Gastroesophageal reflux disease

Overview

Reflux is the return of stomach contents into the esophagus. Rare episodes, e.g. after a heavy meal, also occur in healthy people. When the complaints become frequent, bothersome or cause damage to the esophagus, we speak of gastroesophageal reflux disease (GERD, from the English abbreviation).

Symptoms

• Heartburn — a burning sensation behind the breastbone (sternum), often after eating or when lying down.
• Regurgitation — sour liquid or food coming back into the mouth.
• Complaints at night that wake you from sleep.

A chronic cough, hoarseness or a sore throat may be related to reflux, but they also have many other causes.

Contributing factors

Overweight (especially around the abdomen), hiatal hernia, pregnancy, smoking, large meals and lying down immediately after eating. Reflux can appear at any age.

When to see a doctor

Seek advice if heartburn occurs more than twice a week, if you constantly need medication or if the complaints return as soon as you stop it. Seek assessment without delay if food gets stuck, swallowing is difficult or painful, you lose weight without explanation or you have signs of bleeding (anemia, black stools).

Diagnosis

When the symptoms are typical and there are no alarm signs, the doctor often starts treatment and lifestyle changes directly — without the need for an immediate endoscopy.

• Gastroscopy is recommended when there is difficulty swallowing, bleeding, anemia, weight loss or complaints that do not respond to treatment.
• A normal gastroscopy does not rule out reflux.
• In unclear cases or before a surgical procedure, pH monitoring or pH-impedance monitoring of the esophagus may be needed.

Treatment

Medication. Proton pump inhibitors (PPIs) are the basis of treatment for most patients. The dose, the time of taking (usually 30–60 minutes before food) and the duration are determined by the doctor. If the complaints continue, the diagnosis is reviewed — the dose is not increased indefinitely on your own.

Surgery or endoscopic procedures are reserved for selected patients, after a full assessment.

Practical measures that help

• Gradual weight loss, when overweight.
• Do not lie down for 2–3 hours after eating and avoid meals close to bedtime.
• Raising the head of the bed (with blocks under the bed legs, not just with pillows) helps night-time complaints.
• Stopping smoking.
• Coffee, chocolate, fatty foods, mint or acidic foods can make the complaints worse in some people. There is no need to ban them all — limit those that you have noticed trigger heartburn.