Effective treatment for herb. Treatment of reflux esophagitis with drugs

The date: 27.07.2020

The success of therapy lies not only in adequately carried out medical correction, but also in changing the lifestyle and dietary habits of the patient.

changes in body position during sleep;
nutritional changes;
abstinence from smoking;
abstinence from alcohol abuse;
if necessary, weight loss;
refusal of medications that induce the occurrence of GERD;
exclusion of loads that increase intra-abdominal pressure, wearing corsets, bandages and tight belts, lifting weights of more than 8-10 kg on both hands, work associated with forward bending of the torso, physical exercises associated with overstrain of the abdominal muscles.

To restore the muscle tone of the diaphragm, special exercises are recommended that are not related to the inclination of the torso.

The elimination of a strictly horizontal position during sleep reduces the number of reflux episodes and their duration, as esophageal clearance increases due to gravity. The patient is advised to raise the head end of the bed by 15 cm.

it is necessary to exclude overeating, "snacking" at night;
lying down after eating;
after eating, avoid bending forward and horizontal position;
foods rich in fat (whole milk, cream, fatty fish, goose, duck, pork, fatty beef, lamb, cakes, pastries), drinks containing caffeine (coffee, strong tea or cola), chocolate, foods containing peppermint and pepper (all of them reduce the tone of the lower esophageal sphincter);
citrus fruits and tomatoes, fried foods, onions and garlic, as they have a direct irritating effect on the sensitive mucosa of the esophagus;
limited consumption of butter, margarine;
3-4 meals a day are recommended, a diet with a high protein content, since protein foods increase the tone of the lower esophageal sphincter;
the last meal - at least 3 hours before bedtime, after eating a 30-minute walk.
sleep with the head end of the bed raised; exclude loads that increase intra-abdominal pressure: do not wear tight clothes and tight belts, corsets, do not lift weights of more than 8-10 kg on both hands, avoid physical exertion associated with overexertion of the abdominal press; to give up smoking; maintaining normal body weight;

For prophylactic purposes, it is necessary to prescribe cocktails proposed by G.V. for 2-3 weeks. Dibizhevoi: cream or fermented baked milk 0.5 liters + beaten egg white + 75 ml. 3% tannin. Apply 8-10 times a day, several sips through a straw before and after meals.

Avoid taking drugs that reduce the tone of the lower esophageal sphincter (anticholinergics, tricyclic antidepressants, sedatives, tranquilizers, calcium antagonists, beta-agonists, drugs containing L-dopamine, narcotics, prostaglandins, progesterone, theophylline).

Treatment in most cases should be carried out on an outpatient basis. Treatment should include general measures and specific drug therapy.

Indications for hospitalization

Antireflux treatment for complicated course of the disease, as well as for the ineffectiveness of adequate drug therapy. Carrying out endoscopic or surgical intervention (fundoplication) in case of ineffectiveness of drug therapy, in the presence of complications of esophagitis: Barrett's esophagus stricture, bleeding.

Drug therapy

Includes the appointment of prokinetics, antisecretory agents and antacids.

Brief description of drugs used in the treatment of gastroesophageal reflux disease:

1. Antacids

Mechanism of action: neutralize hydrochloric acid, inactivate pepsin, adsorb bile acids and lysolicetin, stimulate the secretion of bicarbonates, have a cytoprotective effect, improve esophageal cleansing and alkalization of the stomach, which helps to increase the tone of the lower esophageal sphincter.

For the treatment of gastroesophageal reflux disease, it is better to use liquid forms of antacids. It is better to use conditionally insoluble (non-systemic) antacids, such as those containing non-absorbable aluminum and magnesium, antacids (Maalox, Phosphalugel, Gastal, Rennie), as well as antacids, which include substances that eliminate symptoms of flatulence (Protab, Daigin, Gestid).

Of the huge variety of antacids, one of the most effective is Maalox. It is distinguished by a variety of forms, the highest acid-neutralizing ability, as well as the presence of a cytoprotective effect due to the binding of bile acids, cytotoxins, lysolecithin and activation of the synthesis of prostaglandins and glycoproteins, stimulation of the secretion of bicarbonates and protective mucopolysaccharide mucus, almost complete absence of side effects and a pleasant taste.

Preference should be given to third-generation antacids such as Topalkan, Gaviscon. They include: colloidal alumina, magnesium bicarbonate, hydrated silicic anhydrite and alginic acid. When dissolved, Topalkan forms a foamy antacid suspension, which not only adsorbs HCI, but also, accumulating over a layer of food and liquid and getting into the esophagus in case of gastroesophageal reflux, has a therapeutic effect, protecting the mucous membrane of the esophagus from aggressive gastric contents. Topalkan is prescribed 2 tablets 3 times a day 40 minutes after meals and at night.

2. Prokinetics

The pharmacological action of these drugs is to increase antropyloric motility, which leads to accelerated evacuation of gastric contents and an increase in the tone of the lower esophageal sphincter, a decrease in the number of gastroesophageal refluxes and the time of contact of gastric contents with the esophageal mucosa, improvement of esophageal clearance and elimination of delayed gastric evacuation.

One of the first drugs in this group is the central dopamine receptor blocker Metoclopramide (Cerukal, Reglan). It enhances the release of acetylcholine in the gastrointestinal tract (stimulates the motility of the stomach, small intestine and esophagus), blocks central dopamine receptors (impact on the vomiting center and the center for regulating gastrointestinal motility). Metoclopramide increases the tone of the lower esophageal sphincter, accelerates evacuation from the stomach, has a positive effect on esophageal clearance and reduces gastroesophageal reflux.

The disadvantage of metoclopramide is its undesirable central action (headache, insomnia, weakness, impotence, gynecomastia, increased extrapyramidal disorders). Therefore, it cannot be used for a long time.

A more successful drug from this group is Motilium (Domperidone), which is an antagonist of peripheral dopamine receptors. The effectiveness of Motilium as a prokinetic agent does not exceed that of metoclopramide, but the drug does not penetrate the blood-brain barrier and has practically no side effects. Motilium is prescribed 1 tablet (10 mg) 3 times a day 15-20 minutes before meals. As monotherapy, it can be used in patients with grade I-II GERD. It is important to note that taking Motilium cannot be combined in time with taking antacids, since its absorption requires an acidic environment, and with anticholinergic drugs that neutralize the effect of Motilium. The most effective treatment for GERD is Prepulsid (Cisapride, Coordinax, Peristil). It is a gastrointestinal prokinetic devoid of antidopaminergic properties. Its mechanism of action is based on an indirect cholinergic effect on the neuromuscular apparatus of the gastrointestinal tract. Prepulsid increases the tone of the LES, increases the amplitude of contractions of the esophagus and accelerates the evacuation of the contents of the stomach. At the same time, the drug does not affect gastric secretion, so it is better to combine Prepulsid with antisecretory drugs for reflux esophagitis.

The prokinetic potential of a number of other drugs is being studied: Sandostatin, Leuprolide, Botox, as well as drugs acting through 5-HT 3 and 5-HT 4 serotonin receptors.

3. Antisecretory drugs

The goal of antisecretory therapy for GERD is to reduce the damaging effect of acidic gastric contents on the esophageal mucosa. In the treatment of GERD, histamine H2 receptor blockers and proton pump inhibitors are used.

4. Histamine H2-receptor blockers

There are currently 5 classes of H2-blockers available: Cimetidine (I generation), Ranitidine (II generation), Famotidine (III generation), Nizatidine (axide) (IV generation), and Roxatidine (V generation).

The most widely used drugs are from the groups of Ranitidine (Ranisan, Zantak, Ranitin) and Famotidine (Kvamatel, Ulfamid, Famosan, Gastrosidin). These drugs effectively reduce the basal, nocturnal, food and drug-stimulated secretion of hydrochloric acid in the stomach, and inhibit the secretion of pepsins. If there is a choice, preference should be given to Famotidine, which, due to its greater selectivity and lower dosage, lasts longer and does not have the side effects inherent in Ranitidine. Famotidine is 40 times more effective than cimitidine and 8 times more effective than ranitidine. In a single dose of 40 mg, it reduces nocturnal secretion by 94%, basal secretion by 95%. In addition, Famotidine stimulates the protective properties of the mucous membrane by increasing blood flow, bicarbonate production, prostaglandin synthesis, and enhancing epithelial repair. The duration of action of 20 mg Famotidine is 12 hours, 40 mg - 18 hours. The recommended dose in the treatment of GERD is 40-80 mg per day.

5. Proton pump blockers

Proton pump blockers are currently considered the most powerful antisecretory drugs. The drugs of this group are practically devoid of side effects, since in the active form they exist only in the parietal cell. The action of these drugs is to inhibit the activity of Na + /K + -ATPase in the parietal cells of the stomach and block the final stage of HCI secretion, while almost 100% inhibition of hydrochloric acid production in the stomach occurs. Currently, 4 chemical varieties of this group of drugs are known: Omeprazole, Pantoprazole, Lansoprazole, Rabeprazole. The progenitor of proton pump inhibitors is Omeprazole, first registered as Losek by Astra (Sweden). A single dose of 40 mg of omeprazole completely blocks the formation of HCI for 24 hours. Pantoprazole and Lansoprazole are used in dosages of 30 and 40 mg, respectively. A drug from the Rabiprazole Pariet group has not yet been registered in our country, clinical trials are underway.

Omeprazole (Losek, Losek-maps, Mopral, Zoltum, etc.) at a dose of 40 mg allows healing of esophageal erosions in 85-90% of patients, including patients who do not respond to therapy with histamine H2-receptor blockers. Omeprazole is especially indicated for patients with stage II-IV GERD. In control studies with omeprazole, earlier subsidence of GERD symptoms and more frequent cure compared with conventional or doubled doses of H 2 blockers were noted, which is associated with a greater degree of suppression of acid production.

Recently, a new improved form of the drug “Losek” has appeared on the drug market, manufactured by Astra, “Losek-maps”. Its advantage is that it does not contain excipient allergens (lactose and gelatin), is smaller than a capsule, and is coated with a special shell for easier swallowing. This drug can be dissolved in water and, if necessary, used in patients with a nasopharyngeal tube.

Currently, a new class of antisecretory drugs is being developed that do not inhibit the work of the proton pump, but only prevent the movement of Na + /K + -ATPase. The representative of this new group of drugs is ME - 3407.

6. Cytoprotectors.

Misoprostol (Cytotec, Cytotec) is a synthetic analogue of PG E2. It has a broad protective effect on the gastrointestinal mucosa:

reduces the acidity of gastric juice (suppresses the release of hydrochloric acid and pepsin, reduces the reverse diffusion of hydrogen ions through the gastric mucosa;
increases the secretion of mucus and bicarbonates;
increases the protective properties of mucus;
improve the blood flow of the esophageal mucosa.

Misoprostol is given at 0.2 mg four times a day, usually for grade III gastroesophageal reflux disease.

Venter (Sucralphate) is the ammonium salt of sulfated sucrose (a disaccharide). It accelerates the healing of erosive and ulcerative defects of the esophagogastroduodenal mucosa by forming a chemical complex - a protective barrier on the surface of erosions and ulcers and prevents the action of pepsin, acid and bile. Has astringent property. Assign 1 g 4 times a day between meals. The appointment of Sucralfate and antacids should be divided by time.

With gastroesophageal refluxes caused by reflux of duodenal contents (alkaline, bile reflux) into the esophagus, usually observed in cholelithiasis, a good effect is achieved when taking non-toxic ursodeoxycholic bile acid (Ursofalk) at 250 mg per night, which in this case is combined with Coordinax. The use of cholestyramine is also justified (an ammonium anion exchange resin, a non-absorbable polymer, binds to bile acids, forming a strong complex with them, excreted with feces). It is taken at 12-16 g / day.

Dynamic monitoring of detected secretory, morphological and microcirculatory disorders in GERD confirms the currently proposed various schemes for drug correction of gastroesophageal reflux disease.

The most common are (A.A. Sheptulin):

a scheme of "stepwise increasing" therapy, which involves the appointment of drugs and combinations of different strengths at different stages of the disease. So, at the first stage, the main place in the treatment is given to lifestyle changes and, if necessary, taking antacids. If clinical symptoms persist, at the second stage of treatment, prokinetics or H 2 blockers of histamine receptors are prescribed. If such therapy is ineffective, then at the 3rd stage, proton pump inhibitors or a combination of H 2 blockers and prokinetics are used (in especially severe cases, a combination of proton pump blockers and prokinetics);
the scheme of "phasing down" therapy involves the appointment of proton pump inhibitors from the very beginning, followed by the transition, after achieving a clinical effect, to the intake of H2-blockers or prokinetics. The use of such a scheme is justified in patients with severe disease and severe erosive and ulcerative changes in the mucosa of the esophagus.

Options for drug therapy, taking into account the stage of development of GERD (P.Ya. Grigoriev):

With gastroesophageal reflux without esophagitis, Motilium or Cisapride is prescribed orally for 10 days, 10 mg 3 times a day in combination with antacids, 15 ml 1 hour after meals, 3 times a day and 4 times before bedtime.
With reflux esophagitis of the 1st degree of severity, H2 blockers are prescribed orally: for 6 weeks - Ranitidine 150 mg 2 times a day or Famotidine 20 mg 2 times a day (for each drug, taking in the morning and evening with an interval of 12 hours). After 6 weeks, if remission occurs, drug treatment is stopped.
With reflux esophagitis of the II degree of severity, Ranitidine 300 mg 2 times a day or Famotidine 40 mg 2 times a day or Omeprazole 20 mg after dinner (at 14-15 hours) are prescribed for 6 weeks. After 6 weeks, drug treatment is stopped if remission occurs.
In case of reflux esophagitis of the III degree of severity, Omeprazole 20 mg is prescribed orally for 4 weeks, 2 times a day, in the morning and evening with a mandatory interval of 12 hours, and then, in the absence of symptoms, continue taking Omeprazole 20 mg per day or another proton pump inhibitor 30 mg 2 times a day for up to 8 weeks, after which they switch to taking histamine H 2 receptor blockers in a maintenance half dose during the year.
In case of reflux esophagitis of the IV degree of severity, Omeprazole 20 mg is prescribed orally for 8 weeks 2 times a day, in the morning and evening with a mandatory interval of 12 hours, or another proton pump inhibitor 30 mg 2 times a day, and upon the onset of remission, they switch to constant intake of H 2 blockers of histamine. Additional treatments for refractory forms of GERD include Sucralfate (Venter, Sukratgel) 1 g 4 times a day 30 minutes before meals for 1 month.

a mild disease (reflux esophagitis of 0-1 degree) requires a special lifestyle and, if necessary, taking antacids or H2-receptor blockers;
with moderate severity (reflux esophagitis of II degree), along with constant adherence to a special lifestyle and diet, long-term use of H 2 receptor blockers in combination with prokinetics or proton pump inhibitors is necessary;
in severe disease (reflux esophagitis III degree), a combination of H 2 receptor blockers and proton pump inhibitors or high doses of H 2 receptor blockers and prokinetics are prescribed;
the lack of effect of conservative treatment or complicated forms of reflux esophagitis are an indication for surgical treatment.

Considering that one of the main reasons leading to an increase in spontaneous relaxation of the lower esophageal sphincter is an increase in the level of neuroticism in patients suffering from GERD, testing to assess the personality profile and correct the identified disorders seems to be extremely relevant. To assess the personality profile in patients with pathological gastroesophageal refluxes detected by pH-metry, we conduct psychological testing using a computer modification of the Eysenck, Schmishek, MMPI, Spielberger questionnaires, the Luscher color test, which allows us to identify the dependence of the nature and severity of gastroesophageal refluxes on individual personality traits and, accordingly, taking this into account, develop effective treatment regimens. Thus, it is possible to achieve not only a reduction in the duration of treatment, but also significantly improve the quality of life of patients. Along with standard therapy, depending on the identified anxious or depressive personality type, patients are prescribed Eglonil 50 mg 3 times a day or Grandaxin 50 mg 2 times a day, Teralen 25 mg 2 times a day, which improves the prognosis of the disease.

Treatment of gastroesophageal reflux disease in pregnant women

It has been established that the main symptom of GERD - heartburn - occurs in 30-50% of pregnant women. The majority (52%) of pregnant women experience heartburn in the first trimester. The pathogenesis of GERD is associated with LES hypotension in basal conditions, increased intra-abdominal pressure, and delayed gastric evacuation. Diagnosis of the disease is based on clinical data. Conducting (if necessary) endoscopic examination is considered safe. In treatment, lifestyle changes are of particular importance. At the next stage, “non-absorbable” antacids are added (Maalox, Phosphalugel, Sucralfate, etc.). Considering that Sucralfate (Venter) can cause constipation, the use of Maalox is more justified. In case of treatment refractoriness, H 2 blockers such as Ranitidine or Famotidine can be used.

The use of Nizatidine during pregnancy is not indicated, since in the experiment the drug showed teratogenic properties. Given the experimental data, the use of omeprazole, metoclopramide and cisapride is also undesirable, although there are isolated reports of their successful use during pregnancy.

Anti-relapse treatment of gastroesophageal reflux disease

Currently, there are several options for anti-relapse treatment of GERD (permanent therapy):

H 2 blockers in a full daily two-time dose (Ranitidine 150 mg 2 times a day, Famotidine 20 mg 2 times a day, Nizatidine 150 mg 2 times a day).
Treatment with proton pump inhibitors: Omeprazole (Losek) 20 mg in the morning on an empty stomach.
Taking prokinetics: Cisapride (Coordinax) or Motilium at half the dose compared to the dose used during an exacerbation.
Long-term treatment with non-absorbable antacids (Maalox, Phosphalugel, etc.).

The most effective anti-relapse drug is omeprazole 20 mg in the morning on an empty stomach (88% of patients remain in remission within 6 months of treatment). When comparing Ranitidine and placebo, this figure is 13 and 11%, respectively, which casts doubt on the advisability of long-term use of Ranitidine for anti-relapse treatment of GERD.

A retrospective analysis of prolonged permanent use of small doses of Maalox suspension 10 ml 4 times a day (acid-neutralizing capacity 108 mEq) in 196 patients with stage II GERD showed a rather high anti-relapse effect of this regimen. After 6 months of permanent therapy, remission was maintained in 82% of patients. None of the patients experienced side effects that led to the discontinuation of prolonged treatment. Data on the presence of phosphorus deficiency in the body has not been received.

American experts estimate that a five-year full-fledged antireflux therapy costs patients more than $6,000. However, when you stop taking even the most effective drugs and their combinations, there is no long-term remission. According to foreign authors, recurrence of GERD symptoms occurs in 50% of patients after 6 months after discontinuation of antireflux therapy, and in 87-90% after 12 months. There is an opinion among surgeons that adequately performed surgical treatment of GERD is effective and cost-effective.

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Gastroesophageal reflux disease (GERD) occurs when the contents of the stomach are expelled into the esophagus under the influence of hydrochloric acid.

Due to this, pepsin is broken down and the digestive system is disturbed, unpleasant symptoms appear.

GERD with esophagitis can be treated with various methods, but first you need to know the causes and symptoms of the disease.

Establishing diagnosis

Doctors can establish a diagnosis only after collecting an anamnesis, as well as instrumental diagnostic methods.

Often, with a mild course of the disease, patients simply take complaints, on the basis of which a diagnosis is established.

There are also mandatory diagnostic methods that are carried out once, these include:

X-ray examination. A picture of the esophagus, gastrointestinal tract is taken so as not to confuse GERD with esophagitis with other similar pathologies.
Esophagoscopy. In addition to taking a picture, it is necessary to do esophagoscopy, which determines the esophagitis itself, its stage of development, as well as possible complications. At this stage, doctors rule out possible tumors.
Carry out a daily examination of pH-metry. The method allows to determine the acidity when using inhibitors. This research method is very informative for the diagnosis of GERD.
An intraesophageal manometry is done. On it, doctors can determine the degree of performance of the esophagus. With insufficient tone of the sphincter, the diagnosis of GERD is established.
An ultrasound of all organs of the abdomen is performed.

As a rule, the collected data is enough to establish a diagnosis. If GERD cannot be cured for several weeks, then additional diagnostics are performed, which include provocative tests:

Bernstein test. A similar method allows you to determine the sensitivity of the esophagus and its walls to acids. When using the equipment, the patient is injected with an acid solution into the esophagus. If after 10-20 minutes the main symptoms begin in the patient, then the test is positive and indicates the disease. After using antacids, symptoms should disappear. The diagnostic method is very informative and can indicate pathology, even if esophagoscopy has not yielded results.
A common test for GERD that uses acid. 300 ml of a special solution is launched into the stomach, after which an examination is carried out, changing the position of the body and conducting various breathing and other exercises. Based on the data obtained, a diagnosis and its assumptions are established.
Test using an inflatable balloon. Such a device is installed 10 cm higher than the sphincter, and they begin to fill it with air, at a dosage of 1 ml. If symptoms appear with an increase in the balloon, then the diagnosis is positive.

In addition to the described diagnosis, laboratory tests are collected, which include:

Blood test.
Definitions of blood group and Rh factor.

Doctors say that Helicobacter pylori bacteria cannot provoke GERD, but due to acidity disorders, their development in the body is possible.

In addition, the patient can develop quite quickly gastritis in an atrophic form, and even cancer.

Due to this, patients with GERD who have a rather long treatment should be screened for Helicobacter pylori. Approximately people can recognize the disease if they know the main causes.

Causes of esophagitis

Esophagitis can appear as a result of several main reasons:

Great pressure in the abdomen and stomach, which appears during pregnancy, obesity, overeating and flatulence.
Slow bowel movement.
Anatomical features in which part of the work of the esophagus is disrupted. In some cases, the cause is a hernia or scleroderma.
The result of malnutrition can be the cause, as an excess of certain foods relaxes the sphincter and reflux occurs.

GERD often occurs in people who are ill or have been ill with diseases of the gastrointestinal tract, for example, gastritis or ulcers.

Symptoms

There are several main symptoms by which GERD with esophagitis can be identified. These include:

Heartburn. This symptom can most often be identified in sick people. The cause of a burning sensation in the chest is prolonged contact of gastric juice with the walls of the esophagus. Symptoms often appear after ingestion of junk food, as well as alcohol, coffee and chocolate. Another provocateurs are strong physical exertion, frequent bending of the body, tight clothes, especially in the abdomen. Heartburn is treated with antacids.
Belching. When reflux occurs, patients begin to belch, which is accompanied by a bitter and sour taste. The problem appears immediately after a meal, lying down and after heavy exertion on the body.

The disease may not appear for a long period, and all the symptoms may be so insignificant that patients simply do not notice them.

All this refers to the chronic course of the disease. The main symptom in chronic pathology is prolonged heartburn, which gradually begins to torment the patient.

At the initial stage, reflux simply causes a slight itching in the throat area, which is very similar to the onset of the flu.

As a result, patients use cold remedies that do not work. After this, heartburn begins, especially after a hearty meal.

In the advanced stage, patients may have different symptoms, it all depends on the walls of the esophagus and their condition. The first sign of the disease is a hoarse voice.

In general, the disease can be divided into 5 stages of the course:

At the very beginning, there is a sore throat that does not go away after swallowing the products. The mucosa is covered with spots of a pink hue, but if there is an exacerbation. As a rule, it is difficult to establish an accurate diagnosis at the first stage, and doctors use a description of the symptoms from the words of the patient, his complaints and make a presumptive diagnosis.
In the second stage, the patient develops erosions that can affect about 20% of the esophageal mucosa. All symptoms get worse.
At the next stage, erosion affects half of the mucosa, after which reflux with esophagitis causes discomfort while eating, because small ulcers appear.
In the fourth stage, ulcers appear on the mucosa of the entire esophagus. Even without food, in a calm state, the patient begins to experience pain, and other symptoms are possible in the form of constant nausea, weakness in the body, loss of appetite. Patients begin to lose up to 10% of body weight.
At the last stage, the patient must be hospitalized, because further treatment is carried out only by surgery.

It is impossible to start the disease, because this leads to a solution to the problem only by surgery. Knowing the symptoms, it is necessary to consult a doctor in the early stages of the onset of the disease.

Treatment rules

The patient needs to control his weight and avoid obesity.
At the time of treatment, it is necessary to limit yourself to cigarettes.
All things should be free; with GERD with esophagitis, it is forbidden to wear squeezing clothing.
It is necessary to equip the bed and make the right headboard.
On the stomach and stomach, it is necessary to reduce the load.
It is necessary to exclude or limit as much as possible the intake of drugs that can provoke symptoms characteristic of reflux esophagitis.

The essence of drug treatment is the rapid removal of the main symptoms of the disease, as well as the healing of wounds caused by esophagitis.

Also, medicines will prevent repeated acid emissions and prevent complications.

The use of medicines

The treatment, which is carried out with a medical method, consists in the use of drugs that can reduce the effect of gastric juice on the esophagus.

As a rule, all drugs of the antisecretory type must be taken once a day.

Treatment of GERD is carried out for about one and a half months if there are no ulcerative wounds in the esophagus.

If the esophagus is affected by ulcers, then the treatment is extended for a couple of weeks, but only if the ulcers have not affected the entire esophagus and they are single. If the esophagus is covered in ulcers, then therapy continues for another 2 months.

Medicines do not always give positive results, therefore, if the doctor is ineffective, the dosage of the drugs and the course of treatment itself are increased.

Once GERD with esophagitis is detected, doctors prescribe antacids. They are used in the early days of therapy along with prokinetics.

When using this treatment, the removal of symptoms is carried out quickly, heartburn no longer appears. In addition, antacids are always used to stop heartburn, which is quite rare.

Antacids should be taken three times a day an hour after a meal. At night, you can use the medicine only when the symptoms are persistent and severe.

Often, after taking antacids, patients experience improvement and GERD with esophagitis does not develop into a severe form.

When prescribing prokinetics, patients notice an improvement in the functioning of the stomach, and the main work of the esophagus is also stimulated. Prokinetics are used for a combined type of treatment.

The most commonly used "Domperion" at a dosage of 10 ml. It must be taken three times a day. In addition to the drug, the use of "Metoclopramide" in the same dose is prescribed.

The third medicine for therapy includes Bethanechol, it is taken 15 ml 4 times a day. In rare cases, doctors prescribe the medicine "Caesapride", which must be taken three times a day.

Reflux esophagitis can be treated with medication if the disease is not in advanced form. The result of such therapy is positive and quite fast.

Surgical intervention

Not always the treatment of GERD is carried out with medications; in some situations, only surgical intervention may be required. Patients with the following parameters are allowed for the operation:

The patient's age is up to 35 years.
There are no chronic diseases.
The patient does not use certain medications throughout life.
There is no bleeding in the esophagus.
The operation is not performed if the esophagus is in a precancerous condition.
Surgery is prohibited if the patient has GERD with non-esophageal symptoms.

Removal of reflux esophagitis is performed using an endoscope. In general, the procedure is not complicated, in some cases there may be a choice of therapy depending on the following:

The severity of the pathology.
The patient's decision on how to treat.
The cost of therapy.
Possible complications.
Experience of doctors in carrying out operative intervention.
The equipment that is in the hospital.

Even before surgery or drug treatment, doctors advise you to review your lifestyle and adjust your diet.

Folk remedies

Reflux esophagitis, as a rule, is not treated with folk remedies, and their use is not included in the mandatory therapy.

Of course, you can use herbal decoctions and infusions, but they will not get rid of the pathology, but they will relieve certain symptoms.

Doctors advise using the following recipes:

To reduce the pain syndrome, as well as remove inflammation of the mucosa and lower the pH level, it is necessary to use chamomile flowers (2 tbsp), flax seeds (2 tbsp), motherwort (1 tbsp), lemon balm leaf (1 tbsp .l.) and licorice root (1 tablespoon). All ingredients are crushed and poured into 1.5 liters of water. Then it is necessary to steam the medicine in a water bath for 10 minutes and drink 100 ml 4 times a day two hours later.
Symptoms of reflux esophagitis can be overcome with dill infusion. For this, 2 tbsp. crushed into powder and poured into a glass of boiling water. After a couple of hours, the remedy is filtered, and taken before meals, 1 tbsp. 4 times a day.
Jerusalem artichoke can be used for any pathologies of the gastrointestinal tract, including GERD. Two tubers with one apple should be grated and eaten twice a day. The burning sensation in the chest will immediately pass.

GERD is not a disease that is easy to overcome with folk methods, the use of medicines is mandatory. Another treatment for pathology is nutrition, which will be discussed below.

Proper nutrition

People who have GERD and esophagitis should follow the basic rules in the diet for the normal functioning of the gastrointestinal tract, as well as a quick recovery:

You need to cook food for a couple, you can cook and stew food. Eat baked foods at least a couple of times a week.
For cooking, the temperature is not higher than 40 degrees. This will not irritate the walls of the mucosa.
Feed fractional 5-6 times a day. The last meal should be no later than 20:00.
The main load on the stomach falls before lunch, after which lighter dishes are used.

To prevent reflux, it is necessary to exclude from the diet:

Any type of snack, including breakfast cereals, sandwiches and fast food. Especially if the esophagitis is in an exacerbated form.
Harmful food is necessarily excluded from the diet, namely fried and spicy, pickled and salty foods, smoked ingredients, sweets, soda.
You can not eat hard-boiled eggs, as well as fried.
Legumes, corn, pearl barley are not used in dishes. Mushrooms are also better to exclude, they are very difficult for the digestive tract.
A variety of sauces and ketchups, mustard should be excluded. Fatty sour cream, fermented baked milk is not used.
All vegetables that can provoke heartburn are removed from the diet, these include radishes, cabbage, cucumbers and tomatoes with peel, exotic foods, including bananas. Vegetables and fruits are best used not fresh, but baked, boiled or stewed.
The first dishes that are cooked in meat broth should not be consumed.
With sweets, you also need to be careful. It is allowed to use honey in liquid form, but only when added to tea. It is not recommended to eat jam, as it irritates the walls of the esophagus.

To prevent reflux esophagitis, you can use the following tips:

Avoid cigarettes and alcohol.
Adjust your diet and lifestyle.
Sleep on several pillows so that the head is higher than the body.
The last meal should be 2 hours before bedtime.
All medications should be taken with plenty of water.
When sick, only loose clothing is worn.
Weight should be controlled and obesity avoided.
Constantly checked by a gastroenterologist. For prevention, an examination every six months is necessary.

Knowing the basic rules for the appearance of the disease, as well as methods of treatment and prevention, you can quickly recover and prevent GERD from appearing.

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Gastroesophageal reflux disease (GERD), which can be treated by various methods, is a pathology of the digestive system, when the acidic contents of the stomach are thrown into the esophagus, as a result of which its walls become inflamed. The main symptoms of GERD are heartburn and sour belching. The diagnosis and treatment of the disease is carried out by a gastroenterologist. If a person has GERD, the treatment will be to take medications that reduce the acidity of the stomach and protect the lining of the esophagus from the action of acid. Good results are obtained by following a certain diet. Features of the course of GERD, symptoms, treatment will be considered in this article.

Causes of the disease

Often, reflux disease occurs due to a decrease in the tone of the lower esophageal sphincter, and this, in turn, occurs with the use of caffeine and alcohol, smoking, in case of pregnancy under the influence of hormonal factors. What other reasons could there be for the development of GERD? Treatment of any ailments with antispasmodics, analgesics, calcium antagonists can lead to gastroesophageal reflux disease. Also, its occurrence is possible against the background of an increase in intra-abdominal pressure due to ascites, obesity, flatulence. Conditions for reflux are created with diaphragmatic hernia, when the pressure on the lower region of the esophagus in the chest is reduced.

An increase in intragastric pressure and the reflux of stomach contents into the esophagus can occur with abundant and hasty food intake, since then a lot of air is swallowed along with it. The presence in the diet in excess of products containing peppermint, rich in animal fats, hot spices, fried foods, carbonated water leads to the same consequences. A duodenal ulcer can also cause GERD.

Symptoms

Treatment of reflux disease is desirable to start as early as possible, otherwise its manifestations can cause a lot of problems. When the contents of the stomach (and this is food, and digestive enzymes, and hydrochloric acid) enter the esophagus, irritation of its mucosa occurs, inflammation begins and GERD occurs. Symptoms, treatment in this case are typical for many esophageal disorders. So, the symptoms of the disease are usually the following:

In addition to esophageal signs, GERD also manifests itself as extraesophageal. These are digestive disorders (flatulence, abdominal pain, nausea); pathology of the pharynx and oral cavity (caries, tonsillitis, destruction of tooth enamel); damage to the ENT organs (polyps of the vocal cords, rhinitis, laryngitis, otitis media); damage to the respiratory system (pneumonia, bronchial asthma, bronchitis, emphysema, bronchiectasis); ailments of the cardiovascular system (angina pectoris, arrhythmia, arterial hypertension).

Diagnostics

Until GERD is diagnosed by a gastroenterologist, it is pointless to start treatment, because the methods of therapy should be selected based on the characteristics of the pathological process. To identify reflux disease and determine the mechanism of its development, the following methods are used:

X-ray of the esophagus. With such a study, erosion, strictures, ulcers, hernias can be detected.
Endoscopy of the esophagus. This procedure also allows you to identify inflammatory changes.
Radioactive technetium scintigraphy. The study involves taking ten milliliters of egg white with Tc11: the patient takes a sip of this remedy every twenty seconds, and at this time a picture is taken on the halocamera every second for four minutes. This method makes it possible to assess esophageal clearance.
Manometric study of the sphincters of the esophagus. This procedure allows you to detect a change in the tone of the sphincters.
Monitoring pH in the lower esophagus. Such a study is necessary in order to select individual therapy and monitor the effectiveness of medications.

GERD: treatment

The goal of therapeutic measures for this disease is to eliminate its symptoms, combat reflux and esophagitis, improve the quality of life, and prevent complications. Conservative therapy is most often used, surgical treatment of GERD is indicated only in extreme cases. Let's take a closer look at ways to deal with the disease. The set of activities includes:

adherence to a diet and a certain lifestyle;
taking antacids, antisecretory drugs and prokinetics.

Regardless of the stage and severity of GERD, treatment implies the constant observance of certain rules:

Do not lie down or lean forward after eating.
Do not wear tight clothes, corsets, tight belts, bandages - this leads to an increase in intra-abdominal pressure.
Sleep on a bed with the part where the head is raised.
Do not eat at night, avoid large meals, do not eat too hot food.
Give up alcohol and smoking.
Limit the consumption of fats, chocolate, coffee and citrus fruits, as they are irritating and reduce LES pressure.
Lose weight if you are obese.
Refuse to take medications that cause reflux. These include antispasmodics, β-blockers, prostaglandins, anticholinergics, tranquilizers, nitrates, sedatives, calcium channel inhibitors.

Medicines for reflux disease. Antacids and alginates

Such drugs for the treatment of GERD are used when the manifestations of the disease are moderate and infrequent. Antacids should be taken after each meal (after one and a half to two hours) and at night. The main drug from this group is Almagel.

Alginates create a thick foam on the surface of the contents of the stomach and, due to this, return to the esophagus with each episode of reflux, thereby providing a therapeutic effect. Due to the content of antacids, alginates produce an acid-neutralizing effect, at the same time they form a protective film in the esophagus, which creates a pH gradient between its lumen and the mucosa and thus protects the mucosa from the negative effects of gastric juice.

Prokinetics

These drugs restore the normal physiological state of the esophagus by increasing the tone of the lower sphincter, improving clearance and increasing peristalsis. The main means of pathogenetic therapy for GERD is the prokinetic drug "Motilium". It normalizes the motor activity of the upper digestive tract, restores the active peristalsis of the stomach and improves antroduodenal coordination. "Motilium" is well tolerated if long-term therapy is necessary, reduces the percentage of relapses of the disease.

proton pump inhibitors

If GERD with esophagitis is diagnosed, treatment with prokinetics is carried out in combination with proton pump inhibitors. As a rule, a new generation drug "Pariet" is used. Due to its use, acid secretion decreases, there is a positive trend in the clinical manifestations of the disease. Patients talk about a decrease in the intensity or even the complete disappearance of heartburn, a decrease in pain.

With GERD, the treatment regimen with prokinetics and proton pump inhibitors is used as follows: 20 milligrams of Pariet and 40 milligrams of Motilium are prescribed per day.

Therapy in young children

In babies, reflux causes frequent spitting up. Treatment consists of several stages:

Therapy in older children

Of great importance in the treatment of reflux disease is the correction of the child's lifestyle.

You should raise the end of the bed where the head is located by at least fifteen centimeters. Such a simple measure can reduce the duration of acidification of the esophagus.
It is necessary to introduce dietary restrictions for the child: reduce the fat content in the diet and increase the protein content, reduce the amount of food consumed, exclude irritating foods (citrus juices, chocolate, tomatoes).
It is necessary to develop a habit in the child not to eat at night, not to lie down after eating.
It is required to ensure that the child does not wear tight clothes, does not sit for a long time, bent over.

As a medical treatment, as in adults, antacids are used, usually in the form of a suspension or gel (Almagel, Phosphalugel, Maalox, Gaviscon), prokinetic agents (Motilac, Motilium , "Tserukal"). The choice of a specific medication and the determination of the dosage is carried out by the attending physician.

Surgical intervention

Sometimes, to restore the normal function of the cardia, it is necessary to resort to surgery aimed at eliminating reflux. Indications for surgical treatment are as follows:

complications of GERD (repeated bleeding, strictures);
ineffectiveness of conservative therapy;
frequent aspiration pneumonia;
diagnosing Barrett's syndrome with high-grade dysplasia;
the need for young patients with GERD for long-term antireflux therapy.

Reflux is often removed by fundoplication. However, this method is not without drawbacks. So, the result of the operation depends entirely on the experience of the surgeon, sometimes after surgery there is a need for medical treatment, there is a risk of death.

Currently, various endoscopic techniques have been used to influence metaplasia foci: electrocoagulation, laser destruction, photodynamic destruction, argon plasma coagulation, endoscopic local resection of the esophageal mucosa.

Therapy with folk remedies

In the initial stages of GERD, alternative treatment can be very helpful. In general, at these stages, you can cope with the disease simply by observing the antireflux regimen and changing your lifestyle. If the disease is mild, instead of antacids, various traditional medicines can be used to relieve heartburn, which strengthen and protect the esophageal mucosa, improve sphincter tone and reduce the acidity of gastric juice. With a severe course of the pathological process, it will not be possible to do without drug therapy, and in the presence of complications, surgical intervention is generally required. Therefore, the treatment of GERD with folk remedies is rather an auxiliary and preventive method. It can be used as an adjunct to highly effective drug therapy regimens.

Phytotherapy is very popular among people. Here are some traditional medicine recipes for the treatment of reflux disease.

Treatment of GERD with folk remedies involves not only herbal medicine, but also the use of mineral waters. They should be used at the final stage of the fight against the disease or during remissions in order to consolidate the results. With reflux disease, alkaline low-mineralized waters, such as Borjomi, Smirnovskaya, Slavyanovskaya, are effective. You need to drink them, slightly warmed up, since gas is released during the heating process. However, the temperature should not exceed 40 degrees, otherwise the salts will precipitate. Drink warm degassed mineral water should be forty minutes before meals in a glass for one month. After drinking water, it is recommended to lie down for twenty minutes.

Ensuring effective control of gastric secretion is one of the main conditions for successful treatment of the so-called "acid-dependent" diseases of the upper gastrointestinal tract. In clinical and outpatient practice, at present, to inhibit hydrochloric acid by the parietal cells of the gastric mucosa, second-generation (ranitidine) and third (famotidine) histamine H2-receptor blockers are most often used, and somewhat less often, proton pump inhibitors (omeprazole, rabeprazole), and for neutralization of hydrochloric acid already released into the stomach cavity - antacids. Antacids are sometimes used in the treatment of patients suffering from so-called "acid-dependent" diseases, in combination with H2-histamine receptor blockers; sometimes as "on demand" therapy in combination with proton pump inhibitors. One or two "chewed" antacid tablets do not have a significant effect on the pharmacokinetics and pharmacodynamics of famotidine used at a dose of 20 mg.

There are certain differences between these medications, we list the main ones: different mechanisms of action; the rate of onset of the therapeutic effect; duration of action; different degree of effectiveness of their therapeutic action depending on the time of taking the drug and eating; the cost of medications. The above factors are not always taken into account by doctors in the treatment of patients.

In recent years, the literature has increasingly discussed the pharmacoeconomic efficiency of the use of various drugs in the treatment of "acid-dependent" diseases, used according to one or another scheme. The cost of examination and treatment of patients is especially important to consider in cases where patients, due to the characteristics of the disease, need long-term treatment, for example, with gastroesophageal reflux disease (GERD). This is a very common disease, the examination and treatment of such patients require significant costs.

As is known, most patients with GERD do not have endoscopic signs of reflux esophagitis. However, as GERD progresses, pathological changes in the esophageal mucosa appear. The symptoms of this disease have the same impact on the quality of life as the symptoms of other diseases, including coronary heart disease. GERD has a negative impact on quality of life, especially on pain scores, mental health, and social function. Patients with GERD are at high risk of developing Barrett's esophagus and then adenocarcinoma of the esophagus. Therefore, at the very first clinical symptoms of GERD, especially when endoscopic signs of esophagitis occur, sufficient attention should be paid to the timely examination and treatment of such patients.

Currently, patients with GERD are treated, in particular, with the drug famotidine (gastrosidin) in the usual therapeutic dosages (20 mg or 40 mg per day). This drug has a number of advantages: ease of use (1-2 times a day), high efficiency in the treatment of "acid-dependent" diseases, including in comparison with antacids, as well as greater safety compared to cimetidine. However, observations have shown that in some cases, to increase the effectiveness of therapy, it is advisable to increase the daily dose of gastrosidin, which, according to some observations, reduces the likelihood of side effects compared with the use of high doses of histamine H2 receptor blockers of the first (cimetidine) and second (ranitidine) generations. The advantage of famotidine over cimetidine and ranitidine is a longer inhibitory effect on the secretion of hydrochloric acid by the parietal cells of the gastric mucosa.

There are other advantages of histamine H2 receptor blockers (ranitidine or famotidine) over proton pump inhibitors; in particular, the appointment of these drugs at night allows them to be effectively used in the treatment of patients due to the absence of the need to observe a certain "temporary" relationship between the intake of these drugs and food. The appointment of some proton pump inhibitors at night does not allow them to be used at full capacity: the effectiveness of proton pump inhibitors is reduced, even if these drugs are taken by patients in the evening and an hour before a meal. However, 24-hour pH monitoring performed in patients treated with omez (20 mg) or famotidine (40 mg) indicates that the duration of action of these drugs (10.5 hours and 9.4 hours, respectively) does not overlap the period of nocturnal secretion, and in the morning, a significant proportion of patients again observed "acidification" of the stomach. In this regard, it is necessary to take these drugs in the morning.

A certain scientific and practical interest is the study of the efficacy and safety of the use of famotidine and omez (omeprazole) in higher dosages in the treatment of patients suffering from "acid-dependent" diseases of the upper gastrointestinal tract.

We have studied the results of clinical, laboratory and endoscopic examination and treatment of 30 patients (10 men and 20 women) suffering from GERD in the stage of reflux esophagitis. The age of patients is from 18 to 65 years. Upon admission to the Central Research Institute, 30 patients had the main clinical symptoms of GERD (heartburn, pain behind the sternum and / or in the epigastric region, belching), 25 patients had clinical symptoms, mainly associated with impaired motility of the upper gastrointestinal tract (feeling of rapid satiety, fullness and distension of the stomach, heaviness in the epigastric region), usually occurring during or after a meal. The combination of certain clinical symptoms, the frequency and time of their occurrence, as well as the intensity and duration in different patients were different. There were no significant deviations in blood counts (general and biochemical tests), in urine and feces before the start of therapy.

Esophagogastroduodenoscopy (EGD) revealed reflux esophagitis (in the absence of erosions) in 21 patients, including 4 patients with cicatricial and ulcerative deformity of the duodenal bulb and one patient with a slit-like ulcer of the duodenal bulb (5 patients suffered from duodenal ulcer). intestine, combined with reflux esophagitis). In addition, one patient had a peptic ulcer of the esophagus on the background of reflux esophagitis and 8 patients had erosive reflux esophagitis. In all patients, according to endoscopy, cardia insufficiency was found (in combination with axial hernia of the esophageal opening of the diaphragm or without it).

In the treatment of such patients, gastrosidin (famotidine) was used at a dosage of 40-80 mg per day for 4 weeks (the first 2-2.5 weeks of treatment were carried out in the hospital of the Central Research Institute of Human Resources, in the next 2 weeks patients took gastrosidin on an outpatient basis). Therapy with gastrosidin was always started and continued in the absence of pronounced side effects, patients were prescribed 40 mg 2 times a day for 4 weeks; only with the appearance of diarrhea and urticaria, the dosage of gastrosidin was reduced to 40 mg per day.

The study was performed taking into account the criteria for inclusion and exclusion of patients from the study in accordance with the rules of clinical practice.

During endoscopy, NR was determined using a rapid urease test (one fragment of the antrum of the stomach within 2-3 cm proximal to the pylorus) and a histological examination of the biopsy material (two fragments of the antrum within 2-3 cm proximal to the pylorus and one fragment of the stomach body within 4-5 cm proximal to the angle of the stomach). When examining patients, if necessary, ultrasound of the abdominal cavity organs and X-ray examination of the gastrointestinal tract were performed. The data obtained, including the identified side effects, were recorded in the medical history.

During the study period, patients did not additionally take proton pump inhibitors, histamine H2 receptor blockers, or other so-called "anti-ulcerogenic" drugs, including antacids and drugs containing bismuth. 25 out of 30 patients (84%), due to the presence of clinical symptoms most often associated with impaired motility of the upper digestive tract, additionally received prokinetics: domperidone (Motilium) for 4 weeks or metoclopramide (Cerucal) for 3-4 weeks.

Treatment of patients with GERD in the stage of reflux esophagitis was always started with the appointment of gastrosidin 40 mg 2 times a day (it was assumed that in the event of significant side effects, the dose of gastrosidin would be reduced to 40 mg per day). After 4 weeks from the start of treatment (taking into account the condition of the patients), in the presence of clinical signs of GERD and (or) endoscopic signs of esophagitis, therapy was continued for another 4 weeks. After 4-8 weeks, according to the results of clinical, laboratory and endoscopic examination, it was supposed to sum up the results of the treatment of patients with GERD.

In the treatment of patients with gastrosidin (famotidine), the following factors were taken into account: the effectiveness of gastrosidin in suppressing both basal and nocturnal, and stimulated by food and pentagastrin secretion of hydrochloric acid, no changes in the concentration of prolactin in the blood serum and antiandrogenic effects, no effect of the drug on the metabolism in the liver of other drugs funds.

According to the analysis of the examination and treatment of patients with GERD in the stage of reflux esophagitis, in most cases, the therapy was found to be effective. Against the background of ongoing treatment in patients with GERD with reflux esophagitis (in the absence of erosion and peptic ulcer of the esophagus), the main clinical symptoms disappeared within 4-12 days; in patients with erosive reflux esophagitis, the pain behind the sternum gradually decreased and disappeared on the 4-5th day from the start of taking gastrosidin; in a patient with peptic ulcer of the esophagus against the background of reflux esophagitis - on the 8th day.

Two out of 30 patients (6.6%) after 2-3 days from the start of treatment refused to take gastrosidin, according to them, due to increased pain in the epigastric region and the appearance of dull pain in the left hypochondrium, although objectively their condition was quite satisfactory . These patients were excluded from the study.

According to the EGDS data, after 4 weeks of treatment, endoscopic signs of reflux esophagitis disappeared in 17 patients out of 28 (60.7%), and 11 showed positive dynamics - a decrease in the severity of esophagitis. Therefore, in the future, these patients were treated with gastrosidin on an outpatient basis for another 4 weeks, 40 mg 2 times a day (7 patients) and 40 mg 1 time per day (4 patients who had previously reduced the dosage of gastrosidin).

The question remains very controversial - whether to consider reflux esophagitis, often observed in peptic ulcer (most often with duodenal ulcer), as a complication of this disease, or to consider it an independent, concomitant disease of peptic ulcer? Our many years of observational experience shows that, despite some connection between GERD and peptic ulcer disease (their relatively frequent combination and even the appearance or exacerbation of reflux esophagitis as a result of anti-Helicobacter therapy), peptic ulcer disease and GERD (including in the reflux stage -esophagitis) should be considered independent diseases. We have repeatedly observed patients with frequent exacerbations of GERD in the stage of reflux esophagitis (if they have cicatricial and ulcerative deformity of the duodenal bulb). The last exacerbation of peptic ulcer (with the formation of an ulcer in the duodenal bulb) in these patients was observed 6-7 or more years ago (much less often than relapses of GERD in the stage of reflux esophagitis), however, with the next exacerbation of peptic ulcer with the formation of an ulcer in the duodenal bulb intestines, reflux esophagitis was always detected during endoscopic examination. We are confident that with the availability of modern medications, it is much easier to treat uncomplicated peptic ulcer than GERD: the period of therapy for exacerbation of duodenal ulcer takes much less time compared to GERD therapy; and during the period of remission of these diseases, patients with duodenal ulcer feel more comfortable, while patients with GERD are forced to refuse to take much more food and drinks to improve their quality of life.

During the examination (after 8 weeks of treatment), three of 11 patients still presented complaints associated with impaired motility of the upper gastrointestinal tract. Three patients with good health refused to conduct a control EGDS after 8 weeks. According to the endoscopy data, 7 out of 8 patients showed the disappearance of endoscopic signs of esophagitis (including healing of a peptic ulcer of the esophagus in one patient).

HP was determined in all 30 patients: in 11 cases HP contamination of the gastric mucosa was detected (according to the rapid urease test and histological examination of targeted gastrobiopsy materials). Antihelicobacter therapy during the treatment of patients with GERD in the stage of reflux esophagitis was not carried out.

When assessing the safety of the treatment, no significant deviations in the laboratory parameters of blood, urine and feces were noted. In 4 patients (13.3%), who previously had "normal" (regular) stools, on the 3rd day of treatment with gastrosidin (at a dose of 40 mg 2 times a day), "liquid" stools were noted, in their words (mushy, without pathological impurities), in connection with which the dose of gastrosidin was reduced to 40 mg per day. 10-12 days after the dose reduction, the stool returned to normal without any additional therapy. It is interesting to note that in 4 more patients who had previously suffered from constipation, the stool returned to normal on the 7th day during the treatment. In 3 out of 30 patients (10%) on the 3rd-4th day of taking gastrosidin, rashes appeared on the skin of the trunk and extremities (urticaria). After reducing the dosage of gastrosidin to 40 mg per day and additional treatment with diazolin (0.1 g 3 times a day), the skin rash disappeared.

The conducted studies have shown the feasibility and effectiveness of therapy for GERD in the stage of reflux esophagitis with gastrosidin 40 mg 2 times a day, especially in the treatment of patients with severe pain and heartburn. Such treatment can be successfully carried out in inpatient and outpatient settings. The study of the long-term results of the treatment will allow to determine the duration of the period of remission of this disease and the feasibility of treatment with gastrosidin as a "maintenance" therapy or therapy "on demand".

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Reflux esophagitis is a disease that requires mandatory complex medical treatment, which includes lifestyle correction, maintaining a therapeutic diet, the use of medicines and products prepared according to folk recipes. In severe cases of the disease, surgery is prescribed. When prescribing treatment for reflux esophagitis, the gastroenterologist chooses the drugs, relying on data on the causes and symptoms of the disease.

The duration of treatment for reflux esophagitis depends on its form. The non-erosive form therapy lasts 4 weeks. What medications to prescribe and in what dosage - the specialist decides depending on the stage of the disease. In addition to drug therapy, it is possible to take decoctions and infusions of herbs, diet therapy. With an erosive form, treatment increases to 8 weeks and includes the use of hydrochloric acid blockers, healing and hemostatic (if necessary) substances.

In case of complications, concomitant diseases or advanced age, the patient undergoes therapy for up to 12 weeks. With successful completion of treatment, prophylactic use of drugs is recommended in order to achieve remission within six months.

Treatment regimens

One drug is prescribed, not taking into account the symptoms and complexity of the disease. Such a scheme is not useful and in most cases has no effect.
The second way involves following a specific diet and taking antacids. Depending on the stage of the course of inflammation, substances of different effectiveness are prescribed.
The third method is based on the initial relief of symptoms by taking proton pump blockers. The second line is taking prokinetic drugs.

The classical scheme consists of four stages, depending on the stage of tissue damage:

In the first degree, with mild symptoms, it is recommended to take prokinetic drugs and antacids.
The second degree requires maintaining a healthy dietary balance and includes the use of acid blockers.
With a pronounced inflammatory process, proton pump inhibitors, H-2 blockers and prokinetics are prescribed.
The fourth degree is not treated with medication and requires surgical intervention.

Medicines used to treat

Therapy of inflammation of the esophagus takes place with the use of several groups of drugs. At various stages of the disease, the use of drugs is carried out in a complex manner in different combinations and dosages.

Prokinetics

The active substance affects the muscular activity of the digestive organs, normalizes the tone of the esophageal sphincter. Restoring the normal functioning of the esophagus contributes to the rapid promotion of food, helps to cleanse the mucosa. This group includes Itopride, Domperidone, Motilium. The latter is prescribed in the presence of vomiting and a feeling of nausea. Ganaton helps relieve symptoms in a week, heal in three weeks and has no side effects.

proton pump inhibitors

Drugs that help reduce the production of hydrochloric acid by mucosal cells. They are used to relieve severe symptoms of inflammation and relieve pain. Fast-acting substances with minimal side effects.

The course of therapy is prescribed by a specialist, since prolonged use can lead to bone fragility and affect kidney function. The main drugs included in the group: Omeprazole, Lansoprazole, Pantoprazole.

H-2 blockers

They have a similar effect with PPIs, the action occurs due to the blocking of histamine receptors. The production of hydrochloric acid is suspended, which makes it possible to alleviate the condition of the esophagus and stomach.

The fifth generation of such medicines has been developed. The most effective are Ranitidine and Famotidine. Abrupt cessation of use can lead to a short-term increase in the symptoms of the disease.

Alginates and antacids

With esophagitis, drugs that neutralize the effect of acid on the esophagus are prescribed for a successful cure. Antacids are recommended to drink in liquid form. The duration of the drug is 10-15 minutes. The course of therapy is a maximum of two weeks, since the composition of the funds includes magnesium and aluminum. This group includes Phosphalugel, Almagel, Maalox.

Alginates have a milder effect, so they are prescribed during pregnancy. The composition includes alginic acid, which, after ingestion, forms a protective layer on the surface of the mucosa.

Cytoprotectors

Increase the degree of protection of the mucous layer of the esophagus and stomach with. Tablets help improve blood flow, increase the secretion of protective mucus, lower the level of acidity, while promoting the healing of foci of erosion. The most famous drugs are Misoprostol and Dalargin.

Use of antibiotics for esophagitis

With the phlegmous type of esophagitis, antibiotics are prescribed to relieve inflammation in adult patients and relieve pain. With prolonged therapy, it can develop, therefore, the combined use of antifungal agents is recommended.

Use of other drugs

Ursosan reduces the possibility of tissue damage by gastric juice due to the destruction and removal of bile acids. Trimedat helps reduce reflux and increases the speed of food passing through the esophagus.

Symptomatic therapy

If reflux developed against the background of another disease or pathology appeared as a complication of esophagitis, symptomatic treatment is carried out:

For neurological and psychological problems, it is necessary to consult a doctor of the desired profile. Sedatives, etc. may be prescribed.
Antibacterial drugs are prescribed for gastric ulcer. Denol helps to neutralize the action of Helicobacter pylori, improves blood circulation in the walls of the stomach, and alleviates the unpleasant symptoms of the disease.
With a decrease in immunity, immunomodulators are prescribed.

Also, therapy includes the use of vitamin complexes with a high content of macronutrients to improve the general condition of the body.

Treatment approaches

Depending on the stage of tissue damage, the presence of complications, etc., a suitable treatment method is chosen.

The first includes taking medications for esophagitis of different activity in several stages:

Maintenance of a therapeutic diet and the use of antacids.
Use of H-2 blockers or prokinetic drugs.
Comprehensive intake of PPIs and prokinetics.

The second technique is carried out in three approaches:

It is prescribed to relieve symptoms.
Taking inhibitors for five days to relieve discomfort.
The use of tablets only with an exacerbation of the disease.

The third technique is:

For mild inflammation, a short course of antacids or acid blockers and adherence to diet and diet.
For stage II treatment, a long course of PPIs or acid blockers and prokinetics. Diet therapy is also indicated.
Stage III requires the use of a complex of blockers and PPIs or prokinetics. Instructions for use shows the maximum allowed doses.
If previous appointments have not brought effect, surgical intervention is necessary.

Supportive care

Medical treatment of esophagitis is the most effective. After undergoing therapy, it is necessary to adhere to a certain lifestyle and conduct a six-month course of maintenance treatment for reflux.

The use of maintenance therapy, dieting, changing the regimen and some habits, the use of traditional medicine will help to avoid relapse and in the future the disease will not cause inconvenience.