Diagnosis “Reflux” – What Happens Next?

Many patients initially feel relieved when the diagnosis of “reflux disease” is finally made.

But very soon, the next question arises:

What happens next?

In everyday medical practice, treatment often follows a simple pattern:Heartburn → acid blockers → “Next patient, please.”

The rest is left to the patient.

A typical course

A patient wrote to me:

After years of uncertainty, the diagnosis was finally established.She adjusted her diet, consistently avoided many foods, took medication regularly – and hoped for improvement.

But the opposite happened.

Her symptoms actually worsened:

• coughing, throat clearing, breathing difficulties

• pain in the chest and rib area

• swallowing difficulties, nausea

• increasing exhaustion

The medication dosage was steadily increased – without lasting success.

Additional diagnoses were made, further treatments were attempted.Yet the situation remained unchanged.

In the end, one thing remained above all:

the despair of still being ill despite everything.

Two important aspects

1. Variable response to acid blockers

Not all patients respond equally to proton pump inhibitors (PPIs).

Small differences in the molecular structure of these medications can lead to reduced effectiveness in some individuals.

These so-called “non-responders” often do not benefit from increasing the dose, but rather from switching to a different preparation.

2. Side effects and secondary effects of PPIs

PPIs can have a range of significant side effects – affecting the gastrointestinal tract, bone metabolism, and also mental well-being, including depressive symptoms.

Both during treatment and after discontinuation, disturbances in the body’s internal balance may occur.

For example, fungal infections (Candida) may develop more easily.

These typically occur in individuals with weakened immune systems – which illustrates how strongly these medications can interfere with the body’s natural equilibrium.

At the same time, a vicious cycle may develop:Fungal infections can cause symptoms similar to reflux.

The result:Medication doses are often increased further.

What does this mean?

The treatment of reflux disease is complex.

A simple “acid blocker” approach is often not sufficient.

The key point

👉 The individual situation of the patient must be carefully understood.

In this case, after thorough evaluation, we opted for surgical treatment.

Today, the patient is symptom-free.

Conclusion

Reflux is not the same in every patient.

And not every patient benefits from the same treatment.

👉 Only a precise and comprehensive understanding of the individual situation allows for effective and sustainable therapy.

Yours sincerely

Priv.-Doz. Dr. med. Eckhard Löhde