Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patients
    • Disease patterns
    • Diagnostics
    • Therapy
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Allergology and clinical immunology
    • General Internal Medicine
    • Anesthesiology
    • Angiology
    • Surgery
    • Dermatology and venereology
    • Endocrinology and Diabetology
    • Nutrition
    • Gastroenterology and Hepatology
    • Genetics
    • Geriatrics
    • Gynecology
    • Hematology
    • Infectiology
    • Cardiology
    • Nephrology
    • Neurology
    • Emergency and intensive care medicine
    • Nuclear Medicine
    • Oncology
    • Ophthalmology
    • ORL
    • Orthopedics
    • Pediatrics
    • Pharmacology and toxicology
    • Pharmaceutical medicine
    • Phlebology
    • Physical medicine and rehabilitation
    • Pneumology
    • Prevention and health care
    • Psychiatry and psychotherapy
    • Radiology
    • Forensic Medicine
    • Rheumatology
    • Sports Medicine
    • Traumatology and trauma surgery
    • Tropical and travel medicine
    • Urology
    • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
  • Log In
  • Register
  • My account
  • Contact
  • English
    • Deutsch
    • Français
    • Italiano
    • Português
    • Español
  • Publications
  • Contact
  • Deutsch
  • English
  • Français
  • Italiano
  • Português
  • Español
Subscribe
Medizinonline Medizinonline
Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patienten
    • Krankheitsbilder
    • Diagnostik
    • Therapie
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Fachbereiche 1-13
      • Allergology and clinical immunology
      • General Internal Medicine
      • Anesthesiology
      • Angiology
      • Surgery
      • Dermatology and venereology
      • Endocrinology and Diabetology
      • Nutrition
      • Gastroenterology and Hepatology
      • Genetics
      • Geriatrics
      • Gynecology
      • Hematology
    • Fachbereiche 14-26
      • Infectiology
      • Cardiology
      • Nephrology
      • Neurology
      • Emergency and intensive care medicine
      • Nuclear Medicine
      • Oncology
      • Ophthalmology
      • ORL
      • Orthopedics
      • Pediatrics
      • Pharmacology and toxicology
      • Pharmaceutical medicine
    • Fachbereiche 26-38
      • Phlebology
      • Physical medicine and rehabilitation
      • Phytotherapy
      • Pneumology
      • Prevention and health care
      • Psychiatry and psychotherapy
      • Radiology
      • Forensic Medicine
      • Rheumatology
      • Sports Medicine
      • Traumatology and trauma surgery
      • Tropical and travel medicine
      • Urology
      • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
Login

Sie haben noch keinen Account? Registrieren

  • Reflux Cases

When the reflux is not reflux

    • Cases
    • Gastroenterology and Hepatology
    • Partner Content
    • RX
  • 2 minute read

A 35-year-old patient presents with “typical” reflux symptoms but does not respond to treatment with proton pump inhibitors.

Background: A 34-year-old male patient presented to his primary care physician with retrosternal burning and pain on swallowing.
Initial treatment was with 40 mg of a proton pump inhibitor once daily for a period of 2 weeks.
However, the complaints hardly improved as a result.

Gastroscopy was then performed to clarify the persistent symptoms. Signs of reflux esophagitis corresponding to grade A according to the Los-Angeles classification were found. In addition, a tissue sample was obtained from the distal esophagus, in which eosinophilic cells (>20/facial-field) were detected. Histologically, the diagnosis of reflux esophagitis is made.

The patient is therefore treated with high-dose proton pump inhibitor therapy (2x 40 mg/d) for another 4 weeks. However, this again improved the complaints only insignificantly.

History and Diagnosis: The patient was referred to another gastroenterologist for a second opinion for further clarification. The patient reports retrosternal pain, burning of the stomach, food getting stuck in the esophagus, and dysphagia. The patient stated that he has to eat very slowly and drink regularly in between due to his symptoms. The further history also revealed that the patient had non-specific epigastric pain since childhood and suffered from neurodermatitis.

Further tissue samples were obtained by gastroscopy to establish the diagnosis, this time from the proximal and distal esophagus. Classic signs of eosinophilic esophagitis were also detected in the proximal esophagus. This was consistent with the patient’s medical history. For example, atopic diseases, such as atopic dermatitis, and eosinophilic esophagitis often occur in combination.

Therapy: The patient was then treated with topical steroids. These combat the inflammatory response that underlies eosinophilic esophagitis. Under this treatment, the complaints improved rapidly. However, since a cure for the disease is not yet possible, renewed therapy must be given if necessary.

 

Comment by Prof. Stephan Vavricka, MD:
The present case shows that not all patients with apparently typical reflux symptoms actually suffer from reflux disease.
If an attempt at therapy with proton pump inhibitors does not lead to an improvement in the symptoms, further diagnostics are therefore required. This allows other causes of the complaints to be identified and appropriate treatment to be initiated.

 

 

More articles on the topic

  • Reflux cases: mild reflux symptoms after pregnancy
  • Reflux cases: worsening of decades-old reflux symptoms.
  • Reflux cases: grade 1 obesity as a risk factor
  • Reflux Cases: Low-dose therapeutic approach without success
  • Reflux Cases: When reflux is not reflux
  • Reflux cases: pain here, there and everywhere
  • 7 reflux phenotypes at a glance
Related Topics
  • Gastoesophageal reflux disease
  • Reflux Update
Previous Article
  • 28th European Meeting on Hypertension and Cardiovascular Protection

Blood pressure measurement and hypertension: current developments and new study data

  • Cardiology
  • Congress Reports
  • RX
View Post
Next Article
  • AAIC in Chicago

Is amyloid still tenable as a therapeutic target?

  • Congress Reports
  • Neurology
  • RX
View Post
You May Also Like
View Post
  • 5 min
  • From symptom to diagnosis

Dyspnea – thoracic lymphoma

    • Cases
    • Education
    • General Internal Medicine
    • Oncology
    • Pneumology
    • Radiology
    • RX
View Post
  • 5 min
  • Hemophilia A and B

Personalized approach and innovative treatment options

    • Education
    • General Internal Medicine
    • Hematology
    • RX
    • Studies
View Post
  • 6 min
  • Diagnosis and treatment of neurological and psychiatric illnesses

Precision Neurology

    • Education
    • Neurology
    • Psychiatry and psychotherapy
    • RX
    • Studies
View Post
  • 5 min
  • Type 2 diabetes

Pharmacotherapy can lead to remission

    • Education
    • Endocrinology and Diabetology
    • Nutrition
    • Pharmacology and toxicology
    • RX
View Post
  • 4 min
  • Case Report

Mycosis fungoides in an 11-year-old child

    • Allergology and clinical immunology
    • Cases
    • Dermatology and venereology
    • Education
    • Oncology
    • Pediatrics
    • RX
    • Studies
View Post
  • 6 min
  • EHA 2025

Progress in multiple myeloma

    • Congress Reports
    • Hematology
    • Oncology
    • RX
    • Studies
View Post
  • 6 min
  • Interstitial lung diseases

Artificial intelligence improves ILD diagnosis

    • Education
    • General Internal Medicine
    • Pneumology
    • Prevention and health care
    • RX
    • Studies
View Post
  • 7 min
  • Management of patients after alloHCST

ERS/EBMT guideline recommendations on pulmonary cGvHD

    • Education
    • General Internal Medicine
    • Genetics
    • Hematology
    • Pneumology
    • RX
    • Studies
Top Partner Content
  • Herpes zoster

    Zum Thema
Top CME content
  • 1
    Colorectal cancer screening – an update
  • 2
    Yellow nail and Swyer-James syndrome
  • 3
    Individual therapy management for an optimized outcome – an update
  • 4
    Doing sport without fear or risk
  • 5
    UV protection and skin cancer screening – Update 2025

Newsletter

Sign up and stay up to date

Subscribe
Medizinonline
  • Contact
  • General terms and conditions
  • Imprint

Input your search keywords and press Enter.