Reflux disease is extremely common in western society and has been increasing in frequency in recent years. In Germany, about 30% of the adult population complain about symptoms of reflux disease. The most common symptoms are recurring heartburn, pain behind the breastbone or belching. Up to 7% of those affected even suffer permanently from reflux-related symptoms, which can also manifest themselves as hoarseness, bronchitis or asthma. However, patients with chronic gastroesophageal reflux disease are also at risk of complications such as bleeding, ulceration (swelling) and scarring strictures in the area of the esophagus. About 10% of all patients develop a specialized mucosal tissue, the so-called Barrett’s epithelium, which in some cases represents a possible precursor to the development of a form of esophageal cancer.
The cause of reflux disease is a muscular failure of the normally existing closure mechanism in the transition area between esophagus and stomach. The affected patients often also have a diaphragmatic hernia – a so-called hiatal hernia.
After recording the existing symptoms, endoscopy is the decisive diagnostic measure, since even the smallest changes in the mucous membrane in the gastroesophageal transition area can be detected. In addition, a 24-hour acid measurement (pH measurement) can be used to assign symptoms and reflux episodes.
In addition to general measures such as raising the head of the bed, reducing weight or changing eating habits, severe cases of reflux oesophagitis often require long-term drug therapy. Proton pump blockers are among the drugs of first choice today. In about 10%, however, freedom from symptoms cannot be achieved here either, so that surgical procedures such as so-called open fundoplication and, since the early 1990s, laparoscopic fundoplication have increasingly been used, in which an artificially applied muscle cuff narrows the transition from stomach and esophagus and thus preventing ongoing acid reflux.
New endoscopic procedures have been available since the mid-2000s, which may be used alternatively in the future. In addition to suturing techniques, in which the gastroesophageal transition is narrowed by the formation of folds, these include injection and implantation techniques in which substances are placed in the muscle layer or under the mucous membrane of the transition area. The third procedure used is radiofrequency ablation, in which scars are created through the selective application of energy, which are also intended to prevent acid reflux. All endoscopic procedures are still relatively new, so that there is no data on long-term results, which is why these techniques are only offered in selected centers under controlled study conditions.
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