Oesophageal symptoms

Common symptoms of gastro-oesophageal reflux are an acid taste in the mouth, burning in your throat or stomach ('heartburn'), difficult or painful swallowing and chest pain. Other possible symptoms are a sore throat, cough or asthma, increased phlegm, voice changes, tooth erosion or hypersensitivity and gum disease. Reflux may, however, also be completely without any symptoms (silent reflux).

This is one of my special interests, and I closely collaborate with dental clinics and dentists. Reflux from the stomach into the mouth with resulting tooth / dental damage is surprisingly common. This is called dental erosion or erosive tooth wear. The majority of patients with erosive tooth wear do not have any reflux symptoms. This is called 'silent reflux'. Many patients with reflux also have sleep apnoea and bruxism (grinding or clenching of teeth at night).

Yes, this is very important. Swallowing problems should always be investigated by endoscopy, as serious inflammation or cancer must be excluded.

The most common causes of these symptoms in my practice are reflux and allergies, more rarely inflammation or throat cancer. Collaboration with ear-nose-throat specialists is important in this area.

Common causes are a weakened closure between the oesophagus and stomach (e.g. hiatal hernia, or increased abdominal pressure due to obesity, pregnancy or abdominal muscle training), abnormal oesophageal or stomach motility, or reduced production or buffering capacity of saliva.

Certain food can relax the closure between the oesophagus and stomach (e.g. fatty food, peppermint
caffeine, alcohol) or are acid (e.g. tomatoes, citrus fruit). Many individuals spontaneously discover associations between reflux and food and avoid the offending food. Reflux is more common in overweight individuals and smokers.

Chest pain should be investigated in collaboration with other specialists. As a gastroenterologist, I would suspect oesophageal inflammation or muscle spasms, or causes in the stomach, pancreas and gallbladder. Disorders of the heart, abdominal wall and ribs should be considered

This is one of my special interests, and I closely collaborate with dental clinics and dentists. Reflux from the stomach into the mouth with resulting tooth / dental damage is surprisingly common. This is called dental erosion or erosive tooth wear. The majority of patients with erosive tooth wear do not have any reflux symptoms. This is called 'silent reflux'. Many patients with reflux also have sleep apnoea and bruxism (grinding or clenching of teeth at night).

This is a classic symptom occurring especially in younger individuals with a history of allergies. An allergic reaction leads to changes in the movement of the oesophagus and food impaction. This disorder, called eosinophilic oesophagitis, is diagnosed using biopsies obtained during an endoscopy of the oesophagus.

I assess reflux by asking questions regarding symptoms. Detailed investigation is performed using endoscopy and/or a measurement of acid in the oesophagus (pH-metry).

In patients aged below 40 years and irregular symptoms a change in nutrition and acid blockers can be tried first. In case of an incomplete response after a few weeks, a family history of oesophageal disease, swallowing problems or vomiting, or in patients over 50 years old, an endoscopy should be performed.

I recommend an acid measurement in the oesophagus (pH-metry) if endoscopy does not yield a clear diagnosis and if there is an insufficient response to an acid blocker given in an adequate dose.

A pressure measurement, or manometry, is not routinely required for the diagnosis of reflux. However, it is useful for the assessment of swallowing problems and for special indications before or after reflux operations.

I would suggest gastroscopy and possibly the investigation of food intolerances. Why? Either you are producing too much gas in your stomach or intestines (fermentation) due to an intolerance, or the closure at the end of the oesophagus is inadequate. Less commonly, slowed stomach emptying or excessive swallowing of air can be the cause. I also see patients with sleep apnoea, where the CPAP machine can blow air into the stomach at night.

Depending on your age and circumstances, I would recommend changes in lifestyle (food, weight, sleep position), simple antacids, natural medicines or acid blockers (proton pump inhibitors). Surgical repair may be the best option in cases of severe reflux and special forms of hiatal hernia.

The indication for surgery in reflux is dependent on the severity of reflux, the presence of a hernia, your age and personal wishes, and especially the experience of the available surgeons. I would consider the indication for surgery very carefully with you in case of movement disorders of the oesophagus or stomach.

In my personal consultation with you we discuss the latest published study data. Generally speaking, the latest data show good tolerability and low risk with chronic use. There is a possible propensity for a changed gut flora (microbiome), modified absorption of certain minerals and vitamins and increased growth of specific cells in the stomach (development of cysts).

Treatment of an eosinophilic oesophagitis is dependent on the number of eosinophilic cells counted in the biopsies of the oesophagus. Initial treatment is with proton pump inhibitors. If an inadequate effect is seen in the follow-up endoscopy, we will switch to the more effective locally-acting steroid preparation. Either of these treatments are only suppressive, i.e. they do not heal, and they are therefore required long-term.