Reflux Disease

Reflux — flowing back — is a complaint often seen in the population. Normally, once food has entered the stomach the loose valves at the entrance and the exit of the stomach close, and the food begins to be ground down into small pieces. If the loose valve between the gullet and the entrance of the stomach becomes slack and does not close fully, the acid, bile and contents inside the stomach escape into the gullet and cause complaints.

In healthy people reflux may normally occur two or three times a week. If it occurs more than three times, there is reflux disease. Because the gullet has no protective layer and no protective substances against acid as the stomach does, complaints of chest pain, burning, a constant urge to clear the throat, sour fluid coming into the mouth and hoarseness can appear. If a hiatus hernia (a stomach hernia) is present these complaints become more marked still.

In treatment, changes in the way one lives and diet are generally enough: raising the head of the bed by 10–15 cm, small and frequent meals, losing weight, not wearing tight and constricting clothes. Sometimes drugs have to be used. If that too is not enough, endoscopic or surgical treatments can be used.

Reflux is sometimes found together with the condition called Barrett’s. The diagnosis may call for the presence of the complaints, endoscopic examination and biopsies, oesophageal pH measurement and manometry. The condition called an inlet patch is the presence of gastric lining in the upper part of the patient’s gullet.

Reflux disease is divided into stages endoscopically by various classifications (Savary, Los Angeles and others). The one most used today is the Los Angeles classification. It divides them by the development of lesions from mild to severe: grades A, B, C and D. In the second and third pictures you see the burn marks of stomach acid in the lower part of the gullet (where it enters the stomach) in a patient with the complaint of reflux. In the last picture you see an advanced stage with ulcers widely covering the lumen of the gullet.