Dr. Bernhard Drummer, M.D., is a renowned reflux specialist and the chief physician of the Department of General Surgery at the prestigious Forchheim Hospital, north of Nuremberg. With his extensive expertise and many years of experience, he has specialized in the treatment of reflux disorders. As a dedicated physician, Dr. Drummer has successfully treated numerous patients with reflux and heartburn, helping them regain their quality of life. He possesses comprehensive knowledge of the anatomical and physiological causes of reflux, as well as the latest diagnostic and therapeutic approaches for effectively treating this condition.
Dr. Drummer is known for his patient-centered approach and empathetic manner. He takes the time to understand the individual needs and challenges of each patient and to develop personalized treatment plans. This experienced specialist has expertise in many areas of surgery, but already during his doctoral research he specialized in a field in which he has developed exceptional expertise—reflux. As a result, everyone in the greater Forchheim area—the district seat of Bavaria—who suffers from reflux disease has a globally recognized specialist to turn to.
Dr. Drummer gained international renown as the developer of a special mesh used to reinforce a hiatal hernia, i.e., a diaphragmatic hernia. This innovation, known as SERAMESH® PA DRUM, can be flexibly adapted to individual anatomical conditions and is used by reflux surgeons around the world. Surgeons from every continent come to him for observational training on surgical treatments for reflux disease. The editorial team of the Leading Medicine Guide took the opportunity to speak with Dr. Drummer about the important topic of “reflux.”
Reflux is a truly widespread condition: an estimated twenty percent of people in German-speaking countries suffer from the backflow of stomach contents into the esophagus. In most cases, this causes heartburn—a burning sensation that rises from the pit of the stomach behind the breastbone and extends up to the throat. “When the contents of the stomach flow back into the esophagus, acid forms. This leads to irritation and inflammation of the esophagus, which in turn causes heartburn. This is the symptom of reflux,” Dr. Drummer begins our conversation to clarify the difference between heartburn and reflux. Certain foods, such as alcohol, fruit juices, etc., exacerbate the heartburn problem.
“Being severely overweight is also often the cause of reflux, because pressure in the abdominal cavity pushes acid from the stomach into the esophagus. Smoking and drinking carbonated water or consuming acidic foods contribute to reflux. If a patient comes to me with such a list of habits, weight loss and a change in diet are the first steps toward a solution. In cases of morbid obesity, weight loss should be the primary focus. We can help with this as well, since we are a certified obesity center. Elevating the upper body while sleeping can help alleviate reflux,” explains Dr. Drummer regarding the initial steps. “Many people take pills to reduce acid production, but these often don’t help at all. A regular endoscopy is definitely recommended, and above all, a visit to a doctor who specializes in reflux. “I don’t buy sausage at the bakery, after all,” Dr. Drummer advises emphatically, adding one more important point: “There are no certifications for reflux centers—anyone can call themselves a specialist. Standards definitely need to be tightened here. At Forchheim Hospital, we follow what’s known as the ‘tailored approach’ to treatment, which means a therapy customized for each patient. For reflux patients who are severely overweight, for example, an obesity board consisting of six doctors works out the best possible treatment plan for the patient.”
Various risk factors can contribute to the development of reflux and heartburn.
Being overweight, smoking, certain dietary habits, tight clothing, pregnancy, and certain medications can increase the risk. Measures can be taken to minimize these risk factors. These include weight loss, quitting smoking, adjusting dietary habits, avoiding tight clothing, taking medications as directed, and consulting a doctor to tailor these measures to the individual. It is important to take individual differences into account and to consult a doctor to determine the best measures for minimizing these risk factors.
Reflux disease can also cause sleep problems, for example, and thus have an even greater impact on quality of life.
No one should take frequent reflux lightly. This is because reflux disease can cause stomach acids to permanently damage the mucous membranes in the esophagus. And there are many possible complications—ranging from inflammation of the esophagus, larynx, or throat to tooth damage and inflammation of the middle ear or sinuses. Barrett’s syndrome is being diagnosed with increasing frequency; this condition, characterized by damage to the mucous membrane, is considered a precursor to esophageal cancer. “If reflux is left untreated, the likelihood of developing cancer is ten times higher,” warns Dr. Drummer.
Various surgical methods are options for treating reflux
“The effectiveness of treatment is only as good as the diagnosis. Surgery is often the best option to resolve the issue once and for all. Of course, it must then be determined which surgical procedure is best for the patient. There are numerous so-called anti-reflux surgeries, including the option of a diaphragmatic plication with the creation of a small cuff. These various options must always be discussed with the patient on a case-by-case basis. Often, a so-called hiatal hernia—that is, a tear in the diaphragm—is the cause of reflux disease. “In such cases, the resulting opening must be reduced surgically,” explains Dr. Drummer, who developed the aforementioned two-part SERAMESH® PA DRUM implant, which has become the standard solution for diaphragmatic hernias, in part due to its excellent fixability. “The diaphragmatic surgery is performed using a minimally invasive technique, so the patient can usually be discharged from the hospital after 3–5 days. Over a period of four weeks, the patient should then eat several small meals throughout the day. Heartburn is guaranteed to disappear, and after a certain period of time, the patient can eat and drink anything again. Patients are usually quite surprised that they can suddenly drink beverages like orange juice or sparkling wine again, and they all say, ‘If I’d known that, I would have had the procedure done much sooner.’”
Dr. Bernhard Drummer, who is also very familiar with the region as the former team doctor for 1. FC Nürnberg, became known not only for developing the SERAMESH® PA DRUM but also for his scientific publications—such as those on the advancement of laparoscopic surgical techniques, that is, the fine art of keyhole surgery.
Gastroesophageal reflux and heartburn have anatomical and physiological causes.
Among the most common causes are a weak or malfunctioning lower esophageal sphincter (LES), a hiatal hernia (a weak spot in the diaphragm), excessive production of stomach acid, delayed gastric emptying, increased abdominal pressure, and certain dietary habits. These factors, either individually or in combination, can cause stomach acid to enter the esophagus and lead to heartburn. However, each patient may have unique causes, which is why an accurate diagnosis and medical evaluation are important to identify the specific causes.
LES stands for “lower esophageal sphincter” and plays a crucial role in reflux. The LES is a ring-shaped muscle at the end of the esophagus that is normally closed and prevents stomach contents from flowing back into the esophagus. When the LES is functioning normally, the muscle opens only to allow the bolus of food to pass into the stomach and then closes tightly again to prevent stomach acid and digestive enzymes from entering the esophagus. In some people, however, the LES is not sufficiently able to prevent the reflux of stomach contents, which can lead to gastroesophageal reflux.
The LES can be weakened or impaired in various ways. These include, for example, increased intra-abdominal pressure, impaired muscle and nerve function, anatomical abnormalities, or certain conditions such as a hiatal hernia. If the LES does not function properly, this can lead to uncontrolled reflux of stomach contents into the esophagus, causing heartburn and other reflux symptoms.
Treatment for reflux aims, among other things, to improve the function of the sphincter. This can be achieved through various approaches, including lifestyle changes, medication, or even surgical procedures to strengthen the LES or correct anatomical problems.
The effectiveness of non-pharmacological treatments can vary from person to person and depends on the severity of the reflux as well as individual factors. In some cases, these measures alone may be sufficient to relieve symptoms. In more severe cases, however, medication may be necessary to reduce stomach acid production.
Diet plays a major role in heartburn
Diet plays an important role in the frequency and intensity of reflux and heartburn. Certain foods and beverages can exacerbate reflux by increasing pressure in the stomach, promoting relaxation of the lower esophageal sphincter (LES), or stimulating the production of stomach acid. However, there is no universal list of foods that are equally problematic for everyone affected, as individual reactions can vary. Nevertheless, there are some common triggers that can be avoided.
For example, high-fat foods such as fried foods, fatty meats, high-fat dairy products, and greasy snacks can worsen reflux because they can delay stomach emptying and increase pressure in the stomach. Spices, hot sauces, citrus fruits, and acidic foods can also irritate reflux and cause heartburn, especially in sensitive individuals. Reflux is also exacerbated by caffeinated beverages such as coffee and tea, as well as alcoholic beverages, since these increase stomach acid production and relax the LES.
Other problematic foods for people with reflux:
Chocolate: Chocolate contains both fat and caffeine, making it a potential trigger for reflux and heartburn.
Tomatoes and tomato-based products: Tomatoes are acidic and can worsen reflux. This also applies to foods such as tomato sauce, ketchup, and tomato juice
Peppermint and mint: Peppermint and mint can relax the LES and worsen reflux. This also includes peppermint candies and mint tea.
Future Outlook
“Reflux is an interdisciplinary problem. Here at the Forchheim Clinic, we’re well-equipped to address it, as we have all the necessary specialties on-site. In general, better collaboration between gastroenterology and surgery would be desirable. I would also like to see much better communication. But this effort isn’t compensated, and the patient is left in limbo, so to speak. The younger generations, in particular, should devote much more attention to healthy communication with patients so that we can truly ensure the patient receives only the treatment they need,” criticizes Dr. Drummer, bringing our conversation to a close.
Dr. Drummer, thank you very much for such an open and friendly conversation!
