Heartburn: Reflux diseasePlease highlight the appropriate words in the text. With only two clicks you report the error to the editorial office.
Reflux means backflow. This happens when the valve between the esophagus and the entrance to the stomach does not close properly. After a rich meal belching is normal. If it occurs more frequently, it is called reflux disease.
Reflux means reflux. Stomach contents can run back into the esophagus.
Causes may include stress, smoking, pregnancy, obesity, or a diaphragmatic hernia.
A change in lifestyle is often enough to help relieve symptoms.
In reflux, the valve between the esophagus and the entrance to the stomach does not close properly. Therefore, from time to time, half-digested stomach contents and juices run back into the esophagus. This leads to belching and burns unpleasantly, because the mucous membrane of the esophagus is not protected from the acid. If this happens occasionally after a rich meal, this process is completely normal. However, if acid regurgitation occurs very frequently or the esophagus even becomes inflamed, this is referred to as reflux disease.
Causes, triggers, risk factors
The direct trigger of the discomfort is the non-functioning sphincter of the esophagus (esophageal sphincter). But why the again is disturbed, respectively slackened, is not always known.
However, it is known that factors such as smoking, alcohol, stress and fatty foods have a negative effect on the sphincter muscle.
Pathological reflux can also have other physical causes such as a diaphragmatic hernia, pregnancy or severe obesity. These circumstances do not directly affect the obstruction, but stress and change the environment of the entrance to the stomach. Stomach acid can flow back because supporting muscles or the support of the diaphragm are missing. In addition, the function of the esophagus itself may be disturbed. Already on little stomach acid overreacts.
Medication, for example against high blood prere, or the contraceptive pill can also cause or at least intensify the complaints.
Symptoms
The main consequences of reflux disease are frequent and severe heartburn and acid regurgitation. These symptoms are usually so pronounced that those affected feel restricted in their daily lives: They lose their enjoyment of food and often restrict their social contacts as a result.
The esophagus can be inflamed as a result of reflux, but this is not necessarily the case. On average, this is the case in one third of those affected.
The typical burning sensation extends from the upper abdomen almost to the throat. Many feel the burning also still in the throat. Often have a bad taste in the mouth. In addition, there is a feeling of fullness, nausea and nausea, mainly after eating. Swallowing disorders also occur. All of these complaints are usually worse when lying down or sitting than when standing up.
In addition to these typical symptoms, indirect problems also occur due to stomach acid. It can, for example, attack tooth enamel or cause coughing if it reaches the windpipe. Therefore, consequences of reflux disease can also be.
If the disease is not treated, permanent contact with gastric juice can cause long-term damage to the esophagus. The mucosa can form ulcers and sometimes the cells change, so that the esophagus becomes narrower in the lower area. This change, called "beret esophagus", increases the risk of developing esophageal cancer later on.
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Diagnosis
The most important thing for a correct diagnosis is a precise anamnesis, i.e. talking to the patient about his or her symptoms. Only with the help of precise information about the severity and frequency of the symptoms can the doctor assess what is causing the problem.
If the doctor ames a reflux disease after this initial examination, he usually carries out a trial treatment. In this case, the patient swallows a medication for about two weeks that inhibits the formation of stomach acid (PPI, s.h. Below) If the symptoms are less, this treatment is effective and it is indeed a reflux disease.
If the result is not clear, an endoscopy is necessary in any case, but sometimes this order is reversed. The examination is also used to rule out esophageal cancer or other diseases of the gastrointestinal tract. The doctor inserts a small camera on a thin tube through the mouth and can thus examine the mucosa in detail.
Another possibility is a pH-metry. A special probe measures acidity at the bottom of the esophagus. This helps to determine whether the discomfort is actually caused by excessive reflux of gastric acid, and when the strain is greatest. pH-metry serves to confirm the diagnosis, but is still prone to errors due to the strong daily dependence of reflux.
Therapy
One can treat the symptoms of reflux disease relatively well, but successful therapy takes time. Some people are helped by a change in lifestyle, while others have to resort to medication or even surgery to permanently alleviate the symptoms. However, a complete cure is often not possible in severe cases. Since the basic cause, i.e. the weak sphincter, remains, the disease can return at any time even after successful therapy.
Drug treatment
There are several medications on the market that can provide relief from reflux disease. However, they all suppress the symptoms only as long as the patient takes them. If he discontinues them, the symptoms usually return. In consultation with the patient, the doctor will always adjust long-term therapy to the individual and check at regular intervals whether the medication is still necessary.
– Proton pump inhibitors PPI
These drugs inhibit certain enzymes responsible for the production of stomach acid. If there is less acid, there is also less reflux, which means that the unpleasant heartburn occurs much less frequently. This also allows the irritated or even inflamed mucosa to heal. Only at night do PPIs not seem to work quite as well.
Side effects such as abdominal pain, vomiting, diarrhea, or headaches may occur, as well as an increased likelihood of bone fractures in people who take high doses of PPI for many years.
– H2 receptor blockers (H2R-A)
These receptor blockers work similarly, but apparently not quite as strongly. They prevent the hormone histamine from docking at the corresponding receptors in the stomach. Without this contact, the glandular cells secrete much less gastric juice, the discomfort decreases.
This group of drugs is supposed to inhibit reflux by increasing the muscle tension of the sphincter. In addition, prokinetics promote gastric movements so that the stomach empties more quickly, which also relieves prere on the sphincter. However, they are used rather rarely, as they do not help as well as the previously mentioned drugs for a long time. These preparations bind the stomach acid. Can thus neutralize the excess acidic gastric juice. They used to be widely used, but today there are doubts about whether they are really useful for reflux disease. At most, they help with mild symptoms and can be purchased without a prescription and taken as needed for acute pain.
Non-medication treatment
Before or in addition to taking medication, it may be worthwhile to change one's lifestyle and in particular one's Change of diet.
Coffee, tea, acidic drinks, cocoa and alcohol, for example, stimulate the formation of gastric acid and should therefore be avoided. Five to six small meals a day are often better tolerated than a few large meals. And very high-calorie or high-fat foods can stress the stomach, as can late eating. However, it is up to the individual to decide which foods or beverages he or she is sensitive to.
Many patients also find it helpful to stop smoking. Overweight people often succeed by losing a few kilos.
Since psychological factors also play a role, relaxation techniques can relieve stress and thus also improve the symptoms. If you also sleep with your upper body slightly elevated, you limit acid reflux at night.
Who also medicines do not help any more, who can take a Anti-reflux surgery consider. In this procedure, the surgeon places the upper stomach completely or sometimes only partially around the esophagus and secures it in this position. This sling automatically strengthens the closure between the esophagus and the stomach and can prevent reflux. This operation is also called "fundoplication". It often relieves the symptoms of belching and heartburn better than medication at the beginning, but little is known about its long-term effect in comparison.
Swallowing difficulties can occur as a complication. And it is important to know that even patients who have undergone surgery cannot generally do without medication. About 36 out of 100 people are still taking medication a year after surgery, but significantly less than before.