol.