Reflux therapy

Reflux disease can be treated well. The most important strategies are medication and a change in lifestyle. But surgery can also help some people.

Change your lifestyle - the best tips


If you are overweight or obese, you should lose weight. People of normal weight are less likely to suffer from heartburn and reflux disease than overweight people. You can reduce the symptoms by losing weight. Your heart, circulation, joints and metabolism also benefit from a few pounds less.

Sleep properly

Position your upper body higher than your feet when you sleep. Raise the headboard of your bed. If this is not possible, place an additional pillow or a thick blanket under your head. This prevents stomach acid from flowing back into the esophagus so easily at night. It is best to sleep on your left side. In this position, the stomach is lower than the esophagus and the stomach contents rise less easily.

Pay attention to your diet

  • Alcohol, coffee, chocolate, lots of fat, carbonated drinks and hot spices are being discussed by researchers as risk factors for heartburn. However, the connection has not been scientifically proven. Try out which foods are good for you and which are not. It is better to leave these out. Keep a food diary to find out which foods you tolerate well.
  • Do not overload your stomach with large portions during the day and especially in the evening, but rather eat five to six small meals throughout the day.
  • Take your time to eat and don’t wolf it down under time pressure. Enjoy your meals, preferably in a relaxed atmosphere.
  • Do not bend down or lie down immediately after eating – it is better to take a digestive walk. Do not lift any heavy loads.
  • Take a break from eating before going to sleep: Don’t eat anything for about three hours before going to bed. Otherwise the stomach is very busy digesting at night.

Medication for reflux

Often a change in lifestyle does not bring the desired success in the treatment of reflux disease. Medication is then an additional treatment option. They alleviate the symptoms as long as you take the medication.

  • Proton pump inhibitors
    (proton pump inhibitors, acid inhibitors, acid blockers): They slow down the production of stomach acid by blocking a special enzyme. Commonly used active ingredients are pantoprazole or omeprazole. Low doses of the medication are available over the counter from pharmacies or online mail order, while higher doses require a prescription. Proton pump inhibitors are also suitable for long-term treatment, but in lower doses than at the start of therapy. The symptoms often improve to such an extent that you can stop taking the medication again. Proton pump inhibitors are now considered to be the drugs of first choice.
  • H2 receptor blockers: Medications from this group of active ingredients reduce the secretion of stomach acid by preventing the binding of the messenger substance histamine in the stomach.
  • Antacids bind and neutralize stomach acid.
  • Alginate takes on the consistency of a gel in the stomach and is intended to slow down the reflux of stomach acid.
  • Prokinetics promote the emptying of the stomach contents and slow down their reflux into the esophagus.

The effectiveness of antacids, alginate and prokinetics for reflux disease is not well established scientifically. They may help with mild heartburn or if you cannot tolerate the other medication. They are available over the counter from pharmacies or online.

Surgery for reflux

Sometimes medication does not help sufficiently against reflux disease or the symptoms are severe. What’s more, some people don’t want to take medication for years. In these cases, surgery is a treatment option for reflux disease.

Anti-reflux surgery is an option if:

  • long-term treatment is necessary,
  • the reflux of stomach contents into the esophagus is demonstrably pathologically increased,
  • the symptoms are very pronounced and the quality of life suffers,
  • the symptoms are proven to be caused by reflux

If surgery is planned to treat heartburn, you should contact an appropriate competence center. Our Upper GI team specializes in the surgical treatment of heartburn and will be happy to advise you during our special consultation hours. Our expertise is based on decades of experience with hundreds of reflux patients and a wide variety of surgical techniques, so that we can offer you a customized solution in every case.

The procedure is usually performed via laparoscopy, i.e. minimally invasive keyhole surgery. There are various techniques: The surgeon places the upper part of the stomach either partially or completely around the esophagus and sutures it in place. This strengthens the closure of the lower esophageal muscle and thus prevents heartburn and reflux disease. The diaphragmatic hernia must be repaired during the same operation.

Laproscopic fundoplication according to Nissen

Fundoplication, first described by the German surgeon Rudolf Nissen (1896-1981) in 1956 during his time as Director of the Department of Surgery at the University of Basel, was the world’s first permanently effective anti-reflux operation. The surgical technique described by Rudolf Nissen involves the formation of a new “valve” between the esophagus and the stomach in order to permanently prevent the stomach contents from flowing upwards. The valve consists of the upper part of the stomach, which is placed around the lower esophagus like a collar and sutured to itself.

Today, this procedure is almost always minimally invasive, i.e. performed without a large abdominal incision.

Minimally invasive fundoplication according to Nissen is considered the standard procedure today and is certainly the most frequently performed and proven anti-reflux operation worldwide. Studies have shown that around 85-90% of patients who have undergone surgery are still satisfied with the results long after the operation (5-10 years).

Laparoscopic fundoplication according to Toupet

Toupet fundoplication is a variant of Nissen fundoplication in which only a partial sleeve is placed around the posterior part of the esophagus. This procedure is preferably used for patients with impaired swallowing function.

Laparoscopic fundoplication according to Dor

Dor’s fundoplication is also a modification of Nissen’s circular cuff. In this operation, the gastric sleeve is placed exclusively around the front part of the esophagus. This procedure is also used in particular for patients with impaired swallowing function.

Laparoscopic gastroplasty according to Collis with fundoplication according to Nissen

In a very small proportion of patients with particularly severe reflux symptoms, a scarred shortening of the esophagus can occur over the years. These patients then require surgical lengthening of the esophagus so that the fundoplication sleeve can be applied without tension. This lengthening is carried out with the help of a special stapler.

Laparoscopic sphincter augmentation with magnetic implant (LINX®)

This procedure has only been available for the treatment of reflux disease for a few years. Instead of a gastric sleeve, the valve is formed from an implant. The implant consists of a chain of titanium-encapsulated permanent magnets and is placed around the lower esophagus using a minimally invasive technique.

This strengthens the natural valve between the esophagus and stomach and prevents reflux. However, the LINX® implant is only approved for patients with mild reflux symptoms. Compared to classic fundoplication, this procedure has the advantage that the natural anatomy of the esophagus and stomach is largely preserved during the operation.

Laparoscopic implantation of an electrostimulator (EndoStim®)

Like implantation of the magnetic system (LINX®), electrical stimulation of the sphincter muscle between the esophagus and stomach using the EndoStim® procedure has only been approved for the treatment of reflux disease for a few years. During the operation, two electrodes are anchored to the lower esophagus and connected to a pacemaker placed under the skin.

The pacemaker now stimulates the lower sphincter and in this way prevents the backflow of acid into the esophagus. This operation is only offered at a few centers in Switzerland and is only approved for patients with mild symptoms. The main advantage of this technique is also the minimal stress caused to the patient during the procedure.

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Specialties: Upper Gastrointestinal Tract Surgery (Upper-GI) and Endocrine Surgery

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