Many of us are familiar with that burning, uncomfortable sensation in the chest after a hearty meal. We often put this down to simple heartburn, yet there may be a more complex underlying problem: gastro-oesophageal reflux disease (GERD). This condition is not merely a temporary discomfort, but a condition that affects a significant proportion of the population – as many as 20% – on a weekly basis. As the symptoms can often be alarming and may impair quality of life, it is important to understand exactly what signs to look out for and what methods can be used to confirm the diagnosis. In this article, we’ll take a detailed look at the symptoms of reflux, the possible complications and the latest diagnostic procedures, so that you too can gain a clearer understanding of this common digestive problem.
What exactly is reflux?
Gastro-oesophageal reflux disease (GORD) occurs when stomach contents, mixed with stomach acid and digestive juices, flow back into the oesophagus. Normally, the lower oesophageal sphincter prevents this backflow, but if this ring of muscle weakens for any reason or fails to close properly, the acidic contents can irritate the sensitive lining of the oesophagus. This process causes the characteristic symptoms and can also lead to more serious complications in the long term.
The characteristic (typical) symptoms of reflux disease
Reflux most commonly presents with two main symptoms, which are experienced by the majority of those affected.
Heartburn
Heartburn is the most common and best-known symptom of reflux. It typically presents as a burning, stinging sensation behind the breastbone, which may radiate upwards from the chest, even towards the throat or jaw. Many people describe it as a „fire” that starts in the stomach. This sensation often intensifies after eating, particularly after consuming fatty, spicy or acidic foods, as well as when lying down or bending forward. Antacids can provide temporary relief from the symptoms.
Acid regurgitation
Another common symptom is acid reflux, or regurgitation. This occurs when a small amount of stomach contents – which may be liquid or even a piece of food – flows back into the oesophagus or the mouth. This causes a sudden, unpleasant, sour or bitter taste in the mouth. Regurgitation can often occur at night, whilst sleeping, which may lead to choking or coughing.
Atypical and extra-oesophageal (outside the oesophagus) symptoms of reflux
Reflux does not always present with classic heartburn. In many cases, the symptoms affect completely different organs, which can make it difficult to reach a diagnosis. These are known as atypical or extra-oesophageal symptoms.
- Chest pain not of cardiac origin: Chest pain caused by reflux can be extremely alarming, as it can easily be mistaken for the symptoms of a heart attack. The pain may feel tight, pressing or burning, and occurs in the centre of the chest. It is important to always rule out cardiac causes when experiencing chest pain, but if cardiological tests show no abnormalities, reflux should also be considered.
- A lump in the throat (globus sensation): Many patients experience a persistent lump or sensation of a foreign body in their throat, which does not go away even when they swallow. This may be caused by irritation resulting from episodes of mildly acidic reflux.
- Respiratory symptoms: Inhaling acid that has flowed back up can cause a chronic cough, asthma-like symptoms, hoarseness, a sore throat and frequent throat-clearing. Reflux is often the underlying cause of difficult-to-treat asthma or morning hoarseness.
- Ear, nose and throat complaints: Acid vapours can irritate the sinuses, which may lead to chronic sinusitis. Earache and tinnitus may also occur.
- Dental problems: Stomach acid that regularly enters the mouth damages tooth enamel, which can lead to increased tooth decay and tooth erosion.
- Bad breath (halitosis): Undigested food and stomach acid flowing back up can cause bad breath, which cannot be permanently eliminated even by brushing your teeth.
- Nausea and dyspepsia: Reflux symptoms are often accompanied by nausea, bloating and a feeling of fullness.
Complications of untreated reflux
If reflux is not treated properly, persistent irritation of the oesophageal lining can lead to serious complications.
- Oesophagitis: Acid burns cause inflammation, oedema and damage to the mucous membrane. In more severe cases, ulcers may develop, which can cause painful swallowing (odynophagia), difficulty swallowing (dysphagia) and, in rare cases, bleeding.
- Oesophageal stricture: Chronic inflammation can lead to scarring, which narrows the oesophagus. This causes persistent difficulty swallowing; food may become stuck, leading to regurgitation and chest pain.
- Barrett’s oesophagus: This is a precancerous condition in which the normal squamous epithelium of the lower oesophagus is transformed, as a result of acid irritation, into a specialised columnar epithelium resembling intestinal mucosa (intestinal metaplasia). Patients with Barrett’s oesophagus have a significantly increased risk of developing oesophageal cancer (adenocarcinoma).
- Cameron's lesion: Linear ulcers forming in the area of a hiatal hernia, along the impression left by the diaphragm muscle, which may be the source of occult gastrointestinal bleeding and iron-deficiency anaemia.
How is reflux disease diagnosed?
Diagnosing reflux begins with a thorough assessment of the symptoms. If the symptoms clearly point to reflux and there are no warning signs (e.g. difficulty swallowing, bleeding, unintentional weight loss, anaemia), doctors often recommend a so-called PPI test for young patients.
Empirical treatment (PPI test)
This method involves the patient taking a proton pump inhibitor (PPI) for a specified period (usually 2–4 weeks), which effectively reduces gastric acid production. If the symptoms improve significantly or disappear as a result of the treatment, this confirms the suspicion of reflux disease, and further, uncomfortable investigations can be avoided. If the treatment is ineffective, further investigation is required.
Gastroscopy (gastroscopy or upper endoscopy)
Gastroscopy is one of the most important tools for investigating reflux, particularly in cases involving warning signs, patients aged over 50, or symptoms that do not respond to treatment. During the procedure, a thin, flexible tube fitted with a camera (an endoscope) is passed through the mouth into the oesophagus, stomach and duodenum.
Using gastroscopy, the doctor:
- You can assess the condition of the oesophageal mucosa directly.
- It can assess the severity of oesophagitis.
- It can rule out or confirm complications such as ulcers, strictures or Barrett’s oesophagus.
- A tissue sample (biopsy) can be taken from suspicious areas, for example, where Barrett’s oesophagus or a tumour is suspected.
- It can identify anatomical abnormalities, such as a diaphragmatic hernia.
From Endomedix in Gastroenterology Centres Gastroscopies are carried out by highly experienced specialists using state-of-the-art equipment, and may even be performed under general anaesthesia to ensure the procedure causes as little discomfort as possible.
24-hour oesophageal pH and impedance monitoring
This test is the „gold standard” for diagnosing reflux, particularly when an upper gastrointestinal endoscopy shows no abnormalities but symptoms persist. The method involves inserting a thin probe through the nose into the oesophagus, which continuously measures the pH level and changes in electrical resistance (impedance) in the lower oesophagus over a 24-hour period.
Through this study:
- It is possible to quantify precisely how often and for how long acidic (pH <4) fluid in the oesophagus.
- Non-acidic or mildly acidic reflux episodes can also be detected using impedance measurement.
- Reflux episodes can be linked to the symptoms recorded by the patient (e.g. coughing, chest pain).
- Reflux disease can be objectively confirmed or ruled out.
There are now also wireless pH measurement capsules available, which are more convenient but less widely used. The Endomedix Gastroenterology Centres They use the most advanced diagnostic methods to accurately diagnose reflux.
Oesophageal manometry (pressure measurement)
Manometry is used to examine the movement (motility) of the oesophagus and the function of the sphincter muscles. A thin probe fitted with pressure sensors is passed through the nose into the oesophagus and then into the stomach. The patient is asked to swallow small sips of water whilst the instrument records the strength and coordination of the swallowing waves, as well as the pressure in the sphincter muscles.
The test is most commonly:
- This is carried out when planning surgery for reflux (fundoplication) in order to rule out other oesophageal motility disorders (e.g. achalasia, diffuse oesophageal spasm), which could worsen following the operation.
- To determine the cause of difficulty swallowing, if an upper gastrointestinal endoscopy does not provide an explanation.
When you need professional help
Although heartburn can affect anyone from time to time, it is important to see a doctor if symptoms occur more than twice a week, if you regularly need antacids, if the symptoms wake you up at night, or if you experience any warning signs (difficulty swallowing, painful swallowing, weight loss, bleeding).
From Endomedix Gastroenterology Centres Its highly qualified specialists and state-of-the-art diagnostic facilities help to ensure the accurate diagnosis and effective treatment of reflux disease and other digestive complaints. Don’t let reflux affect your quality of life – seek professional help in good time!
