Brief overview
- Symptoms: heartburn, feeling of pressure behind the breastbone, difficulty swallowing, bad breath when belching, damaged tooth enamel, irritable cough and inflamed respiratory tract.
- Causes: sphincter muscle at the lower esophagus closes the stomach incompletely, certain food stimulates production of gastric acid, diaphragmatic hernia, anatomical reasons, pregnancy, organic diseases
- Diagnosis: gastroscopy, long-term pH measurement over 24 hours.
- Prognosis: Untreated and with permanent acid exposure inflammation of the esophagus, possible complications are a cauterized trachea, pneumonia, bleeding in the esophagus or esophageal cancer.
- Prevention: unclear if and which behavioral changes help permanently or even prevent, individual trying of different therapeutic measures (like dietary changes) to detect possible influence
What symptoms are caused by reflux?
Heartburn
Feeling of pressure in the chest
Difficulty swallowing
The mucous membrane of the esophagus becomes inflamed much more easily due to the increased acid contact in reflux disease. The irritated mucosa is a good breeding ground for bacteria, and food debris sticks to it more easily. The irritation of the mucosa often causes patients to suffer from difficulty swallowing (dysphagia). The contact of the food with the mucosa puts additional strain on the inflamed tissue and causes pain.
Bad breath and belching
The permanent irritation of the esophageal mucosa results in bacteria and food debris settling more easily on the inflamed mucosa. The inflamed tissue forms a good breeding ground for bacteria. The germs produce substances that are exhaled with the breath and cause bad breath (halitosis).
Damage to the enamel
Classic reflux symptoms also include acid exposure of the teeth and the associated damage to the enamel. Tooth enamel is normally the hardest and most robust substance in the body and protects the teeth from external influences. If the acidic gastric juice even enters the mouth during burping, it attacks the tooth enamel. As a rule, this is first noticeable on the necks of the teeth.
Cough and damaged airways
Symptoms in babies and young children
Reflux symptoms are already possible in infancy. However, the symptoms manifest themselves differently than in an adult: The children have problems with food intake when breastfeeding or drinking. They behave restlessly and cry more often. Some babies stretch their head and upper body backwards to make it easier for them to feed. Other children vomit more often after eating.
Recognize reflux symptoms and take them seriously
The symptoms of reflux disease are usually easy to recognize. Nevertheless, even today, reflux is not always treated because those affected often trivialize the symptoms. If patients take reflux disease seriously and treat it, complications are usually avoidable. Differentiating reflux symptoms from other causes such as heart disease, on the other hand, can only be done by a doctor.
What are the causes and risk factors?
There is a primary and a secondary form of the disease.
Causes of primary reflux disease
The exact mechanism leading to repeated leakage of gastric contents in primary reflux disease has not yet been fully elucidated. However, there are several factors that cause increased gastric acid production and slackening of the esophageal sphincter, thus promoting reflux disease.
Influence of diet on the primary form
The role of the diaphragm and the His angle in the primary form.
Another factor that promotes reflux disease is an increased “His angle”. The His angle is the angle between where the esophagus enters the stomach and the uppermost portion of the stomach. Normally, it is about 50 to 60 degrees. If it is increased above 60 degrees, gastric juice flows more easily back into the esophagus.
Causes of the secondary form
Pregnancy
Organic diseases
There are various organic diseases that promote narrowing of the gastric outlet (pyloric stenosis). Also, if a gastric tumor is appropriately located, the outflow of the stomach contents may be restricted. The stomach contents then do not pass into the small intestine, but back up. This increases the pressure and the stomach contents pass more easily into the esophagus, leading to reflux symptoms.
What are the examinations and diagnoses?
The right contact person for suspected reflux disease is your family doctor or a specialist in internal medicine and gastroenterology. By giving a detailed description of your symptoms and any previous illnesses, you provide the doctor with important information about your current state of health (anamnesis interview). In order to get an accurate picture of your condition, the doctor will ask you the following questions, among others:
- Do the symptoms increase when lying down or bending over?
- Do you have to burp more often?
- Do you suffer from a feeling of pressure in your throat?
- Do you have difficulty swallowing?
- Have you noticed an irritating cough that occurs more often at night?
- Have you noticed bad breath more often?
- Do you have any previous diseases of the esophagus or stomach?
- Do you take any medications?
- Do you drink alcohol and coffee, smoke, and what is your diet?
Gastroscopy (esophago-gastro-duodenoscopy)
Long-term pH-metry (over 24 hours)
Measuring the pH value in the esophagus over 24 hours is considered the standard method for reliably diagnosing reflux disease. Long-term pH-metry is particularly important if gastroscopy has not revealed any evidence of mucosal damage.
How is reflux disease treated?
Reflux disease is easily treatable. General measures such as a change in dietary habits and lifestyle already lead to significant relief of symptoms in many sufferers. Reflux treatment with medication helps 90 percent of those affected. In the event of a particularly severe course of reflux disease, surgical measures may be considered.
General measures
Diet for reflux problems
Avoid harmful substances
Medication to inhibit acid production
Operational options
Home remedy
Many people swear by the use of substances that neutralize acid (antacids) for heartburn. These include, for example, the so-called Bullrich salt. This consists of 100 percent sodium hydrogen carbonate, which balances the stomach acid. Although Bullrich salt often helps well against acute heartburn, it has been shown to really crank up acid production in the stomach. Therefore, it is not recommended for permanent use.
Home remedies have their limits. If the symptoms persist for a long time, do not get better or even get worse, you should always consult a doctor.
Who is affected?
What is reflux disease?
Features of different forms of the disease
Differentiation between NERD and ERD
If reflux exists without mucosal changes, it is referred to as non-erosive gastroesophageal reflux disease (NERD). NERD accounts for approximately 60 percent of all gastroesophageal reflux disease sufferers. If, on the other hand, mucosal changes can be detected in a tissue sample from esophageal endoscopy, this is referred to as erosive reflux disease (ERD).
Secondary gastroesophageal reflux occurs as a result of a known physical change – it occurs less frequently than primary reflux disease. Examples include pregnancy with the accompanying increase in abdominal pressure. Furthermore, diseases of the digestive tract that lead to an anatomical change in the esophagus or stomach are possible triggers for secondary reflux disease.
Course of the disease and prognosis
Gastroesophageal reflux disease with esophagitis.
Esophagitis is inflammation of the esophagus (food pipe), triggered by increased acid contact in gastroscopy with changes in the mucosa. Typically, the inflamed mucosa is red and swollen. If no mucosal changes are seen on gastroscopy and tissue samples taken during the procedure, the condition is non-erosive gastroesophageal reflux (NERD).
Barrett’s esophagus
This cell remodeling (metaplasia) of the esophagus is called Barrett’s esophagus or Barrett’s syndrome. However, the cell changes increase the risk of malignant tumor (adenocarcinoma) of the esophagus. Approximately one in ten patients with Barrett’s esophagus develops esophageal cancer. Therefore, if Barrett’s esophagus is known, consistent reflux treatment with regular checkups is important.
Further complications
Reflux disease should therefore always be treated to avoid secondary damage.
