Diseases

Reflux - causes, symptoms, treatment

Reflux - causes, symptoms, treatment


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The term “reflux” is usually understood to mean the backflow of gastric juice into the esophagus, which leads to heartburn and acid regurgitation. This process is to a certain extent completely natural and harmless, but if the reflux occurs more often, it can lead to severe impairments of the mucous membrane and massive discomfort. In this case, doctors speak of a "gastroesophageal reflux disease", which is one of the most common gastrointestinal complaints. The essentials in brief:

In western industrialized countries, one in four adults is estimated to have reflux disease. This is usually limited to the lower esophagus. However, a frequent occurrence should not go unnoticed, because sometimes serious complications can arise from heartburn.

Prolonged duration may cause inflammation of the esophagus or degeneration, which can lead to cancer of the esophagus. Accordingly, the symptoms should always be taken seriously and medically clarified. In many cases, the symptoms can already be alleviated by changing the diet. Proven home remedies for heartburn can promote and accelerate the healing process.

The term “reflux” comes from the Latin word “refluere” and means “to flow back”. As the term suggests, reflux disease is primarily the reflux of acidic gastric juice into the esophagus, causing typical symptoms such as heartburn and regurgitation. While this is quite normal in an occasional form, frequent occurrence leads to permanent impairments of the mucous membrane. This can cause massive damage to those affected.

If heartburn occurs regularly, doctors speak of a "gastroesophageal reflux disease" (GERD). It is estimated to affect a quarter of the population in western industrialized countries. Various forms occur, of which the most common variant is “non-erosive reflux disease” (NERD), in which the esophagus is not inflamed.

The reflux of gastric acid can also lead to inflammation of the esophagus (reflux esophagitis). This can take on massive dimensions and lead to scarring and swallowing problems and, in an emergency, can promote the development of esophageal cancer. Patients with a so-called "Barrett's syndrome" (Barrett's esophagus) are particularly affected, since the chronic course of the esophagus has already changed significantly.

It is also possible that the effects of gastroesophageal reflux disease also manifest outside the esophagus, causing symptoms such as chronic cough, bronchial asthma or dental erosions on the teeth (extraesophageal manifestations).

Usually, gravity already ensures that the gastric juice cannot flow back into the esophagus. In addition, it can twist as a stretchable muscle tube so that the stomach entrance (cardia) is closed. The lower sphincter of the esophagus (esophageal sphincter) usually only relaxes when swallowing and for short moments in which swallowed air is expelled.

In most patients, the gastric occlusion mechanism is disturbed, causing the gastric acid to flow up and attack the esophageal wall. Unlike the stomach, this is not surrounded by a corresponding protective mucous membrane ("primary reflux disease"). Above all, heartburn occurs when lying down and in the stooping position when the gastric juice flows towards the esophagus due to gravity.

The esophagus runs through a gap in the diaphragm and ends in the stomach entrance. Regular improper nutrition can lead to overstretching, which widen this gap. When the gap widens, parts of the upper stomach also slide into the widened opening in the diaphragm. If the diameter of the gap is two to three centimeters, doctors speak of a small diaphragmatic hernia (hiatal hernia). If the opening is larger than three centimeters, there is a large diaphragmatic hernia. A diaphragmatic rupture is often responsible for the disturbed locking mechanism of the stomach.

In addition to this, decreased mobility of the esophagus can also be the cause of a primary disease. If the gastric acid flows back, the esophagus usually corrects the “acid problem” through its own movement (peristalsis). The corrosive gastric juice is pushed back into the stomach by the movement, so that there is no possibility of damage. If this mobility is restricted, the cleaning process will no longer work properly. As a result, the acid has longer contact with the esophagus wall, which ultimately leads to severe damage and the typical burning pain (heartburn).

There are also numerous other risk factors and possible causes of heartburn. These include, for example, the following factors:

Reflux can also occur as a result of other illnesses or interventions. In this case, doctors speak of a "secondary reflux disease". This can occur, for example, as a result of subsequent diseases:

  • Scleroderma: With the rare connective tissue disease scleroderma, hardening and thickening of the skin or mucous membrane as well as the internal organs can occur, especially in the digestive tract, lungs, heart and kidneys.
  • Operations: Heartburn can also result from surgery such as cardiomyotomy.
  • Narrowing of the stomach: A narrowing of the stomach outlet is also possible, because here gastric emptying can only take place with a delay, which results in increased pressure in the stomach over a longer period of time and thus a higher risk.
  • Premature birth: In addition, premature birth can cause reflux in the baby because the sphincter is not yet mature.
  • Zollinger-Ellison syndrome: The so-called "Zollinger-Ellison syndrome" can also be responsible for the complaints, in which there is an increased formation of stomach acid as a result of pathological overproduction of the hormone gastrin.
  • Reflux symptoms

    The main symptom is frequent acid regurgitation of stomach acid and / or heartburn, which is accompanied by burning chest pain, which is usually felt behind the breastbone. The complaints intensify in most cases on the one hand when bending down or lifting heavily, and on the other hand after eating larger, more extensive meals, foods with a high sugar content (cakes, sweets, desserts) or the consumption of alcohol and nicotine.

    Lying position often increases the symptoms

    Due to the lying position, in which gastric juice gets into the esophagus more easily, the symptoms are particularly severe at night. If the acid gets into the trachea, it can also cause a strong nightly cough or even shortness of breath.

    Frequent complaints

    In addition to the typical symptoms, many people have other complaints. These include, for example:

    • More or less pronounced upper abdominal pain,
    • Nausea and vomiting,
    • Throat pain,
    • Hoarseness,
    • Swallowing problems with inflammation of the esophagus (esophagitis).

    Intensity of symptoms

    The form and intensity of the symptoms can be very different and is not - as with many other diseases - directly related to the course of the disease. Accordingly, it can happen that sufferers only show weak signs of disease even with severe damage to the mucous membrane, while in other cases, for example, despite massive heartburn, there are no abnormalities in the findings.

    Treatment

    Which therapeutic steps are taken in individual cases depends on the severity of the disease. If no changes in the mucous membrane can be seen in earlier stages, the symptoms can often be alleviated by changing the diet and changing certain lifestyle habits.

    Medication and surgery

    If there is no success here or if there is already damage to the mucous membrane, medication is usually used for treatment. In very rare cases, however, surgery is also necessary to restore the functionality of the lower esophageal occlusion. Operations are also used when there is a major diaphragmatic breakthrough.

    Reflux nutrition

    Food plays a very special role, so that especially with light and medium-weight forms, the symptoms can usually be significantly alleviated by changing the diet. However, there are no generally applicable rules for this, because not everyone affected reacts equally to all foods. Nevertheless, there are some foods that are less tolerated by heartburn.

    Food with a high fat content

    Heavy meals often lead to heartburn. This includes, for example, foods with a high percentage of fat, because on the one hand this lowers the tension of the lower esophageal sphincter and on the other hand delays gastric emptying, which increases the risk of gastric contents flowing back into the esophagus. Therefore, special attention should be paid to high quality (e.g. oils with omega-3 fatty acids). In addition, only a little fat should be used per meal and fried, heavily seared and particularly fatty foods (fatty meat and sausage products, mayonnaise, fast food, fatty fish etc.) should be avoided as far as possible.

    Desserts

    Likewise, you should not eat too much sweets, since sugar-rich foods such as cakes, desserts, lemonades and juices additionally stimulate gastric acid production and thereby increase reflux in many cases.

    Spicy and spicy food

    Spicy food or spices such as paprika, pepper, garlic or chili also stimulate the formation of acid, whereby the sharpening alkaloid capsaicin additionally increases the sensitivity of the esophagus and the complaints are often exacerbated.

    Chocolate

    In addition, there are a number of hidden “acid generators” that should be avoided. This includes, above all, chocolate, because it contains plenty of sugar and fat as well as methylxanthines (theobromine, theophylline), which also have a relaxing effect on the lower esophageal sphincter and stimulate acid secretion.

    Mint tea

    The same applies to peppermint tea, which is usually a tried and tested home remedy for many ailments, but should be better avoided in the case of reflux to prevent further muscle weakening.

    Acid-rich fruits and vegetables

    Some of those affected also report increased symptoms after eating acidic vegetables or fruits (citrus fruits, tomatoes, etc.), while fruits with little acidity (e.g. apples or bananas) have no negative effects.

    Dietary recommendations for reflux

    Accordingly, a low-fat and high-fiber diet that contains mainly basic foods is recommended for heartburn. The following are suitable for this:

    • Vegetables (potatoes, eggplants, kohlrabi, carrots etc.),
    • Fruit (strawberries, plums, kiwi, etc.),
    • Salads (Batavia, arugula, dandelions etc.),
    • steamed and spicy fish,
    • Seafood with little oil,
    • white meat (turkey, chicken),
    • protein-rich dishes such as kefir, yoghurt or curd.

    When and how to eat?

    In general, care should be taken to avoid late meals and sumptuous meals. Instead, it is advisable to consume several small meals consciously and at rest, with extensive chewing (flickering) being particularly important in reflux to relieve the stomach.

    Also consider drinking

    In addition to eating, drinking is very important. Non-carbonated mineral water, warm tap water and mild teas (e.g. fennel, mallow) are particularly suitable here, whereas coffee and black tea should only be consumed to a limited extent. Alcohol - like nicotine - should be avoided as much as possible, because on the one hand this causes an increased acid production in the stomach and on the other hand the tension of the sphincter is reduced and the muscular activity (peristalsis) of the esophagus is disturbed.

    Medication

    If the symptoms cannot be alleviated by a change in lifestyle and eating habits alone, the next step is usually to try to treat the reflux disease with medication. So-called "proton pump inhibitors" (PPI for short), such as omeprazole or pantoprazole, are primarily used here, which act as "stomach protection" by suppressing the formation of stomach acid in the parietal cells of the stomach.

    Medicines for light forms

    If there is only a mild form of reflux disease, H2 blockers (e.g. ranitidine, cimetidine) are also possible, which also inhibit the release of acid from the glandular cells of the stomach, but with a weaker effect than the proton pump inhibitors. These acid blockers are effective for up to 12 hours, taking into account that the active ingredients can suppress the breakdown of other drugs in the body, so a simultaneous use with other agents should not be done.

    Operations

    If drug therapy cannot remedy the situation, or if the symptoms are very pronounced or long-lasting, a surgical intervention may be necessary in rare cases.

    Gastric cuff surgery

    The most frequently used surgical method so far is the so-called "fundoplication" ("gastric cuff surgery"), which can be performed openly or endoscopically and leads to permanent healing of the reflux disease in over 90 percent of the patients. During the procedure, a gastric sleeve is placed around the esophagus, narrowing the passage into the stomach and finally compensating for the weakness of the lower sphincter. As a result, food can continue to be transported from the esophagus to the stomach, but reflux is prevented by the cuff.

    Flexible magnetic tape

    In addition to this, a new surgical procedure has been used for some time, in which a flexible magnetic tape is intended to stabilize the function of the lower esophageal occlusion (esophageal sphincter). With this so-called "LINX Reflux Management System", a magnet ring is placed above the stomach around the esophagus. This is designed so that the chyme continues to get into the stomach without any problems. However, since the magnets keep the lower part of the tube closed, a backflow of stomach acid and bile can be prevented.

    Experts see advantages here above all in the fact that, in contrast to the conventional methods, no anatomical changes need to be made in the patient, for example in the case of fundoplication, in which part of the stomach is used to form the cuff. The surgery is carried out under general anesthesia in a minimally invasive manner (“keyhole surgery”), which means that only a small incision above the navel is necessary. After the procedure, the patient can usually be discharged home after a few days and will soon be able to eat normally again. Nevertheless, care should still be taken to ensure that the food is not taken in too quickly and chewed sufficiently, and regular medical follow-up should take place.

    Naturopathy for reflux disease

    If you suffer from heartburn or regurgitation frequently or for more than two days at a time, you should first of all consult a doctor in order to identify or rule out organic disorders. The complaints should be taken seriously in any case, because if reflux disease persists over a long period of time, serious damage to the esophagus and, in the worst case, even esophageal cancer can occur. However, if the symptoms appear only slightly and irregularly, naturopathy can offer a meaningful and effective support or alternative to conventional therapy.
    [GList slug = ”10 home remedies for heartburn”]

    Change of diet

    In general, with persistent or recurring heartburn, it is important to deal carefully and critically with your own lifestyle and eating habits, e.g. fatty food, too much sweetness and an increased consumption of alcohol and nicotine can promote the development of reflux as well as psychological stresses that "hit the patient's stomach". In this context, urgent efforts should be made to reduce obesity and to reduce smoking and the consumption of alcoholic beverages.

    Change certain habits

    In addition, a change in certain habits (late eating, slings, etc.) is central. In addition, regular physical activity should be firmly integrated into everyday life in order to release tensions and increase well-being. Reflux mainly occurs when lying down and in the stooping position, which is why it is better not to lie down immediately after eating and generally to sleep with a higher upper body.

    Stress management

    In order to reduce stress and learn how to deal with pressure and tension in a healthier way, various exercises and procedures for reducing stress such as yoga, meditation or autogenic training are also suitable.

    The healing power of chamomile

    In addition to this, there are a number of other options for self-treatment for heartburn caused by reflux, through which the symptoms can be successfully alleviated. Chamomile has proven itself in many cases, which has an anti-inflammatory and calming effect on the over-irritated stomach nerves and can help to reduce the production of gastric juice.

    Chamomile tea roll cure

    Here, naturopaths and naturopathic doctors often recommend a roller cure with chamomile tea. In this case, a cup of tea is first drunk, then the patient lies on the back, right side, abdomen, left side and finally back again for about five minutes, so that the valuable ingredients of the chamomile reach the entire gastric mucosa can. “Rolling” should be done for at least a week in the best case in the morning on an empty stomach and in the evening directly before going to bed, if necessary distributed up to three times a day.

    Other natural remedies

    In addition to the "panacea" chamomile, fennel, lemon balm, plantain and nettle are particularly suitable from the field of herbal natural remedies, and valerian in the form of a tea or as a drop can also be very beneficial for stress-related heartburn.

    Homeopathy for reflux

    In addition, homeopathy also offers a number of remedies that have proven themselves in the treatment. Here, for example, Robinia pseudacacia (D6) comes into consideration in case of severe burning pain and stomach pressure as well as nightly acid regurgitation. Occurs alongside heartburn and regurgitation e.g. If you experience chills, nausea and vomiting and if you are averse to chilled drinks and coffee, Acidum sulfuricum (D6) can also be the treatment of choice. In addition, Nux vomica or Capsicum is also suitable in some cases. However, a detailed consultation with a naturopath or naturopathic doctor should always take place before self-treatment.

    Schuessler salts

    Schüßler salts are also suitable for treatment, although salt 9 (sodium phosphoricum) has proven particularly effective in the case of rising acid. If the esophagus burns at the same time, it is advisable to take it in alternation with salt no. 2 (Calcium Phosphoricum), whereby the exact potency as well as the duration and frequency of intake should always be discussed with an appropriate expert in advance.

    Acupuncture

    Acupuncture can also drastically reduce the symptoms of heartburn.

    Wraps and hot water bottles

    Another tried-and-true home remedy for heartburn is warm, moist wraps on the upper abdomen or a hot water bottle, in some cases warm milk, which is best diluted, helps in acute cases.

    Potatoes and potato juice

    Raw potatoes can also be a real “miracle cure” in acute cases, since the starch they contain can also neutralize stomach acid. Here, a juicer can be used to quickly prepare a freshly squeezed potato juice, which is also available as an alternative in the health food store. Instead of the juice, a piece of raw potato can also be eaten.

    Protein-rich dairy products

    Protein-rich foods such as kefir, yoghurt or curd can help alleviate the symptoms, since they release the hormone gastrin, which in turn promotes tension and thus the ability of the muscles to close.

    Bullrich Salt

    In many cases, the so-called “Bullrich Salt” also helps, which neutralizes excess stomach acid with the natural active ingredient sodium hydrogen carbonate and can thus alleviate acute burning pain in a gentle way. (no, tf, vb)

    Author and source information

    This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

    Graduate editor (FH) Volker Blasek, Barbara Schindewolf-Lensch

    Swell:

    • Schenk, Maren: Treatment of gastroesophageal reflux disease: alternatives and supplements, Dtsch Arztebl, 2018, aerzteblatt.de
    • Amboss GmbH: Gastroesophageal Reflux Disease (GERD) (accessed: July 17, 2019), amboss.com
    • Merck and Co., Inc .: Gastroesophageal Reflux Disease (GERD) (accessed: July 17, 2019), msdmanuals.com
    • German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS): S2l Guideline Gastroesophageal Reflux Disease, status: May 2014, detailed view of guidelines
    • Institute for Quality and Efficiency in Health Care (IQWiG): Heartburn and Reflux Disease (accessed: July 17, 2019), gesundheitsinformation.de
    • Luescher, Thomas / Steffel, Jan / Fried, Michael / u.a .: gastrointestinal tract, Springer, 2013
    • Mayo Clinic: Gastroesophageal reflux disease (GERD) (access: July 17, 2019), mayoclinic.org
    • NHS inform: Gastro-oesophageal reflux disease (GORD) (access: July 17, 2019), nhsinform.scot
    • UpToDate, Inc .: Clinical manifestations and diagnosis of gastroesophageal reflux in adults (accessed: July 17, 2019), uptodate.com
    • American Gastroenterological Association: Gastroesophageal Reflux Disease (GERD) (access: July 17, 2019), gastro.org

    ICD codes for this disease: K21ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


    Video: GERD Symptoms and Treatment - Whiteboard Series (September 2022).


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