Reflux disease is noticeable by heartburn. Patients suffer from acid regurgitation, irritable cough, hoarseness and severe burning behind the breastbone. This disease is common and must be treated to rule out secondary damage.
What is reflux disease?
Schematic diagram showing the anatomy of reflux disease or heartburn. Click to enlarge. Doctors refer to reflux disease when the lining of the esophagus is inflamed. Stomach contents and acidic gastric juice flow into the esophagus because the sphincter of the stomach entrance fails and does not prevent reflux. The lower third of the esophagus is inflamed because of irritation from the acid. If reflux disease becomes chronic, there is a risk of secondary diseases, such as esophageal cancer. Reflux disease is a typical disease in industrialized countries. Here, about 20 percent suffer from recurrent heartburn. Children and infants can also suffer from reflux disease. The incidence is increasing, just as esophageal cancer is increasing at the same rate. This is a rare consequence of reflux disease.
Causes
Reflux disease is triggered when the sphincter of the entrance to the stomach fails. Stomach contents and stomach acid can flow back into the lower part of the esophagus. There are several factors that cause reflux disease. These include the sphincter being too weak, the esophagus passing too far through the diaphragm, other anatomical abnormalities that prevent upper gastric closure. The risk of developing reflux disease is favored by nicotine, alcohol, obesity and certain medications. Some patients get heartburn when they are under stress. Heartburn is especially common during pregnancy. This is because the growing baby presses on the stomach. In the last trimester of pregnancy, a good half of women suffer from reflux disease.
Symptoms, complaints and signs
Typical symptoms of reflux disease include heartburn, chest pain (retrosternal pain) and regurgitation, a backflow of contents from hollow organs. In this case, the reflux of food pulp from the stomach into the mouth. In reflux disease, these symptoms are aggravated by eating, lying down, drinking alcohol, smoking, bending, or both physical and mental stress. Chest pain is localized behind the breastbone (sternum) and is often mistaken for pain of the heart. It is a burning, very uncomfortable pain that worsens after eating. Upper abdominal pain (epigastric pain), belching of air or gastric juice, and dysphagia (odynophagia) are also common symptoms. Reflux disease also occasionally manifests itself in atypical symptoms, such as a compulsion to clear the throat, chronic cough, a lumpy feeling in the throat (globus sensation), hoarseness, recurrent pneumonia, bad breath (halitosis), a persistent dry feeling that does not improve even with drinking, or penetrating, never-ending hiccups. Acid regurgitation and regurgitation cause damage to the tooth enamel as secondary damage. Reflux disease can also occur in infancy. In this case, infants show problems with feeding and there is increased crying and restlessness. In some cases, the infant stretches the head backward.
Diagnosis and course
The doctor can first diagnose reflux disease based on the symptoms. This is done on the basis of the anamnesis interview, where information about the type, frequency and lifestyle habits are important. Other diseases that have similar symptoms must be ruled out first. A reliable diagnostic method is gastroscopy. Especially in the case of chronic reflux disease, this is performed to detect possibly malignant changes in the mucosa. However, not only changes in the mucosa can be detected by means of this esophago-gastroscopy. Tissue samples can also be taken in the same step. During gastroscopy, a capsule can also be placed in the esophagus to measure acidity over a 24-hour period. Here, physicians refer to this as long-term pH metry. The concentration of acid is measured, and the data are transmitted immediately to a recording device.
Complications
Reflux disease is at risk of developing complications as the disease progresses.These include esophagitis (inflammation of the esophagus). It is caused by constant contact with acid, which leads to changes in the mucous membrane. This can cause inflammation of the mucous membrane, which also swells. Basically, esophagitis is one of the typical sequelae of reflux disease. The teeth can also be affected by the disease, which is due to the reflux of the acidic stomach contents. Lesions of the tooth enamel become noticeable through pain-sensitive teeth, caries, periodontitis and inflammation of the oral cavity. Another effect of reflux disease is narrowing of the esophagus. In this case, the cavity of the esophagus is narrowed by inflammatory strictures or reflux-related scarring. This consequence becomes noticeable by disturbances of the swallowing reflex and pain. Because the influence of the gastric acid is permanent, there is a risk of burns to the gastric mucosa. As a result, the esophagus contracts due to the formation of scars, which in turn leads to a pronounced narrowing. Physicians then speak of a peptic stricture. Another complication of reflux disease is the formation of ulcers in the mucosa of the esophagus. In most cases, they settle in the lower esophageal region, which is located at the transition to the stomach. Bleeding is considered a possible consequence of the ulcers, which can have both an acute and a chronic course.
When should you see a doctor?
Frequently, severe heartburn occurs after eating fatty and spicy foods. Affected individuals have an uncomfortable feeling in the mouth or a strong burning sensation. Heartburn is not a medical condition that must be treated by a doctor. If heartburn occurs several times a week for no apparent reason, such as pregnancy, it should be discussed with the family doctor. The stomach contents flow back again because fatty foods increase the pressure in the stomach. A doctor can pinpoint the exact cause of the food reflux and prescribe appropriate medication against it.
Treatment and therapy
Drug treatment for reflux disease can inhibit acidity. Antacids, hydrotalcite, and magaldrate neutralize or bind stomach acid. The drugs are available as tablets, gels, coated tablets and suspensions. They are usually taken when the symptoms occur. For example, at night or after a meal. Antacids are also suitable for pregnant women. H2 antihistamines inhibit the formation of stomach acid. These H2 receptor blockers are usually taken at night and are available over the counter. Proton pump inhibitors require a prescription. They are used for very severe symptoms and block the formation of an enzyme responsible for acid production. The symptoms disappear within two weeks. However, a cancer risk remains. If nausea and vomiting occur due to reflux disease, prokinetics are also used. They stimulate the movement of the stomach and intestines and thus ensure faster removal of stomach acid. Chronic reflux disease can be treated surgically if treatment with medication is unsuccessful. This operation is performed as a minimally invasive procedure. The closure mechanism of the sphincter is restored. Stomach acid can then no longer flow back. As home remedies for occasional discomfort, rusks, yogurt, milk and almonds have proven effective.
Prevention
Those who are prone to heartburn should avoid fatty and lavish meals. Especially in the evening, the stomach should not be burdened with too large portions. High-fiber food also helps. Coffee, alcohol and nicotine promote reflux disease and should therefore only be enjoyed in very small quantities. Stress and excitement should be avoided. Those who are overweight should try to lose weight.
Aftercare
Via diet, it is possible to reduce acid production in the stomach. Here it is recommended to consume a low-fat and alkaline-rich diet. Bread and oatmeal can be used to reduce occasional heartburn to a minimum. Moreover, those who suffer from overweight should reduce their body weight, or at least normalize it. Various medications affect the lower esophageal sphincter and thus promote gastroesophageal reflux. For this reason, current medication should be critically reviewed and even replaced if necessary.Various measures can counteract potential reflux: These include refraining from eating large meals shortly before bedtime as well as raising the headboard when sleeping. In general, sufficient sleep should be ensured. Thus strong lack of sleep can lead to the fact that the mucous membrane of the esophagus experiences a larger sensitivity opposite the sour gastric juice. No question: reflux disease can usually be treated well. In about 90 percent of cases, reflux esophagitis is cured after PPI therapy. However, when therapy is discontinued, recurrences occur in about 50 percent of patients. If left untreated, some cases develop complications, which can sometimes be very serious. Those who temporarily resort to medication against reflux and consciously change their diet are very likely to prevent permanent esophagitis.
What you can do yourself
People who are affected by reflux disease have a number of ways to make everyday life with this disease easier. Affected person should pay strict attention to your diet. Acidic and heavy foods should be avoided. This is because the more spicy or even acidic foods are consumed, the more acid is produced in the body. However, this process is counterproductive in reflux disease. If the affected person wants to counteract the disease, he should emphasize mild foods. Foods that can be digested quickly, such as white bread, cooked vegetables or even rice, are also optimal for this disease. When it comes to drinks, patients should pay attention to low-carbonated beverages. Carbon dioxide stimulates acid production in the body. Still water or mild fruit juices are more suitable. If help is needed in putting together a diet, a trained nutritionist can be consulted at any time. Besides the nutritional base, certain over-the-counter medications such as stomach gels or acid blockers can be taken. This method can also be discussed with the doctor in charge at any time. If these tips are followed, improvement will be felt quickly and symptoms will be relieved.
