Gastro-oesophageal reflux: symptoms, causes, diagnosis and treatment

By Cristiano Antonino On Jun 15, 2023

Gastro-oesophageal reflux is a disorder characterised by severe burning in the sternum due to regurgitation of stomach acid from the stomach

The contact of stomach acid with the walls of the oesophagus is natural and can occur physiologically several times during a day, especially after meals.

If, however, this occurs too frequently or with greater intensity than normal, we speak of true gastro-oesophageal reflux disease.

How does reflux disease manifest itself?

Gastro-oesophageal reflux disease is a pathological condition that affects about 10-20% of the population, especially in Europe, while it is rarer in Asian populations.

Typical symptoms are retrosternal burning that radiates posteriorly between the shoulder blades or at the neck up to the ears (so-called retrosternal heartburn) and acid regurgitation in the mouth, which occurs when there is a perception of bitter or acidic liquid in the mouth.

These two symptoms can occur continuously throughout the day, or intermittently.

The most frequent are when waking up in the morning, but also after meals and during the night, when lying down facilitates the rise of acid.

Less typical symptoms are instead:

Sensation of a lump in the throat with dysphagia (difficulty swallowing)
Chest pain
Digestive difficulty
Nausea
Chronic laryngitis accompanied by coughing, vocal depression and hoarseness
Asthma
Frequent hiccups
Otitis media
Insomnia

These so-called ‘atypical’ symptoms usually occur when the disorder worsens and becomes daily.

In this case, the symptoms become more complicated and can also result in lesions and erosions of the oesophagus wall, ulcers and narrowing of the digestive canal.

What causes it?

The triggering factors for reflux disease can be various: they range from incorrect diet, based on excessively acidic and irritating substances, to alcohol and drug abuse, to an anatomical dysfunction of the lower oesophageal sphincter.

When the cause is mechanical, it concerns the malfunctioning of the valve that regulates the passage of food and flows between the oesophagus and the stomach.

If this barrier does not function properly, acids arrive and stay too long in areas where their action is too aggressive and poorly tolerated by the mucous membrane, which cannot neutralise them or balance them differently.

The pressure at the junction between the oesophagus and stomach is influenced by diet, circulating hormones and certain medications and undergoes variations throughout the day.

This is why overweight people or pregnant women are more prone to gastro-oesophageal reflux: in these cases, the intra-abdominal pressure on the stomach and oesophagus are always much higher than normal.

Gastro-oesophageal reflux: diagnosis

A visit to the gastroenterologist is usually sufficient to diagnose the typical symptoms and trace them back to gastro-oesophageal reflux.

Therapy, which involves the use of gastroprotectors, is carried out for a trial period.

If at the end of this period symptoms do not subside, and other complications such as lack of appetite, weakness or anaemia are noted, further diagnostic tests must be performed.

Tests will always be prescribed at the gastroenterological examination.

Here are the tests that the gastroenterologist may decide to prescribe in the event of reflux symptoms that do not abate with gastroprotectors:

Gastroscopy: during the test, the oesophagus, stomach and duodenum are examined through the introduction of a flexible instrument in which a camera and a thin channel are incorporated, through which the biopsy forceps can be passed to perform small mucosal samples (biopsies).
X-ray of the digestive tract: the patient is asked to drink a small amount of contrast liquid, which allows visualisation of the anatomy and function of the oesophagus, stomach and the first parts of the small intestine.
pH-impedancometry: this test lasts 24 hours and allows the amount of acid material that ends up in the oesophagus to be monitored by placing a probe; the latter passes through the nose into the oesophagus. The probe is equipped with a sensor connected to a hand-held device that can detect the degree of acidity in the environment.
Oesophageal manometry: the test consists of introducing a probe through the nose after having the patient drink water in small sips. It can be useful for assessing peristalsis and detecting any abnormalities in oesophageal motility.

Prevention and treatment of gastro-oesophageal reflux

If reflux is significant, the doctor may prescribe several medications including:

Antacid medications, which neutralise the acid in the stomach and are fast-acting but purely symptomatic, as they are unable to heal the oesophageal mucosa from any erosions
H2 antagonist drugs, which reduce acid production and whose effect lasts longer than antacids.
Proton pump inhibitor drugs, which have a somewhat slower initial action than H2 antagonists, but which heal erosions in the oesophagus more effectively.
Prokinetic drugs, which are used to improve the emptying of the oesophagus and stomach. These drugs prevent reflux of material, especially after meals.
Laparoscopic surgery for the treatment of gastro-oesophageal reflux is a more extreme remedy reserved for patients who do not respond to medication and who have concomitant anatomical problems, such as large hiatal hernias.

In less severe cases, however, reflux can be cured starting with the diet.

It will be necessary to avoid all foods with an acidic and stinging base (so-called refluxogens) such as chocolate, mint, coffee, tomatoes (especially in sauce and concentrate) but also citrus fruits either fresh (lemon, orange and mandarin) or taken in the form of juices and freshly squeezed and fried foods that particularly stimulate the gastric juices to be digested properly.

Meals should be light and preferably eaten far from bedtime.

It will also be very important to pay attention to body weight, avoiding conditions of significant obesity and overweight.

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