Reflux disease refers to various symptoms that can be explained by an increased reflux of acidic stomach contents into the oesophagus. This reflux is caused by a disturbed closure mechanism of the lower sphincter of the oesophagus.

Jörg Zehetner, MD
Jörg Zehetner MD Professor (USC) MMM, FACS, FEBS (hon.)

Reflux disease, also known as gastroesophageal reflux disease – or GERD for short – is one of the most common diseases of the digestive tract. Thus, about ten percent of the population suffer from the symptoms of reflux disease.

What are the causes and risk factors for reflux disease?

Obesity, pregnancy, excessive consumption of nicotine and alcohol and various medications are among the risk factors that can promote the occurrence of reflux disease.

There are two main causes of reflux disease:

  • The function of the lower sphincter of the oesophagus is insufficient.
  • The mobility of the oesophagus is reduced.

Both triggers can be either primary – i.e. without specific reasons – or secondary – related to other diseases or disorders.

What are the symptoms of reflux disease?

The leading symptom of reflux disease is usually a burning pain that is felt behind the breastbone – so-called heartburn. This pain can occur in combination with a sour taste in the mouth and frequent belching.

Other symptoms that may be associated with reflux disease are:

– Nausea and vomiting

– frequent coughing attacks

– Infections in the larynx and throat area

– Swallowing discomfort

– Pain in the upper abdomen

– frequent hoarseness

– Pain and burning in the throat

It is characteristic of reflux disease that the above-mentioned complaints often occur after eating, after drinking alcohol or after eating sweet or fatty foods.

How is reflux disease diagnosed?

First of all, the doctor will ask about the patient’s symptoms, general lifestyle habits and possible concomitant diseases. This is followed by a thorough physical examination. If the suspicion of reflux disease is confirmed, the doctor has various examination options at his disposal.


This is an endoscopy of the oesophagus. This examination allows the doctor to assess the condition of the oesophageal mucosa and evaluate its texture.

During an endoscopy, the doctor can determine whether and to what extent there is an infection of the mucous membrane. It is also possible to take a mucosal sample during this examination. It is then analysed in the laboratory with the aim of identifying changes in the tissue.


pH-metry is another test option to diagnose reflux disease. A thin tube is inserted through the patient’s nose into the oesophagus and remains there for up to 24 hours.

The aim is to continuously measure the acidity level, i.e. the pH value, within the oesophagus over a longer period of time. This examination can help determine whether stomach contents are flowing back into the oesophagus and in what quantities.

Further diagnostic procedures

  • In order for the doctor to be able to assess the swallowing process of the patient more precisely, he sometimes orders an X-ray examination. With this method, the patient has to swallow a contrast medium mush, which can then be seen in the X-ray image.
  • If symptoms suggest damage to the airways, an additional examination by an ear, nose and throat specialist may be useful.

Self-help for reflux disease

Nutrition factor

In the context of reflux disease, those affected often suffer from digestive disorders. These can be curbed with a diet as rich in protein as possible, as proteins stimulate the stomach to produce the hormone gastrin. This in turn improves the muscle tension of the oesophageal sphincter so that it can subsequently close better again.

Basically, the course of reflux disease can be positively influenced by choosing the right amount of food and nutrition. Small, low-fat and low-carbohydrate portions are recommended.

It is also advisable to eat meals a few hours before going to bed.

Factor stimulants

If you suffer from reflux disease, you should completely avoid consuming alcohol if possible, as this leads on the one hand to the slackening of the lower oesophageal sphincter and on the other hand to direct damage to the stomach lining.

However, the influence of coffee on reflux disease is controversial. On the one hand, caffeine can stimulate stomach acid production, which can further irritate the mucous membrane. On the other hand, caffeine increases the production of gastrin, which promotes the functionality of the oesophageal sphincter.

People who suffer from reflux disease should generally avoid nicotine. Nicotine leads to an increase in gastric acid production and is also known to have other negative effects on the body.

What are the treatment options for reflux disease?

Usually, the doctor first prescribes conventional therapy for the patient with reflux disease. This consists of the self-help measures already mentioned and, under certain circumstances, an additional accompanying drug therapy.

Surgery, on the other hand, is rarely used and is mainly indicated in cases of additional diseases affecting the gastrointestinal tract.

Conventional (non-surgical) procedures

In the context of reflux therapy, proton pump inhibitors are the drug of first choice. These drugs are generally well tolerated and eliminate symptoms in 90 percent of sufferers. However, once the tablets are stopped, half of the patients experience a recurrence of symptoms.

In order to curb the excessive production of gastric acid, the use of medicines that reduce gastric acid – so-called antacids – has also proven to be useful.

Operative procedures


This surgical intervention makes sense, for example, if the reflux disease repeatedly leads to infections of the oesophagus. As a result, scarring occurs and the oesophagus narrows.

The aim of fundoplicatio surgery is to improve the closing function of the lower end of the oesophagus and at the same time support the mobility of the oesophagus.

Magnetic ring surgery

Magnetic ring surgery is a comparatively new, gentle surgical procedure. In this procedure, the doctor places a chain of magnetic beads around the outlet of the oesophagus. The magnetic beads attract each other and seal the anti-reflux valve by pulling the chain together.

During the swallowing process, the beads can separate again and food and drinks can enter the stomach. The ring then closes again.

This surgical procedure can usually be done in a minimally invasive way. The operation takes about 20 minutes.

Fig. 1 The LINX® system helps the oesophagus resist opening, preventing or reducing reflux.
Fig. 1
The LINX® system helps the oesophagus resist opening, preventing or reducing reflux.
Fig. 2 The LINX® system stretches to allow normal swallowing.
Fig. 2
The LINX® system stretches to allow normal swallowing.


Reflux disease is comparatively widespread. It can be treated quite well with the help of various self-help measures and possibly an accompanying drug therapy. Surgery is only necessary or advisable in individual cases.