Reflux Disease

Reflux disease is the leading cause of heartburn and heartburn is just a symptom of reflux disease. Reflux disease is often confused with the most common symptom of this disease, heartburn. Reflux, the rising of stomach acid into the esophagus, causes heartburn. Occasional heartburn is not a disease, but is mostly the result of large meals or excessive drinking.

If heartburn occurs regularly, reflux disease may be the cause. This cause is usually a malfunction of the lower esophageal muscle. This lower esophageal sphincter separates the esophagus from the stomach and ensures the closure between the two organs. In reflux disease, stomach contents easily get through the weakened sphincter into the esophagus – and cause discomfort there.

Two forms of reflux disease: NERD and ERD

Doctors usually speak of reflux esophagitis. They mainly differentiate reflux disease into two subgroups:

    • NERD stands for non-erosive gastroesophageal reflux disease (Non-Erosive Reflux Disease). In this form, the mucous membrane of the esophagus is not (yet) demonstrably damaged by the rising stomach acid.
    • ERD is the abbreviation for erosive reflux disease (Erosive Reflux Disease). In this form, the protective mucous membrane of the esophagus is visibly injured and changed like an ulcer.

The frequency of reflux disease in Germany is given as between 10 and up to 25 percent of the total adult population. In the studies, however, a precise distinction is not always made between occasional or recurring heartburn (pyrosis) and actual reflux oesophagitis, i.e. reflux disease. Experts estimate that around 10 percent of adults have chronic reflux disease that requires treatment.

For more on the symptoms and complications of reflux disease: see heartburn

The most common cause of reflux disease is a weak lower esophageal muscle. The so-called lower esophageal sphincter separates the esophagus from the stomach. If the muscle is too weak, acidic stomach contents can easily get from the stomach into the esophagus and damage the mucous membrane.

In most cases, the cause of the weakness of the esophageal sphincter cannot be determined. Doctors then speak of primary reflux disease. This form is by far the most common.

Secondary reflux disease, on the other hand, results from a change in the physical structure or function. In half of the cases, the secondary form is caused by the spatial shifts during pregnancy. Another common cause is stomach disorders such as a narrowed stomach outlet (pyloric stenosis). Congenital or acquired changes in the esophagus, excessive gastric acid production, weakness of the stomach orifice (cardiac insufficiency), or diaphragmatic weakness (hiatal hernia) are other causes of secondary reflux disease.

Reflux Disease

Medicines can also irritate the lining of the food. So-called pill esophagitis is triggered, for example, by antibiotics (e.g. tetracyclines, clindamycin, and penicillin) or bisphosphonates against osteoporosis (e.g. alendronate, etidronate, and pamidronate) if they are taken lying down and swallowed with too little water.

Furthermore, antiviral drugs such as zidovudine and zalcitabine, non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen, cardiovascular drugs such as alprenolol, captopril, and nifedipine, cortisone preparations, ascorbic acid as well as iron sulfate and potassium chloride can cause esophageal damage.

Symptoms as a result of primary reflux disease can be relieved primarily by changing your diet. The most important thing is not to overfill the stomach. On the other hand, avoiding substances that irritate the stomach has a positive effect. This applies, for example, to carbonated drinks, foods rich in fat and carbohydrates, alcohol, and coffee. Nicotine is also one of the stomach-irritating substances. Too many pounds in the form of excess weight also have a negative effect on the esophageal sphincter. You can find detailed information here: Diet for reflux disease and heartburn.

A number of active ingredients are available for the drug treatment of primary reflux disease and heartburn. You can read more about this here: Heartburn.

In secondary reflux disease, therapy aims to treat the causative disease or to change the medication. After pregnancy, the closing strength of the esophageal sphincter normalizes in most cases within weeks or months.

Stomach Acid Blockers Involve Risks

Proton pump inhibitors such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole are among the best-selling drugs in Germany. According to the drug report of the Barmer health insurance company, almost 12 million German proton pump inhibitors were prescribed in 2018. In addition, the active ingredients omeprazole, pantoprazole, or esomeprazole are also available over the counter.

In public perception, gastric acid blockers from the active ingredient group of proton pump inhibitors are considered to be simple and safe drugs. However, 2 aspects are left out: the side effects and the fact that proton pump inhibitors can be addictive.

Kidney Damage As A Side Effect

The most common side effects of proton pump inhibitors include bone loss (osteoporosis) and magnesium deficiency with an increased risk of cardiac arrhythmias and seizures. These side effects have now been proven by a number of studies. It is even more serious that the medication permanently disrupts the natural regulatory cycle of gastric acid production. After prolonged use, between 14 and 64 percent of patients remain permanently dependent on the medication.

Connection Between Proton Pump Inhibitors And Allergies Possible

Proton pump inhibitors may increase the risk of allergic diseases. Scientists from the University of Vienna published a study in the journal “Nature Communications” (August 2019) (see sources) that produced at least one striking statistical connection between the long-term use of proton pump inhibitors and allergic diseases. The scientists had evaluated data from Austrian health insurance companies. They found that the likelihood of prescribing antiallergic drugs increases by up to 300 percent if gastric acid blockers were previously prescribed. This does not necessarily mean that proton pump inhibitors actually trigger or promote allergies. In the opinion of the study authors, however, the connection cannot be dismissed out of hand and suggests that gastric acid blockers should only be used in very dosed quantities.

The German Society for Gastroenterology, Digestive and Metabolic Diseases assessed the study results differently. According to the press release, the specialist society does not see an “obvious connection between gastric acid blockers and allergies”. The design of the Austrian study does not give a corresponding assessment.

Heartburn (Pyrosis)

Heartburn is the reflux of stomach contents into the esophagus. Heartburn can be harmless, but in the long run, it can also be pathological and indicate reflux disease or cause esophagitis. Read more about the symptoms, causes, therapy, and prevention of heartburn.

Most people are familiar with heartburn (pyrosis) or acid regurgitation (ructus). As a rule, it is uncomfortable – but it also quickly passes and is harmless. Recurring or regular heartburn, on the other hand, should be examined by a doctor. Either the constant reflux of gastric acid into the esophagus is due to the disease and indicates a reflux disease or it injures the esophagus and causes esophagitis (esophagitis). With a few exceptions, heartburn can be treated very well with medication and a change in diet or behavior.

A typical symptom of heartburn is a burning pain in the center of the chest (above the stomach area) that can radiate to the throat, throat, or even face. This often happens after meals (due to overcrowding or acidification of the stomach) or when bending over and changing positions.

Occasionally, stomach acid or digested food gets into the oral cavity with the acidic burping. This leads to an unpleasant burning sensation in the throat and a sour or bitter taste in the mouth. This can cause nausea and, rarely, vomiting.

Heartburn is often accompanied by an unpleasant, sour-smelling bad breath. Heartburn or the pain associated with heartburn are sometimes also perceived as heart pain. In English, heartburn is therefore also called heartburn.

Heartburn Complications

Recurring heartburn puts stress on the esophagus. The result can be inflammation of the esophagus. In turn, esophagitis could increase the risk of esophageal cancer.

Causes

Heartburn is caused by acidic stomach contents flowing back into the esophagus (acid regurgitation). The causes of stomach contents getting back into the esophagus can be very different.

Typically, very large meals trigger heartburn once we’ve eaten enough to fill the stomach. Then a slight pressure – for example by moving – is enough to let the stomach contents get into the esophagus.

As the pregnancy progresses, the child puts pressure on the stomach and can cause stomach contents to enter the esophagus. Heartburn can also indicate conditions such as stomach ulcers, duodenal ulcers, or stomach cancer.

Cause Reflux Disease

Heartburn is the main symptom of acid reflux disease. This is a malfunction of the lower esophageal muscle (lower esophageal sphincter) that separates the esophagus from the stomach. As a result, the weakened sphincter muscle can get stomach contents easily into the esophagus.

Heartburn

Other Causes Of Heartburn

The excessive production of stomach acid and the resulting heartburn can have a variety of other causes:

    • excessive consumption of alcohol, coffee, or cigarettes
    • Obesity
    • nervous stomach
    • Diaphragmatic hernia
    • Use of certain medications such as pain relievers and anti-rheumatic drugs (e.g. acetylsalicylic acid, diclofenac, and ibuprofen), cortisone, and chemotherapy drugs
    • Stress or other psychological stress.

Cause In The Duodenum

In the case of heartburn with bitter and bilious belching, the cause is often in the duodenum. Often the intestine is overactive (so-called motility disorder) or the gastric sphincter (also called gastric gatekeeper or pylorus) does not close properly.

Investigation

The main focus of diagnosing heartburn is finding the cause of the backflow of stomach contents into the esophagus. A frequently used examination method for this is the esophagus and gastroscopy. You will find detailed information on this under gastroscopy.

Treatment

Inhibiting gastric acid production with medication is usually the essential element of medical treatment for heartburn. Different groups of drugs are used.

    • Antacids are drugs with aluminum or magnesium salts such as aluminum hydroxide or magnesium hydroxide. Other active ingredients are Algedrat, Magaldrat or Simeticon. These drugs bind excess stomach acid for heartburn and also relieve the symptoms of inflammation of the stomach lining (gastritis) or a stomach ulcer. The chewable tablets or sachets of suspension are chewed or swallowed approximately one hour after eating and before going to bed. Sometimes it takes 2 chewable tablets or sachets for the heartburn to go away. Suspensions work faster than chewable tablets because the milky solution quickly lines the stomach lining and protects it from acid. Antacids are also useful during pregnancy.
    • H2 blockers are another group of heartburn medication. So-called H2-receptor blockers such as cimetidine, famotidine and ranitidine inhibit the production of stomach acid. For some time now, various H2-receptor blockers have been available in pharmacies without a prescription.
    • Proton pump inhibitors, such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole, are another group of drugs that can be used to treat heartburn. For example, the proton pump inhibitors omeprazole, pantoprazole, or esomeprazole are now freely available (see also below: gastric acid blockers involve risks)
    • Prokinetics such as metoclopramide accelerate the intestinal transit and the further transport of food in the intestine. As a result, less acidic food pulp can get into the esophagus.

Recall Of Drugs Containing Ranitidine

Numerous drugs with the active ingredient ranitidine may no longer be used for the time being since September 2019. A current list of the drugs concerned can be found here: Recall ranitidine drugs due to nitrosamine contamination. Ranitidine belongs to the active substance group of H2 antihistamines and is also mainly used in the following clinical pictures:

    • Anaphylactic shock
    • gastritis
    • Diaphragmatic hernia

The European Medicines Agency ordered the EU-wide recall because impurities had been detected at a manufacturer of the active ingredient in India (Saraca Laboratories Limited). According to the Federal Institute for Drugs and Medical Devices (BfArM), this is N-nitrosodimethylamine (NDMA). These nitrosamines are thought to be potentially carcinogenic.

In 2018, NDMA contaminants had already caused numerous recalls for another group of active ingredients, the sartans. The Central Laboratory of German Pharmacists has now examined 38 preparations and declared them not to be contaminated.

Heartburn Surgery

In rare cases, surgery is needed to get rid of heartburn. Reasons for an operation can be, for example, stomach and duodenal ulcers, stomach cancer, or a rupture of the diaphragm.

Self-Help Against Heartburn

To help yourself with heartburn – assuming no other illnesses – you can usually use the above-mentioned over-the-counter medications or sodium hydrogen carbonate (such as baking soda and Bullrich’s salt). However, this only applies if the heartburn occurs occasionally and another disease is excluded as the cause. In the best-case scenario, discuss any medication with your doctor.

Chamomile, yarrow, or liquorice root in the form of teas or drops, like peppermint, caraway, anise or fennel tea, have a digestive and calming effect on the stomach.

Stomach Acid Blockers Involve Risks

Proton pump inhibitors such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole are among the best-selling drugs in Germany. According to the drug report from the Barmer health insurance company, almost 12 million German proton pump inhibitors were prescribed in 2018. In public perception, gastric acid blockers from the active ingredient group of proton pump inhibitors are considered to be simple and safe drugs. However, two aspects are left out: the side effects and the fact that proton pump inhibitors can be addictive.

Kidney Damage as a Side Effect

The most common side effects of proton pump inhibitors include bone loss (osteoporosis) and magnesium deficiency with an increased risk of cardiac arrhythmias and seizures. These side effects have now been proven by a number of studies. It is even more serious that the medication permanently disrupts the natural regulatory cycle of gastric acid production. After prolonged use, between 14 and 64 percent of patients remain permanently dependent on the medication.

Connection Between Proton Pump Inhibitors And Allergies Is Possible

Proton pump inhibitors may increase the risk of allergic diseases. Scientists from the University of Vienna published a study in the specialist magazine “Nature Communications” (August 2019) (see sources) that at least produced a striking statistical connection between the long-term use of proton pump inhibitors and allergic diseases. The scientists had evaluated data from Austrian health insurance companies. They found that the likelihood of prescribing antiallergic drugs increases by up to 300 percent if gastric acid blockers were previously prescribed. This does not necessarily mean that proton pump inhibitors actually trigger or promote allergies. In the opinion of the study authors, however, the connection cannot be dismissed out of hand and suggests that gastric acid blockers should only be used in very dosed quantities.

The German Society for Gastroenterology, Digestive and Metabolic Diseases assessed the study results differently. According to the press release, the specialist society does not see an “obvious connection between gastric acid blockers and allergies”. The design of the Austrian study does not give a corresponding assessment.

Prevention

There are few meaningful studies on the effects of behavior change on heartburn. However, many experiences confirm that, for example, avoiding coffee, alcohol, and smoking relieves heartburn or prevents heartburn from developing in the first place. If you have a tendency to heartburn, you should also take note of the following tips:

    • Avoid very spicy or citrus-acid foods and drinks
    • Avoid fatty foods and chocolate if possible
    • eat in an upright position
    • Keep evening meals as small as possible
    • Avoid being overweight
    • no overly tight clothing and constant sitting
    • Do not bend forward after meals
    • Increase the headboard of the bed if you have heartburn at night.

Acute Kidney Failure

Acute kidney failure is a life-threatening emergency that requires the fastest possible therapy. Read about the vital functions our kidneys perform and the symptoms that indicate kidney failure. You will also learn everything you need to know about diagnosis, therapy, and prevention of acute kidney failure.

When the kidneys do their job no longer or only very incompletely, doctors speak of kidney failure. A distinction is made between two forms of progression: acute kidney failure (ANV) and chronic kidney failure (CRF). Acute kidney failure develops within hours to days and usually heals without consequences once the cause has been eliminated. In chronic kidney failure, the disease progresses slowly over months to years and, if left untreated, leads to death.

Function Of The Kidneys

Healthy people have two kidneys, one on the left and one on the right. Both kidneys perform important tasks in the body:

    • Excretion of metabolic end products (so-called urinary substances) and drugs
    • Keeping the water balance constant
    • Regulation of the electrolyte balance
    • Maintaining the acid-base balance
    • Production of hormones (such as erythropoietin and renin)
    • Conversion of inactive to active vitamin D.
    • Blood pressure regulation.

The kidneys as an excretory organ

Around 1500 liters of blood flow through the kidneys every day. Every day they excrete about one and a half liters of urine, which is filtered out of the blood. The blood flows through special filter systems (nephrons). A healthy kidney contains about 1 million such nephrons. In these filters, substances that the body no longer needs are, so to speak, sifted out of the blood (so-called urinary substances). If the urinary substances remain in the blood, they will poison the body. On the other hand, the nephrons also hold back important substances in the body. Above all, this includes proteins and electrolytes.

Symptoms

The symptoms of acute kidney failure are different. In any case, the main symptom is the significantly reduced amount of urine that is excreted. Sometimes no water can be left at all. In the course of decreasing urine production, the overhydration of the body increases. The consequences are, for example, water retention in the legs (edema) and in the lungs (pulmonary edema). Furthermore, life-threatening electrolyte disturbances (e.g. increased blood potassium concentrations) and life-threatening acidosis (acidosis) can occur. These make z. B. in the form of cardiac arrhythmias, nausea, and vomiting as well as rapid fatigue noticeable. If fluid builds up in the brain, the patient’s behavior can change. Psychological abnormalities such as excessive tiredness, indifference to impaired consciousness are indicative.

Causes

Doctors classify the causes of acute kidney failure as follows:

    • Prerenal ANV: In a maximum of 60 percent of cases, the cause of the kidney failure lies before the kidney (i.e. prernally). Often this is a suddenly greatly reduced blood flow to the kidneys, for example, due to circulatory shock in accidents or operations, due to blood clots in the kidney arteries, or due to drug side effects.
    • Intrarenal or renal ANV: Here the cause lies in the kidney itself (i.e. intra-renal). Triggers are damaged kidney tubules due to long-term lack of oxygen, damage from drugs or contrast media, and, rarely, severe inflammation of the kidney function bodies (so-called glomerulonephritis).
    • Postrenal ANV: The cause is an obstruction of the flow of urine behind the kidney (i.e. post-renal). The main obstacles to the outflow of urine are enlarged prostates, kidney, bladder, or urinary tract stones, inflammations, or tumors.

Examination

To diagnose acute kidney failure, the doctor must first clarify whether it is acute kidney failure or chronic kidney failure. The ANV is easier to recognize: The lack of urine production quickly gives the decisive clue.

Further diagnostic methods are anamnesis (i.e. questioning the patient), physical examination with listening to the heart and lungs, and laboratory tests. In particular, urinary substances such as creatinine and urea are determined in the blood. Test strips help with the urine examination. They record proteins, red and white blood cells, nitrite as an indication of a urinary tract infection, the urine pH value, glucose, ketone bodies, and bile pigments. This is followed by an examination of the urine in the laboratory.

The imaging methods used are ultrasound (sonography) and color Doppler sonography of the kidneys as well as X-rays of the chest with the heart and lungs. If the cause is inflammatory, a kidney biopsy may be performed. In this examination, a tissue sample is taken from the kidney during an endoscopic procedure.

Acute-Kidney-Failure

Treatment

The therapy of acute kidney failure depends primarily on the cause. This includes the following steps in particular:

    • Compensate for lack of fluids (if necessary with infusions)
    • raise low blood pressure (with medication if necessary)
    • Stop or switch drugs (such as antibiotics, pain relievers, and X-ray contrast agents) that have caused acute kidney failure
    • Surgically remove obstructions to the flow of urine (e.g. bladder or urethral stones, enlarged prostate, tumors).

Medical therapy

In acute kidney failure, your doctor can try to stimulate the excretory function with medication. For this purpose, so-called loop diuretics such as furosemide, piretanide, and torasemide are primarily administered. Alternatively, dehydrating agents of the thiazide-type such as hydrochlorothiazide and xipamide or potassium-sparing agents such as spironolactone can also be used.

Dialysis

If it is not possible to stimulate the kidney function again with medication, the phase until the kidneys produce urine independently must be bridged with a kidney replacement procedure (dialysis).

Transplantation

Sometimes drug therapy and dialysis are not enough to restore or replace kidney function to a sufficient extent. In these rare cases, a kidney transplant may be necessary.

Forecast

The chances of recovery are very good if the cause of the acute kidney failure does not lie in the kidney itself. This is the case with prerenal and postrenal kidney failure.

Acute intrarenal kidney insufficiency is much less treatable, as more or less kidney tissue has been lost to varying degrees and irretrievably in this form. Acute intrarenal forms often lead to chronic renal failure. In addition, the complication rate (dialysis requirement) is significantly higher.

In many cases, serious illnesses, accidents or poisoning (also due to medication) are the cause of acute kidney failure. In these cases, up to 50 percent of those affected do not survive. The main cause of this is not kidney failure, but the circumstance that caused this failure.

Prevention

Many over-the-counter drugs can damage the kidneys and cause acute kidney failure. Examples of this are popular over-the-counter drugs such as the pain relievers diclofenac, ibuprofen, and paracetamol or gastric acid inhibitors from the group of proton pump inhibitors. Therefore, you should not take pain relievers in particular for longer than recommended. In principle, it is advisable to discuss any prolonged use of medication with a doctor.

Stomach Acid Blockers Involve Risks

Proton pump inhibitors such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole are among the best-selling drugs in Germany. According to the drug report of the Barmer health insurance company, almost 12 million German proton pump inhibitors were prescribed in 2018. In addition, the active ingredients omeprazole, pantoprazole, or esomeprazole are also available over the counter. In public perception, gastric acid blockers from the active ingredient group of proton pump inhibitors are considered to be simple and safe drugs. However, two aspects are left out: the side effects and the fact that proton pump inhibitors can be addictive.

Kidney Damage as a Side Effect

The most common side effects of proton pump inhibitors include bone loss (osteoporosis) and magnesium deficiency with an increased risk of cardiac arrhythmias and seizures. These side effects have now been proven by a number of studies. It is even more serious that the medication permanently disrupts the natural regulatory cycle of gastric acid production. After prolonged use, between 14 and 64 percent of patients remain permanently dependent on the medication.

The connection between proton pump inhibitors and allergies is possible

Proton pump inhibitors may increase the risk of allergic diseases. Scientists from the University of Vienna published a study in the specialist magazine “Nature Communications” (August 2019) (see sources) that at least produced a striking statistical connection between the long-term use of proton pump inhibitors and allergic diseases. The scientists had evaluated data from Austrian health insurance companies. They found that the likelihood of prescribing antiallergic drugs increases by up to 300 percent if gastric acid blockers were previously prescribed. This does not necessarily mean that proton pump inhibitors actually trigger or promote allergies. In the opinion of the study authors, however, the connection cannot be dismissed out of hand and suggests that gastric acid blockers should only be used in very dosed quantities.

The German Society for Gastroenterology, Digestive and Metabolic Diseases assessed the study results differently. According to the press release, the specialist society does not see an “obvious connection between gastric acid blockers and allergies”. The design of the Austrian study does not give a corresponding assessment.