Depending on the severity and disease, state different therapeutic measures are necessary. These range from general as weight loss drug over to operational measures. The drugs thus reduce the secretion of stomach acid. The operational measures are necessary in very special cases, for example after failure of conservative therapies or a repeated occurrence of symptoms after healing (relapses).

The following information is based on rigorous and current scientific evidence that have shown a far-reaching benefit in the treatment. It is essential to adapt the treatment options shown here subject to certain conditions. The personal life goals and wishes of the patient play a fundamental role, as can age, severity of illness and possible co-morbidities have a decisive influence on the recommendations.

The family physician should always be sure to put on comorbidities notified and advised of any medications that are taken. The doctor will decide the appropriate treatment for the patient according to the above criteria, this form of treatment is not necessarily the newest or most expensive. The main factor is that the chosen therapy is the best choice for the person concerned. High quality of treatment is expressed not in innovation and high costs. Questions should always concerned to rectify their GP.

General principles of treatment

The first treatment goal is to reduce reflux by general measures, as well as the neutralization of back-flowing, aggressive and acidic stomach contents through medication. Proceeding should by avoiding harmful influences, such as alcohol and nicotine are strengthened, the lower esophageal sphincter function and its closure.

Proton pump inhibitors (PPIs)

Proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, rabeprazole or pantoprazole are the first choice for reflux esophagitis; they are used in the nichterosiven (NERD) and erosive reflux esophagitis in (ERD).

Operative Therapies

Operational measures are used when there are:

• Recurrent symptoms and complications
• Non-response to the conservative / drug therapy
• Presence of precancerous lesions (Barrett’s esophagus)

There are many reasons for the emergence of gastroesophageal reflux disease; some of them are still unknown. Play an important role in organic diseases such as morbid obesity and diabetes mellitus, but also lifestyles and eating habits. The lower esophageal sphincter (lower esophageal sphincter / cardia) in healthy people prevents the reflux of stomach acid and of gastric contents into the esophagus. This does not work properly, the stomach contents pass through the otherwise closed lower esophageal sphincter and thus reaches back into the esophagus.

The reason for this is the morbid (pathological) relaxation of the lower esophageal sphincter. As a result, there is no pressure difference between the lower esophageal sphincter and the stomach interior, which stops backflow normally. The result is that the esophagus of gastric mucosa is exposed. Considers this to längfristig reflux, there can be increased mucosal sensitivity, damage to the esophageal mucosa or even inflammation (esophagitis) to ulceration (ulceration). Special attention must be drawn to food and diets.

Frequent beverage consumption, about cigarettes (nicotine), alcohol (especially of spirits) and coffee, as well as fatty and sugary food for the formation of gastroesophageal reflux disease responsible. An occasional and low reflux after oily, very large or sugary food is normal (physiological) and therefore to be distinguished from pathological (pathophysiological) reflux.

The human digestive system

Functioning of the lower esophageal sphincter under normal conditions

The lower esophageal sphincter (esophageal sphincter) in healthy makes for a pressure barrier between the stomach and esophagus, the lower esophageal sphincter resting pressure is higher than the internal pressure in the stomach. Only when swallowing reflex from the lower esophageal sphincter schlafft short and opens then he pulls himself together, he contracted and thus stops the reflux of stomach contents into the esophagus.

Together with a self-cleaning function of the esophagus (oesophageal clearance) is the lower esophageal sphincter is thus responsible for a further transport of the chyme in the stomach, as well as at the same time it provides a locking mechanism provides the lower esophagus.

Dysfunction of the lower esophageal sphincter

Different conditions can be summarized under the term “gastroesophageal reflux disease”. They are as different disease manifestations, either with or without damage to the esophageal mucosa and the surrounding tissue. Cause of gastroesophageal reflux disease is a disorder of the closing ability of the lower esophageal sphincter.

As a result, a painful, burning feeling of pressure in the stomach and chest area is usually triggered: the so-called heartburn.

The treatment of the herniated disc is highly dependent on the severity of the symptoms and the subjective symptoms and duration of illness. With a bulging with mild discomfort, conservative treatment with medication and physiotherapy exercises enough. Only with longer symptoms of more than 6 weeks, or if there is no improvement with conservative treatment, surgery is performed. This also happens with high subjective distress by the herniated disc.

Conservative therapy

A disc bulge is formed, as long as no fibres are finally enters the spinal canal, sometimes spontaneously. A functional release, for example by bed rest on a firm surface with hips and knees bent (stages bed storage) is only set once. The focus initially is a correction of the reflex tension of the back muscles in the affected segment, in order to break the vicious cycle of additional stress on the joints and other pains.

In addition to drug therapy, a pain physiotherapy support is useful. As soothing local application of heat is often perceived by mud (mudpacks) or a targeted heating of body tissue by short-wave therapy (diathermy). A massage is also quite helpful, but this therapy should gain in pain during the massage to be terminated since the spine instabilities amplify the nerve pinch.

Following a strengthening the back and abdominal muscles will be set to prevent a renewed poor posture or improper loading in this area. It makes sense this is an outpatient implementation of physiotherapy. In part, nursing reasons or personal effort and a hospitalization during therapy makes sense. After the initial treatment, the exercises shown should be carried out at home, in order to prevent a new disc problem. Prevention among other exercises are shown which are useful suitable for the prevention of first or renewed herniated discs.

Surgical treatment

Surgical treatment should be carried out carefully considered, since an elaborate disc surgery always involves an additional risk for the patient. Therefore, conservative treatment should be performed if possible first. The results of disc surgery are still very good and exceed the long-term results of conservative therapy. After surgery, about 80% of patients are symptom-free. Only in 5% of patients experience after surgery again on intervertebral discs in the operational area.