Digestive Disorders > Symptoms

Reflux – symptoms, cause and treatment

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Reflux is the backflow of stomach acid or food into the esophagus. But the symptoms we tend to summarize under heartburn or acid regurgitation can have several causes and can make an exact diagnosis difficult at times. That's because regurgitation is not always based on an underlying clinical disease.

What is reflux?

Reflux is the technical term for acid regurgitation, also known as heartburn. Here, gastric acid is “refluxed” back up through the esophagus. That burns and hurts - which is why it is called heartburn. In contrast to reflux disease, reflux is not a disease in itself, but a direct reaction to hectic food consumption or the enjoyment of cold, carbonated drinks.

Reflux does not become reflux disease until heartburn occurs very frequently in the same circumstances. In the most severe degree, it can even cause changes in the lining of the esophagus. However, the acid regurgitation itself is harmless in most cases. Find out more about the symptoms and treatment here!

What is silent reflux?

It mainly occurs in the area of the larynx, i.e. the larynx, or the pharynx, the throat. It is usually refluxed up to the back of the mouth. In technical terms it is therefore called laryngo-pharyngeal reflux or LPR for short. The stomach acid is transported from the throat upwards. This happens primarily in gaseous form and rarely in liquid form. If this causes inflammation of the larynx, it is known as reflux laryngitis.

Reflux in babies

To a certain extent, reflux is normal in babies. It occurs as spit-up after drinking. This occurs when the seal between the stomach and esophagus relaxes after drinking. This allows some of the food to flow back up into the esophagus. This differs from a functional disorder in the gastric occlusion in which the physical separation between the stomach and esophagus does not work properly. In these cases, it is referred to as reflux disease in children.

Take note! Detecting reflux in babies

Whether reflux is dangerous for a baby can be seen from the following symptoms: Frequent vomiting, frequent crying after breastfeeding, frequent milk reflux (more than five times a day) and frequent coughing after drinking,

If one of these features applies, you should see a doctor!

The symptom also appears frequently in children and is difficult to classify correctly, but mostly harmless. Light medication for acidification or binding agents often helps.

Overview of therapies:

  • Conservative therapy includes natural measures against occasional and harmless heartburn, such as high camps, changes in diet, etc.
  • Drug therapy works with proton pump inhibitors, such as esomeprazole, omeprazole and similar medicines, which ensure that stomach acid is not regurgitated.
  • Surgical therapy involves an operation. However, this should be the last step and should only be considered if the clinical course of the disease is difficult. Surgery is also performed in exceptional cases for children with lung disease. The surgery is also referred to as fundoplication.

Did you know that…

... many patients who experience reflux complaints often do not even have GERD (Gastroesophageal Reflux Disease)?

Studies show overweight people and women suffer more from acid regurgitation?

Reflux disease one of the most common diseases worldwide?

Fatty food leads to reflux because it reduces the muscle tone of the esophageal occlusion?

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Natural reflux therapy

When something annoys us, it feels very uncomfortable. It often burns in the chest and esophagus. Most of the time, reflux is harmless and more a result of our lifestyle - every tenth person in Germany for example suffers from heartburn. If the symptom occurs only occasionally and does not involve any physiological issues, even a small change in lifestyle can bring relief.

  • Raising the head during sleep helps the body to keep the acid in the stomach. Special reflux pillows are available for this purpose. They allow the head to be raised gently without putting strain on the spine.
  • Even slight changes in diet can help. If you observe closely, you will quickly find out what causes reflux and can reduce these foods or habits or omit them altogether.
  • Treatment with homeopathy is also becoming increasingly popular: Healing earth, Schüßler salts, Bach flowers etc. can help.

Medicinal treatments, for example with proton pump inhibitors such as esomeprazole, have a good effect in the short term. But only measures such as a change in diet or stress reduction help in the long term against heartburn.

Tip

Protein-rich foods increase the tension in the esophagus by up to 50 percent and thus reduce reflux! Fats lower it significantly and thus intensify the heartburn. Carbohydrates, on the other hand, have little effect on reflux.

Foods such as chocolate or a very high-fat diet, as well as alcohol, intensify reflux symptoms by causing a food-induced pressure drop.

How are reflux and nutrition related?

Most of the time, spontaneous reflux occurs after eating. A connection with nutrition is obvious. But which foods promote uncomfortable heartburn and can you treat it by changing your diet? Reflux always occurs when the occlusion between the stomach and esophagus, the so-called lower esophagus, does not work properly. This involves a muscle. As studies show, it automatically relaxes a little after eating. What is the normal process? But some foods cause too much relaxation in the esophagus, which can lead to symptoms of reflux.

Did you know that…

.... the muscle tone in the lower esophagus (esophagus) decreases more when lying down than when sitting upright. So if you lie down after eating, you may experience more symptoms.

Often it is not the food itself that causes reflux, but rather the type of food intake and the composition of the food. As with many other health problems, these are primarily greasy and difficult to digest dishes. They weaken tension in the lower esophagus and thus promote the reflux of stomach acid or food. This process is known in technical terms as food-induced pressure drop.

Reflux is not the same as reflux disease

Not every case of reflux speaks for the presence of reflux oesophagitis or gastroesophageal reflux disease. Rather, like heartburn, it is a main symptom of reflux disease. Especially among laypeople, the terms reflux, reflux esophagitis and gastroesophageal reflux disease (GERD) are often conflated.

Gastroesophageal reflux disease (GERD) is also popularly shortened to the term heartburn. This happens despite it being an independent clinical diagnosis according to the ICD-10 classification. GERD is referred to as heartburn if it is a chronic disease, the causes of which are deeper. A chronic cough is often associated with GERD patients.

As gastroesophageal reflux is however, a sub-form of gastroesophageal reflux disease. It is accompanied by measurable or visible changes in the mucous membrane in the esophagus.

Briefly summarized

Reflux simply refers to the regurgitation of stomach acid. We commonly call this heartburn. Reflux does not have to be related to reflux disease. It can also arise because we eat our food too hastily and this creates air in the stomach. The same applies to carbonated drinks. Stress can also trigger a short-term occurrence of heartburn. So if it only happens every now and then, you don't have to worry.

Herregods, T. V. K., Troelstra, M., Weijenborg, P. W., Bredenoord, A. J., & Smout, A. J. P. M. (2015). Patients with refractory reflux symptoms often do not have GERD. Neurogastroenterology & Motility, 27(9), 1267-1273. https://www.ncbi.nlm.nih.gov/pubmed/26088946

Kahrilas, P. J., Keefer, L., & Pandolfino, J. E. (2015). Patients with refractory reflux symptoms: What do they have and how should they be managed?. Neurogastroenterology & Motility, 27(9), 1195-1201. https://www.ncbi.nlm.nih.gov/pubmed/26303047

Roman, S., Keefer, L., Imam, H., Korrapati, P., Mogni, B., Eident, K., ... & Pandolfino, J. E. (2015). Majority of symptoms in esophageal reflux PPI non‐responders are not related to reflux. Neurogastroenterology & Motility, 27(11), 1667-1674. https://www.ncbi.nlm.nih.gov/pubmed/26337396

Sun, J., Yuan, YZ, Hou, XH, Zou, DW, Lu, B., Chen, MH, ... & Zhou, L. Y. (2015). Esomeprazole regimens for reflux symptoms in Chinese patients with chronic gastritis. World Journal of Gastroenterology: WJG, 21(22), 6965. https://www.ncbi.nlm.nih.gov/pubmed/26078574

Gesundheitsamt Bremen: Ernährung und Refluxösophagitis. https://www.gesundheitsamt.bremen.de/sixcms/media.php/13/3ERNRefluxoesophagitis%202013.pdf.

Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara.

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