Own measures
Before initiating therapy for reflux disease, or for other stomach complaints in general, it makes sense to first reduce the risk of reflux esophagitis by taking general measures:
- In case of overweight a weight reduction
- Avoidance of coffee, alcohol and nicotine
- No large meals before going to bed
- Instead of a few large meals, it is better to eat several small portions throughout the day.
- No strongly spiced or acidic foods
- Sleep in a bed with the head end raised
Stages of reflux esophagitis
The treatment of reflux disease depends on the stage of the disease:
- Non-erosive reflux disease: this is a reflux disease in which there is not yet any injury to the esophageal mucosa. Proton pump inhibitors, antacids and prokinetics are recommended for therapy. Non-erosive reflux disease is the most common form of the disease.
- Erosive reflux disease: If there are already lesions of the oesophageal mucosa, proton pump inhibitors are the drug of choice. In most cases, the symptoms disappear within two weeks.
- Barrett's oesophagus: If cell changes have already occurred in the mucous membrane of the oesophagus, this is known as Barrett's oesophagus. In this case, the risk of developing esophageal cancer is increased. Patients without symptoms do not require any special treatment, but the oesophageal mucosa must be examined regularly for malignant changes. Proton pump inhibitors can be used to alleviate any symptoms, but the risk of cancer is not affected.
Drug therapy
Stomach acid inhibitors can be used to effectively alleviate the symptoms:
- Antacids: Antacids are used to neutralize stomach acid, providing temporary relief of symptoms. These preparations are available over the counter and may also be suitable for the treatment of pregnancy reflux disease. Because the stomach compensates for antacid therapy over time by increasing stomach acid production, long-term therapy is not indicated.
- Histamine H2 receptor blockers: These agents block the histamine receptor, which the body uses to regulate the production and release of stomach acid. In this way, the acid in the stomach is reduced.
- Proton pump inhibitors: These drugs inhibit an enzyme in the stomach lining that is responsible for transporting stomach acid to the inside of the stomach. Since this enzyme is mainly produced in the morning, the preparations must be taken in the morning. Since proton pump inhibitors act specifically on the gastric mucosa and cause relatively few side effects, these agents represent the standard in long-term therapy.
Taking prokinetics stimulates the peristalsis (muscle movements) of the stomach and intestines, which results in faster removal of gastric acid from the stomach to the intestines. In addition, the function of the esophageal sphincter (sphincter between the stomach and esophagus) is improved. Prokinetics are mainly used for nausea and vomiting.
Stomach discomfort is often accompanied by flatulence as well as a feeling of fullness . These complaints can be alleviated by numerous active substances available over the counter, for example by drops or teas with mixtures of anise, caraway and fennel.
If chronic reflux disease cannot be adequately treated with medication, the symptoms can be remedied by surgery. This involves a procedure known as hiatoplasty, in which the function of the sphincter between the oesophagus and the stomach is restored, thus preventing the backflow of gastric acid. This procedure is normally performed in a minimally invasive manner during laparoscopic surgery.
In radiofrequency therapy , the sphincter muscle between the oesophagus and stomach is heated using a special catheter with the aid of radio waves. This heating causes a permanent thickening of the connective tissue, which prevents the stomach acid from flowing back into the oesophagus. In some cases, however, patients must continue to take antacid medication despite radiofrequency therapy.
