Reflux – Causes, Symptoms and Treatment
Reflux refers to the backflow of stomach contents into the esophagus. It causes heartburn and irritation of the mucous membrane and is one of the most common digestive disorders worldwide.
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Reflux refers to the backflow of stomach contents into the esophagus. It causes heartburn and irritation of the mucous membrane and is one of the most common digestive disorders worldwide.
What is Reflux?
Reflux describes the involuntary backflow of stomach contents – including stomach acid, digestive enzymes, and partially digested food – into the esophagus. The medical term for this condition is gastroesophageal reflux disease (GERD). It is one of the most prevalent gastrointestinal conditions, affecting millions of people globally and significantly impacting quality of life.
Causes
The primary cause of reflux is a dysfunction of the lower esophageal sphincter (LES), a ring of muscle that acts as a valve between the esophagus and the stomach. When this muscle weakens or relaxes inappropriately, stomach contents can flow back upward.
- Overweight and obesity
- Pregnancy (increased abdominal pressure)
- Hiatal hernia (part of the stomach pushing through the diaphragm)
- Certain foods (e.g., fatty foods, chocolate, alcohol, caffeine, citrus fruits)
- Smoking
- Stress and psychological factors
- Certain medications (e.g., calcium channel blockers, nitrates)
Symptoms
The hallmark symptom of reflux is heartburn – a burning sensation behind the breastbone, typically occurring after meals or when lying down. Other common symptoms include:
- Acid regurgitation (stomach contents rising into the throat or mouth)
- Difficulty swallowing (dysphagia)
- Chronic cough or hoarseness
- Globus sensation (feeling of a lump in the throat)
- Chest pain (which must be distinguished from cardiac causes)
- Nausea, especially in the morning
Diagnosis
Diagnosis is primarily based on the medical history and reported symptoms. For persistent or severe cases, the following investigations may be performed:
- Upper endoscopy (gastroscopy): Direct visualization of the esophageal and gastric mucosa
- 24-hour pH monitoring: Measures acid levels in the esophagus over a full day
- Esophageal manometry: Measures pressure within the esophagus and sphincter function
- Barium swallow X-ray: Imaging of the upper digestive tract using contrast dye
Treatment
Lifestyle Modifications
Many patients benefit significantly from changes in daily habits:
- Weight loss if overweight
- Eating smaller, more frequent meals
- Avoiding food and drink at least 2–3 hours before bedtime
- Elevating the head of the bed slightly
- Avoiding trigger foods, alcohol, and carbonated drinks
- Quitting smoking
Medications
When symptoms persist, medications are prescribed:
- Proton pump inhibitors (PPIs) such as omeprazole or pantoprazole: Reduce stomach acid production and are the most effective drug treatment
- H2 receptor antagonists (e.g., famotidine): Moderately reduce acid secretion
- Antacids: Neutralize stomach acid rapidly but only provide short-term relief
- Prokinetics: Help speed up gastric emptying and strengthen the sphincter
Surgical Treatment
In severe or medication-resistant cases, surgery may be considered. The most common procedure is laparoscopic fundoplication, in which the upper part of the stomach is wrapped around the lower esophagus to reinforce the sphincter.
Complications
Untreated chronic reflux can lead to serious complications:
- Esophagitis: Inflammation and erosion of the esophageal lining
- Esophageal stricture: Narrowing of the esophagus due to scar tissue
- Barrett's esophagus: A change in the lining cells of the esophagus that significantly increases the risk of esophageal cancer
- Esophageal adenocarcinoma: A form of esophageal cancer arising from long-standing GERD
References
- Vakil N. et al. – The Montreal Definition and Classification of Gastroesophageal Reflux Disease. American Journal of Gastroenterology, 2006; 101(8): 1900–1920.
- Katz P.O. et al. – Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. American Journal of Gastroenterology, 2022; 117(1): 27–56.
- World Gastroenterology Organisation (WGO) – Global Guidelines: Gastroesophageal Reflux Disease (GERD), 2017. Available at: www.worldgastroenterology.org
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