A refluxbetegség, vagy orvosi nevén gasztroözofageális refluxbetegség (GERD), egyike a leggyakoribb emésztőrendszeri panaszoknak, amely a lakosság jelentős részét érinti. Sokan tapasztalják a gyomorégést vagy a savas felböfögést, de kevesen tudják, hogy ezek a tünetek egy összetett állapotra utalhatnak, amely hosszú távon komoly szövődményekhez is vezethet.
Ebben a cikkben részletesen bemutatjuk, mi is pontosan a refluxbetegség, milyen tipikus és atipikus tünetekkel járhat, és milyen diagnosztikai módszerek állnak rendelkezésre a pontos kórkép felállításához. Célunk, hogy közérthető, mégis szakmailag pontos tájékoztatást nyújtsunk, amely segít megérteni a reflux hátterében álló folyamatokat és a kivizsgálás fontosságát. Az Endomedix Gastroenterology Centre szakértői elkötelezettek a páciensek alapos és empatikus ellátása mellett, ezért kiemelten fontosnak tartjuk, hogy Ön is tisztában legyen a betegségével kapcsolatos legfontosabb tudnivalókkal.
What is gastro-oesophageal reflux disease (GERD)?
A refluxbetegség (GERD) egy olyan állapot, amely akkor alakul ki, amikor a gyomortartalom – beleértve a gyomorsavat és az emésztőenzimeket – rendszeresen visszaáramlik a nyelőcsőbe. A nyelőcső alsó végén található egy záróizom (alsó nyelőcső-záróizom, angolul lower esophageal sphincter, LES), amely normális esetben megakadályozza ezt a visszaáramlást. Ez az izomgyűrű csak akkor nyílik ki, amikor nyelünk, hogy az étel a gyomorba juthasson.
In cases of reflux disease, this sphincter weakens or does not function properly – for example, due to frequent transient loss of sphincter tone (TLESR) – allowing acidic stomach contents to flow back into the oesophagus. Whilst the lining of the stomach is resistant to the corrosive effects of acid, that of the oesophagus is not; consequently, the refluxed acid causes irritation, inflammation and unpleasant symptoms.
A Montreali definíció (2006) szerint a GERD „mindazon kellemetlen panaszok és/vagy szövődmények összessége, amelyek a gyomortartalom visszaáramlása következtében alakulnak ki”.
The most common symptoms of reflux disease
The symptoms of reflux can vary greatly. We distinguish between typical symptoms affecting the oesophagus (oesophageal) and atypical symptoms occurring outside the oesophagus (extra-oesophageal).
Typical symptoms of reflux
These symptoms are directly related to acid reflux into the oesophagus, and they are most commonly what prompt patients to seek medical attention.
- Heartburn (pyrosis): This is the most common symptom, which patients describe as a burning, gnawing sensation behind the breastbone. The pain may radiate upwards towards the throat or even the jaw. It typically worsens after meals, when bending over or whilst lying down.
- Acid regurgitation: Small amounts of stomach contents with a sour or bitter taste flow back into the oesophagus or mouth without belching. This is often a sudden, unpleasant experience, particularly at night whilst sleeping.
- Water brash (excessive salivation): A nyelőcsőbe jutó sav hatására a nyálmirigyek reflexesen fokozott működésbe lépnek, ami hirtelen, nagy mennyiségű, sós ízű nyál termelődését okozza a szájban.
Atypical (extra-oesophageal) symptoms
In many cases, reflux does not present as classic heartburn, but causes symptoms that affect other organs. It can be more difficult to link these to reflux.
- Chronic cough: A nervous reflex triggered by tiny droplets of acid entering the airways or by irritation of the oesophagus can cause a persistent, dry cough that does not ease even with rest.
- Hoarseness and throat clearing: The acid can damage the vocal cords and the mucous membrane of the pharynx, which may result in hoarseness, a change in voice quality and a constant urge to clear one’s throat.
- A lump in the throat (globus pharyngeus): The patient feels as though something is stuck in their throat, even though there is nothing there. This sensation may be caused by a spasm of the upper oesophageal sphincter.
- Chest pain not caused by the heart: Chest pain caused by reflux can be so intense and constricting that it can easily be mistaken for the symptoms of a heart attack. It is important to always rule out cardiac causes when experiencing chest pain.
- Symptoms similar to asthma: Inhaling acidic vapours may aggravate existing asthma or trigger asthma-like symptoms (wheezing, shortness of breath).
- Dental problems: Stomach acid that refluxes into the mouth damages tooth enamel, which can lead to an increased risk of tooth decay.
- Ear, nose and throat complaints: Reflux may also underlie chronic sinusitis, middle ear infection or earache.
- Difficulty swallowing (dysphagia): Chronic inflammation can lead to scarring and narrowing of the oesophagus, making it difficult to swallow food. This is an alarming symptom that requires immediate medical attention.
Warning signs
Certain symptoms may indicate a more serious problem or complication. If you experience any of the following, seek medical advice immediately:
- Difficulty swallowing (dysphagia): Particularly if swallowing solid food is a problem.
- Painful swallowing (odynophagia): A sharp pain when swallowing.
- Unintentional weight loss: Significant weight loss over a short period of time, for no apparent reason.
- Signs of bleeding: Vomiting blood or black, tarry stools (melena), which indicate the presence of digested blood.
- Anaemia: It may develop as a result of chronic, hidden bleeding.
- Repeated bouts of vomiting.
These symptoms require immediate gastroenterological investigation, usually an endoscopy.
Diagnosing reflux
A reflux diagnózisa gyakran már a jellegzetes tünetek alapján felállítható. Fiatal, 40 év alatti pácienseknél, alarmírozó tünetek hiányában az orvos gyakran javasol egy úgynevezett PPI-tesztet. Ennek során a beteg néhány hétig protonpumpa-gátló (PPI) gyógyszert szed. Ha a tünetek a kezelésre jelentősen javulnak, az megerősíti a reflux diagnózisát, és elkerülhetők a további, kellemetlenebb vizsgálatok.
However, if the symptoms are atypical, do not respond to treatment, or if there are any alarming symptoms, diagnostic tests are required to establish an accurate diagnosis and rule out any complications.
Gastroscopy
An oesophagoscopy is the most important test for diagnosing reflux. During the procedure, a thin, flexible instrument fitted with a camera (an endoscope) is passed through the mouth into the oesophagus, the stomach and the duodenum. The examination allows:
- Assessment of the condition of the mucous membrane: The doctor can see the signs of inflammation caused by acid (oesophagitis), the erosions and the ulcers straight away.
- Identifying complications: Esophageal stricture or Barrett’s oesophagus – a precancerous condition – may be detected.
- Tissue sampling (biopsy): Small tissue samples can be taken from suspicious areas and examined under a microscope. This makes it possible to rule out cancerous lesions and to diagnose conditions such as eosinophilic oesophagitis, the symptoms of which are similar to those of reflux.
- Ruling out other conditions: The test helps to rule out other conditions that cause similar symptoms, such as peptic ulcer disease or Helicobacter pylori infection.
From Endomedix Gastroenterology Centre modern, kíméletes eszközökkel és altatásban is végzi a gyomortükrözést, hogy a vizsgálat a lehető legkevesebb kellemetlenséggel járjon.
24-hour oesophageal pH and impedance monitoring
This test is the „gold standard” for diagnosing reflux. It is particularly indicated when an upper gastrointestinal endoscopy shows no abnormalities (known as NERD, or non-erosive reflux disease), but symptoms are still severe, or if the symptoms do not respond to acid-reducing treatment.
During the examination, a thin catheter is inserted through the nose into the oesophagus, where it measures the pH level (acidic or non-acidic reflux) in the lower part of the oesophagus, as well as changes in impedance (indicating the backflow of liquid or gas). The patient uses a small, portable device to record their symptoms, meals and sleep periods. At the end of the 24-hour monitoring period, the doctor assesses whether there is a correlation between the symptoms and the episodes of reflux.
Oesophageal manometry (pressure measurement)
This test measures the movement (motility) of the oesophagus and the function of the sphincter muscles. A thin catheter fitted with pressure sensors is inserted into the oesophagus, and the patient is asked to swallow small sips of water. The test detects whether the movement of the oesophagus is abnormal (e.g. achalasia) or whether the pressure of the lower oesophageal sphincter is too low. Manometry is essential prior to surgical procedures to treat reflux.
Capsule endoscopy (PillCam UGI)
This is another, gentler technology which may offer an alternative for those who refuse a conventional gastroscopy, or for whom such a procedure cannot be carried out. The patient swallows a capsule, about the size of a vitamin tablet and fitted with a camera, which takes images of the oesophagus and stomach. It is important to note that this method does not currently fully replace gastroscopy, as it does not allow for tissue sampling and the examination of the mucous membrane may be more limited.
When should you see a doctor?
If you regularly experience heartburn or any of the other symptoms mentioned above, you should definitely consult a gastroenterologist. Untreated reflux not only impairs your quality of life but can also lead to serious long-term complications, such as oesophagitis, ulcers, strictures and even oesophageal cancer.
Ne hagyja, hogy a panaszok irányítsák az életét! A korai és pontos diagnózis a sikeres kezelés alapja.
From Endomedix Gastroenterology Centre felkészült szakorvosai és modern diagnosztikai eszközei segítenek a refluxbetegség és egyéb emésztőrendszeri panaszok okainak feltárásában. Empatikus és páciensközpontú megközelítésünkkel arra törekszünk, hogy a kivizsgálás folyamata a lehető legkisebb megterhelést jelentse Önnek. Kérjen időpontot, és tegyen lépést az egészsége és a jobb életminőség felé!
