Dr Bernhard Drummer is a renowned reflux specialist and Head 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 clinician, Dr Drummer has successfully treated numerous patients with reflux and heartburn, helping them to 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 the effective treatment of 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 tailored 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, anyone suffering from reflux disease in the wider area of the Bavarian district town of Forchheim has a contact person who is highly regarded worldwide.
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 all over 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 per cent 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 reaches 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,” begins Dr Drummer, explaining the difference between heartburn and reflux. Certain foods, such as alcohol, fruit juices, etc., exacerbate the problem of heartburn.
“Being severely overweight is also often the cause of reflux, as pressure in the abdominal cavity causes acid to be pushed from the stomach into the esophagus. Smoking and drinking fizzy drinks or acidic foods promote reflux. If a patient comes to me with such a list of habits, weight loss and a change in diet are the first steps. In cases of morbid obesity, weight loss should be the primary focus. We can also help here, as we are a certified obesity center. Elevating the upper body while sleeping can help alleviate reflux,” explains Dr Drummer regarding the initial measures. “Many people take tablets to reduce acid production, but these often don’t help at all. A regular gastroscopy is definitely recommended, and above all a visit to a doctor specializing in reflux. I don’t buy my sausages from the baker either,” advises Dr Drummer emphatically, mentioning another important point: “There are no certificates for reflux centers – anyone can call themselves a specialist. Standards definitely need to be tightened up here. At Forchheim Hospital, we follow what is known as the ‘tailored approach’ to treatment, meaning a therapy tailored specifically to the patient. For reflux patients who are severely overweight, for example, an obesity board comprising six doctors works out the best possible treatment for the patient.”
The occurrence of reflux and heartburn can be exacerbated by various risk factors.
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, giving up smoking, adjusting dietary habits, avoiding tight clothing, taking medication responsibly, and seeking medical advice to tailor the measures to the individual. It is important to take individual differences into account and to seek medical advice to determine the best measures for minimizing these risk factors.
Reflux disease can, for example, also cause sleep problems 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 acid to permanently damage the mucous membranes in the esophagus. And there are many potential 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 available 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. It must then, of course, be assessed which operation is best for the patient. There are numerous so-called anti-reflux operations, including the option of a diaphragmatic plication with the creation of a small cuff. These various options must always be discussed on a case-by-case basis with the patient. Often, a so-called hiatal hernia – that is, a tear in the diaphragm – is the cause of reflux disease. “In such cases, the resulting hole 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, partly due to its excellent fixability. “The diaphragmatic surgery is performed using a minimally invasive technique, so the patient can usually leave 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 the patient can eat and drink everything again. Patients are usually quite amazed that they can suddenly drink beverages such as orange juice or sparkling wine again, and they all say, ‘If I’d known that, I would have had the procedure done much earlier’.”
Dr Bernhard Drummer, who is also very familiar with the region as the former club doctor for 1. FC Nürnberg, has made a name for himself not only through the development of the SERAMESH® PA DRUM but also through scientific publications – for example, on the further development of laparoscopic surgical procedures, that is, the fine art of keyhole surgery.
Gastro-esophageal reflux and heartburn have anatomical and physiological causes.
The most common causes include a weak or malfunctioning lower esophageal sphincter (LES), a hiatal hernia (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 individual causes, which is why an accurate diagnosis and medical assessment are important to identify the specific causes.
LES stands for ‘lower esophageal sphincter’ and plays a crucial role in relation to reflux. The LES is a ring-shaped muscle at the end of the esophagus, which 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 gastro-esophageal 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.
The treatment of 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-medicinal 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 required 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 drinks 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, as they can delay gastric emptying and increase pressure in the stomach. Spices, hot sauces, citrus fruits and acidic foods can also irritate reflux and cause heartburn, particularly in sensitive individuals. Reflux is also exacerbated by caffeinated drinks such as coffee and tea, as well as alcoholic beverages, as these increase the production of stomach acid and relax the LES.
Other problematic foods for reflux patients:
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 exacerbate 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 exacerbate reflux. This also includes peppermint sweets and mint tea.
Future prospects
“Reflux is an interdisciplinary problem. Here at Forchheim Clinic, we are well placed to address this, as we have all the necessary specialist departments on site. In principle, better collaboration between gastroenterology and surgery would be desirable. I would also like to see much better communication. However, this service is not paid for, and the patient is left in limbo, so to speak. The younger generations, in particular, should devote much more attention to healthy communication with the patient, 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!
