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.