What triggers GERD

Reflux disease (GERD, acid regurgitation)

Medicinal

  • Proton pump blocker (PPI): inhibitor of gastric acid production. PPIs are most effective for post-meal discomfort. Optimized treatment can be achieved by increasing the dose, dividing the dose over twice a day and taking it before meals. Long-term side effects have not yet been confirmed. No accumulated cancers could be proven. As a precaution, the vitamin B12 concentration should be measured after 5 years of treatment.
  • H2 receptor antagonists: These only inhibit the histamine-stimulated acid production in the stomach and are only effective for a relatively short period of time (4-8 hours). Over a period of 24 hours, however, up to 70% of the acid production can be inhibited for a short time. Long-term treatment is not possible, as tolerance to the active ingredient already arises after 2 weeks.

Other treatment options

Endoscopic (by gastroscopy) suturing techniques and radiofrequency treatments, with sclerotherapy and scarring in the gastro-oesophageal junction (junction between the gastric outlet and the esophagus). The injection of biopolymers or the implantation of prostheses were abandoned for the treatment of reflux disease.

surgery

Surgery * is considered if the reflux disease is confirmed and the patient is responding well to medication. However, if there is no improvement in symptoms despite medication, surgery is not recommended. In addition, a third of those who have been operated on have to take medication again within 10 years.

* During the operation, the barrier function between the gastric outlet and the esophagus is improved, the pressure difference between the esophagus and stomach is increased and any diaphragmatic hernia that may be present is closed.

Dietary adjustment

High fat meals

Recent research has not been able to confirm that avoiding high-fat foods alleviates the symptoms. A high-fat meal provoked increased acid reflux only in healthy test subjects, but not in reflux patients. Burning stomach after eating was not affected. Even acidic belching could not be influenced by the different fat content of the meals.

Sweets, chocolate, onions

With all of these data, the number of people studied is so small that no definitive answer to their clinical significance is possible.

Carbonated and / or caffeinated drinks, fruit juices

Carbon dioxide can potentially increase the number of spontaneous relaxation movements of the lower muscle of the esophagus and thus also increase the acid reflux. The further composition of the drink then does not play a role.

Decaffeinated coffee causes fewer reflux episodes than caffeinated coffee. Fruit juices, especially citrus fruits, provoke more reflux in about a third of the patients examined.

Eating behavior

Stomach distension caused by meals that are too large relax the lower muscle of the esophagus. This helps explain why smaller meals do better. Nevertheless, there are no adequate studies that actually confirm the effectiveness of this advice.

alcohol

Research has shown that the type of alcohol drunk plays a role: white wine provokes more acid reflux than beer or red wine. However, this does not depend on the alcohol content or the pH value of the liquid you drink.

About the development of esophageal cancer (esophageal cancer): Wine can provoke reflux, but it does not appear to be associated with the development of esophageal cancer caused by acid reflux. Beer or alcohol consumption seems to be more likely to promote this type of cancer.

nicotine

Why nicotine increases acid reflux is not entirely clear. The available data are controversial and range from none to an unfavorable effect on reflux episodes. Smoking definitely lowers the pressure in the lower esophageal muscle and reduces the neutralizing bicarbonate secretion of the saliva. Smokers are more likely to develop esophageal cancer caused by acid reflux; that is proven. It certainly makes sense - for your health as a whole - to stop smoking.

Physical activities

Obviously, running can provoke acid reflux. The up and down movement can disrupt the barrier function between the stomach and esophagus. Active athletes with acid reflux problems are therefore advised to take an anti-acid medication before running.

Sleeping position

How relevant is the advice that if you have typical reflux symptoms, you should sleep with your upper body raised and not lie down for at least 3 hours after eating?

Study results:

  • Patients with esophagitis caused by reflux show increased acid reflux in a flat, lying position.
  • In patients without inflammation, the constant sleeping position tended to result in a decrease in reflux episodes. For these patients, the flat, lying position can help.
  • When lying down, it was found that the left lateral position provoked less acid reflux than the right.

Summary

A variety of lifestyle changes have a positive impact on acid reflux. In some cases, however, the implementation is relatively laborious and yet of less importance. Recommendation from experts: The drugs currently available can be used efficiently at the beginning of the disease and improve the patient's quality of life.