What is Gastroesophageal Reflux?

Moving food from the mouth to the stomach involves a long tube called the esophagus. Although it has a robust wall, this structure can only protect the stomach from food, not from variations in acidity or alkalinity. To preserve the integrity of the organ, an effective solution exists: a one-way valve where the esophagus connects to the stomach. This valve allows food to pass into the stomach while preventing the backflow of gastric contents. Known as the lower esophageal sphincter, this valve is commonly called the cardia. While not a valve in the strictest sense, it's actually a thickening of the esophageal muscle wall itself. Under certain circumstances, the valve malfunctions, allowing stomach contents to rise and reach the esophagus. This is known as gastroesophageal reflux and can cause a burning sensation and pain in the area just below or behind the sternum, spreading between the shoulder blades or a little lower. This sensation is caused by the strong acids or alkaline substances in the stomach contents that irritate and burn the esophageal walls, causing a contraction reflex. Reflux is often linked to a hiatal hernia, although in some cases, a significant hiatal hernia may be present without causing reflux.

 

How to Recognize Gastroesophageal Reflux?

Often, major digestive disorders are labeled as "gastritis," but in reality, they are linked to gastroesophageal reflux.

 

If you experience the following symptoms, you may be suffering from gastroesophageal reflux:

• Acidity rising to the mouth, causing coughing and a sore throat, especially after lying down all night;
• Retrosternal and epigastric pain, radiating to the back. It is described as a sword piercing the body at the sternum and exiting between the shoulder blades;
• Pain that seems to simulate a heart attack;

What are the Symptoms of Gastroesophageal Reflux?

The main sign of gastroesophageal reflux often manifests as a burning sensation behind the sternum, which can even extend to the throat. This pain can also be so intense that it causes the patient to go to the emergency room, convinced they are having a heart attack. The patient describes a pain that pierces them, like a sword, from the sternum to the back. Other forms are those that present atypical symptoms, that is, where the symptoms are due to contact of acid vapors with the respiratory tract. The patient complains of a wheezing cough, especially at night, that does not respond to treatment, recurrent sinusitis, hoarseness, especially in the morning, asthma episodes, or recurrent infections. Tooth erosion may also be present. Another condition, which is asymptomatic, is the transformation of part of the mucous membrane, which takes on the appearance of the mucous membrane lining the stomach. This condition is known as Barrett's esophagus, and it is considered dangerous because it increases the risk of developing esophageal cancer (precancer).

 

How to Treat Gastroesophageal Reflux?

Good Habits to Adopt

There are good habits that are strongly recommended to follow during the treatment of gastroesophageal reflux:

• Changing eating habits, following a special diet, and losing weight are a good start;
• It is helpful to raise the head during sleep by raising the mattress;
• You can then switch to pharmacological treatment that inhibits gastric secretion or forms a protective film on the esophageal mucosa;

Gastroesophageal Reflux: Pharmacological Therapy

The pharmacological therapy of gastroesophageal reflux is essentially based on:

• Antacids: Antacids function to chemically neutralize the acidity of gastric juices;
• Proton pump inhibitors: Prevent the cells of the stomach lining from producing acid;

Gastroesophageal Reflux: Surgical Therapy

To resolve the problem of gastroesophageal reflux, experienced surgeons use a laparoscopic technique that does not involve opening the abdomen. This procedure is recognized as the only method offering a cure rate of over 95%. Its main goal is to restore the anti-reflux barrier retention mechanism, permanently preventing acid from rising from the stomach to the esophagus. In other words, it aims to guarantee lifelong healing for the patient.

 

When a hiatal hernia is detected, a slightly more invasive procedure can be performed. The procedure consists of:

• Reducing the hiatal hernia: the part of the stomach that has migrated into the chest is returned to the abdomen;
• Reconstructing the esophageal hiatus (possibly using a reinforcing material);

This procedure can also be performed during various obesity surgery procedures:

• Gastric banding;
• Sleeve gastrectomy;
• Gastric bypass;

When is Surgery Indicated for Gastroesophageal Reflux?

Surgical indication is generally reserved for patients in whom:

• It is essential to find an effective solution to relieve common symptoms of the disease such as heartburn and retrosternal pain. Unfortunately, medical treatment is insufficient or symptoms reappear as soon as treatment is stopped. It is therefore essential to explore other options;
• There are signs of regurgitation, coughing at night, and inhalation that cannot be controlled through medical treatments, diet, and hygiene-behavioral rules;
• A large hiatal hernia is present;
• There is persistence of mucosal lesions (erosive esophagitis), despite adequate medical treatment;
• According to the patient, it seems preferable (or even necessary) not to use drugs that block the production of gastric acid over long periods;

Thanks to recent advances in minimally invasive (laparoscopic) surgery, more and more patients have been able to benefit from an effective solution to their reflux problem through surgery. Formerly, when the operation required opening the chest or long abdominal incisions, the cases where surgery was recommended were much more limited.

 

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