Reflux Center at Döbling Private Hospital
What is "Reflux Disease"?
The main causes are either a reduced function of the occlusive system between the stomach and esophagus (diaphragmatic hernia or hiatal hernia) or insufficient emptying of the esophagus. Since the esophagus only tolerates aggressive substances such as gastric juice and bile salts for a short time, prolonged and / or more frequent exposure of the esophagus with these substances leads to inflammation, in 35% subsequent cell changes (Barrett syndrom – a precancerous condition) and - if no adequate therapy is initiated - possibly to esophageal cancer. Reflux and Barrett's are the biggest risk factors for cancer of the esophagus (esophageal cancer), and the number of new cases is increasing faster than any other type of tumor.
Symptoms
In an uncomplicated cases, typical symptoms include heartburn, belching (sour, bitter or just gas), bloating, regurgitation (the food comes up again before it reaches the stomach). Complicated diseases manifest themselves as hoarseness, sore throat, chronic cough, bronchitis, pneumonia or asthma.
Diagnosis
The most important thing is a precise survey of the patient's medical history and complaints.
The duodenum, stomach and esophagus are clarified by means of gastroscopy. In this examination, a diaphragmatic hernia (hiatal hernia) and inflammation of the esophagus can be diagnosed and tissue samples (biopsies) can be taken from all areas. Special dyes (chromoendoscopy, indigo carmine, vinegar) and filters (narrow band imaging) significantly improve the contrast so that an accurate result can be achieved. The possibility of taking a tissue sample is a decisive advantage over all other examinations such as of the gastric x-ray.
The impedance measurement is a further development of the pH-Metry and offers a number of advantages: The reflux disease is recorded quantitatively. It measures how often each substance (acid or bile) comes up, how aggressive the substances are and how long it takes the esophagus to get rid of these substances in order to create a "harmless" environment again. The measurement is very accurate and there are almost no incorrect measurements. Another advantage over pH-metry is that gastric medication does not have to be discontinued.
The examination by means of video cinematography brings the last information that is necessary to initiate a tailor-made therapy. In video cinematography, the movement of the esophagus when swallowing is shown with a contrast medium. Movement or emptying disorders of the esophagus or achalasia (lack of swallowing-induced relaxation of the lower esophageal occlusion system) can be diagnosed. In addition, a diaphragmatic hernia can be visualized in different positions.
In principle, a clarification should always be carried out if the complaints do not disappear within a very short time with adequate therapy or if they come back. No blind long-term administration of medication without professional clarification! The test results are essential for the decision-making about the further therapeutic procedure, especially if the question of a possible surgical therapy arises. In addition, these methods are particularly suitable for excluding other causes of the complaints.
Therapy
In some cases a change in lifestyle leads to success. Many patients become symptom-free under drug therapy. Often, however, the tablets have to be taken for years. However, long-term use should be carefully reconsidered, as it is also associated with side effects. For long-term treatment, adequate clarification is essential! In some of the patients, drug therapy is insufficient. These can be helped with an operation.
Surgery
Fundoplication is a surgical procedure in which parts of the stomach wall are sewn around the lower part of the esophagus in the form of a cuff. The more the stomach fills up when eating, the more chyme gets into the cuff, the muscles of which then also contract. This prevents acidic stomach contents - the cause of heartburn - from flowing back into the esophagus. At the same time, the fundoplication enables the patient to eat normally.
Since this is a demanding procedure, it should be carried out by an experienced specialist.
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Döbling Private Hospital
Heiligenstädter Straße 55-63
1190 Vienna • Austria
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