{"id":8261,"date":"2024-03-22T14:25:08","date_gmt":"2024-03-22T13:25:08","guid":{"rendered":"https:\/\/www.roleca.com\/gastroesophageal-reflux-disease-gerd-and-heartburn\/"},"modified":"2026-10-29T09:08:26","modified_gmt":"2026-10-29T08:08:26","slug":"gastroesophageal-reflux-disease-gerd-and-heartburn","status":"publish","type":"page","link":"https:\/\/www.roleca.com\/en\/healthy-digestion\/heartburn\/gastroesophageal-reflux-disease-gerd-and-heartburn\/","title":{"rendered":"Gastroesophageal Reflux Disease (GERD) and Heartburn"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-14qbdb-0e0ca6127a950559eaa98a66a82d2001\">\n.avia-section.av-14qbdb-0e0ca6127a950559eaa98a66a82d2001{\nbackground-color:var(--green2);\nbackground-repeat:no-repeat;\nbackground-image:url(https:\/\/www.roleca.com\/wp-content\/uploads\/rolecapharma-sodbrennen_web.jpg), linear-gradient( to bottom, var(--green2), var(--green1) );\nbackground-position:50% 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class='avia_textblock'  itemprop=\"text\" ><h1>Gastroesophageal Reflux Disease (GERD): A Comprehensive Analysis of Quality of Life and Its Impairment by Symptoms<\/h1>\n<h3><u>Introduction:<\/u><\/h3>\n<p>Gastroesophageal reflux disease (GERD) is a common organic upper abdominal disease affecting millions of people worldwide (El-Serag et al., 2014; Richter et al., 2018). It is caused by the backflow of stomach acid into the esophagus and can cause a variety of symptoms such as <a href=\"https:\/\/www.roleca.com\/en\/healthy-digestion\/heartburn\/\">heartburn<\/a>, regurgitation, chest pain, and difficulty swallowing (Vakil et al., 2006). While the physical effects of GERD are well-documented, it is equally important to understand the impact of this condition on the quality of life (QoL) of those affected. This article provides a comprehensive overview of GERD, focusing on the components considered relevant to quality of life, including the questions established in the GERD-HRQL (Gastroesophageal Reflux Disease-Health-Related Quality of Life) questionnaire.   <\/p>\n<h3><u>Anatomy and Pathophysiology of GERD:<\/u><\/h3>\n<p>Gastroesophageal reflux disease (GERD) is closely linked to the anatomy and pathophysiology of the digestive system. A fundamental understanding of these aspects is crucial to understanding the mechanisms that contribute to the development and progression of GERD. <\/p>\n<p>The anatomy of the digestive system includes the gastrointestinal tract and the esophagus, which connects the stomach to the mouth. The esophagus runs through the chest and abdomen and contains layers of muscle and mucosa that transport food into the stomach during swallowing. The lower esophageal sphincter (LES) describes a closure mechanism consisting, among other things, of a ring-shaped muscle at the junction between the esophagus and the stomach. The normally closed mechanism prevents the backflow of stomach contents into the esophagus (Sch\u00fcnke et al., 2018).   <\/p>\n<p>The pathophysiology of GERD is multifactorial and can be pathologically based on the influence of the harmful properties of refluxing stomach acid, bile, pepsin, and stomach contents on the protective esophageal barriers (Kahrilas, 2003). The primary mechanism involves dysfunction of the LES and an increased volume of acidic stomach contents into the esophagus (Orlando, 1997). A weakening of the LES allows stomach acid and contents to flow back into the esophagus, leading to irritation of the sensitive mucosa. These reflux events can be triggered or exacerbated by various lifestyle factors such as overeating, certain foods, alcohol consumption, smoking, and obesity (BMI), but can also occur as a result of certain medications, pregnancy, or hormonal changes (Kahrilas, 2003; Eusebi et al., 2018).   <\/p>\n<p>Furthermore, anatomical abnormalities such as a hiatal hernia can impair the normal function of the LES and increase the risk of GERD. A hiatal hernia occurs when part of the stomach is displaced into the chest cavity through a gap in the diaphragm, which increases pressure in the abdominal cavity and promotes the reflux of stomach acid (Liu et al., 2019). <\/p>\n<p>Due to the fact that there is currently no single procedure for diagnosing or ruling out reflux disease, it is evident that the anatomy and pathophysiology of GERD are of decisive importance for understanding the underlying mechanisms of this disease. To date, data from one study show a sensitivity and specificity of 70% and 67%, respectively, for accurate history-taking among experts in the field of gastroenterology (Dent et al., 2010). Through detailed knowledge of these aspects, physicians can develop more targeted treatment approaches and respond individually to the needs of patients.  <\/p>\n<h3><u>Epidemiology of GERD:<\/u><\/h3>\n<p>Gastroesophageal reflux disease (GERD) is a widespread gastrointestinal condition that affects people all over the world. The epidemiology of GERD encompasses a variety of factors, including prevalence, incidence, and risk factors that contribute to the development and persistence of the disease. <\/p>\n<p>The prevalence of GERD varies by geographic region, population group, and age group. In recent years, an increase in prevalence has been recorded, with GERD being diagnosed more often in countries with a high standard of living (15-25%) than in poorer countries (10%) (Richter et al., 2018; El-Serag et al., 2014). <\/p>\n<p>The incidence of GERD describes the number of newly diagnosed cases per year and reflects the risk of developing GERD. Studies have shown that the incidence of GERD has increased over time, possibly due to changes in lifestyle, dietary habits, and the rise in obesity (Sandhu et al., 2018; Katzka et al., 2020). <\/p>\n<p>The epidemiology of GERD is of great importance for public health, as it reflects a high prevalence, affects all age groups and genders, and generates high costs (Gyawali et al., 2018). The development of preventive measures and the creation of resources for the treatment and prevention of GERD must be clearly moved into the focus of research (Herregods et al., 2015). A better understanding of the epidemiology of GERD can also help quantify the burden of this disease on healthcare systems and support the development of public health interventions. Here, validated quality-of-life questionnaires and patient-reported outcomes play an important role in advancing further therapeutic studies (Alrubaiy et al., 2014). In this context, the \u201cGastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL)\u201d questionnaire can be seen as a reliable, valid, and suitable tool (Velanovich, 2007).    <\/p>\n<h3><u>Symptoms of GERD:<\/u><\/h3>\n<p>Gastroesophageal reflux disease (GERD) manifests through a variety of symptoms ranging from mild discomfort to serious complications. A comprehensive understanding of these symptoms is crucial for the diagnosis and treatment of GERD patients. The most common symptoms include chronic heartburn, chest pain, chronic cough and hoarseness, belching and bloating, nausea, and a sour taste in the mouth (Kahrilas, 2003).  <\/p>\n<p>The most common symptom of GERD is heartburn (Kahrilas, 2003), which is felt as a burning sensation behind the breastbone or in the upper abdominal area (R\u00f6sch &#038; Hotz, 2000). This burning often occurs after eating (R\u00f6sch &#038; Hotz, 2000) or when lying down and can be triggered by certain foods or drinks. Regurgitation, the feeling of the unhindered backflow of acidic stomach contents or food into the esophagus or mouth, is another characteristic symptom of GERD (Bredenoord et al., 2006).  <\/p>\n<p>In addition to heartburn and regurgitation, GERD patients may also suffer from chest pain, which can often be mistaken for heart-related issues. In half of these cases, the pain is cardiac in origin, while the other half is primarily due to diseases of the esophagus (Lenfant, 2010). Difficulty swallowing or dysphagia are also common symptoms of GERD and occur due to irritation of the esophagus by the refluxing stomach contents (Bollschweiler et al., 2008). This can lead to food getting stuck when swallowing or causing pain during swallowing.   <\/p>\n<p>Coughing, especially nocturnal coughing, can also be a symptom of GERD. Hypotheses for the mechanism by which reflux could lead to a cough include the stimulation of an esophageal-bronchial reflex or regurgitation, with or without aspiration (Kahrilas et al., 2014). This can lead to a persistent cough that often does not respond to conventional cough medicines. Other less common symptoms of GERD include hoarseness, asthma attacks, nausea, and a feeling of tightness in the throat or chest, known as globus sensation (Yuksel &#038; Vaezi, 2012).   <\/p>\n<p>It is important to note that not all GERD patients have all of these symptoms. The type and severity of symptoms can vary from person to person and can also fluctuate over time. Some patients experience occasional, mild symptoms, while others suffer from chronic and more severe complaints. The identification and appropriate treatment of these symptoms is crucial to improving patients&#8217; quality of life and preventing complications (Dent et al., 1999; Koop et al., 2005; Madisch et al., 2023).   <\/p>\n<h3><u>Diagnosis of GERD:<\/u><\/h3>\n<p>The diagnosis of gastroesophageal reflux disease (GERD) requires a careful evaluation of symptoms, a thorough medical history, and, if necessary, a series of diagnostic tests to rule out other possible causes of the symptoms and confirm the diagnosis. The Montreal Classification is seen as a widely suitable definition of GERD (Madisch et al., 2023). Some of the most important diagnostic procedures used when GERD is suspected are listed below:  <\/p>\n<p><strong>Medical history and physical examination<\/strong>: The doctor will ask the patient about their symptoms and medical history, including the timing and frequency of the complaints. A thorough physical examination can provide clues to gastrointestinal problems, such as signs of inflammation or irritation in the abdominal area. <\/p>\n<p><strong>Symptom evaluation<\/strong>: A detailed description of symptoms, particularly heartburn, regurgitation, chest pain, and difficulty swallowing, is crucial for the diagnosis of GERD. Regardless of specific measurement methods, the doctor will use the Montreal Classification to ask about the intensity of symptoms, their triggers, and possible accompanying symptoms to define GERD (Madisch et al., 2023). <\/p>\n<p><strong>Proton Pump Inhibitor (PPI) test<\/strong>: In some cases, a therapeutic trial with proton pump inhibitors may be performed to see if symptoms respond to treatment with acid blockers. If symptoms improve during the PPI test, this suggests a possible GERD diagnosis. However, collected data show only low specificity, which is why patients with functional dyspepsia also respond when using the PPI test (Sifrim &#038; Zerbib, 2012). Further studies have additionally shown that 28% of reflux-associated symptoms are caused by non-acidic reflux. In these cases, the PPI test is negative (Boeckxstaens &#038; Smout, 2010).    <\/p>\n<p><strong>Endoscopy<\/strong>: An endoscopy is a diagnostic procedure in which a flexible tube with a camera (endoscope) is inserted through the mouth into the esophagus, stomach, and duodenum. This allows the doctor to assess the condition of the mucosa, identify inflammation, ulcers, or changes, and take tissue samples (biopsies) to rule out other diseases (Lin et al., 2019). In addition to obtaining important information for prognosis and treatment planning, endoscopy can also have a reassuring effect on anxious patients (Garc\u00eda-Alt\u00e9s et al., 2005).  <\/p>\n<p><strong>pH monitoring<\/strong>: pH monitoring is a procedure for measuring the acidity in the esophagus over a 24-hour period. This can help identify abnormal amounts of stomach acid in the lower esophagus and quantify the degree of acid reflux. However, studies here have also shown that only half of reflux episodes could be detected with pH measurement alone (Sifrim et al., 1999).  <\/p>\n<p><strong>Manometry<\/strong>: Manometry is an examination in which the pressure in the esophagus is measured to assess the function of the lower esophageal sphincter. This can help determine if the sphincter closes properly and if there are abnormalities in muscle movement. For the differential diagnostic exclusion of a motility disorder and before surgical intervention for GERD, high-resolution (HR) esophageal manometry should be performed (Madisch et al., 2023).  <\/p>\n<p><strong>X-ray examinations<\/strong>: Although used less frequently, X-ray examinations such as a barium swallow study can be performed to reveal changes in the anatomy of the esophagus and stomach (Varban et al., 2011; Wilshire et al., 2016).<\/p>\n<p>The choice of diagnostic tests depends on the individual symptoms and the clinical presentation of the patient. A holistic approach considering symptoms, medical history, and test results is crucial for an accurate diagnosis and the development of an appropriate treatment plan for GERD patients. <\/p>\n<h3><u>Treatment Options for GERD:<\/u><\/h3>\n<p>The treatment of gastroesophageal reflux disease (GERD) aims to relieve symptoms, prevent complications, and improve the quality of life of patients (Wood-Dauphinee &#038; Korolija, 2006). There are various treatment options that can be adjusted depending on the severity of symptoms, response to treatment, and individual patient needs. Here are some of the common treatment options for GERD:  <\/p>\n<p><strong>Lifestyle changes<\/strong>: One of the first measures in treating GERD often involves lifestyle changes. Reducing weight in cases of obesity, avoiding large meals, and abstaining from triggering foods\/factors such as fatty, spicy, or acidic foods, alcohol\/caffeine, and smoking can already achieve significant improvements in GERD patients (Ness-Jensen et al., 2016; Yuan et al., 2019). <\/p>\n<p><strong>Drug therapy<\/strong>: Various medications can be used to treat GERD and aim to reduce acid production (including proton pump inhibitors (PPIs) or H2 blockers), neutralize stomach acid (antacids), or have an effect on the LES (prokinetics) (Wright, 2007). PPIs are the most commonly prescribed medications and work by reducing the production of stomach acid, specifically acting on the gastric acid pump in the final step of acid production in the stomach (Sachs et al., 1993; Pettit, 2005). H2 blockers decrease the production of stomach acid by blocking the H2 receptors of cells involved in acid production (Omari et al., 2007). In contrast, antacids neutralize excess stomach acid (Kroch &#038; Madanick, 2017). Prokinetics help the stomach empty faster and reduce reflux (Dean et al., 2004; Sanger, 2009).    <\/p>\n<p><strong>Surgical interventions<\/strong>: It has been shown that patients for whom medications are not sufficiently effective or who do not respond to lifestyle changes can benefit from surgical therapy (Smith et al., 2010; Kaufman et al., 2006). Fundoplication is a commonly performed surgery for treating GERD, in which the upper part of the stomach is wrapped around the lower esophageal sphincter to prevent the backflow of stomach acid (Cao et al., 2012; Broeders et al., 2013). This surgery is usually performed minimally invasively and can provide long-term relief of symptoms (Maret-Ouda et al., 2015; Maret-Ouda et al., 2016).  <\/p>\n<p><strong>Endoscopic procedures<\/strong>: Advanced endoscopic procedures such as transoral incisionless fundoplication (TIF) can be an alternative to conventional surgery. In TIF, an endoscope is inserted through the mouth into the esophagus to perform the fundoplication without having to make incisions in the abdomen. This method can be less invasive and offer a faster recovery time (Huang et al., 2017).  <\/p>\n<p><strong>Monitoring and adjustment of therapy<\/strong>: The treatment of GERD often requires continuous monitoring and adjustment to achieve the best results. This may include regular assessment of symptoms, monitoring of medication reactions, and adjustment of dosages or treatment modalities. <\/p>\n<p>It is important that the treatment of GERD is tailored individually to the needs and preferences of each patient. A holistic approach involving lifestyle changes, medications, and, if necessary, surgical measures can help control symptoms, avoid complications, and improve the quality of life of patients. <\/p>\n<h3><u>Impact of GERD on Quality of Life:<\/u><\/h3>\n<p>Gastroesophageal reflux disease (GERD) can have a significant impact on the quality of life of those affected, going far beyond purely physical symptoms. The chronic complaints associated with GERD can severely impair patients&#8217; daily lives and lead to psychosocial problems (Lee et al., 2014; Lee et al., 2017). <\/p>\n<ol>\n<li>Impairment of physical activity (Ronkainen et al., 2006): A common symptom of GERD, such as heartburn or difficulty swallowing, can impair patients&#8217; ability to perform certain activities, especially those requiring physical exertion. As a result, patients may not be able to move as freely as desired or may even have to give up certain activities, which can lead to a loss of quality of life. <\/li>\n<li>Dietary restrictions (Lee et al., 2017): Many GERD patients experience restrictions in their diet due to trigger foods that can worsen their symptoms. These restrictions can lead to frustration and limitations in food choices, which can affect social and emotional well-being. Furthermore, the fear of trigger situations can negatively influence eating habits and lead to a reduced quality of life.  <\/li>\n<li>Sleep disorders (Lee et al., 2017): Many GERD patients suffer from sleep disorders due to nocturnal heartburn or regurgitation. The backflow of stomach acid into the esophagus can lead to nocturnal coughing, waking from sleep, and a general feeling of restlessness, resulting in sleep disturbances and reduced sleep quality. This can lead to the development of fatigue, exhaustion, and impairments in daytime functioning.  <\/li>\n<li>Psychosocial effects (Wahlqvist et al., 2002): The chronic symptoms of GERD can also have psychosocial effects, such as anxiety, depression, social isolation, and a general feeling of dissatisfaction. The constant burden of symptoms and the need to constantly watch for possible triggers can impair patients&#8217; emotional well-being and lead to a reduced quality of life. <\/li>\n<li>Impairment of work ability (Wahlqvist et al., 2002; Dean et al., 2003; Dubois et al., 2007): For many people, GERD can also impair work ability, especially if symptoms occur during working hours or interfere with certain professional activities. This can lead to absenteeism, reduced productivity, and professional difficulties, which in turn can affect the mental well-being and quality of life of those affected. <\/li>\n<\/ol>\n<p>Overall, these effects show that GERD can have far-reaching consequences for the quality of life of those affected, going beyond purely physical symptoms. A holistic treatment approach that not only controls symptoms but also considers psychosocial effects is crucial to achieving a comprehensive improvement in the quality of life of GERD patients. <\/p>\n<h3><u>The GERD-HRQL Questionnaire:<\/u><\/h3>\n<p>The GERD-HRQL questionnaire, whose full name is Gastroesophageal Reflux Disease-Health-Related Quality of Life, is an important instrument for assessing the quality of life of patients with gastroesophageal reflux disease (GERD) (Velanovich, 2007). This questionnaire was developed to capture not only the physical symptoms of GERD but also to consider the impact of the disease on daily life, mental well-being, and the social activities of those affected. <\/p>\n<ol>\n<li>Origin and development: The GERD-HRQL questionnaire was developed in the 1990s by researchers to provide a standardized method for capturing the quality of life of GERD patients. It is based on the idea that the effects of GERD go beyond purely physiological symptoms and therefore aspects such as emotional well-being, social interactions, and daily activities must also be considered. <\/li>\n<li>Questionnaire structure and content: The GERD-HRQL questionnaire consists of a series of questions covering various aspects of quality of life. Topics include the frequency and severity of heartburn, regurgitation, chest pain, difficulty swallowing, and the impact of these symptoms on activities such as eating, sleeping, working, and social interactions. The questions are designed to provide a comprehensive overview of the physical, psychological, and social effects of GERD on the patient&#8217;s quality of life.  <\/li>\n<li>Application and assessment: The GERD-HRQL questionnaire is used in clinical practice as well as in clinical trials to assess the quality of life of GERD patients and measure the success of treatments. Patients&#8217; responses are used to calculate an overall score that indicates how much quality of life is impaired by GERD. A higher score indicates a poorer quality of life, while a lower score signals a better quality of life.  <\/li>\n<li>Validity and reliability (Velanovich et al., 1996; Velanovich et al., 1998): The GERD-HRQL questionnaire has been extensively validated and has proven to be a reliable instrument for measuring the quality of life of GERD patients. Studies have shown that the questionnaire has good internal consistency, test-retest reliability, and construct validity. This means that it is repeatable and actually measures what it is intended to measure.  <\/li>\n<li>Clinical significance: By using the GERD-HRQL questionnaire, doctors and researchers can develop a better understanding of the impact of GERD on patients&#8217; daily lives and well-being. This makes it possible to develop treatment strategies that not only control physical symptoms but also improve the quality of life of those affected. The questionnaire can also help improve communication between doctor and patient by allowing patients to articulate their symptoms and their effects more clearly.  <\/li>\n<\/ol>\n<h2><u>Conclusion:<\/u><\/h2>\n<p>In conclusion, the comprehensive analysis of GERD and its impact on quality of life illustrates the complex nature of this disease and the need for a holistic treatment approach. The symptoms of GERD can cause not only physical complaints but also significant psychosocial burdens that can severely impair the quality of life of those affected. The GERD-HRQL questionnaire proves to be a valuable tool for quantifying these effects and developing treatment strategies that not only relieve symptoms but also improve quality of life. Through a holistic view of GERD, doctors and researchers can help increase patient well-being and maximize their quality of life, ultimately leading to better management and a better lifestyle for GERD patients.<\/p>\n<\/div><\/section><\/div><div class='av-flex-placeholder'><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-22lbze-394068518114cb0f6aab8df72f10ad70\">\n#top .flex_column_table.av-equal-height-column-flextable.av-22lbze-394068518114cb0f6aab8df72f10ad70{\nmargin-top:-5px;\nmargin-bottom:0px;\n}\n.flex_column.av-22lbze-394068518114cb0f6aab8df72f10ad70{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-22lbze-394068518114cb0f6aab8df72f10ad70 av_one_fifth  avia-builder-el-5  el_after_av_three_fifth  avia-builder-el-last  flip-mobile av-break-at-tablet flex_column_table_cell av-equal-height-column av-align-middle av-zero-column-padding  '     ><\/div><\/div><!--close column table wrapper. Autoclose: 1 --><\/div><\/div><\/div><!-- close content main div --><\/div><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-4t32pj-8570157c0eb32b4f5382d91be5aafcb7\">\n.avia-section.av-4t32pj-8570157c0eb32b4f5382d91be5aafcb7{\nbackground-color:var(--green1);\nbackground-image:unset;\n}\n<\/style>\n<div id='av_section_3'  class='avia-section av-4t32pj-8570157c0eb32b4f5382d91be5aafcb7 main_color avia-section-default avia-no-border-styling  avia-builder-el-6  el_after_av_section  el_before_av_postcontent  column_flex_reorder avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-8261'><div class='entry-content-wrapper clearfix'>\n<div class='flex_column_table av-22verb-60c6ec3f8a91bc2ec3bebe6c28d33022 sc-av_one_full av-break-at-tablet-flextable av-equal-height-column-flextable'>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-22verb-60c6ec3f8a91bc2ec3bebe6c28d33022\">\n.flex_column.av-22verb-60c6ec3f8a91bc2ec3bebe6c28d33022{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-22verb-60c6ec3f8a91bc2ec3bebe6c28d33022 av_one_full  avia-builder-el-7  avia-builder-el-no-sibling  first av-break-at-tablet flex_column_table_cell av-equal-height-column av-align-middle av-zero-column-padding  '     ><section  class='av_textblock_section av-lu2ou9gb-94412687cade045e97a72f7835b0f402 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h4>References<\/h4>\n<ol>\n<li>Alrubaiy L, Hutchings HA, Williams JG (2014). Assessing patient reported outcome measures: a practical guide for gastroenterologists. United European Gastroenterol J 2:463\u201370.  <\/li>\n<li>Boeckxstaens GE, Smout A (2010). Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastro-oesophageal reflux disease. Alimentary Pharmacology &#038; Therapeutics 32: 334\u2013343  <\/li>\n<li>Bollschweiler E, Knoppe K, Wolfgarten E &#038; H\u00f6lscher AH (2008). Prevalence of dysphagia in patients with gastroesophageal reflux in Germany. Dysphagia, 23, 172-176.  <\/li>\n<li>Bredenoord AJ, Weusten BL, Curvers WL, Timmer R &#038; Smout AJ (2006). Determinants of perception of heartburn and regurgitation. Gut, 55(3), 313-318.  <\/li>\n<li>Broeders JA, Broeders EA, Watson DI, Devitt PG, Holloway RH &#038; Jamieson GG (2013). Objective outcomes 14 years after laparoscopic anterior 180-degree partial versus nissen fundoplication: results from a randomized trial. <\/li>\n<li>Broeders JA, Roks DJ, Ali UA, Watson DI, Baigrie RJ, Cao Z, &#8230; &#038; Maddern GJ (2013). Laparoscopic anterior 180-degree versus nissen fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials. Annals of surgery, 257(5), 850-859.  <\/li>\n<li>Cao Z, Cai W, Qin M, Zhao H, Yue P &#038; Li Y (2012). Randomized clinical trial of laparoscopic anterior 180 partial versus 360 Nissen fundoplication: 5-year results. Diseases of the Esophagus, 25(2), 114-120.  <\/li>\n<li>Dean BB, Crawley JA, Schmitt CM, Wong J, Ofman JJ (2003). The burden of illness of gastro-oesophageal reflux disease: impact on work productivity. Aliment Pharmacol Ther.   17(10):1309-1317.<\/li>\n<li>Dean BB, Gano Jr AD, Knight K, Ofman JJ &#038; Fass R (2004). Effectiveness of proton pump inhibitors in nonerosive reflux disease. Clinical Gastroenterology and Hepatology, 2(8), 656-664.  <\/li>\n<li>Dent J, Brun J, Fendrick AM et al. (1999). An evidence-based appraisal of reflux disease management \u2013 the Genval Workshop Report. Gut 44: S1\u2013S16 <\/li>\n<li>Dent J, Vakil N, Jones R et al. (2010). Accuracy of the diagnosis of GORD by questionnaire, physicians and a trial of proton pump inhibitor treatment: the Diamond Study. Gut 59: 714\u2013721 <\/li>\n<li>Dubois RW, Aguilar D, Fass R, Orr WC, Elfant AB, Dean BB, Harper AS, et al. (2007). Consequences of frequent nocturnal gastro-oesophageal reflux disease among employed adults: symptom severity, quality of life and work productivity. Aliment Pharmacol Ther.  25(4):487-500.<\/li>\n<li>El-Serag HB, Sweet S, Winchester CC et al. (2014). Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63: 871\u2013880 <\/li>\n<li>Eusebi LH, Ratnakumaran R, Yuan Y et al. (2018). Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut 67: 430\u2013440 <\/li>\n<li>Garcia-Altes A, Rota R, Barenys M et al. (2005). Cost effectiveness of a \u201cscore and scope\u201d strategy for the management of dyspepsia. Eur J Gastroenterol Hepatol 17: 709\u2013719 <\/li>\n<li>Gyawali CP, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout AJ, &#8230; &#038; Roman S (2018). Modern diagnosis of GERD: the Lyon Consensus. Gut, 67(7), 1351-1362.  <\/li>\n<li>Herregods TV, Bredenoord AJ, Smout AJ (2015). Pathophysiology of gastroesophageal reflux disease: new understanding in a new era. Neurogastroenterol Motil.   27: 1202-13.<\/li>\n<li>Huang X, Chen S, Zhao H, Zeng X, Lian J, Tseng Y &#038; Chen J (2017). Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surgical endoscopy, 31, 1032-1044.  <\/li>\n<li>Kahrilas PJ (2003). GERD pathogenesis, pathophysiology, and clinical manifestations. Cleveland Clinic journal of medicine, 70(5), S4.  <\/li>\n<li>Kahrilas PJ, Smith JA &#038; Dicpinigaitis PV (2014). A causal relationship between cough and gastroesophageal reflux disease (GERD) has been established: a pro\/con debate. Lung, 192, 39-46.  <\/li>\n<li>Katzka DA, Kahrilas PJ (2020). Advances in the diagnosis and management of gastroesophageal reflux disease. 371: m3786.  <\/li>\n<li>Kaufman JA, Houghland JE, Quiroga E et al. (2006). Long-term outcomes of laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD)-related airway disorder. Surg Endosc 20: 1824\u20131830 <\/li>\n<li>Koop H, Schepp W, Muller-Lissner S et al. (2005). Gastroosophageale Refluxkrankheit \u2013 Ergebnisse einer evidenzbasierten Konsensuskonferenz der Deutschen Gesellschaft fur Verdauungs- und Stoffwechselkrankheiten. Z Gastroenterol 43: 163\u2013164 <\/li>\n<li>Kroch DA &#038; Madanick RD (2017). Medical treatment of gastroesophageal reflux disease. World journal of surgery, 41, 1678-1684.  <\/li>\n<li>Lee SW, Lien HC, Lee TY, Yang SS, Yeh HJ &#038; Chang CS (2014). Heartburn and regurgitation have different impacts on life quality of patients with gastroesophageal reflux disease. World Journal of Gastroenterology: WJG, 20(34), 12277.  <\/li>\n<li>Lee SW, Lee TY, Lien HC, Peng YC, Yeh HJ &#038; Chang CS (2017). Correlation between symptom severity and health-related life quality of a population with gastroesophageal reflux disease. Gastroenterology research, 10(2), 78.  <\/li>\n<li>Lenfant C (2010). Chest pain of cardiac and noncardiac origin. Metabolism, 59, S41-S46.  <\/li>\n<li>Lin EC, Holub J, Lieberman D et al. (2019). Low Prevalence of Suspected Barrett\u02bcs Esophagus in Patients With Gastroesophageal Reflux Disease Without Alarm Symptoms. Clinical Gastroenterology and Hepatology 17: 857\u2013863 <\/li>\n<li>Liu L, Li S, Zhu K et al. (2019). Relationship between esophageal motility and severity of gastroesophageal reflux disease according to the Los Angeles classification. Medicine 98: e15543\u2013e15543 <\/li>\n<li>Madisch A, Koop H, Miehlke S, Leers J, Lorenz P, Lynen P, &#8230; &#038; Pr\u00fcfling I (2023). S2k-Leitlinie Gastro\u00f6sophageale Refluxkrankheit und eosinophile \u00d6sophagitis der Deutschen Gesellschaft f\u00fcr Gastroenterologie, Verdauungs-und Stoffwechselkrankheiten (DGVS). Z Gastroenterol.  <\/li>\n<li>Maret-Ouda J, Brusselaers N &#038; Lagergren J (2015). What is the most effective treatment for severe gastro-oesophageal reflux disease?. BMJ, 350.<\/li>\n<li>Maret-Ouda J, Yanes M, Konings P, Brusselaers N &#038; Lagergren J (2016). Mortality from laparoscopic antireflux surgery in a nationwide cohort of the working-age population. Journal of British Surgery, 103(7), 863-870.  <\/li>\n<li>Ness-Jensen E, Hveem K, El-Serag H, Lagergren J (2016). Lifestyle Intervention in Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol. 14: 175-82 e1-3.   <\/li>\n<li>Omari TI, Haslam RR, Lundborg P &#038; Davidson GP (2007). Effect of omeprazole on acid gastroesophageal reflux and gastric acidity in preterm infants with pathological acid reflux. Journal of pediatric gastroenterology and nutrition, 44(1), 41-44.  <\/li>\n<li>Orlando RC (1997). The pathogenesis of gastroesophageal reflux disease: the relationship between epithelial defense, dysmotility, and acid exposure. Am J Gastroenterol 92(suppl 4):3S\u20135S.  <\/li>\n<li>Pettit M (2005). Treatment of gastroesophageal reflux disease. Pharmacy World and Science, 27, 432-435.  <\/li>\n<li>Richter JE, Rubenstein JH (2018). Presentation and Epidemiology of Gastroesophageal Reflux Disease. Gastroenterology 154: 267\u2013276  <\/li>\n<li>Ronkainen J, Aro P, Storskrubb T, Lind T, Bolling-Sternevald E, Junghard O, Talley NJ, et al. (2006). Gastroesophageal reflux symptoms and health related quality of life in the adult general population &#8211; the Kalixandra study. Aliment Pharmacol Ther.  23:1725-1733.<\/li>\n<li>R\u00f6sch W &#038; Hotz J (2000). Volkskrankheit Sodbrennen: Therapieoptimierung mit Protonenpumpenhemmern. Dtsch Arztebl, 97(40).  <\/li>\n<li>Sandhu DS, Fass R (2018). Current Trends in the Management of Gastroesophageal Reflux Disease. Gut Liver.   12: 7-16.<\/li>\n<li>Sanger GJ (2009). Translating 5\u2010HT4 receptor pharmacology. Neurogastroenterology &#038; Motility, 21(12), 1235-1238.  <\/li>\n<li>Sachs G, Shin JM, Besancon M &#038; Prinz C (1993). The continuing development of gastric acid pump inhibitors. Alimentary pharmacology &#038; therapeutics, 7, 4-12.  <\/li>\n<li>Sch\u00fcnke M, Schulte E &#038; Schumacher U (2018). PROMETHEUS Innere Organe: LernAtlas Anatomie. Georg Thieme Verlag.  <\/li>\n<li>Sifrim D, Silny J, Holloway RH et al. (1999). Patterns of gas and liquid reflux during transient lower oesophageal sphincter relaxation: a study using intraluminal electrical impedance. Gut 44: 47\u201354 <\/li>\n<li>Sifrim D, Zerbib F (2012). Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut 61: 1340\u20131354  <\/li>\n<li>Smith JA, Decalmer S, Kelsall A et al. (2010). Acoustic cough reflux associations in chronic cough: potential triggers and mechanisms. Gastroenterology 139: 754\u2013762 <\/li>\n<li>Varban OA, McCoy TP, Westcott C (2011). A comparison of pre-operative comorbidities and post-operative outcomes among patients undergoing laparoscopic nissen fundoplication at high- and low-volume centers. J Gastrointest Surg 15: 1121\u20131127  <\/li>\n<li>Vakil N, van Zanten SV, Kahrilas P et al. (2006). The Montreal Definition and Classification of Gastroesophageal Reflux Disease: A Global Evidence-Based Consensus. The American Journal of Gastroenterology 101: 1900\u20131920 <\/li>\n<li>Velanovich V, Vallance S R, Gusz J R, Tapice F V, Hurkabus M A (1996). Quality of life scale for gastroesophageal reflux disease. J AM Coll Surg 183: 217\u201324.  <\/li>\n<li>Velanovich V (1998). Comparison of generic (SF-36) vs. diseasespecific (GERD-HRQL) quality-of-life scales for gastroesophageal reflux disease. J Gastrointest Surg 2: 141\u20135.  <\/li>\n<li>Velanovich V (2007). The development of the GERD-HRQL symptom severity instrument. Diseases of the Esophagus, 20(2), 130-134.  <\/li>\n<li>Wahlqvist P, Carlsson J, Stalhammar NO, Wiklund I (2002). Validity of a Work Productivity and Activity Impairment questionnaire for patients with symptoms of gastro-esophageal reflux disease (WPAI-GERD) &#8211; results from a cross-sectional study. Value Health.   5(2):106-113.<\/li>\n<li>Wilshire CL, Louie BE, Shultz D et al. (2016). Clinical Outcomes of Reoperation for Failed Antireflux Operations. Ann Thorac Surg 101: 1290\u20131296 <\/li>\n<li>Wood-Dauphinee S, Korolija D (2006). Symptoms, health related quality of life and patient satisfaction: using these patient-reported outcomes in people with gastroesophageal reflux disease. In: Granderath F A, Kamolz T, Pointner R, (eds). Gastroesophageal Reflux Disease: Principles of Disease, Diagnosis, and Treatment. Vienna: Springer, 269\u201386.    <\/li>\n<li>Wright W (2007). Taming the Flame, Advance for Nurse Practitioners (Vol. 15), No. 9, pages 49-53. <\/li>\n<li>Yuan LZ, Yi P, Wang GS, Tan SY, Huang GM, Qi LZ, et al. (2019). Lifestyle intervention for gastroesophageal reflux disease: a national multicenter survey of lifestyle factor effects on gastroesophageal reflux disease in China. Therap Adv Gastroenterol.  12: 1-12.<\/li>\n<li>Yuksel ES &#038; Vaezi M (2012). Extraesophageal manifestations of gastroesophageal reflux disease: cough, asthma, laryngitis, chest pain. Swiss medical weekly, 142(1112), w13544-w13544.  <\/li>\n<\/ol>\n<\/div><\/section><\/div><\/div><!--close column table wrapper. Autoclose: 1 -->\n<\/p>\n[av_section min_height='' min_height_pc='25' min_height_px='500px' padding='default' custom_margin='0px' custom_margin_sync='true' color='main_color' background='bg_color' custom_bg='var(--green1)' background_gradient_color1='var(--green100)' background_gradient_color2='var(--green1)' background_gradient_direction='vertical' src='' attachment='' attachment_size='' attach='scroll' position='bottom right' repeat='no-repeat' video='' video_ratio='16:9' overlay_opacity='0.5' overlay_color='' overlay_pattern='' overlay_custom_pattern='' shadow='no-border-styling' bottom_border='no-border-styling' bottom_border_diagonal_color='#333333' bottom_border_diagonal_direction='' bottom_border_style='' custom_arrow_bg='' id='' custom_class='column_flex_reorder' aria_label='' av_element_hidden_in_editor='0' av_uid='av-9ypwv']\n\n[av_one_full first min_height='av-equal-height-column' vertical_alignment='av-align-top' space='' row_boxshadow_color='' row_boxshadow_width='10' margin='0px' margin_sync='true' mobile_breaking='av-break-at-tablet' border='' border_color='' radius='0px' radius_sync='true' padding='0px' padding_sync='true' column_boxshadow_color='' column_boxshadow_width='10' background='bg_color' background_color='' background_gradient_color1='' background_gradient_color2='' background_gradient_direction='vertical' src='' attachment='' attachment_size='' background_position='top left' background_repeat='no-repeat' highlight_size='1.1' animation='' link='' linktarget='' link_hover='' title_attr='' alt_attr='' mobile_display='' id='' custom_class='flip-mobile' aria_label='' av_uid='av-sifpz']\n\n[av_textblock size='' av-medium-font-size='' av-small-font-size='' av-mini-font-size='' font_color='' color='' id='' custom_class='' av_uid='av-kuzes252' admin_preview_bg='']\n<h3>Learn more about the following topics<\/h3>\n[\/av_textblock]\n\n[\/av_one_full][av_one_third first min_height='av-equal-height-column' vertical_alignment='av-align-top' space='' row_boxshadow_color='#757575' row_boxshadow_width='10' margin='0px' margin_sync='true' mobile_breaking='av-break-at-tablet' border='' border_color='' radius='0px' radius_sync='true' padding='0px' padding_sync='true' column_boxshadow_color='' column_boxshadow_width='10' background='bg_color' background_color='' background_gradient_color1='' background_gradient_color2='' background_gradient_direction='vertical' src='' attachment='' attachment_size='' background_position='top left' background_repeat='no-repeat' highlight_size='1.1' animation='' link='' linktarget='' link_hover='' title_attr='' alt_attr='' mobile_display='' id='' custom_class='img_rahmen' aria_label='' av_uid='av-sifpz-5']\n\n[av_image_txt src=\"https:\/\/www.roleca.com\/wp-content\/uploads\/169_ROLECA_Verdauungsbeschwerden.jpg\" attachment=\"2213\" attachment_size=\"full\" copyright=\"\" caption=\"yes\" styling=\"\" align=\"center\" font_size=\"\" overlay_opacity=\"0.4\" overlay_color=\"#000000\" overlay_text_color=\"#ffffff\" animation=\"no-animation\" hover=\"\" appearance=\"\" link=\"\" target=\"\" title_attr=\"\" alt_attr=\"bl\u00e4hungen und v\u00f6llegef\u00fchl\" lazy_loading=\"disabled\" id=\"\" custom_class=\"\" av_element_hidden_in_editor=\"0\" av_uid=\"av-kuza838l\" admin_preview_bg=\"\"]\n<h4>Bloating and Fullness<\/h4>\nIn a survey, 7 out of 10 respondents reported having suffered from digestive issues in the past 12 months. Bloating and fullness are often leading symptoms that are uncomfortable for those affected. You can find more detailed information and a suggested treatment here.  \n\n<span class=\"rpbutton\"><a href=\"https:\/\/www.roleca.com\/verdauung\/verdauungsprobleme\/#haeufigesymptomeverdauungsprobleme\">Learn More<\/a><\/span>\n[\/av_image_txt]\n\n[\/av_one_third][av_one_third min_height='av-equal-height-column' vertical_alignment='av-align-top' space='' row_boxshadow_color='#757575' row_boxshadow_width='10' margin='0px' margin_sync='true' mobile_breaking='av-break-at-tablet' border='' border_color='' radius='0px' radius_sync='true' padding='0px' padding_sync='true' column_boxshadow_color='' column_boxshadow_width='10' background='bg_color' background_color='' background_gradient_color1='' background_gradient_color2='' background_gradient_direction='vertical' src='' attachment='' attachment_size='' background_position='top left' background_repeat='no-repeat' highlight_size='1.1' animation='' link='' linktarget='' link_hover='' title_attr='' alt_attr='' mobile_display='' id='' custom_class='img_rahmen' aria_label='' av_uid='av-sifpz-4']\n\n[av_image_txt src=\"https:\/\/www.roleca.com\/wp-content\/uploads\/rolecapharma_21968563.jpg\" attachment=\"2199\" attachment_size=\"full\" copyright=\"\" caption=\"yes\" styling=\"\" align=\"center\" font_size=\"\" overlay_opacity=\"0.4\" overlay_color=\"#000000\" overlay_text_color=\"#ffffff\" animation=\"no-animation\" hover=\"\" appearance=\"\" link=\"\" target=\"\" title_attr=\"\" alt_attr=\"darmmirkobiom\" img_scrset=\"\" lazy_loading=\"disabled\" id=\"\" custom_class=\"\" template_class=\"\" av_element_hidden_in_editor=\"0\" av_uid=\"av-kuza838l-3\" sc_version=\"1.0\" admin_preview_bg=\"\"]\n<h4>The Gut Microbiome<\/h4>\nCentral functions such as breaking down food, providing essential vitamins and nutrients, and protecting against pathogens and strengthening the immune system are just an initial indication of how important the gut microbiome is for holistic health.\n\n<span class=\"rpbutton\"><a href=\"https:\/\/www.roleca.com\/verdauung\/mikrobiom\/\">Learn More<\/a><\/span>\n[\/av_image_txt]\n\n[\/av_one_third][av_one_third min_height='av-equal-height-column' vertical_alignment='av-align-top' space='' row_boxshadow_color='#757575' row_boxshadow_width='10' margin='0px' margin_sync='true' mobile_breaking='av-break-at-tablet' border='' border_color='' radius='0px' radius_sync='true' padding='0px' padding_sync='true' column_boxshadow_color='' column_boxshadow_width='10' background='bg_color' background_color='' background_gradient_color1='' background_gradient_color2='' background_gradient_direction='vertical' src='' attachment='' attachment_size='' background_position='top left' background_repeat='no-repeat' highlight_size='1.1' animation='' link='' linktarget='' link_hover='' title_attr='' alt_attr='' mobile_display='' id='' custom_class='img_rahmen' aria_label='' av_uid='av-sifpz-2']\n\n[av_image_txt src=\"https:\/\/www.roleca.com\/wp-content\/uploads\/roleca_laxan_brausetablette_anwendung_web.jpg\" attachment=\"3909\" attachment_size=\"full\" copyright=\"\" caption=\"yes\" styling=\"\" align=\"center\" font_size=\"\" overlay_opacity=\"0.4\" overlay_color=\"#000000\" overlay_text_color=\"#ffffff\" animation=\"no-animation\" hover=\"\" appearance=\"\" link=\"\" target=\"\" title_attr=\"\" alt_attr=\"tr\u00e4ger darm ankurbeln\" img_scrset=\"\" lazy_loading=\"disabled\" id=\"\" custom_class=\"\" template_class=\"\" av_element_hidden_in_editor=\"0\" av_uid=\"av-kuza838l-1\" sc_version=\"1.0\" admin_preview_bg=\"\"]\n<h4>Roleca\u00ae Macrogol Effervescent Tablets<\/h4>\nStaying active is a commonly heard piece of advice for general health. Movement is beneficial and contributes to a healthy lifestyle, especially outdoors. Our gut also benefits from a change of pace from long periods of sitting. But what to do when the gut is sluggish?\n\n<span class=\"rpbutton\"><a href=\"https:\/\/www.roleca.com\/produkte\/macrogol\/\">Learn More<\/a><\/span>\n[\/av_image_txt]\n\n[\/av_one_third][\/av_section]\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":14,"featured_media":0,"parent":8360,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8261","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.roleca.com\/en\/wp-json\/wp\/v2\/pages\/8261","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.roleca.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.roleca.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.roleca.com\/en\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/www.roleca.com\/en\/wp-json\/wp\/v2\/comments?post=8261"}],"version-history":[{"count":5,"href":"https:\/\/www.roleca.com\/en\/wp-json\/wp\/v2\/pages\/8261\/revisions"}],"predecessor-version":[{"id":8303,"href":"https:\/\/www.roleca.com\/en\/wp-json\/wp\/v2\/pages\/8261\/revisions\/8303"}],"up":[{"embeddable":true,"href":"https:\/\/www.roleca.com\/en\/wp-json\/wp\/v2\/pages\/8360"}],"wp:attachment":[{"href":"https:\/\/www.roleca.com\/en\/wp-json\/wp\/v2\/media?parent=8261"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}