Gastroesophageal reflux disease is the pathological reflux of stomach contents (food or fluid) into the esophagus (med. esophagus).
Gastroesophageal reflux is a chronic disease; once it occurs, it is usually permanent. Inflammation of the inner wall of the esophagus (esophagitis) can mean a chronic disorder.
If the esophagus is healed and treatment is interrupted, the problem returns in most patients within a few months.
Treatment of gastroesophageal reflux disease usually needs to be continued indefinitely; however, in some cases, when symptoms occur at irregular intervals, it can be limited to the symptomatic phases.
The reflux of gastric fluid into the esophagus is quite normal and occurs in all people; Studies have shown that reflux is observed in people without reflux disease as well as in people with reflux disease.
However, in patients suffering from gastroesophageal reflux disease, this reflux is different:
- the reflowing fluid contains increased gastric acid;
- the stomach acid remains longer in the esophagus;
- the liquid rises higher.
What is the esophagus?
Simply put, the esophagus is a tube that connects the stomach to the pharynx located in the back of the throat.
The lower esophageal sphincter is located at the junction between the stomach and esophagus. The stomach produces stomach acid and enzymes (gastric juices), which are used to digest food.
The inner wall of the stomach has various mechanisms that protect it from the action of digestive juices, while the inner wall of the esophagus is unprotected. The one under sphincter of the esophagus, which prevents the reflux of stomach contents into the esophagus, is called esophageal sphincter.
If this sphincter does not work properly, the digestive juices can ascend upwards into the esophagus.
Causes of gastroesophageal reflux disease
Risk factors for reflux disease include:
- Diaphragmatic hernia or hiatal hernia (a pathological passage of parts of the stomach through the diaphragm – the muscle-tendon plate that separates the thoracic and abdominal cavities)
Worry and stress can exacerbate the disorder, but there is no evidence that they are the trigger.
Heartburn and reflux can be caused or intensified by pregnancy and various medications.
- Anticholinergic (for seasickness)
- Beta-blockers (e.g. for high blood pressure))
- Bronchospasmolytics (treatment of asthma)
- Calcium antagonists (treatment of high blood pressure)
- Dopamine agonists for the treatment of Parkinson’s disease
- Progestin for abnormal menstrual periods or contraceptive pill
- Sedatives for sleep disorders or anxiety
- Tricyclic antidepressants
If there is a suspicion that any of these medicines cause heartburn, it is necessary to consult a doctor. One must never replace one medication with another or stop the drug treatment without first discussing this with a doctor.
What causes reflux in children?
Children usually suffer from reflux because the lower sphincter of the esophagus is not yet fully formed.
The child may spit and vomit because:
- it has a short and narrow esophagus;
- the digestive system works slowly and it takes a certain amount of time for milk to pass from the stomach to the small intestine;
- it needs to consume a lot of caloric fluid to grow, even if the esophagus and stomach are still developing.
The stomach volume of a newborn is roughly equivalent to a small marble, after three days a large marble and after ten days a ping-pong ball.
The sphincter at the entrance to the stomach of the infant gradually becomes stronger.
Over time, the stomach grows and the esophagus lengthens; the further growth of the child takes place without reflux. Between the 10th and 12th month, only 5 percent of children suffer from gastroesophageal reflux.
What are the typical symptoms of acid reflux?
Heartburn: a burning pain that can move from the stomach to the abdomen, chest and throat.
Acid regurgitation: a pungent or sour taste in the throat and mouth.
Other signs of reflux disease include:
- Swallowing disorder (dysphagia) – constriction of the esophagus, causing the feeling that food gets stuck in the throat;
- white tongue coating;
- shortness of breath (dyspnea), dry cough, hoarseness or chronic sore throat;
- throat irritation or rough voice;
- bitter taste in the mouth and bad breath;
- difficulty swallowing;
- Stomach pain.
You may also experience some rare symptoms.
If any of these symptoms become noticeable, diagnosis may be difficult because it can indicate other conditions.
Sometimes a persistent cough occurs, especially at night. This is caused by the stomach acid-related irritation of the esophagus.
The symptoms of asthma, coughing, and wheezing breath can result from leakage of stomach acid.
Other possible ailments affecting the mouth and throat include gum problems, bad breath, sore throat, hoarseness, and the feeling of a lump in the throat.
Sometimes severe chest pain also occurs, which can be confused with a heart attack (infarction).
Complications and sequelae
As a long-term effect of gastroesophageal reflux disease, Barrett’s esophagus may develop. Due to the long-lasting irritation caused by stomach acid, the cells of the esophagus change and become precancerous (precancerous stage).
Eventually, this can lead to esophageal cancer.
Barrett’s esophagus occurs mainly in adults who have been suffering from reflux disease for many years.
The complications of reflux disease also include inflammation of the esophagus, which in the acute phase is characterized by pain behind the sternum and fever.
Some studies show that reflux can also cause hearing problems, such as a middle ear infection; this happens especially in childhood.
Diagnosis of gastroesophageal reflux disease
The symptoms of gastroesophageal reflux disease can be so clear that all further examinations are superfluous.
If the doctor has doubts or severe complaints, the doctor may consider a gastroscopy.
During this examination, oesophagitis (esophagitis), diaphragmatic hernia (hiatal hernia), stomach ulcers and other diseases can be detected or excluded.
Another option is a 24-hour pH-metry (acidity measurement). This makes it possible to constantly measure the acidity (pH value) of the lower esophagus for 24 hours. This examination can be used to detect how long and how often stomach contents flow back into the esophagus.
In addition, the pressure in the esophagus can be determined with the help of an esophageal pressure measurement (esophageal manometry).
This method of examination is not often used if there are no complications.
The symptoms of gastroesophageal reflux disease may be similar to those of other conditions, including stomach ulcers, chest pain caused by angina, muscle pain, back pain, constipation, irritable bowel syndrome, gallstones, pancreatic discomfort, etc. Sometimes these diseases must be ruled out in order to make the diagnosis.
What can be done? Therapy and natural remedies for reflux disease
Natural forms of treatment and home remedies are listed below; however, there are few studies that show the extent to which lifestyle changes affect return:
Smoking. The chemical substances contained in cigarettes relax the lower esophageal sphincter and promote the rise of stomach acid (reflux).
Smokers should stop smoking to relieve symptoms.
Abstain from certain foods. One can make life with reflux much easier by avoiding symptom-triggering things. Some people only have to limit the consumption of certain foods, others have to abstain from them completely. This depends entirely on the symptoms and the individual reaction.
It may seem difficult at first to give up carbonated drinks and favorite foods; but after a while, many patients realize that they feel much better and that the renunciation of certain things is not as difficult as expected.
Certain foods and drinks may increase reflux; it is assumed that some foods relax the sphincter and thus promote the return.
You should be guided by your feeling: if it is suspected that a certain food is causing the symptoms, you leave it out for a while and see if the symptoms get better.
Critical foods include: peppermint, tomatoes, spicy food, chocolate, hot drinks, coffee and alcoholic beverages; rather, freshly squeezed lemon juice should be drunk.
It is recommended to replace sugar with honey.
One should avoid larger meals, eat slowly and wait until the food has cooled.
Avoid certain medications that can irritate the esophagus, relax the sphincter, and make acid reflux more likely.
This is usually due to anti-inflammatories and painkillers (dolormin or aspirin). Other medicines include diazepam, theophylline, nitrates, and calcium antagonists such as nifedipine.
Weight. Being overweight puts additional pressure on the stomach and promotes the reflux of stomach acid. Weight loss can relieve symptoms.
Posture and sleeping position. The reflux is favored by lying down or frequent bending forward. A crooked back when sitting and tight seat belts can put extra pressure on the stomach and increase reflux.
You should sleep on your left side at night so that your stomach is lower.
The head should be about 10-20 cm higher when sleeping (to do this, raise the head end or raise the front feet of the bed with books or bricks). Gravity can stop gastric juice from rising into the esophagus. Do not put extra pillows at the bottom, as this could increase the pressure on the stomach.
Going to bed on an empty stomach. The period between dinner and bedtime should be three hours, two hours before the night’s rest nothing should be drunk.
Some reflux patients have mucus in their throat.
In this case, it is recommended to abandon dairy products. In addition, there are products, such as snail juice, that dissolve the mucus.
Medicinal plants for the treatment of reflux
Licorice, mallow and aloe vera gel (not the juice) have an anti-inflammatory effect and relieve heartburn.
There are some essential oils that promote digestion and reduce reflux because they have antispasmodic effects and fight nausea; these include: fennel, ginger and marjoram.
Home remedies also include sodium bicarbonate, which can temporarily relieve symptoms.
Effective natural treatments for gastroesophageal reflux
Based on my experience, manipulations of the diaphragm can solve reflux problems in many cases in the medium or long term.
The diaphragm is a muscle that separates the chest and abdominal cavities.
In this muscle, there are various openings, including the esophageal slit.
If there is greater pressure in the abdominal cavity than in the chest cavity, the stomach tends to ascend through this slit into the chest cavity.
If the diaphragm is hardened, it can push the last thoracic vertebrae forward and increase the pressure on the stomach.
In addition, the retraction of connective tissue can pull the stomach upwards.
Osteopathy consists of manipulations, massages and techniques to stretch connective tissue in conjunction with breathing, which can reduce pressure on the stomach and pain.
Thus, one can often notice a decrease in pain and acid regurgitation.
The H2receptor antagonists are very potent histamine receptor antagonists.
Histamine is needed to reduce inflammation. An inflamed stomach produces more stomach acid. If this additional gastric acid formation is inhibited, the rise of stomach acid can be prevented.
Proton pump inhibitors – they reduce the formation of gastric acid. They act on the stomach acid-forming cells of the stomach wall, e.g. pantoprazole (Pantozole ®).
Prokinetic agents (e.g. domperidone) – they speed up gastric emptying so that excessive gastric filling is avoided.
Antacids – they are often used to treat mild symptoms related to stomach acid, such as heartburn or indigestion; known remedies include Gaviscon® and Maalox®.
antacids neutralize gastric acid; they are not recommended in case of frequent heartburn in reflux patients.
If there are no contraindications, the doctor may recommend surgery, laparoscopic fundoplication after nits; As part of the procedure, the leaked stomach is repositioned in the abdomen and the upper part of the stomach is wrapped around the lower esophageal sphincter. In this way, the disease-causing reflux of stomach contents into the esophagus is prevented.
Therapy in children
If the baby is breastfed, the mother may have to abstain from milk or dairy products.
If the baby gets the bottle, a hypoallergenic product should be tried for two weeks according to the doctor’s recommendation to see if there is an improvement.
You could add a thickener to breast or bottled milk for two weeks, or buy milk that already contains thickeners.
Thickeners and thickened milk are available at the pharmacy according to a doctor’s prescription.
Thickeners should only be used as recommended by a doctor.
How to counteract reflux?
A baby with continuous reflux can become a stressful task.
Under certain circumstances, the milk splashes out wide, soiling mother, child and the entire facility; in addition, the sour smell of milk rises into the nose.
Here are some practical tips:
- The child should wear a romper suit, which is easy to wash; it is best to keep a whole stock of it so that you always have clean laundry at hand.
- Sitting on the sofa or a chair, the child can be covered with a napkin; If it is dirty, it can be replaced quickly.
- An easy-care blanket can protect the child seat and stroller; here, too, it is advisable to have a second blanket ready to change.
- Cover the back seat in the car with towels to protect the fabric. This habit can also be maintained when the child grows up.
- Wear white or light cotton clothes, on which the milk stains are not so easily recognizable and they can be washed together with the light baby clothes.
How long does reflux last? When does it pass?
Prognosis for patients with gastroesophageal reflux disease
In some cases, effective therapy leads to a complete cure of the disease, without it becoming acute again or provoking complications.
As a rule, the prognosis is better the earlier treatment is started.
The drugs have no curative, but only a symptom-relieving effect; the treatment must therefore be continued permanently, otherwise they make the problems noticeable again.
- Burning sensation in the throat and chest
- Hiatal hernia or diaphragmatic hernia
- Esophageal achalasia