Reflux

Symptoms and causes

What is it?

Gastroesophageal reflux (GOR), also known as heartburn or acid reflux, is the return of stomach contents to the oesophagus. We speak of reflux if the reflux occurs repeatedly and more than twice a week.

(Serious) reflux symptoms can be caused by a diaphragmatic rupture (hiatal hernia or herniated diaphragmatic hernia). In the diaphragm (i.e. the muscle that separates the thoracic cavity from the abdominal cavity), there is an opening through which the oesophagus goes from the chest to the abdominal cavity. If the opening is wider than necessary, this is called a diaphragmatic rupture.

Reflux is not always a trivial problem. It can arise from:

Oesophagitis
Narrowing of the oesophagus
Bleeding
Barrett's oesophagus

Symptoms

Typical reflux symptoms of reflux include:

acid regurgitation
swallowing problems
nagging or burning pain behind the sternum

When gastric acid reaches the throat or mouth, it can cause local irritation, foul-smelling breath and tooth erosion. It can also lead to hoarseness (by affecting the vocal cords), coughs or asthma (by acting on the air pipe).

Consequences

If the return of gastric acid to the oesophagus is prolonged and regular, the oesophagus can become irritated and inflamed (refluxusophagitis), sometimes resulting in blood loss or constriction (stenosis). With prolonged exposure, the mucous membrane of the oesophagus may undergo gradual changes (Barrett's oesophagus). This increases the likelihood of developing oesophageal cancer (adenocarcinoma).

Persistent reflux symptoms can lead to a reduced quality of life due to poor sleep (reflux becomes worse) or because certain activities that require bending forwards cannot be performed.

Diagnosis and treatment

Diagnosis

Treatment

Gastro-oesophageal reflux can be treated surgically as well as non-surgically (conservatively).

Conservative treatment

The non-surgical treatment of reflux consists of general adaptations to lifestyle and medication.

Surgical treatment

Surgery may be necessary when antacid drugs and lifestyle adjustments do not have sufficient effect on reflux symptoms. Surgery may also be considered if patients do not want to take antacids for the rest of their lives, if medication is not well tolerated or if medication is not taken reliably.

A surgical treatment is applied when complications of reflux occur such as:

Oesophageal inflammation (oesophagitis) that is not easily cured or is recurrent
Benign narrowing of the oesophagus (benign stricture)
Barrett's metaplasia (without severe dysplasia or carcinoma)
Asthma

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