Reflux disease and heartburn
The famous "lump in the throat" and swallowing problems are often an undetected and thus untreated reflux of stomach acid. In industrialised countries, the number of undiagnosed sufferers of reflux disease is up to 15% and is on the rise. Dietary and lifestyle habits are the triggers. Long-term reflux can damage the mucous membrane to such an extent that it can lead to cell remodelling and even aggressive cancer.
How does reflux disease develop?
Gastro-oesophageal reflux disease (GERD), as it is called, occurs when stomach contents flow back into the oesophagus, causing acid to reach mucous membranes that are not prepared for it. The result is bothersome symptoms such as heartburn or complications such as a local ulcer. This reflux from the stomach can contain acid of different strengths and be basic, liquid or gaseous.
Symptoms
- There are a number of symptoms to this:
- First and foremost, pain behind the breastbone, similar to that experienced during a heart attack.
- Acid regurgitation with or without parts of the stomach contents
- Difficulty swallowing
- Pain when swallowing
Outside the oesophagus, other areas may also be affected. These include:
- Chronic inflammation of the larynx (laryngitis) with corresponding hoarseness
- compulsive clearing of the throat
- Chronic cough
- asthma
- Changes in the teeth
A connection to other diseases can be established in pronounced cases:
- chronic sinusitis (inflammation of the sinuses)
- pharyngitis (inflammation of the throat)
- pulmonary fibrosis
- inflammation of the middle ear
Furthermore, reflux disease is related to
- Respiratory diseases
- Snoring
- Obstructive sleep apnoea (OSAS).
Medication can cause reflux
Medications can also cause or increase reflux if they affect the closure mechanism at the entrance to the stomach:
- Calcium antagonists
- Nitro
- Theophyllines
- Aminophyllines
- Anticholinergics
- Benzodiazepines
- Beta-adrenergic agonists
- Oestrogen preparations of postmenopausal hormone therapy
- Peppermint
Other medications may have a direct effect on the oesophageal mucosa:
- ASA
- Doxycyline
- Ascorbic acid
- Ferrous sufate
- Bisphosphonates
- NSAIDS
- Cytostatics
Diagnosis of reflux disease
Often, a "trial therapy" with a proton pump inhibitor (PPI) is carried out first: These agents inhibit acid secretion from the glandular cells in the stomach by up to 90%. They can cause a decrease in symptoms of between 50% and 75%.
When the proton pump inhibitors are discontinued, in many cases the acid production of the stomach mucosa increases for a certain period of time.
Endoscopic clarification
It is true that a gastroscopy, i.e. an endoscopic check of the swallowing route, is not always performed as the first measure. However, it can detect the severity of reflux oesophagitis (inflammation of the oesophagus) and possible complications such as an ulcer or a narrowing in good time. If there is also unexplained weight loss or anaemia as an indication of blood loss, endoscopic clarification should definitely be carried out. An endoscopy or oesophago-gastroscopy can show inflammation of the mucous membrane, which can vary in severity from mild to ulcer-like changes (ulcer).
However, it does not always have to be inflammation or tumour-like changes that cause significant problems. Passage obstacles such as narrowing (stenosis) or a sliding up of the upper parts of the stomach into the chest cavity (hiatus hernia). This is caused by an excessively wide opening in the diaphragm, the muscle between the chest and abdomen. The result is the unchecked rise of acid, which is otherwise held back by the muscular closure ring between the oesophagus and the stomach.
Acid concentration measurement
If changes occur in the oesophageal mucosa, pH-metry (acid concentration measurement) also shows conspicuous values. While endoscopy has a high specificity (i.e. reliably detects whether you are not ill), but a low sensitivity (reliably detects whether you are ill), pH-metry has both a high sensitivity and a specificity.
This means that not all reflux patients show a corresponding inflammatory change in the mucous membrane during endoscopy, but the majority of reflux patients have conspicuous values during pH-metry. Since reflux events also occur in almost every healthy person - especially after eating - long-term measurement makes sense.
Impendance measurement
The pH-metry can be combined with the simultaneous impedance measurement. This test uses a probe that inflates a balloon in the oesophagus. This measures how much pressure is needed to expand it to a certain degree. If the oesophagus is stiffer or looser than usual, this may indicate a condition. Weak acid or non-acid reflux can also be determined.
Oesophageal manometry
Diagnostic oesophageal manometry or oesophageal pressure measurement is a procedure for clarifying functional disorders of the oesophageal muscles in the oesophagus. The oesophagus. It can be used to assess the patency or passage of the food pulp through the oesophagus.
Reflux and snoring
Snoring or obstructive sleep apnoea often causes obstruction of the upper airways. In order not to suffocate, the body tries to convert this potentially life-threatening condition back into normal breathing by releasing adrenaline and contracting muscle groups. This also exerts pressure on the stomach contents, which are usually acidic. Here, the stomach acid then rises up through the oesophagus. The level of the stomach and the oesophagus, the larynx and the trachea, as well as the mouth and the nasopharynx are on the same horizontal. Muscular pressure or rocking movements between the diaphragm - the muscle that usually helps keep the stomach contents from flowing back into the oesophagus - and the abdominal muscles literally squeeze out the stomach contents. Patients often notice a burning sensation or a feeling of pressure with a need to clear their throat the next morning, in addition to the feeling of dryness. The scenario just described occurs regularly in almost every high-grade apnoea patient. Therefore, attention must also be paid to this during the comprehensive clarification of this disease and appropriate diagnostic procedures must be applied.
(Source S2k guideline 021/013 Gastrooesophageal reflux disease)
