The typical complaints of a reflux disease, such as heartburn and regurgitation, can sometimes be relieved by a change in diet. There are also effective medications. For some people, an operation can be useful.
Not everyone manages to take medication daily for years to relieve the reflux symptoms. It may also be that the drug treatment in reflux does not bring the desired success or the symptoms are very strong. Then some people consider whether they should be operated on against reflux.
The aim of an anti-reflux operation (fundoplication) is to prevent acid from flowing back from the stomach into the esophagus. In this operation, the upper part of the stomach is placed around the lower end of the esophagus and sutured to the diaphragm, stomach or esophagus. This strengthens the occlusion at the bottom of the esophagus (the esophageal sphincter) and is designed to prevent heartburn and reflux.
Today, reflux is usually performed laparoscopically. In doing so, the doctor inserts the surgical instruments into the abdominal cavity through small skin incisions.
A fundoplication can occur in two ways, depending on whether part of the stomach is completely or partially placed around the esophagus. If the stomach completely surrounds the esophagus, this is called a fundoplication according to Nissen and Rosetti. In the fundoplication according to Toupet, the stomach only partially encloses the esophagus. This surgical technique is preferred, for example, when the movement of the esophagus is disturbed (so-called motility disorder).
Heartburn (pyrosis) is a disturbing symptom of reflux of aggressive stomach acid into the esophagus. If acid inhibitors no longer help and a change in the stomach's position can be detected, surgery can help to reduce the symptoms. The following text presents the currently available keyhole surgeries and explains the risks.
Reflux disease (gastroesophageal reflux disease) is a pathologically increased reflux of the acidic gastric contents into the esophagus. About every fifth person in Germany is concerned. Patients with reflux disease suffer from heartburn and pain behind the sternum, which often worsens when lying down. With the help of a 24-hour pH-metry, the reflux disease can be reliably diagnosed. Medication or a diet change relieve the symptoms.
Reflux disease: description
The occasional reflux of gastric juice into the esophagus is quite normal during the day. In gastroesophageal reflux disease, the amount of acidic gastric juice, which rises back into the esophagus (esophagus), but increased morbid. Gastric acid is good if left in the stomach. There, the low pH of between 1 and 4 helps in the digestive process and the killing of harmful substances. The stomach is also specially protected from the acid. Not so the esophagus - her mucous membrane is not resistant enough and is attacked by the acid.
On the way from the mouth to the stomach, the esophagus passes through a small opening in the diaphragm. This is usually the cause of the reflux disease: The lower sphincter muscles, which actually ensure that after swallowing the food porridge, the esophagus closes again, are dysfunctional. Reflux disease causes the lower oesophageal sphincter (lower oesophageal sphincter) to no longer seal completely when lying down or bending over, and the hydrochloric acid from the gastric juice comes into contact with the esophageal mucosa. If this happens for a longer period of time, the mucous membrane of the esophagus is damaged. This can lead to a painful inflammation with mucosal changes (reflux oesophagitis).
Reflux disease: who is concerned?
In the western population, ten to twenty percent of people suffer from the reflux disease. It is therefore a very common disease that affects women more often than men. The incidence of reflux disease increases with age, but in rare cases, babies and toddlers are concerned.
Reflux disease: forms
Distinction NERD and ERD
Reflux without mucosal changes is called non-erosive gastroesophageal reflux disease (NERD). NERD accounts for approximately 60 percent of all patients with gastroesophageal reflux disease. On the other hand, if mucosal changes can be detected in a tissue sample from the esophageal reflection, this is referred to as erosive reflux disease (ERD).
Distinction primary and secondary reflux disease
In addition, two different forms of reflux disease are distinguished: primary and secondary reflux disease. Both have either a loss of function of the lower oesophageal sphincter (esophageal sphincter) and / or a restriction of mobility of the esophagus. This means that the body's own cleaning mechanism of the esophagus is impaired. Normally, it eliminates gastric acid through its proper movements (peristalsis). If mobility is limited, however, the duration of contact of the acid to the oesophageal mucosa is prolonged and slight damage occurs.
Primary reflux disease
Primary gastroesophageal reflux disease is by far the most common form of reflux disease. Primary means that no clear cause was found for it. But it is clear that the lower sphincter of the esophagus relaxes outside of the regular swallowing act and no longer seals the esophagus sufficiently against the stomach. There are several factors that favor the development of primary reflux disease. These include obesity, certain dietary habits (see Causes and Risk Factors), a weakening of the diaphragm or inadequate protective mechanisms of the esophagus (reduced mobility or reduced production of saliva).
Secondary reflux disease
Secondary gastroesophageal reflux occurs as a result of a known physical change - it is less common than primary reflux disease. For example, in 50 percent of women in the last trimester of pregnancy pregnancy causes a reflux disease due to the pressure increase in the abdomen. Furthermore, digestive tract disease leading to anatomical changes in the esophagus or stomach may trigger secondary reflux disease.
Gastroesophageal reflux disease with esophagitis
Esophagitis is an inflammation of the esophagus caused by increased acid contact in the gastroscopy with changes in the mucosa. Typically, the inflamed mucosa is red and swollen. If there are no mucosal changes in a gastroscopy and the tissue samples taken, it is a non-erosive gastroesophageal reflux (NERD).
The mucous membrane of the esophagus is not made for contact with stomach acid. As a result of high levels of acidity and recurrent inflammation, the mucosa in some patients changes and adapts to constant contact with the stomach acid. The tissue is rebuilt and then contains more resilient cells (columnar epithelium) with mucus-producing cells (goblet cells) which are more resistant to gastric acidity. This cell transformation (metaplasia) of the esophagus is referred to as Barrett's esophagus or Barrett's syndrome. The cell changes, however, increase the risk of a malignant tumor (adenocarcinoma) of the esophagus. About every tenth patient with Barrett's esophagus develops esophageal cancer. Therefore, in case of known Barrett's esophagus, a consistent reflux treatment should be carried out with regular controls.
Reflux disease: causes and risk factors
Reflux disease is usually due to relaxation of the lower oesophageal sphincter (lower oesophageal sphincter). The sphincter does not adequately seal the esophagus outside of the swallowing cycle with respect to the stomach. Especially when lying down and bending over, acidic gastric contents enter the esophagus and irritate the mucous membrane. In other cases there is a reduced motility of the esophagus, whereby the esophagus can not cleanse sufficiently and the stomach acid has longer contact with the mucous membrane. The corrosive gastric acid damages the mucous membrane, which in many cases causes burning pain (heartburn).
If the reflux disease is in a very advanced stage and can not be treated by medication, surgery may be necessary. In the so-called surgical technique "Nissen Fundoplication", a cuff is formed from the upper area of the stomach, placed around the lower end of the esophagus and sewn up. The cuff serves as a stabilizer of the esophageal sphincter. The operation can be fraught with complications and should therefore only be performed if, for example, no improvement can be achieved despite proton pump inhibitors or antacids. Even if gastric juice has already returned to the trachea (aspiration), surgery should be discussed otherwise it may lead to pneumonia. In addition to Nissen fundoplication, other surgical procedures such as hiatoplasty and fundopexy are also available.
Reflux disease - complications
There is a risk that the stomach acid gets into the trachea. The corrosive properties can irritate the larynx, causing inflammation (laryngitis). Patients often suffer from hoarseness. The "inhalation" of gastric acid can also cause a chronic irritable cough. Acid-induced damage to the lungs also causes pneumonia (aspiration pneumonia). The mucosal damage of the esophagus can also lead to chronic bleeding, which can lead to anemia (anemia). Reflux disease should therefore always be treated in order to avoid the consequential damage.
In a reflux disease, aggressive gastric acid flows back into the esophagus and irritates the mucous membrane there. In 90% of cases, it is responsible for a shift of the stomach. He is then no longer completely in the abdominal cavity, but slips through a hole in the diaphragm into the chest (hiatal hernia). During an operation (antireflux operation), the stomach can be pulled back into the abdomen and the passage of the stomach through the diaphragm be narrowed. This is done either by a direct suture or a net is sewn into the diaphragm. This quite new operation method is called 3-shift procedure. In order to prevent the stomach from re-sliding upwards and to establish a more favorable angle between the stomach and the esophagus, the upper part of the stomach is sutured to the diaphragm (fundopexy).
To reduce gastric acidity in the esophagus, the gastric entrance is additionally narrowed. For this purpose, the upper part of the stomach is formed into a cuff and placed around the rest of the stomach. It creates so under the actual stomach entrance another intended bottleneck. Depending on whether the stomach is folded in half and is sutured to the opposite diaphragm or a complete cuff is formed from the upper stomach, this surgery is called Semifundoplicatio (after Toupet) or Fundoplicatio (after Nissen-Rosetti).
All these operations can all be performed with a keyhole technique in most cases. This means that only very small cuts in the abdomen have to be placed and operated with the help of a camera and specially made instruments in the abdomen. Experience reports have confirmed that this method can lead to a faster recovery time and above all to less pain after the operations.
Risks and side effects
As with any surgery, there are basically risks of bleeding or injury to nerves and surrounding organs and a risk of infection. However, keyhole technology has made these risks very rare. If the gastric cuff is stitched too tightly, some patients experience difficulties with swallowing, which usually recede after three to twelve months. Partial gas from the stomach can no longer escape through the narrow esophagus, a regurgitation is impossible. Ingested air and gases in the stomach must then find their way through the intestine, which can manifest itself in a feeling of fullness and flatulence. If the stomach slips out of the sewn cuff, a second operation must be done in rare cases.
Reflux: Is surgery useful?
Many people suffer from it: Burning pain behind the sternum, pressure in the stomach area and acid regurgitation after eating. Often the symptoms get worse in a lying position, when drinking alcohol or after consuming acidic foods. Popularly these complaints are called heartburn. They are - if they occur more frequently - expression of another disease: gastroesophageal reflux disease (GERD). Those who suffer from heartburn are not alone in this, because about 20% of the population in the western industrial nations suffer from it.
When does an operation make sense?
There are several surgical options for gastroesophageal reflux, but all have in common that some important criteria must be met.
First of all, surgery should only be considered if there is a long-term need for treatment and effective acid blocking drugs can not relieve the symptoms. This means that the heartburn over long periods of time must occur again or constantly. If this is the case, some research must be done to objectively measure the extent of reflux. This includes a so-called pH-metry, ie a measurement of the pH value in the lower esophagus. This measurement shows how severe the acid load in the esophagus actually is and how often it occurs. In addition, it can be measured by means of a manometry, how strong is the relaxation of the circular muscle actually and whether additionally there is a paralysis of the esophagus. Only in combination of these results of the examination with the patient's psychological stress should the possibility of surgery be discussed. It is also important that all drug treatment options should be exhausted. In rare cases patients suffer from intolerance to proton pump inhibitors. If you can not tolerate omeprazole and pantoprazole, but you still have constant gastroesophageal reflux, surgery may be a good long-term alternative.
Quick help with reflux: The LINX reflux management system
The LINX ™ reflux management system can gently and quickly alleviate the symptoms of reflux disease. In a small, laparoscopic operation ("keyhole technique"), the lower esophageal sphincter is strengthened and its barrier function is restored quickly and easily. There is a rapid and significant improvement in the patient's quality of life.
Special features of the LINX ™ reflux management system
The LINX ™ reflux management system can be thought of as a small, flexible string of pearls that is placed around the part of the esophagus near the stomach. It consists of titanium "pearls" with a magnetic core inside. Due to the magnetic attraction between the beads, the esophageal sphincter is kept closed by the system so that reflux is prevented. When swallowing, i.e. when food is to get into the stomach, the chain expands and the passage is made possible. The same applies to increased pressure in the stomach to allow relief (belching or vomiting).
The LINX ™ reflux management system is placed around the esophagus directly above the stomach in a laparoscopic keyhole operation. As a rule, the abdominal wall does not have to be opened, a procedure that is gentle on the patient. All of this happens under general anesthesia, so that the patient does not even notice the operation. After the short operation, which usually takes less than 1 hour, your LINX ™ will start working immediately.
In contrast to conventional surgical procedures used in reflux disease, the LINX ™ implantation does not require any anatomical changes to the stomach.
What can I expect after the operation?
As a rule, patients can resume their usual activities after a week at the latest and - after consulting their doctor - can eat as usual again. The side effects of the procedure are usually minimal and wear off over time.
Who is the LINX ™ reflux management system for?
As a rule, the LINX procedure can be used in almost all patients with reflux and the corresponding symptoms. We would be happy to advise you whether the LINX ™ reflux management system is suitable for you! We are also available at any time for further questions about this method.
Benefits of the LINX ™ reflux management system
With the LINX ™ reflux management system, the symptoms of reflux disease can be remedied quickly and easily, thereby significantly alleviating the patient's symptoms. With the help of a minimally invasive surgical method, the lower esophageal sphincter is strengthened in such a way that the impaired barrier function is restored.
A small, flexible pearl necklace consisting of titanium "pearls" with a magnetic core inside is attached around the esophagus. The magnetic attraction between the beads ensures that the esophageal sphincter remains closed and that no reflux occurs. When swallowing or when there is increased pressure in the stomach, the chain expands and enables relief, i.e. belching or vomiting. The short procedure takes a maximum of 1 hour and is performed under general anesthesia. After just one week, patients can usually resume normal activities and, after consulting their doctor, eat normally. Any side effects of the procedure are usually minimal and go away completely over time. We would be happy to advise you on whether the LINX ™ reflux management system is a treatment option for you.
The following are contraindications for the LINX Band Impantation:
- severe reflux esophagitis (Los Angeles grade C and D)
- BMI > 35
- Barrett's esophagus
- Motility disorders
- Allergy (Ti, Ni, Fe)
An important question with metal implants always relates to MRI capability, i.e. whether a patient is allowed to have magnetic resonance imaging. According to the manufacturer, this is possible up to a magnetic field strength of 1.5 Tesla.
Medical treatment of gastroesophageal reflux
The attending physician may prescribe medication for GERD. Since GERD is often a chronic disease, you will have to take medications throughout your life. In some cases, long-term treatment is not required.
Be patient, it takes time to find the right drug and dosage. If symptoms do not go away even after taking medications or if they resume immediately after completing the course, consult your doctor. If GERD symptoms occur during pregnancy, consult an obstetrician before starting taking medications.
Below is information about the drugs that are usually prescribed for the treatment of GERD.
Such remedies help with mild and rarely manifested symptoms. Their effect is to neutralize acidic gastric juice. Usually antacids act quickly and can be taken as needed. Since their action does not have a long-lasting effect, they do not prevent the occurrence of heartburn and are less effective for symptoms that often manifest.
Most antacids contain calcium carbonate ("Maalox" Maalox) or magnesium hydroxide. Sodium bicarbonate or baking soda, helps with heartburn and indigestion. It should be mixed with at least 120 ml of water and taken one to two hours after a meal, so as not to overload a full stomach. Talk to your doctor about the need for such treatment. Do not use this method for more than two weeks and use it only in extreme cases, since soda can lead to metabolic disorders (pH) and the formation of erosions in the esophagus and stomach. Before applying it to children under 12 years of age, consult a doctor.
Another type of antacids contains alginate or alginic acid (for example, Gaviscon Gaviscon). The advantage of such an antacid is that it does not allow fluid to seep back into the esophagus.
Antacids can affect the body's ability to absorb other medications, so if you are taking other medications, consult your doctor before you start taking antacids.
Ideally, you should take antacids at least 2-4 hours after taking other medications to minimize the likelihood of their non-absorption. People with high blood pressure should refrain from taking antacids with a high sodium content (Gaviscon Gaviscon).
Finally, antacids are not a reliable treatment for erosive esophagitis, a disease that needs to be treated with other drugs.
Preparations suppressing the production of hydrochloric acid
These drugs reduce the amount of acid produced by the stomach, and are available both by prescription and without it. Usually the same drugs are dispensed by prescription, but in a higher dosage. They can help those who are not helped by antacids. It becomes easier for most patients if they take drugs that suppress the production of hydrochloric acid and change their lifestyle.
According to the mechanism of action , two groups of such drugs are distinguished:
- H2-histamine receptor blockers
- Proton pump inhibitors
Most likely, at first the doctor recommends taking the drug in a standard dose for several weeks, and then if the desired effect cannot be achieved, he will prescribe a drug with a higher dosage.
Traditional H2 blockers include:
- nizatidine (Axid AR)
- Famotidine (Pepcid AC)
- cimetidine (Tagamet HB)
- ranitidine (Zantac 75)
Pepcid Complete is a combination of famotidine, calcium carbonate and magnesium hydroxide contained in antacids.
Traditional proton pump inhibitors include:
- lansoprazole (Prevacid)
- omeprazole (Prilosec)
- rabeprazole (aciphex, Pariet)
- pantoprazole (Protonix, Nolpaza)
- esomeprazole (Nexium)
- omeprazole + sodium bicarbonate (Zegerid)
- dexlansoprazole (Dexilant)
Proton pump inhibitors (PPIs) also lower acidity, but are more powerful than H2 blockers. Proton pump inhibitors are most often prescribed for the treatment of heartburn and acid reflux.
These drugs block the release of acid by the cells of the gastric mucosa, and significantly reduce the amount of gastric acid. They do not act as quickly as antacids, but they can relieve reflux symptoms for many hours.
PPIs are also used to treat esophageal inflammation (esophagitis) and esophageal erosions. Studies have shown that the majority of patients suffering from esophagitis who took such drugs recovered after 6-8 weeks. Most likely, the attending physician will re-evaluate your health after 8 weeks of taking proton pump inhibitors and, in accordance with the results obtained, reduce the dosage or discontinue treatment. If the symptoms do not resume within three months, you will have to take medication only from time to time. Before taking these drugs, people suffering from liver diseases should consult their doctor.
Prokinetics, for example, metoclopramide (Cerucal, Raglan, Metozolv), increase the tone of the lower esophageal sphincter, so that acid does not enter the esophagus. They also increase the contractions of the esophagus and stomach to some extent, so that the stomach is released faster. These drugs can be used as an additional treatment for people with GERD.
First of all, it is necessary to pay attention to lifestyle and avoid situations that can provoke the appearance of the disease.
Remember that GERD happens when stomach acid is thrown into the esophagus, which connects the pharynx with the stomach.
In order for the lower esophageal sphincter to function normally, follow the following recommendations:
- Do not do bends and other physical exercises during which the pressure on the abdominal cavity increases. Do not exercise on a full stomach.
- Do not wear clothing that fits tightly around the waist, such as elastic belts and belts, which can increase pressure on the stomach.
- Do not lie down after eating. If you lie on your back after a hearty meal, it will be easier for the contents of the stomach to get into the esophagus. For a similar reason, do not eat before going to bed. The headboard of the bed should rise by 15-20 cm so that, under the influence of gravity, the acid remains in the stomach, where it should be while you sleep.
- Don't overeat. Due to the fact that there is a large amount of food in the stomach, the pressure on the lower esophageal sphincter increases, as a result of which it opens.
In order for the lower esophageal sphincter and esophagus to function normally, follow the following tips:
- Quit smoking and do not use products containing tobacco. Due to smoking, the lower esophageal sphincter relaxes, and the amount of saliva neutralizing acid decreases in the oral cavity and pharynx, and damage to the esophagus occurs.
- Do not eat foods that exacerbate symptoms, such as tomato sauces, mints, citrus fruits, onions, coffee, fried and carbonated drinks.
- Do not drink alcoholic beverages. Due to alcohol, the lower esophageal sphincter relaxes, and the esophagus may begin to contract unevenly, as a result of which acid will be thrown into the esophagus and heartburn will begin.
- Check the medications you are taking. Due to taking certain medications, symptoms may worsen. Do not interrupt the prescribed treatment without consulting a doctor. Drugs that have such an effect include drugs for the treatment of asthma and emphysema (for example, theophylline), anticholinergics for the treatment of Parkinson's disease and asthma, sometimes contained in over-the-counter drugs, some calcium channel blockers, alpha-blockers and beta-blockers for the treatment of heart disease or high blood pressure, some drugs that affect the nervous system, iron preparations.
- Despite the fact that some drugs exacerbate the symptoms of GERD, due to the use of others, drug esophagitis may occur, a disease in which the same symptoms occur as with GERD, but not because of reflux. Medicinal esophagitis occurs when a tablet is swallowed, but does not reach the stomach, as it sticks to the wall of the esophagus. Because of this, the mucous membrane of the esophagus is corroded, chest pain occurs, esophageal ulcers and painful sensations during swallowing.
- Drugs that provoke medicinal esophagitis include aspirin, non-hormonal anti-inflammatory drugs (NSAIDs), for example, ibuprofen (Motrin Mortin, Aleve Aleve), alendronate (Fosamax Fosamax), potassium and some antibiotics (especially tetracycline and doxycycline).
Treatment of gastroesophageal reflux begins with lifestyle changes. First you need to understand what influences the occurrence of symptoms.
If you have GERD symptoms, use the following tips:
- Avoid taking foods and drinks that stimulate relaxation of the lower esophageal sphincter, such as foods flavored with mint, chocolate and alcohol.
- Lose weight if you are overweight. Overweight and obesity contribute to the occurrence of GERD, since overweight increases pressure on the stomach and lower esophageal sphincter, which leads to the discharge of acidic gastric juice into the esophagus and irritation of the esophageal mucosa.
- Do not lie down for at least two or three hours after eating. After eating, it is useful to take a walk. This not only prevents the onset of GERD symptoms, but also burns extra calories.
- Avoid foods that provoke GERD symptoms in the diet. Do not eat fatty or fried foods, creamy sauces, mayonnaise or ice cream. Other foods that may increase symptoms include coffee, tea, carbonated drinks, tomatoes and citrus fruits.
- Quit smoking. Due to smoking, the digestive system is disrupted and, according to the results of some studies, the lower esophageal sphincter relaxes. Due to smoking, the content of bicarbonate in saliva also decreases, and its ability to protect the esophagus from gastric acid decreases. Some types of nicotine replacement therapy (nicotine patch, nicotine gum) can cause indigestion, abdominal pain and vomiting. Before using, discuss with your doctor the possible side effects of these products.
- Do not wear clothes that put pressure on the stomach, such as tight belts, tight jeans and elastic belts, which increase pressure on the stomach and lower esophageal sphincter.
- Lift the headboard of the bed by 15-20 cm or use a wedge-shaped pillow so that the acid enters the stomach under the influence of gravity.
- Do not bend over after eating. If you need to pick something up from the floor, it is better to sit down on half-bent knees and try not to bend at the waist. Do not exercise or do physical labor after eating.
- Check the medications you are taking. Due to taking certain medications, symptoms may worsen. Such drugs include theophylline, calcium channel blockers, alpha-blockers and beta-blockers, anticholinergics, which may be present in drugs used to treat Parkinson's disease, asthma, as well as some over-the-counter remedies for runny nose and cough. If you think that the drug you are taking affects your symptoms, discuss with your doctor what it can be replaced with. Do not interrupt the prescribed treatment without consulting a doctor.
GERD Diet: Foods That Help with Acid Reflux
The most important principle of therapeutic nutrition for GERD, regardless of the phase of the disease, is frequent fractional nutrition (5-6 times a day) in medium portions. It is extremely important not to lie down or stay in an uncomfortable sitting (half-bent) position for 1.5-2 hours after eating, do not take food immediately before going to bed. It is not advisable to wear tight clothes, tighten the belt tightly. It is advisable to sleep with an elevated headboard. It is advisable for overweight people to lose weight. Animal fat contained in foods should be evenly distributed over all meals and eliminated (minimized) in the last meal before bedtime.
When eating, part of the acid accumulated in the stomach is "consumed" for the digestive process. When eating a small amount of food at one meal, gastric hyperextension is excluded, which is an additional factor contributing to excessive secretion of hydrochloric acid. At the same time, even a small meal is enough to bind and remove enough acid from the stomach. Reduction of acid aggression is achieved by fractional feeding in small portions of food, as well as by monitoring the quality of the diet (animal fat is retained in the stomach for as long as possible, which is accompanied by significant secretion of hydrochloric acid after eating). The most important aspect of therapeutic nutrition in GERD is the timely evacuation of food from the stomach to the intestines. Recumbent and semi-bent sitting position complicate the normal evacuation of food from the stomach. Overeating and wearing tight clothes increase the pressure in the abdominal cavity and contribute to the discharge of gastric contents into the esophagus.
The food should be steamed, boiled or stewed. In the period of exacerbation of GERD and in the presence of erosions in the esophagus, all products should be served in a mashed form. In remission and in the presence of NERD (non-erosive reflux disease) it is also possible to eat baked dishes; if it is possible to chew food adequately, it is permissible to use unpeeled food. The temperature of the dishes served should be within 40-50'C.
Mechanically coarse food can injure the esophageal mucosa and stay in the stomach longer, which contributes to additional secretion of hydrochloric acid, excessive gastric peristalsis and reflux of gastric contents into the esophagus. This can increase heartburn, belching, regurgitation and provoke the appearance of pain in the epigastrium and behind the sternum. Optimal food temperature ensures timely evacuation of food from the stomach. When eating cold dishes, food lingers for a long time in the lumen of the stomach, since adequate digestion begins only when the temperature reaches 38 'C inside the food lump. Hot food has a traumatic effect on the mucous membrane of the esophagus and stomach.
Permitted and not recommended products for people with reflux disease
|Name of the product or dish
- light bread, whole grain bread, coarse bread;
- cereals: small, for example, semolina, large, for example, pearl barley;
- rice, pasta
|Milk and dairy products
- milk up to 2% fat content, yogurt, kefir, natural and fruit yogurts;
- low-fat and semi-fat cottage cheese, a limited amount of homogenized cheese, cream with a fat content of up to 18%
|fat milk (3.2% or more fat content), fat cottage cheese, yellow cheese, processed cheese, cheese with mold, feta cheese, cream cheese, cream (with a fat content of 22% or more)
||fried eggs in fat/bacon
|Meat, cold cuts, fish
- lean meat: beef, veal, chicken, turkey (without skin), lean pork in limited quantities;
- low-fat fish: freshwater (for example, bream, perch, walleye), marine (for example, cod, hake, flounder), freshwater and marine fatty fish in limited quantities;
- lean pork, poultry, beef, boiled and stewed meat and fish, baked in foil, grilled (in limited quantities)
|fatty meat: pork, lamb, goose, duck, fatty meat, giblets, pates, canned meat, fried meat and fish
||butter in small quantities, margarine in small quantities, vegetable oils in small quantities
||boiled, mashed potatoes without butter, dumplings
||french fries, fried potatoes, potato pancakes, chips
|Vegetables and canned vegetables
||all vegetables and canned vegetables not mentioned in the next column
||tomatoes and tomato juice, onions and onion vegetables (leeks, shallots, garlic), asparagus, artichokes, legumes
||all fruits and jams not mentioned in the next column
||citrus fruits: grapefruit, oranges, tangerines, lemons, citrus juices, apples, bananas
|Sugar and sweets
||sugar, honey, sweets not listed in the next column
||chocolate and chocolate products, halva
||all spices not mentioned in the adjacent column
||hot pepper, chili, curry, pepper, mustard, horseradish
||all, except those mentioned in the column next to, soups from legumes and cruciferous vegetables in limited quantities
||cooked in bone broth/fatty meat, bleached with heavy cream
|Meat dishes and fish
||boiled, stewed without frying, baked in aluminum foil, on parchment or in a foil sleeve, meatballs, meat and fish puddings
||fried, stewed, baked in the traditional way
|Flour and cereals
||all dishes not listed in the next column
||fried dishes, deep-fried, dishes with pork rinds, greased with oil
||tender, seasoned with yogurt, skimmed milk, a small amount of butter or egg yolk, thickened with a suspension of flour in water or milk
||spicy, cooked in a broth of bones or fatty meat, thickened with sauce, with the addition of heavy cream, mayonnaise and mayonnaise-based sauces
||compotes, jelly, mousses, sherbets, jelly, sponge cake, yeast dough
||cream and cakes, puff pastry products, shortbread dough, donuts
||non-carbonated mineral water, "weak" tea, herbal teas (except mint), fruit teas, alcohol in very limited quantities (in the case of people with esophagitis – a complete exception)
||coffee, "strong" tea, mint infusion, carbonated drinks, low-alcohol alcohols (especially beer, white wine), alcoholic beverages with citrus juice, carbonated drinks or tomato juice
It should be emphasized that the body's reaction to certain foods is an individual feature. Patients should limit the consumption of non-recommended foods, but this does not mean that they should not be eaten at all. It is possible that the symptoms of the disease will appear after the products not mentioned in the text. That is why every patient should monitor the reaction of his body to various foods and exclude from the diet those that cause or worsen symptoms.
Sample menu for a person with reflux disease
- rye bread, whole grain bread, thinly spread with margarine;
- lean white cheese;
- fruit tea without sugar or with very little sugar.
- bread thinly spread with margarine;
- turkey tenderloin;
- fresh cucumber;
- pineapple slices;
- tea is weak without sugar or with very little sugar.
- barley soup with pearl barley;
- brown rice, veal meatballs in gravy, stewed beetroot without added fat;
- tea is weak without sugar or with very little sugar.
- mousse with raspberries;
- non-carbonated mineral water.
- rye bread, whole grain bread, thinly spread;
- broccoli salad with ham (boiled broccoli, turkey tenderloin, pumpkin seeds, fried without adding fat, natural yogurt, spices);
- herbal tea without sugar or with very little sugar content.
13 foods that fight Acid Reflux
1. Oatmeal porridge
Oatmeal consumption reduces the likelihood of heartburn. In heartburn, stomach acid rises into the esophagus and causes chest and neck pain. This happens over a longer period of time it is called reflux disease. The mucous membranes of the esophagus can take permanent damage. The high content of fiber in oatmeal binds the stomach acid and thus reduces the amount of acid present. The likelihood of gastric acid secretion into the esophagus is reduced and the symptom of heartburn is temporarily improved.
Oatmeal is made from seeds of oats. To understand the effects of oatmeal in the stomach, the properties of the oat seed must be considered.
Germination is primarily by water absorption. The large amount of fiber acts as a kind of sponge. When the oat seeds come into contact with water, it "sucks up" the liquid. The stored water causes the fibers to swell and the shell of the seed bursts. The plant begins to germinate. This mechanism of fluid retention is used in the treatment of reflux disease. The oatmeal reaches the stomach with food and absorbs the gastric juice there.
The sour porridge then passes into the intestine, where the acid is neutralized by the juice of the pancreas. The reflux disease is mainly caused by a disturbed closure of the stomach entrance. This can be favored by overweight. Oatmeal can also help in reducing weight (weight reduction) in regular use in addition to the acid-reducing effect. The swelling effect of oatmeal produces a faster and longer-lasting satiety.
In summary, fiber in oatmeal reduces the incidence of heartburn. When taken regularly, they are proven to reduce the development of reflux disease and its associated sequelae, such as oesophageal mucosal changes (such as Barrett's esophagus) and esophageal cancer.
In moderation, ginger is one of the best products for acid reflux. It has been used since ancient times as an anti-inflammatory agent, as well as for the treatment of gastrointestinal disorders. Ginger root can be easily peeled, sliced or diced, grated. It can be used for cooking, add it to smoothies, drink ginger tea or snack on ginger chewable candies.
3. Aloe Vera
Aloe vera is known as a natural healing agent, as well as, in addition, fighting acid reflux. This remedy is available as a living plant, but sometimes its leaves and the liquid form of Aloe vera are sold separately in grocery stores and health food stores. Aloe vera is used in formulations as a thickener or as a means for solidifying liquids.
It would be right to eat salad every day. Salad is the main food for acid reflux, but tomatoes and onions should not be added to it, as well as cheese and fatty dressings. Sauces containing some acids or fat can be added, but not more than one tablespoon (or less), and not by eye and not approximately!
Bananas are a great snack, and with their slightly acidic pH of 5.6, they are usually great for people with acid reflux. However, about 1% of people with acid reflux believe that their condition worsens when eating bananas. So keep in mind: what works for most people may not work for you.
Melon (pH 6.1) is also good for acid reflux. However, as with bananas, a small percentage (from 1% to 2%) of people should avoid eating it. Also included in this category are muscat white melon with a rich honey flavor, musk melon and watermelon.
Fennel (pH 6,9) dill with anise flavor, excellent food for acid reflux, actually improving the function of the stomach. This crispy vegetable has a unique taste-a soft licorice flavor. Sliced into thin slices (the white bottom part), it makes arugula and spinach salad a healthy food. It's also great for chicken dishes and appetizers, provided you like that licorice (licorice root) flavor.
8. Chicken and turkey
Poultry is the main element of the reflux diet. It can be boiled, stewed, baked, grilled, but not deep-fried. It would be better to give up skin that contains a lot of fat.
9. Fish and seafood
Seafood is also one of the main types of food for reflux. They should also never be deep-fried for you. Shrimps, lobsters and other shellfish fit perfectly into this diet. It is recommended to use wild fish rather than farm-grown varieties.
10. Root vegetables and greens
Cauliflower, broccoli, asparagus, green beans and other greens are all great for nutrition with acid reflux. Almost all greens and root vegetables are recommended for people who follow this diet.
Celery has almost no calories due to its high water content, is a good choice for acid reflux. It also suppresses appetite and is an excellent source of fiber.
For thousands of years, parsley has been used as a healing herb in order to improve the functioning of the stomach and help digestion. Smooth-leaved and curly parsley are widely available, and turn seasoning and garnish into an excellent addition.
13. Couscous and rice
Couscous (wheat groats), bulgur (groats made from boiled, dried and crushed wheat) and rice (especially brown rice) are excellent dishes for acid reflux. A complex carbohydrate is a good carbohydrate!