Diseases

Reflux - causes, symptoms, treatment

The term "reflux" is usually understood to mean the backflow of gastric juice into the esophagus, causing heartburn and acid regurgitation. This process is somewhat natural and harmless to some extent, but if reflux occurs more frequently, it can cause severe mucosal impairment and massive discomfort. In this case, doctors speak of a "gastroesophageal reflux disease", which is one of the most common gastrointestinal complaints. Here are the essentials in brief:

definitionReflux is primarily a condition based on the return of acid gastric juice to the esophagus or other parts of the body.
symptomsTypical symptoms include heartburn and constant burping. But it can also lead to esophagitis, coughing fits and a number of other nonspecific symptoms.
causes: The main causes include limitations in the function of the gastric sphincter (often a consequence of wrong nutrition) or the movement function of the esophagus. However, reflux can also occur as a result of certain illnesses or surgical interventions.
treatment: Often the symptoms can be corrected by diet and behavioral changes. This can be supported by naturopathic procedures. In worse cases, a drug treatment or even surgery is needed.

contents

disease
Reflux definition
Reflux causes
Secondary reflux disease
Symptoms of reflux
treatment
Diet at reflux
Nutritional recommendations for reflux
drugs
operations
Naturopathy in reflux disease
Homeopathy in reflux

disease

In western industrialized countries, one in four adults is estimated to be suffering from a reflux disease. Most of these are limited to the lower esophageal sections. But a frequent occurrence should not be ignored, because sometimes can cause serious sequelae caused by heartburn.

Prolonged duration can cause esophagitis or degeneration, which can lead to cancer of the esophagus. Accordingly, the symptoms should always be taken seriously and medically clarified. In many cases, the symptoms can be alleviated by changing the diet. Proven home remedies for heartburn can promote and accelerate the healing process.

Reflux diseases with symptoms such as heartburn are very common in western industrialized countries. (Image: Adiano / fotolia.com)

Reflux definition

The term "reflux" comes from the Latin word "refluere" and means "to flow back". As the term suggests, reflux disease is primarily reflux of acid gastric juice into the esophagus, leading to typical symptoms such as heartburn and regurgitation. While this is quite normal in occasional cases, frequent occurrence of permanent mucosal damage. This can cause massive damage to those affected.

Gastroesophageal reflux disease

If heartburn occurs regularly, doctors speak of a "gastroesophageal reflux disease" (English: Gastroesophageal Reflux Disease, short: GERD). This is estimated to affect a quarter of the population in western industrialized countries. There are various forms, of which the "non-erosive reflux disease" (English: Non-Erosive Reflux Disease, NERD), in which the esophagus is not inflamed, forms the most common variant.

esophagitis

The reflux of gastric acid can also lead to inflammation of the esophagus (reflux oesophagitis). This can take massive proportions and lead to scarring and swallowing problems and in emergencies favor the development of esophageal cancer. Patients with a so-called "Barrett's syndrome" (Barrett's esophagus) are particularly affected here because the esophageal mucosa is already significantly altered by the chronic course.

Frequent leakage of gastric acid into the esophagus can lead to esophagitis. (Image: Anatomy Insider / fotolia.com)

Reflux outside the esophagus

It is also possible that the effects of gastroesophageal reflux disease also manifest themselves outside the esophagus and, for example, cause symptoms such as chronic cough, bronchial asthma or dental erosions on the teeth (extra esophageal manifestations).

Sphincter of the esophagus

Normally, gravity already ensures that the gastric juice can not flow back into the esophagus. In addition, this can twist as a stretchable muscle tube so that the stomach entrance (Cardia) is closed. The lower sphincter of the esophagus (esophageal sphincter) usually relaxes only during swallowing as well as for brief moments when swallowed air is pushed open.

Reflux causes

In most patients, the gastric occlusion mechanism is disturbed, causing the stomach acid to flow upwards and attack the wall of the esophagus. This is - unlike the stomach - not surrounded by a corresponding protective mucous membrane ("primary reflux disease"). Above all, the heartburn occurs while lying down and in the Bück position when the gastric juice flows by gravity towards the esophagus.

diaphragmatic hernia

The esophagus passes through a gap in the diaphragm and ends in the stomach entrance. Regular inappropriate diets can lead to overstretching, which allows this gap to widen. When the gap gets bigger, parts of the upper stomach also slip into the dilated opening in the diaphragm. If the diameter of the gap is two to three centimeters, physicians speak of a small diaphragmatic hernia (hiatal hernia). If the opening is larger than three centimeters, there is a large diaphragmatic fracture. A diaphragmatic fracture is often responsible for the disturbed occlusive mechanism of the stomach.

A dilation or breakthrough of the diaphragm is a common cause of reflux disease. (Image: bilderzwerg / fotolia.com)

Decreased mobility of the esophagus

In addition, however, a reduced mobility of the esophagus may be the cause of a primary disease. If the gastric acid refluxes, the esophagus normally corrects the "acid problem" by its own movement (peristalsis). The movement forces the corrosive gastric juice back into the stomach so that there is no possibility of damage. If this flexibility is limited, however, the cleaning process does not work properly. As a result, the acid has prolonged contact with the wall of the esophagus, ultimately causing severe damage and the typical burning pain (heartburn).

Other risk factors

In addition, there are numerous other risk factors and possible causes of heartburn. These include, for example, the following factors:

print: An increased pressure in the abdominal cavity due to overweight (obesity) or pregnancy.
nutrition: Various fatty, sweet or spicy foods and sweets that increase acid secretion.
Alcohol and nicotine: Tobacco smoke and regular alcohol consumption also increase acid production in the stomach.
drugs: Also medicines can cause heartburn. Various medications, such as opiates, beta-blockers or nitrates, can increase discomfort, for example, by breaking down protective mucous membrane components or enhancing acid secretion.
psycheLast but not least, mental factors such as stress or other stress can also affect the tone of the lower oesophageal muscle and lead to a reflux.

These are the reasons for a reflux syndrome. Image: designua / fotolia.de

Secondary reflux disease

Reflux may also occur as a result of other disorders or interventions. In this case, doctors speak of a "secondary reflux disease". This can occur, for example, as a result of subsequent illnesses:

scleroderma: In the rare connective tissue disease scleroderma it can lead to hardening and thickening of the skin or mucous membrane and internal organs, especially in the digestive tract, the lungs, the heart and kidneys.
operations: Heartburn may also occur as a result of surgery such as cardiomyotomy.
Gastric outlet narrowing: It is also possible a narrowing of the stomach outlet, because the gastric emptying can take place only delayed, resulting in increased pressure in the stomach and thus a higher risk for a long time.
premature birth: In addition, a premature birth can cause a reflux in the baby, because the sphincter is not mature.
Zollinger-Ellison syndrome: The so-called "Zollinger-Ellison syndrome" may also be responsible for the symptoms, in which it comes as a result of a pathological overproduction of the hormone gastrin to increased production of gastric acid.

Symptoms of reflux

The main symptom is frequent acid regurgitation of stomach acid and / or heartburn, which is accompanied by burning chest pain, which are usually perceived behind the breastbone. In most cases, the symptoms are more pronounced when stooping down or heavy lifting, as well as after eating large, rich meals, foods rich in sugars (cakes, sweets, desserts) or the consumption of alcohol and nicotine.

Lying position often amplifies the symptoms

Due to the lying position, in which the gastric juice gets into the esophagus more easily, the symptoms are especially noticeable at night. In addition, the acid in the trachea, it can also lead to severe nocturnal cough or even shortness of breath.

Frequent complaints

The typical symptoms are associated with many sufferers more complaints. These include, for example:

More or less pronounced upper abdominal pain,
Nausea and vomiting,
throat pain,
hoarseness,
Swallowing problems with esophagitis.

Intensity of the symptoms

The form and intensity of the symptoms can be quite different and is not - as with many other diseases - directly related to the course of the disease. Accordingly, it may happen that sufferers show only weak signs of disease even with severe damage to the mucous membrane, while in other cases, for example, despite massive heartburn no abnormal results in the findings.

treatment

Which therapeutic steps are taken on a case-by-case basis depends on the severity of the disease. If no changes in the mucous membranes are seen at earlier stages, the symptoms can often be alleviated by changing diet and changing habits of life.

Medicines and surgeries

If there is no success or if there is already damage to the mucous membrane, medicines are usually used for treatment. In very rare cases, however, surgery is necessary to restore the functioning of the lower esophageal occlusion. Even with a larger diaphragmatic breakthrough operations are used.

Diet at reflux

The food plays a very special role, so that can be relieved, especially in mild and moderate forms, the symptoms mostly by a change in diet significantly. However, there are no universally valid rules for this, because not all affected people react equally to all foods. Nevertheless, there are quite a few foods that are less well tolerated in heartburn.

Food with high fat content

Heavy meals often cause heartburn. These include, for example, food with a high proportion of fat, because it lowers the tension of the lower oesophageal sphincter and also delays the gastric emptying, which increases the risk that gastric contents flow back into the esophagus. Therefore, special attention should be paid to high quality (eg oils with omega-3 fatty acids). In addition, only little fat should be used per meal and should be avoided as far as possible on deep-fried, strongly simmered and especially fatty foods (fatty meat and sausage products, mayonnaise, fast food, greasy fish etc.).

desserts

Likewise, do not eat too much sweets, as sugar-rich foods such as cakes, desserts, sodas, and juices will boost gastric acid production and, in many cases, increase reflux.

Spicy and spicy food

Spicy food or spices such as paprika, pepper, garlic or chilli also stimulate the formation of acid, whereby the alkaloid capsaicin, which gives it its pungency, additionally increases the sensibility of the esophagus and often makes the symptoms even worse.

chocolate

In addition, there are a number of hidden "acidifiers", which should be better avoided. This includes, above all, chocolate, because it contains plenty of sugar and fat as well as methylxanthines (theobromine, theophylline), which also have a relaxing effect on the lower esophageal sphincter and stimulate acid secretion.

peppermint tea

The same applies to peppermint tea, which is usually a proven home remedy for many ailments, but should be better avoided in reflux to prevent further muscle weakening.

Acid-rich fruits and vegetables

In part, sufferers also report increased discomfort following consumption of acid-rich vegetables or fruits (citrus fruits, tomatoes, etc.), while low-acid fruits (such as apples or bananas) have no negative effects.

Nutritional recommendations for reflux

Accordingly, heartburn recommends a low-fat and high-carb diet that contains predominantly basic foods. Suitable for this are:

Vegetables (potatoes, aubergines, kohlrabi, carrots etc.),
Fruit (strawberries, plums, kiwi etc.),
Salads (Batavia, rocket, dandelion etc.),
steamed and spicy fish,
Seafood with little oil,
light meat (turkey, chicken),
protein-rich foods such as kefir, yoghurt or quark.

When and how to eat?

Generally, care should be taken to avoid late meal and sumptuous meals. Instead, it is advisable to take several small meals consciously and in peace, with extensive chewing (fletching) in reflux is particularly important to relieve the stomach.

Also note the drinking

In addition to the food, sufficient drinking is very important. Non-carbonated mineral water, warm tap water and mild teas (such as fennel, mallow) are particularly suitable here, whereas coffee and black tea should be drunk only to a limited extent. Alcohol - like nicotine - should be avoided as far as possible, because it causes an increased acid production in the stomach and the tension of the sphincter muscle is reduced and the muscle activity (peristalsis) of the esophagus is disturbed.

drugs

If the symptoms can not be alleviated by a change in lifestyle and dietary habits alone, the next step is usually to treat the reflux disease with medication. Here are primarily so-called "proton pump inhibitors" (PPI, also called "proton pump inhibitor" called) such as omeprazole or pantoprazole used, which act as a "stomach protection" by suppressing the formation of gastric acid in the parietal cells of the stomach.

Medicines for mild forms

If there is only a mild form of reflux disease, H2-blockers (such as ranitidine, cimetidine), which also inhibit acid secretion from gastric glandular cells, may be used as an alternative, but with a weaker effect than proton pump inhibitors. These acid blockers are effective for up to 12 hours, taking into account that the active ingredients can suppress the breakdown of other drugs in the body, so that concomitant use should not be made by other means.

operations

Even if the drug therapy can not remedy the symptoms or if the symptoms are very pronounced or long-lasting, in rare cases an operative intervention may become necessary.

Stomach cuff surgery

The surgical method most commonly used so far represents the so-called "fundoplication" ("gastric cuff surgery"), which can be performed open or endoscopically and leads in more than 90 percent of patients to a permanent cure of the reflux disease. The procedure involves placing a gastric cuff around the esophagus, narrowing the transition into the stomach and eventually balancing the weakness of the lower sphincter. As a result, the food can continue to be transported from the esophagus to the stomach, but reflux is prevented by the cuff.

Flexible magnetic tape

In addition, a new surgical procedure has been used for some time, in which a flexible magnetic tape to stabilize the function of the lower oesophageal sphincter (esophageal sphincter). In this so-called "LINX Reflux Management System", a magnet ring is placed around the esophagus above the stomach. This is constructed in such a way that the chyme continues to enter the stomach without any problems. However, as the magnets keep the lower part of the tube closed, reflux of gastric acid and bile can be prevented.

Above all, experts see advantages in that, in contrast to the conventional methods, no anatomical changes have to be made in the patient, for example in a fundoplication in which a part of the stomach is used for the formation of the cuff. The surgery is performed under general anesthesia minimally invasive ("keyhole surgery"), whereby only a small cut above the belly button is necessary. After the procedure, the patient can usually be discharged home after just a few days and will soon return to normal eating. Nevertheless, care should be taken to ensure that the food is not absorbed too quickly and chewed enough, also a regular medical follow-up should take place.

Naturopathy in reflux disease

If you suffer from heartburn or belching frequently or for more than two days at a time, you should first consult a doctor to identify or rule out organic disorders. In any case, the symptoms should be taken seriously, because if there is a reflux disease over a longer period, it can lead to serious damage to the esophagus and in the worst case even to esophageal cancer. However, if the symptoms appear only slightly and irregularly, naturopathy can certainly offer a meaningful and effective support or alternative to conventional therapy.

dietary changes

In general, it is important for persistent or recurrent heartburn, carefully and critically deal with their own living and eating habits, since, for example. greasy food, too much sweets, and increased consumption of alcohol and nicotine can promote the development of reflux as well as mental stress that "hits the patient's stomach". In this context, an urgent attempt should be made to reduce obesity and to limit the smoking and consumption of alcoholic beverages.

Change certain habits

In addition, a change in certain habits (late meal, slings, etc.) is central. In addition, regular physical activity should be firmly integrated into everyday life to relieve tension and enhance well-being. Reflux occurs more often in lying and in the Bück position, which is why sufferers better not lie down directly after eating and should generally sleep with higher upper body.

stress management

In order to reduce the stress and to learn a healthier way of dealing with pressure and tension, are also various exercises and procedures for stress relief such as yoga, meditation or autogenic training.

The healing power of chamomile

In addition to a number of other options for self-treatment of heartburn by reflux into consideration, by which the symptoms can be successfully alleviated. Chamomile has proved its worth in many cases, which has an anti-inflammatory and calming effect on the over-stimulated gastric nerves and can help to reduce the production of gastric juice.

Chamomile Tea Rollkur

Here, alternative practitioners and naturopathic physicians often recommend a Rollkur with chamomile tea. In this case, first a cup of tea is drunk, then the patient lies down for about five minutes on the back, the right side, the stomach, the left side and finally back on the back so that the valuable ingredients of chamomile reach the entire gastric mucosa can. "Rolling" should be done for at least a week in the best case in the morning on an empty stomach and in the evening just before going to bed, if necessary, a total of up to three times throughout the day.

Other natural remedies

In addition to the "panacea" chamomile fennel, lemon balm, plantain and stinging nettle are particularly suitable in the field of herbal natural remedies, as well as valerian in the form of a tea or as a drop can be very beneficial in stress-related heartburn.

Homeopathy in reflux

In addition, homeopathy also offers a number of effective remedies. Here, for example, Robinia pseudacacia (D6) is considered for severe burning pain and stomach pressure, and especially for nocturnal acid regurgitation. Occurs alongside heartburn and regurgitation, e.g. Shivering, nausea and vomiting and showing a dislike for chilled drinks and coffee, Acidum sulphicum (D6) may also be the drug of choice. In addition, Nux vomica or Capsicum is also suitable in some cases. However, before the self-treatment should always take a detailed consultation with a naturopath or naturopathic doctor.

Schüßler salts

Likewise, Schuessler salts are suitable for treatment, with the salt No. 9 (sodium phosphoricum) having proved particularly useful here with ascending acid. If burning of the esophagus occurs in parallel, it is advisable to take this in alternation with the salt no. 2 (Calcium Phosphoricum), whereby the exact potency as well as the duration and duration of intake should always be discussed in advance with a suitable expert.

acupuncture

Acupuncture can also dramatically reduce the symptoms of heartburn.

Wraps and hot water bottles

Another well-tried home remedy for heartburn are moist-warm wraps on the upper abdomen or a hot water bottle, in some cases, in the acute case also helps some warm milk, which is best diluted.

Potatoes and potato juice

Even raw potatoes can be true "miracle" in the acute case, since the starch contained in it can also neutralize stomach acid. Here you can use a juicer to quickly prepare a freshly squeezed potato juice, which is also available as an alternative in the health food store. Instead of the juice but also a piece of raw potato can be eaten as well.

Protein-rich dairy products

Protein-rich foods such as kefir, yoghurt or cottage cheese can help alleviate the discomfort caused by the release of the hormone gastrin, which in turn promotes tension and thus the ability of the muscle to close.

Bullrich Salt

In many cases, the so-called "Bullrich salt" helps, which neutralizes excess stomach acid through the natural active ingredient sodium bicarbonate and thereby gently relieves acute burning pain. (nr, tf, vb, updated 18 March 2018)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)

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