TL;DR: In GERD (gastro-oesophageal reflux disease), stomach acid flows back into the oesophagus, causing a burning pain in the chest, regurgitation and other symptoms. If left untreated, serious complications, including Barrett’s oesophagus and cancer, may develop. An accurate diagnosis and personalised treatment are essential.
A burning sensation in the chest, acid reflux, an irritating cough – these symptoms make everyday life difficult for many people, yet they do not seek medical advice in good time. GERD, or gastro-oesophageal reflux disease, is one of the most common digestive disorders in Hungary. It is estimated that 10–20% of the adult population experience reflux symptoms on a weekly basis.
This article explains in detail exactly what GERD is, what symptoms it causes, when you should see a doctor, and what modern treatment options are available. If you are experiencing similar symptoms, the information below can help you take informed and confident steps to look after your health.
What is GERD?
GERD (gastro-oesophageal reflux disease) is a chronic digestive condition caused by the abnormal reflux of stomach acid – and, in some cases, bile and alkaline stomach contents – into the oesophagus. This irritates and, over time, damages the lining of the oesophagus, which – unlike the stomach – is unable to withstand the effects of acid.
A key player in this process is the lower oesophageal sphincter (LES), whose role is normally to prevent the contents of the stomach from flowing back up. If this muscle weakens or relaxes irregularly (these are known as transient lower oesophageal sphincter relaxations, or TLESRs for short), stomach acid can flow freely into the oesophagus.
Who is most at risk of developing GERD?
Certain factors significantly increase the risk of reflux disease:
- Overweight or obesity – excess abdominal fat, in particular, increases the pressure on the stomach
- Diaphragmatic hernia (hiatus hernia) – when part of the stomach passes through the diaphragm and into the chest cavity
- Smoking and alcohol consumption – both impair the function of the sphincter muscle
- Certain medicines – for example, calcium channel blockers, aspirin
- Pregnancy – due to increased abdominal pressure
- Regular consumption of fatty, spicy and acidic foods, and caffeine
- Over 50 years of age – the tone of the sphincter muscle decreases over time
Symptoms of GERD: when should you be concerned?
The symptoms of reflux can be divided into two main groups: typical and atypical (extra-oesophageal) symptoms.
Typical symptoms of reflux
- Heartburn: A burning, warm sensation behind the breastbone, which may radiate upwards, even as far as the throat. It typically worsens after eating, when bending over or whilst lying down.
- Acid reflux (regurgitation): A liquid or food residue with a sour or bitter taste comes back up into the mouth.
- Belching (eructatio): Many people burp deliberately to relieve the discomfort, but this can actually make swallowing air worse in the long run.
Atypical and extra-oesophageal symptoms
GERD does not always present with „classic” heartburn. Less well-known, but equally important, symptoms may include:
- Chronic cough, particularly at night
- Hoarseness, tightness in the throat (globus sensation)
- Asthma-like symptoms, shortness of breath
- Tooth erosion, bad breath
- Chest pain not caused by the heart (which may mimic a heart attack)
- Ear, Nose and Throat complaints
If you regularly experience any of these symptoms, it is definitely worth having them investigated. The so-called warning signs – such as weight loss, blood in the stools, recurrent vomiting, anaemia or increasing difficulty swallowing – an investigation is urgently required.
Complications of untreated GERD
Unfortunately, many people put off seeing a doctor for years, take medication as a form of self-medication, or simply get used to their symptoms. However, persistent, untreated reflux can have serious consequences.
Oesophagitis
Refluxing stomach acid inflames and erodes the lining of the oesophagus. This can cause painful swallowing (odynophagia), ulcers and bleeding.
Oesophageal stricture
Scarring caused by chronic inflammation leads to a narrowing of the oesophagus. This results in progressive, increasingly severe difficulty swallowing (dysphagia).
Barrett's downpipe
The most serious complication: the squamous cells of the oesophagus are replaced by more resistant columnar cells (intestinal metaplasia). This is a pre-malignant condition, which significantly increases the risk of developing oesophageal adenocarcinoma. The annual risk of cancerous transformation in Barrett’s oesophagus is 0.12–0.33%; therefore, regular endoscopic monitoring is mandatory.
Screening for Barrett’s oesophagus is particularly recommended for men who have had weekly reflux symptoms for more than 5 years and who also have at least two of the following risk factors: age over 50, Caucasian ethnicity, central obesity, smoking, or a family history of Barrett’s oesophagus or oesophageal cancer.
How is GERD diagnosed?
The diagnostic process consists of several steps and always begins with a specialist’s assessment of the symptoms. In young patients with no warning symptoms, an empirical PPI trial (trial treatment with a proton pump inhibitor) may be sufficient as a first step. If the symptoms respond favourably to treatment, this in itself confirms the diagnosis.
Gastroscopy (upper endoscopy)
The most important and most reliable test is the Gastroscopy (gastroscopy). This enables the specialist to examine the mucous membrane of the oesophagus and stomach directly, assess the severity of the inflammation (based on the Los Angeles classification grades A–D), and take a tissue sample if necessary. This is essential for ruling out Barrett’s oesophagus, strictures and malignant lesions.
It is important to note that in some patients with GERD, the endoscopic findings may be completely normal – this is known as non-erosive reflux disease (NERD), which occurs in 60–70% of patients.
24-hour pH monitoring and impedance measurement
This test accurately counts and measures episodes of acid reflux and confirms their link to symptoms. Acid exposure is considered pathological if the pH remains below 4 for more than 5% of the total measurement time. Impedance monitoring is also capable of detecting non-acidic (gas or alkaline) reflux.
Esophageal manometry
It is used to assess the motor function of the oesophagus and the pressure of the sphincter. It is primarily used prior to planning anti-reflux surgery and to rule out other motility disorders.
Treating GERD: step by step
The treatment of reflux disease is complex and must always be tailored to the individual’s condition. It consists of three main pillars: lifestyle changes, medication and – in severe cases – surgery.
Lifestyle changes
The first and most important step, which in many cases can lead to a significant improvement in its own right:
- Avoid fatty, spicy and acidic foods, chocolate, coffee, fizzy drinks and citrus fruits
- Let’s eat smaller portions and avoid lying down for at least 2–3 hours after a meal
- Raise the head of the bed whilst sleeping (by approx. 15–20 cm)
- Let’s lose weight if necessary
- Let’s give up smoking and drink in moderation
Medication
- Proton pump inhibitors (PPIs): The first-line, most effective drug treatment. For typical GERD, a once-daily dose is recommended for 8 weeks (taken 30–60 minutes before breakfast). In cases of extra-oesophageal reflux, twice-daily dosing is required for 12 weeks. In the event of long-term use, the medicine should be withdrawn gradually, as abrupt discontinuation may cause a temporary rebound in gastric acid production (rebound effect).
- H2 receptor antagonists: They can be used in cases of mild to moderate reflux, including as an adjunctive therapy.
- Antacids and alginates: They are suitable for rapid, short-term relief of symptoms.
- Baclofen: It may be an effective solution for reducing non-acid reflux and transient LES relaxations.
Surgical treatment
If drug treatment does not produce lasting results, or if a hiatal hernia is the underlying cause, laparoscopic fundoplication (using the Nissen, Toupet or Dor method) may be considered. During the operation, the base of the stomach is sutured around the lower part of the oesophagus, thereby strengthening the function of the sphincter. It is important to note, however, that temporary gas-bloat syndrome and difficulty burping may occur following the procedure.
Why should you turn to Endomedix if you have GERD?
The accurate diagnosis and treatment of GERD requires specialist knowledge in gastroenterology. The Endomedix Gastroenterology The team is committed to offering its patients the very latest diagnostic and treatment options – with minimal discomfort and maximum safety.
Anaesthesia, not sedation – for the patient’s comfort
At Endomedix, for professional reasons, only full general anaesthesia administered under the supervision of an anaesthetist General anaesthesia is used during endoscopic examinations, rather than simply sedation. This means that the patient undergoes the examination completely free from pain and discomfort, whilst the specialist carries out the necessary procedures with precision and without interruption. General anaesthesia ensures that the patient remains motionless, reduces the risk of complications, and enables the most accurate diagnostic results.
Tests available from Endomedix for GERD
Depending on the nature of the complaints and the severity of the symptoms, the following investigations are recommended:
- Gastroenterology specialist consultation: Every diagnostic process begins with the drawing up of a personalised examination plan. Book a consultation →
- Gastroscopy under general anaesthesia: The gold standard for diagnosing GERD and oesophagitis, which also allows Barrett’s oesophagus and tumours to be ruled out. Find out more →
- Colonoscopy under general anaesthesia: If, in addition to reflux, there are also symptoms affecting the lower digestive tract. Find out more →
- Combined gastroscopy and colonoscopy under general anaesthesia: The most convenient and effective solution, where it is appropriate to examine both areas, is to do so under a single anaesthetic. Find out more →
Don’t wait any longer: take the first step
GERD can be treated – and the sooner you are assessed, the lower the risk of serious complications developing. Recurrent heartburn, acid reflux and a persistent cough should not be taken lightly.
If you are also experiencing such symptoms, book an appointment for a for a specialist gastroenterology consultation at Endomedix. The assessment is quick, and the procedures are carried out under general anaesthesia in comfortable surroundings – all you have to do is turn up.
Frequently asked questions about GERD
What is the difference between heartburn and GERD?
Heartburn is a simple symptom that anyone may experience from time to time. GERD, on the other hand, is a chronic, recurrent condition in which reflux occurs regularly, several times a week or even daily, and can lead to long-term complications – such as oesophagitis or the development of Barrett’s oesophagus.
When should you definitely see a doctor if you have reflux?
Seek medical attention immediately if, in addition to heartburn, you experience any of the following: increasing difficulty swallowing, unintentional weight loss, black or bloody stools, recurrent vomiting, anaemia, or new symptoms appearing in people aged 40 or over. These are known as ‘alarm symptoms’, which require urgent medical investigation.
Do you have to take proton pump inhibitors for the rest of your life?
Not necessarily. In the acute phase, a course of treatment lasting 8–12 weeks is usually recommended. The need for long-term treatment is determined by the specialist on a case-by-case basis. Abruptly stopping PPI treatment is not recommended, as it may cause a temporary worsening of symptoms (rebound effect) – gradual withdrawal is advised.
Can the tests be carried out under anaesthesia if I’m afraid of endoscopy?
Yes. At Endomedix, all endoscopic examinations – including gastroscopy and colonoscopy – are performed exclusively under full general anaesthesia supervised by an anaesthetist. The patient remains unconscious for the entire duration of the procedure and therefore experiences no pain or discomfort.
Can GERD be cured through lifestyle changes?
In mild cases, lifestyle changes – such as weight loss, healthy eating habits and avoiding trigger foods – can bring about significant improvement on their own. In more severe cases, medication and, in some instances, surgery may be required. It is important that the treatment strategy is always determined by a specialist based on the individual’s condition.
What is Barrett’s oesophagus, and how can it be diagnosed?
Barrett’s oesophagus is one of the most serious complications of GERD, in which the normal squamous cells of the oesophagus are replaced by columnar epithelium. This pre-malignant condition increases the risk of oesophageal adenocarcinoma. It can be detected by gastroscopy and biopsy. If diagnosed, regular endoscopic monitoring is required: every 3–5 years in the absence of dysplasia, and every 6–12 months in the case of mild dysplasia.
