Reflux is the most commonly occurring disease of the upper digestive tract and affects up to 40% of the population once a month. The underlying cause is often a hiatal hernia which can be either hereditary or acquired. Regardless of the size, this can cause various symptoms, sometimes severe, such as heartburn. This term is used to describe unpleasant, burning pain behind the breastbone. 14% of those affected experience heartburn at least once a week, and for 7% of sufferers it causes unpleasant symptoms every day.
What is “reflux disease”?
Reflux means backward flow! The main causes are either impaired function of the closure mechanism between the stomach and esophagus (hiatal hernia) or incomplete emptying of the esophagus. As the esophagus can only tolerate aggressive substances such as gastric juices and bile salts for a short time, persistent and/or frequent exposure to these substances in the esophagus causes inflammation, which in 35% of cases also results in cell changes (Barrett’s esophagus), and – if it is not appropriately treated – can lead to cancer of the esophagus. Reflux and Barrett’s esophagus are the principal risk factors for cancer of the esophagus, and the number of new cases of this disease is rising faster than any other form of tumor.
- Uncomplicated disease:
- Belching (acid, bitter-tasting or purely gassy)
- Regurgitation (food comes back up before it reaches the stomach)
- Complicated disease:
- Hoarseness, sore throat
- Chronic coughing
- Bronchitis, pneumonia
The most important aspect of diagnosis is to take a detailed history of the illness and the patient’s symptoms.
Morphological using gastroscopy
This approach includes close examination of the duodenum and stomach, and also the esophagus. This allows diagnosis of a hiatal hernia or inflammation of the esophagus, and also allows biopsies to be taken in all these areas. Special dyes (chromoendoscopy, indigo carmine, vinegar) and filters (narrow band imaging) enhance the contrast greatly so that accurate results can be obtained. The option of a biopsy offers a crucial advantage over other forms of examination such as abdominal x-ray.
Quantitative using impedance measurement
Impedance measurement is an enhanced form of pH monitoring and offers a number of advantages: Reflux disease is quantitatively assessed. Impedance measurement records how many times per day which substance (acid or bile) flows back into the esophagus, how aggressive the substances are and how long it takes the esophagus to rid itself of them and restore a “harmless” environment. This form of monitoring gives very precise results with almost no errors. Patients can record their own symptoms by pressing buttons on the device. Analysis of the readings and correlation of the continuous monitoring against symptoms recorded makes it possible to identify whether the symptoms are caused by reflux or not. A further advantage of this method compared to pH monitoring is that stomach medication does not have to be discontinued.
Functional using video camera
This form of examination adds the final details needed so that treatment can be appropriately customized. A video camera is used to map the muscle movements of the esophagus when swallowing, using a contrast agent for clarity. This allows impaired function or evacuation of the esophagus to be diagnosed, and also achalasia (insufficient relaxation of the lower closure mechanism in the esophagus when swallowing). It also allows hiatal hernia to be identified in various different locations.
In principle symptoms should always be investigated if they do not disappear within a short time when appropriately treated, or if they recur. It is not advisable to simply continue taking medications over a long period without investigation by a specialist! Diagnostic findings are crucial when making decisions about further treatment, especially if the question of possible surgical intervention arises. These methods are also particularly useful for excluding other possible causes of the symptoms.
In some cases, lifestyle changes alone can have a positive effect. Many patients remain symptom-free with appropriate medication. Sometimes, however, tablets may need to be taken for many years. Long-term use of medication should be carefully considered! Long-term treatment should not be given without expert investigation!
For some patients, medicinal treatment is not sufficient. Surgery can be helpful for these patients.
Please phone to make an appointment! When you come for your appointment, please bring your e-card and, where relevant, a referral and any other test results.
Direct billing insurance agreements
Agreements in place with the following insurers: SVS (formerly SVA and SV), BVAEB (formerly VA der österr. Eisenbahnen und des Bergbaus and BVA), KFA
Please note: Impedance measurement is not covered by insurance providers. The fee for this private service is €250.