Reflux disease, or gastro-oesophageal reflux disease (GERD), is one of the most common digestive problems of our time. Many people experience the characteristic symptom of heartburn, but the condition can be far more complex than that. An accurate diagnosis and up-to-date treatment are essential for preventing complications and improving quality of life. In this article, we provide a detailed overview of the causes of reflux, diagnostic methods and the latest therapeutic approaches.
A reflux nem csupán egy kellemetlen érzés, hanem egy olyan állapot, amely során a savas gyomortartalom visszaáramlik a nyelőcsőbe. Ez a folyamat irritálja, és hosszú távon károsíthatja a nyelőcső nyálkahártyáját. A tünetek sokfélék lehetnek, a klasszikus gyomorégéstől a rekedtségen át a krónikus köhögésig. Fontos, hogy a panaszokat komolyan vegyük, és szakemberhez, például az Endomedix Gastroenterology Centre orvosaihoz forduljunk, akik segítenek a pontos diagnózis felállításában és a személyre szabott kezelés megtervezésében.
What exactly is gastro-oesophageal reflux disease (GERD)?
GERD is a motility disorder characterised by the lower oesophageal sphincter not functioning properly. Normally, this ring of muscle only opens when we swallow, and then closes immediately, preventing stomach contents from flowing back up. In cases of reflux disease, this sphincter often relaxes frequently and spontaneously, or is persistently weaker, allowing acidic contents to flow freely back into the oesophagus.
There are several forms of the disease:
- Non-erosive reflux disease (NERD): The most common form, in which the patient experiences typical reflux symptoms, but no damage to the oesophageal mucosa is visible during an oesophagogastroduodenoscopy.
- Erosive reflux disease (ERD): In this case, a gastroscopy reveals erosion and inflammation of the oesophageal mucosa.
- GERD with complications: The most severe form of the disease, which can lead to complications such as oesophageal ulcers, oesophageal stricture or Barrett’s oesophagus, which is a precancerous condition.
Diagnosis of reflux disease
Diagnosing reflux involves several steps. The aim is to pinpoint the cause of the symptoms and to rule out other conditions that present with similar symptoms (e.g. heart problems).
1. Medical history and physical examination
The doctor will first ask the patient in detail about their symptoms, their frequency and severity, and what triggers or alleviates them. Typical symptoms include heartburn (a burning pain felt in the chest), acid reflux and difficulty swallowing. GERD can also cause atypical, so-called extra-oesophageal (outside the oesophagus) symptoms, such as:
- Hoarseness, throat clearing
- Chronic cough, asthma-like symptoms
- Earache and sore throat
- Tooth enamel damage
2. Gastroscopy
An oesophagogastroduodenoscopy is the most important test for diagnosing reflux disease. During the procedure, a thin, flexible instrument fitted with a camera (an endoscope) is passed through the mouth into the oesophagus, stomach and duodenum.
- Purpose: It allows for a direct view of the oesophageal mucosa. The doctor can see any inflammation, erosions, ulcers or narrowings. During the examination, a tissue sample (biopsy) can also be taken, which is essential for ruling out Barrett’s oesophagus or cancerous lesions.
- When is it appropriate? Különösen fontos a vizsgálat elvégzése, ha ún. „alarm” tünetek jelentkeznek: nyelési nehézség, akaratlan fogyás, vérzés vagy vérszegénység.
From Endomedix Gastroenterology Centre modern, fájdalommentes gyomortükrözést kínál, amely altatásban is elvégezhető, így a páciensek számára a lehető legkisebb kellemetlenséggel jár.
3. pH and impedance measurements of the oesophagus
This test is the „gold standard” for diagnosing reflux, particularly when an upper gastrointestinal endoscopy reveals no abnormalities but the symptoms persist.
- How does it work? A thin probe is inserted through the nose into the oesophagus, where it records the number and duration of acidic and non-acidic reflux episodes over a 24-hour period. The device also records when symptoms occur, making it possible to establish a link between reflux episodes and the patient’s symptoms.
- When is it proposed? In cases of treatment-resistant disease, where atypical symptoms are present, or prior to surgical intervention, to confirm the diagnosis.
4. Oesophageal manometry
This test measures the movement of the oesophagus and the function of the sphincter muscles. A thin probe fitted with pressure sensors is inserted into the oesophagus. The patient is asked to swallow small sips of water whilst the instrument records the strength and coordination of the muscle contractions.
- When is it necessary? Particularly when planning anti-reflux surgery, to rule out other oesophageal motility disorders (e.g. achalasia) which could worsen following the operation.
Modern treatment options
A refluxbetegség kezelése személyre szabott, és a tünetek súlyosságától, a szövődmények jelenlététől, valamint a páciens egyéni adottságaitól függ. A cél a tünetek enyhítése, a nyelőcső gyógyulásának elősegítése és a szövődmények megelőzése.
1. Lifestyle changes
They form the basis of treatment and, in many cases, can bring about significant improvement on their own in cases of mild reflux.
- Meals: You should avoid foods that trigger symptoms, such as fatty and spicy dishes, chocolate, coffee, alcohol and fizzy drinks. It is recommended that you eat more frequently, in smaller portions.
- Weight control: Being overweight increases intra-abdominal pressure, which exacerbates reflux. Losing even a few kilograms can help alleviate the symptoms.
- Sleeping position: Raising the head of the bed (by approx. 15–20 cm) helps to prevent the backflow of stomach acid at night.
- Giving up smoking: Smoking weakens the lower oesophageal sphincter.
2. Drug therapy
If lifestyle changes are not enough, medication is required.
- Proton pump inhibitors (PPIs): These medicines are the most effective inhibitors of acid production. They are considered the „gold standard” of treatment. By reducing gastric acid production, they alleviate symptoms and allow the oesophageal mucosa to heal. Doctors typically recommend a course of treatment lasting 8–12 weeks, which may be followed by maintenance treatment if necessary. Taking the medicine correctly is crucial: it should be taken 30–60 minutes before a meal.
- H2 receptor antagonists: They have a milder acid-reducing effect and are mainly used to treat mild, intermittent symptoms.
- Antacids and alginates: These medicines either quickly neutralise existing stomach acid (antacids) or form a protective layer on the surface of the stomach contents (alginates), thus providing immediate but only temporary relief.
3. Surgical treatment
Surgery may be considered if drug treatment does not produce satisfactory results, if the patient cannot tolerate the medication, or if they do not wish to take medication for the rest of their life, and if tests have clearly confirmed the presence of severe reflux.
- Laparoscopic fundoplication: The most commonly performed anti-reflux surgery. During the procedure, a sleeve is formed from the upper part of the stomach and placed around the lower section of the oesophagus, thereby strengthening the function of the lower oesophageal sphincter. The operation effectively eliminates reflux, but, as with any surgical procedure, it does carry certain risks.
What next?
Reflux disease is a chronic condition that can be effectively managed with appropriate treatment and care. Don’t let heartburn and unpleasant symptoms affect your quality of life! If you have symptoms suggestive of reflux, don’t hesitate to consult a specialist.
From Endomedix Gastroenterology Centre tapasztalt szakorvosai és a legmodernebb diagnosztikai eszközök állnak rendelkezésre, hogy pontos diagnózist állítsanak fel és megtalálják az Ön számára legmegfelelőbb kezelési stratégiát. A korai felismerés és a hatékony terápia a kulcs a szövődménymentes, teljes élethez.
