Reflux stomach disease. Gastroesophageal reflux without esophagitis (K21.9)

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

• changes in body position during sleep;
• changes in nutrition;
• abstaining from smoking;
• abstaining from alcohol abuse;
• if necessary, decrease in body weight;
• refusal of medications that induce the onset of GERD;
• elimination 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 involving forward bending of the body, 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 tilt of the torso.

The exclusion of a strictly horizontal position during sleep allows you to reduce the number of reflux episodes and their duration, since the esophageal cleansing increases due to the action of 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 (they all reduce the tone of the lower esophageal sphincter);
• citrus fruits and tomatoes, fried, onions and garlic, since they have a direct irritating effect on the sensitive mucous membrane of the esophagus;
• the consumption of butter, margarine is limited;
• 3-4 meals a day are recommended, a diet with a high protein content, since protein food increases the tone of the lower esophageal sphincter;
• the last meal - at least 3 hours before bedtime, after a meal, 30-minute walks.
• 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 arms, avoid physical exertion associated with overstrain of the abdominal press; to give up smoking; maintaining normal body weight;

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

Avoid taking medications that reduce the tone of the lower esophageal sphincter (anticholinergics, tricyclic antidepressants, sedatives, tranquilizers, calcium antagonists, beta-agonists, drugs containing L-dopamine, drugs, 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 in case of a complicated course of the disease, as well as in case of 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 characteristics of drugs used in the treatment of gastroesophageal reflux disease:

1. Antacids

Mechanism of action: neutralizes hydrochloric acid, inactivates pepsin, adsorbs bile acids and lysolitsetin, stimulates the secretion of bicarbonates, has a cytoprotective effect, improves 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 best to use liquid forms of antacids. It is better to use conditionally insoluble (non-systemic) antacids, such as those containing nonabsorbable aluminum and magnesium, antacids (Maalox, Fosfalugel, Gastal, Rennie), as well as antacids, which include substances that eliminate si, mptoms of flatulence (Protab, Daidzhin, Gestide).

Of the vast array of antacids, Maalox is one of the most effective. 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 pleasant taste.

Preference should be given to III 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 accumulates above the layer of food and liquid and gets into the esophagus in case of gastroesophageal reflux, has a therapeutic effect, protecting the esophageal mucosa 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 an 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 (Cerucal, Raglan). It enhances the release of acetylcholine in the gastrointestinal tract (stimulates the motility of the stomach, small intestine and esophagus), blocks central dopamine receptors (affects the vomiting center and the center for regulating gastrointestinal motility). Metoclopramide increases the tone of the lower esophageal sphincter, accelerates gastric evacuation, 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 an acidic environment is required for its absorption, and with anticholinergic drugs that neutralize the effect of Motilium. The most effective treatment for GERD is Prepulside (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. Prepulside increases the tone of the LPS, increases the amplitude of contractions of the esophagus and accelerates the evacuation of stomach contents. At the same time, the drug does not affect gastric secretion, therefore, 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 the serotonin receptors 5-HT 3 and 5-HT 4.

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. Blockers of H 2 -receptors of histamine

Currently, 5 classes of H 2 blockers are available: Cimetidine (I generation), Ranitidine (II generation), Famotidine (III generation), Nizatidine (Axid) (IV generation) and Roxatidine (V generation).

The most widely used drugs are from the groups 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, inhibit the secretion of pepsins. If possible, preference should be given to Famotidine, which, due to its greater selectivity and lower dosage, acts for a longer time and does not have the side effects inherent in Ranitidine. Famotidine is 40 times more effective than cymitidine 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. Duration of action of 20 mg Famotidine 12 hours, 40 mg - 18 hours. The recommended dose for 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 their active form they exist only in the parietal cell. The effect 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 the production of hydrochloric acid in the stomach is almost 100% inhibited. Currently, 4 chemical varieties of this group of drugs are known: Omeprazole, Pantoprazole, Lanzoprazole, Rabeprazole. The ancestor 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 Lanzoprazole are used at a dosage of 30 and 40 mg, respectively. The 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 to achieve 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, there was an earlier submission of GERD symptoms and a more frequent cure in comparison with the usual or double doses of H 2 -blockers, which is associated with a greater degree of suppression of acid production.

Recently, a new improved form of the drug "Losek", produced by the company "Astra", "Losek-maps", has appeared on the drug market. Its advantage lies in the fact that it does not contain filler allergens (lactose and gelatin), is smaller than the capsule, and is coated with a special shell to facilitate 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 operation of the proton pump, but only interfere with 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 against 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 production of mucus and bicarbonates;
• increases the protective properties of mucus;
• improve blood flow to the esophageal mucosa.

Misoprostol is given at 0.2 mg 4 times daily, usually for grade III gastroesophageal reflux disease.

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

With gastroesophageal reflux caused by the throwing of duodenal contents into the esophagus (alkaline, bile type of reflux), which is usually observed in cholelithiasis, a good effect is achieved when non-toxic ursodeoxycholic bile acid (Ursofalk) is taken at 250 mg per night, which in this case is combined with Coordinate. 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, which is excreted with feces). It is taken at 12-16 g / day.

Dynamic observation of the revealed secretory, morphological and microcirculatory disorders in GERD confirm the currently proposed various schemes for the drug correction of gastroesophageal reflux disease.

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

• the scheme of "step-by-step" therapy, which involves the appointment at different stages of the disease, drugs and combinations of various strengths. So, at the first stage, the main place in the treatment is given to changing the lifestyle 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 turns out to be 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 "step-by-step" therapy assumes from the very beginning the appointment of proton pump inhibitors with a subsequent transition after the achievement of a clinical effect on the intake of H 2 -blockers or prokinetics. The use of such a scheme is justified in patients with a severe course of the disease and pronounced erosive and ulcerative changes in the mucous membrane of the esophagus.

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

1. In case of gastroesophageal reflux without esophagitis, Motilium or Cisapride is administered 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.
2. In case of reflux esophagitis of the 1st severity, H 2 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, taken in the morning and in the evening with an interval of 12 hours). After 6 weeks, if remission occurs, drug treatment is discontinued.
3. In case of 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 lunch (at 14-15 hours) is prescribed for 6 weeks. After 6 weeks, drug treatment is discontinued if remission occurs.
4. With reflux esophagitis of the III degree of severity - for 4 weeks, Omeprazole 20 mg is prescribed orally 2 times a day, in the morning and in the 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 for a year.
5. In case of reflux esophagitis of the IV degree of severity - for 8 weeks, Omeprazole 20 mg is prescribed orally 2 times a day, in the morning and in the evening with a mandatory interval of 12 hours or another proton pump inhibitor, 30 mg 2 times a day, and when remission occurs, they switch to constant intake of H 2 -histamine blockers. Additional means of therapy for refractory forms of GERD include Sucralfat (Venter, Sukratgel) 1 g 4 times a day 30 minutes before meals for 1 month.

• a mild disease (reflux esophagitis 0-1 degree) requires a special lifestyle and, if necessary, taking antacids or H2 blockers;
• with moderate severity (reflux esophagitis of the II degree), along with constant adherence to a special regime of life and diet, long-term intake of H 2 receptor blockers in combination with prokinetics or proton pump inhibitors is necessary;
• in case of severe illness (reflux esophagitis of the 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 absence of the 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 neurotization in patients with 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 revealed by pH metry, we conduct psychological testing using computer modification of the Eysenck, Schmischek, MMPI, Spielberger questionnaires, Luscher color test, which allows us to reveal the dependence of the nature and severity of gastroesophageal refluxes on individual personality characteristics and, accordingly, with this in mind, develop effective treatment regimens. Thus, it is possible to achieve not only a reduction in the duration of treatment, but also to 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 was found 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 hypotension of the LPS in basal conditions, an increase in intra-abdominal pressure and a delayed evacuation function of the stomach. Diagnosis of the disease is based on clinical evidence. Carrying out (if necessary) an endoscopic examination is considered safe. Lifestyle changes are especially important in treatment. At the next stage, "non-absorbable" antacids are added (Maalox, Fosfalugel, Sucralfat, etc.). Considering that Sucralfat (Venter) can cause constipation, the use of Maalox is more justified. In case of refractoriness of treatment, such H 2 -blockers as Ranitidine or Famotidine can be used.

The use of Nizatidine during pregnancy is not shown, since in the experiment the drug showed teratogenic properties. Taking into account the experimental data, the use of Omeprazole, Metoclopramide and Cisaprid 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 (Losec) 20 mg in the morning on an empty stomach.
• Taking prokinetics: Cisapride (Coordinax) or Motilium in half the dose compared to the dose used during the exacerbation.
• Long-term treatment with non-absorbable antacids (Maalox, Fosfalugel, 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 indicator 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 the 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 forced them to stop prolonged treatment. Data on the presence of phosphorus deficiency in the body have not been obtained.

American experts estimate that a five-year full-fledged antireflux therapy costs patients more than $ 6,000. At the same time, when you stop taking even the most effective drugs and their combinations, long-term remission is not observed. According to foreign authors, relapse of GERD symptoms occurs in 50% of patients after 6 months, after stopping 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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Proper functioning of the digestive system provides the body with a full range of nutrients and energy. But unfortunately, a lot of harmful factors that negatively affect health, lead to a disruption in the functioning of this system.

Gastroesophageal reflux disease (GERD) is associated with damage to the muscle ring (sphincter) that separates the esophagus and stomach. Due to this pathology, the contents of the stomach are thrown into the esophagus, thereby leading to irritation and subsequent inflammation.

Reflux Disease Causes

Unbalanced and inappropriate nutrition. For all the troubles, both forced snacks at work (sandwiches and dry meals) and a completely natural desire to look slim and fit (an inadequate diet leading to a deficiency of vital nutrients) should be blamed. Also, gastroesophageal reflux can develop due to the predominance of fatty, spicy and overly salty foods in the diet.

2. Frequent and profuse vomiting (happens in case of poisoning, including alcoholic ones).

3. Bad habits that contribute to the destruction of the mucous membranes of the stomach and duodenum 12 (smoking, alcohol abuse, drug addiction).

4. A side effect of taking certain medications that reduce the tone of the sphincter (another confirmation that reading the accompanying instructions for medications is not a whim, but an urgent need).

5. Hereditary predisposition (it almost always explains cases of reflux in newborns).

6. Obesity.

7. Complication of some diseases (or, which is also possible, a consequence of their treatment):

• hiatal hernia;

• systemic scleroderma (rare connective tissue pathology);

• neuropsychic anorexia (it is often diagnosed in models who, despite the symptoms of extreme exhaustion, continue to torture themselves with a diet);

• some disorders of the central nervous system;

• incorrect installation of a nasogastric tube.

Classification and stages of reflux disease

There are two main forms of gastroesophageal reflux disease:

• non-erosive (endoscopically negative) reflux disease (NERD) - occurs in 70% of cases;

The condition of the esophageal mucosa is assessed by stages according to the Savary-Miller classification or according to the degrees of the Los Angeles classification.

The following degrees of GERD are distinguished:

• zero - symptoms of reflux esophagitis are not diagnosed;

• the first - there are non-merging areas of erosion, hyperemia of the mucous membrane is noted;

• the total area of ​​erosive areas occupies less than 10% of the entire area of ​​the distal part of the esophagus;

• the second - the area of ​​erosion is from 10 to 50% of the total surface of the mucous membrane;

• third - there are multiple erosive and ulcerative lesions that are located over the entire surface of the esophagus;

• fourth - deep ulcers occur, Barrett's esophagus is diagnosed.

The Los Angeles classification applies only to erosive varieties of the disease:

• grade A - there are no more than several mucosal defects up to 5 mm long, each of which extends to no more than two of its folds;

• degree B - the length of the defects exceeds 5 mm, none of them extends to more than two folds of the mucous membrane;

• degree C - defects are spread over more than two folds, their total area is less than 75% of the circumference of the esophageal opening;

• grade D - the area of ​​defects exceeds 75% of the circumference of the esophagus.

Reflux Disease Symptoms

Heartburn. Heartburn is the main symptom of GERD. It is a burning sensation that spreads upward from the abdomen to the chest and throat. Heartburn is most likely due to the following activities:

- when eating heavy food;

- when tilting;
- when climbing;
- lying, especially on the back.

All GERD patients tend to experience more pain at night than at other times of the day.
The severity of heartburn does not necessarily indicate actual damage to the esophagus. For example, Barrett's esophagus, which causes pre-cancerous changes in the esophagus, may show only a few symptoms, especially in the elderly. On the other hand, people can have severe heartburn without damage to the esophagus.

- Dyspepsia. About half of GERD patients have dyspepsia, a syndrome that consists of the following:

- pain and discomfort in the upper abdomen;
- a feeling of fullness in the stomach;
- nausea after eating;
- regurgitation. Regurgitation is the sensation of acid and accumulation in the throat. Sometimes acid is spewed out into the mouth and can be perceived as "wet belching". It can come out like vomit. People without GERD may also have dyspepsia.

- Feelings of chest pain. Patients may feel that food is trapped behind the breastbone. Chest pain is a common symptom of GERD. It is very important to distinguish it from chest pain caused by heart problems (angina pectoris, heart attack, etc.).

- Symptoms in the throat. Less commonly, GERD can cause throat symptoms:

- Acid laryngitis. A condition that is accompanied by hoarseness, dry cough, feeling of a lump in the throat and frequent need to cough up;
- problems with swallowing (dysphagia). In severe cases, patients can be shocked and food can get stuck in their esophagus, causing severe chest pain. This may indicate a temporary spasm that narrows the tube, or serious damage or abnormalities in the esophagus;
- chronic sore throat;
- persistent hiccups;
- cough and respiratory (respiratory) symptoms - cough, wheezing, etc.;
- chronic nausea and vomiting. Nausea persists for weeks or even months and does not stem from frequent stomach upsets, incl. heartburn symptoms. In rare cases, vomiting may occur more frequently than once a day. All other causes of chronic nausea and vomiting must be ruled out, including ulcers, stomach cancer, obstruction, pancreatic or gallbladder disease.

Reflux Disease Diagnostics

In the diagnosis of gastroesophageal reflux disease, a thorough collection of complaints and anamnesis plays an important role. Since the clinical picture of GERD is quite specific, the correct diagnosis can be made at this stage with a high degree of probability.

To confirm the diagnosis, as well as to establish the severity of the disease, endoscopic examination of the esophagus and stomach (EGD) and daily pH monitoring of the esophagus are performed.

With the help of FGDS, the lesion of the esophageal mucosa is determined, if necessary, a biopsy of the most suspicious areas is performed. Daily pH monitoring allows you to measure fluctuations in acidity in the esophagus, to determine what these fluctuations are associated with.

Additional research methods:

• X-ray examination of the esophagus and stomach;
• Esophageal manometry (study of the tone of the esophagus and its sphincters);
• Impedansometry (study of the peristalsis of the esophagus).

For the purpose of differential diagnosis, we perform ECG and ultrasound of the heart. If there are indications (search for the causes of GERD, treatment planning), we perform computed tomography or MRI.

Reflux Disease Treatment

1. Lifestyle changes

Includes sleeping with a raised headboard, eating at least an hour and a half before bedtime, refusing to eat that provokes heartburn (fatty, starchy foods, citrus fruits, coffee, chocolate, carbonated drinks)

2. Inhibitors (blockers) of the proton pump (abbreviated PPI, PPP)

These drugs decrease the production of hydrochloric acid by the stomach glands. PPIs are not suitable for immediate relief, as their effect develops several days after the start of admission.

PPD is currently considered the drug of choice in most patients with GERD. This group should be used in patients with reflux disease for a course of 6-8 weeks. All proton pump inhibitors should be taken half an hour before meals 1-2 times a day.

APIs include:

• Omeprazole (Omez) 20 mg 1-2 r / day;
• Lansoprazole (Lanzap, Acrylanz) 30mg 1-2 r / day;
• Pantoprazole (Nolpaza) 40 mg once a day;
• Rabeprazole (Pariet) 20 mg once a day. If necessary, it can be taken continuously in half the dose.
• Esomeprazole (Nexium) 20-40 mg once a day. Swallow without chewing with water.

3. Antacids

Drugs in this group quickly neutralize hydrochloric acid, so they can be used to eliminate heartburn at the time of its occurrence. Antacids can be prescribed for GERD as the only drug in cases where there are no erosions and ulcers, or antacids are used at first in conjunction with proton pump blockers, since the latter do not begin to act immediately.

Of the medicines in this group, dispensed without a doctor's prescription, the following have been shown to be the best:

Aluminum and magnesium hydroxide in the form of gels:

• Maalox - 1-2 tablets 3-4 times a day and before bedtime, take 1-2 hours after meals, chewing or dissolving thoroughly;

• Almagel 1-3 dosage spoons 3-4 times a day. Take half an hour before meals;

• Phosphalugel 1-2 sachets (you can dilute 100 ml of water) 2-3 times a day immediately after meals and at night.

Sucking tablets: simaldrat (Gelusil, Gelusil varnish), 1 tablet (500mg) 3-6 times a day one hour after a meal, or occasionally in case of heartburn, 1 tablet.

4. Preparations of alginic acid

have a quick effect (heartburn stops after 3-4 minutes), and therefore can be used for "ambulance" at the first symptoms of reflux disease. This result is achieved due to the ability of alginates to interact with hydrochloric acid, converting its foam with a PH close to neutral. This foam covers the outside of the food lump, therefore, with reflux, it is it that ends up in the esophagus, where it also neutralizes hydrochloric acid.

If a patient with GERD does not have erosions and ulcers in the esophagus according to endoscopic examination, alginates can be used as the only treatment for reflux disease. In this case, the course of treatment should not exceed 6 weeks.

Alginates include:

• Gaviscon 2-4 tab. after meals and before bedtime, chewing thoroughly;

• Gaviscon forte - 5-10 ml after each meal and before bedtime (maximum daily dose 40 ml).

5. Blockers of H2-histamine receptors of the III generation

This group of drugs also reduces the production of hydrochloric acid, but its effectiveness is lower than that of proton pump inhibitors. For this reason, H2 blockers are a "reserve group" in the treatment of GERD. The course of treatment is 6-8 (up to 12) weeks.

Currently used for the treatment of GERD:

• Famotidine 20-40 mg 2 times a day.

6. Prokinetics

Since GERD occurs as a result of impaired motility of the gastrointestinal tract, in cases where the evacuation of food from the stomach is slowed down, drugs are used that accelerate the passage of food from the stomach into the duodenum. The funds of this group are also effective in those patients who have reflux of the contents of the duodenum into the stomach, and then into the esophagus.

The drugs in this group include:

• Metoclopramide (Cerucal, Raglan) 5-10 mg 3 times a day 30 minutes before meals;

• Domperidone (Motilium, Motilak) 10 mg 3-4 times a day 15-30 minutes before meals.

At the end of the 6-8-week course of treatment, those patients who did not have erosion and ulcers of the esophageal mucosa switch to situational intake of proton pump blockers (better), or antacids or alginates. For patients with erosive and ulcerative forms of GERD, proton pump inhibitors are prescribed for continuous administration, while the minimum effective doses are selected.

Traditional methods of treating reflux disease

To eliminate the described disease, you can use folk remedies. The following effective recipes are distinguished:

• Flaxseed decoction. Such therapy with folk remedies is aimed at increasing the stability of the esophageal mucosa. It is necessary to pour 2 large spoons of ½ liter of boiling water. Infuse the drink for 8 hours, and take 0.5 cups with nitrogen 3 times a day before meals. The duration of such therapy with folk remedies is 5-6 weeks;

• Milkshake. Drinking a glass of cold milk is considered an effective folk remedy in eliminating all manifestations of gastroesophageal reflux disease. Therapy with such folk remedies is aimed at getting rid of the acid in the mouth. Milk has a soothing effect on the throat and stomach;

• A decoction of marshmallow root. Therapy with folk remedies that include this drink will help not only get rid of unpleasant manifestations, but also have a calming effect. To prepare the drug, you need to put 6 g of crushed roots and add a glass of warm water. Infuse the drink in a water bath for about half an hour. Treatment with folk remedies, including the use of marshmallow root, includes taking a chilled broth for ½ cup 3 times a day;

• In therapy with folk remedies, celery root juice is effective. Its reception should be carried out 3 times a day for 3 large spoons. Alternative medicine involves a large number of recipes, the choice of a particular one depends on the individual particular of the human body.

But treatment with folk remedies cannot act as a separate therapy, it is included in the general complex of therapeutic measures.

Prevention of reflux disease

• last meal - at least 1-1.5 hours before bedtime;

• selection of loose clothing that does not hinder movement. We do not urge you to get your grandmother's dresses and grandfather's shirts out of the closet, but it's definitely worth thinking about the safety of most designer models;

• do not overeat;

• if the doctor has prescribed certain medications for you, drink them with a sufficient amount of ordinary boiled water;

• the head of the bed should be raised (a Japanese-style bed - strictly parallel to the floor - is contraindicated for you);

• consult a gastroenterologist at least 2 times a year (even when the symptoms of GERD have not bothered you for a long time). And if the doctor offers to undergo outpatient treatment, do not refuse;

• remember the benefits of a healthy diet. Note that "diet" and reasonable restriction of spicy, salty and overly cold foods are not the same thing. But it is still better to refuse soda and strong coffee;

• treatment with folk remedies (no matter how harmless it may seem to you) should be agreed with your doctor.

Gastroesophageal reflux disease (GERD) is a chronic relapsing disease in which the contents of the stomach are thrown back up into the esophagus.

Stomach acid helps digest food, and when that acid flows back up into the esophagus (the channel that carries food from the throat to the stomach), it causes irritation, leading to symptoms of GERD.

The muscle ring that allows food to pass from the esophagus to the stomach and prevents acidic contents from entering the esophagus is called the lower esophageal sphincter (LES), which essentially acts as a valve in the upper stomach. This valve relaxes and opens during meals.

GERD occurs when the NPC relaxes and opens up whether you swallow or not. This allows stomach contents to flow back up into the esophagus.

GERD is a more serious, chronic form of gastroesophageal reflux (GER).

Doctors may also use names like:

• Acid indigestion
• Sour burp
• Heartburn
• Reflux

GERD can definitely be uncomfortable and make it difficult for a person to live a full life, but with treatment, most people can get relief.

How common is GERD

GERD symptoms are more common in developed countries, including Russia, the European Union, the United States, Canada, and Australia.

10 to 20% of people in developed countries suffer from heartburn at least once a week, compared with only about 5% of people in Asia.

About 6% of people in developed countries experience frequent, prolonged bouts of heartburn associated with gastroesophageal reflux disease.

About 16% of people report having symptoms of regurgitation (rapid movement of fluids or gases in the opposite direction to normal), which is another sign of GERD.

Causes and risk factors

If you have a close relative with GERD in your family, you may be more likely to develop the condition. Other risk factors include:

• Being overweight or obese.
• Smoking - relaxes the lower esophageal sphincter.
• Consuming alcohol, caffeine, carbonated drinks, chocolate, citrus fruits, onions, mint, tomatoes, spicy or fried foods will also relax the NPC.
• Rest in a supine position after eating.
• Pregnancy, as during this period there is an increased intra-abdominal pressure.
• Lifting heavy objects is another cause of intra-abdominal pressure.
• Taking medications such as Estradiol or Estrogen, Prometrium (Progesterone), Propylene glycol (Diazepam), or beta blockers.

Complications of GERD

Gastroesophageal reflux disease is usually not life-threatening. However, GERD can lead to complications such as:

• Esophageal bleeding or an ulcer that occurs with chronic or acute esophagitis
• Scar tissue formation in the esophagus, which can narrow the esophagus and make it difficult to swallow
• Tooth decay
• Sleep apnea
• Respiratory diseases and problems: cough, hoarseness, shortness of breath in asthma, chronic bronchitis, chronic laryngitis and pneumonia
• Barrett's esophagus (a rare condition that causes esophageal cancer)
• Esophageal cancer (an even rarer but life-threatening condition)

GERD symptoms

This condition often causes heartburn, a sour taste in the mouth, and hoarseness.

Your doctor can usually diagnose gastroesophageal reflux disease (GERD) based on the symptoms you experience, their frequency, and the severity of your condition. They may also refer you to a diagnostic procedure to check for the amount of acid present in the esophagus.

If your doctor suspects that you have complications from GERD, he or she may need to have an endoscopy, a diagnostic procedure in which a diagnostician will insert a long tube through your mouth with a camera at the end to examine your throat, esophagus, and stomach.

Gastroesophageal reflux disease can cause a variety of symptoms, not all of which may be present on a case-by-case basis.

These symptoms include:

• Frequent heartburn (burning sensation in the chest or throat)
• A sour or bitter taste in the mouth resulting from the discharge of stomach contents into the esophagus
• Sore throat
• Cough
• Hoarse voice
• Difficulty swallowing (dysphagia)
• Feeling of a lump in the throat
• Tooth damage from stomach acid

You may also experience symptoms such as nausea, bloating, and belching - but these symptoms can also indicate other medical conditions.

Diagnosing GERD

Gastroesophageal reflux (GER) is a term used to describe many of the symptoms, such as heartburn, that occur with GERD. But GER is more common and less serious than GERD.

GER is less common and usually resolves with antacids. GERD describes more persistent symptoms.

Some doctors distinguish between GER and GERD by looking at the frequency of your symptoms. If you have heartburn more than twice a week for several weeks in a row, your doctor may diagnose GERD.

Heartburn or Heart Attack?

People with GERD often report chest pain.

People who have had a myocardial infarction (heart attack) or who have other heart problems also often experience chest pain. Chest pain that occurs in the area of ​​the heart may indicate a disease called angina pectoris.

Before you see a gastroenterologist, it is important to make sure that your chest pain is not caused by heart problems.

Chest pain caused by a heart attack is more likely to be accompanied by the following symptoms:

• chest pressure and pain radiating to the arm, neck, jaw, or back
• nausea
• cold sweat
• troubled breathing
• dizziness
• light-headedness
• fatigue

A common symptom of heartburn is that it doesn't get worse with physical activity or improve with rest.

If you experience severe chest pain, or pain radiates to the left arm or jaw, see your doctor immediately, as this may indicate a myocardial infarction.

If you have chest pain and are not sure what exactly caused it, you need to go to an ambulance.

Diagnostic procedures

In most cases, a diagnosis of GERD does not involve any medical tests or procedures, as most often the doctor makes the diagnosis based on the symptoms you are experiencing.

Your doctor may prescribe certain medications to see if your condition improves. If your symptoms improve, it will most likely mean that the diagnosis has been confirmed and you have GERD.

However, in some cases, your doctor may refer you for a diagnosis, which may consist of performing some diagnostic procedures.

An endoscopic pH meter (pH probe) is used to measure the amount of acid in the esophagus. This procedure is done by inserting a flexible tube that is inserted through the nose into the esophagus and connected to a small data logger from the outside. This tube stays in place for 24 hours or longer to get the information it needs.

If your doctor suspects that you are at risk of developing complications from GERD, such as esophageal ulcers, he may order an upper GI endoscopy.

In this procedure, the diagnostician will insert a flexible tube with a camera at the end of the throat to examine the esophagus and assess how badly it has been damaged by acid.

If you have signs of Barrett's esophagus (a rare, precancerous disease of the esophagus), your doctor may recommend that you have regular esophageal examinations with an endoscope.

GERD treatment

Although most cases of GERD can be effectively controlled with medication, some cases may require surgery. Most people with gastroesophageal reflux disease take medications to treat the condition.

Medications are generally used effectively to relieve GERD symptoms such as heartburn, which allows the esophagus to recover from damage from stomach acid.

Most people with GERD get better within a few weeks or months of treatment. However, it is sometimes necessary to continue taking the medication for a longer period of time.

Lifestyle changes such as smoking cessation and weight loss can also be effective in treating gastroesophageal reflux disease.

If GERD persists with medication, surgery may be indicated.

Medication for GERD

Three types of drugs are used to treat gastroesophageal reflux disease:

• Antacids such as Maalox (magnesium hydroxide and aluminum hydroxide)
• H2-histamine receptor blockers such as Tagamet (cimetidine), Zantac (ranitidine), and Pepsid (famotidine)
• Proton pump inhibitors such as Omez (omeprazole) and others

These drugs are listed in ascending order of potency, that is, histamine H2 receptor blockers are more effective at lowering acid than antacids, and proton pump inhibitors are stronger than histamine H2 receptor blockers.

The typical course of treatment is one tablet a day for eight weeks.

If GERD does not respond to treatment with the above drugs, your doctor may also prescribe a drug that may help strengthen the lower esophageal sphincter (LES). Lyoresal (baclofen) is a muscle relaxant and antispastic drug sometimes used for this purpose.

Surgical treatment of GERD

Surgery may be beneficial if your gastroesophageal reflux disease does not respond to medication, or if there is some reason why you cannot take medications to treat the condition.

- This is the most common type of surgery, the purpose of which is to increase the pressure in the lower esophageal sphincter to prevent reflux, so that acid cannot enter the esophagus.

The most recent type of surgery is to wrap a ring of tiny magnetic titanium balls around the area where the stomach connects to the esophagus.

The magnetic ring allows food to pass freely into the stomach during swallowing, and prevents acid contents from being thrown back into the esophagus.

Nissen fundoplication using a ring of tiny magnetic titanium balls

Home treatment

There are several steps you can take to reduce or eliminate the symptoms of GERD - without medication or surgery:

• If you are overweight, your doctor may suggest you lose weight. When you are overweight, there is pressure on the stomach, which can lead to acid entering the esophagus.
• Wear loose clothing to relieve pressure on your stomach.
• Avoid or limit your intake of foods that can cause heartburn, such as alcohol, caffeine, chocolate, fatty foods, fried foods, garlic, mint, citrus fruits, onions, tomatoes, and tomato sauces.
• Eat small meals. Eat less, but more often.
• Wait two to three hours after eating before lying down.
• Equip your bed so that the headboard is 15-20 cm higher than where your legs are.
• Stop smoking.

In addition to the lifestyle and dietary changes listed above, your doctor may also recommend some of the alternative treatments for GERD.

While these remedies have not been scientifically proven to be effective, they can help you feel better:

• Herbs such as chamomile, licorice, marshmallow, and slippery elm are sometimes taken to relieve symptoms of GERD.
• Also, propolis is a very good remedy for any kind of inflammation and for the rapid restoration of the esophageal mucosa.
• Relaxation techniques such as guided imagination and progressive muscle relaxation help reduce stress and anxiety, and may relieve symptoms of GERD (see How to Get Rid of Stress - 10 Best Ways).
• Acupuncture can help people with heartburn (some studies support this).

Herbal remedies can have side effects, so check with your doctor or research yourself before using any remedy.

Diet for GERD

Eating less food in one sitting, chewing thoroughly, and avoiding certain foods can help relieve GERD symptoms.

If you are experiencing heartburn or other symptoms of gastroesophageal reflux disease, chances are good that adjusting your daily diet will help you get rid of the condition.

Certain foods tend to make GERD symptoms worse. You can eat these foods less often or eliminate them entirely from your diet. The way you eat can also be a trigger for your symptoms. Changing portion sizes and meal times can significantly reduce heartburn, regurgitation, and other symptoms of GERD.

What foods should be excluded

The consumption of certain foods and drinks contributes to the onset of GERD symptoms, including heartburn and sour belching.

Eating fatty meats may worsen symptoms of gastroesophageal reflux disease

Here is a list of foods and beverages that people with GERD should avoid at least some of:

• alcohol
• caffeine (coffee, cola, black tea)
• carbonated drinks
• chocolate
• citrus fruits and juices
• fatty food
• fried food
• garlic
• spicy food
• tomatoes and products based on them

These foods usually worsen the symptoms of GERD by increasing stomach acidity.

Alcoholic beverages primarily cause GERD by weakening the lower esophageal sphincter (LES). This allows stomach contents to enter the esophagus and causes heartburn.

Caffeinated beverages such as coffee and tea usually do not cause problems when consumed in moderation, such as a cup or two a day.

Carbonated drinks can increase acidity as well as increase pressure in the stomach, which encourages stomach acid to travel up through the LPS and up into the esophagus. In addition, many types of carbonated drinks contain caffeine.

The most problematic fatty foods include dairy products, such as ice cream, and fatty meats: beef, pork, etc.

Chocolate is one of the worst foods for people with GERD because it contains high amounts of fat, as well as caffeine and other natural chemicals that can cause reflux esophagitis.

Different people tend to have different reactions to certain foods. Pay attention to your diet, and if a certain food or drink is causing you heartburn, just avoid it.

Chewing gum can help reduce symptoms of GERD.

Eating habits

In addition to changing your diet, your doctor may recommend that you change the way you eat.

• Eat small meals more often
• Eat your food slowly
• Limit snacks between meals
• Avoid lying down for two to three hours after eating

When your stomach is full, eating extra food can increase the pressure in your stomach. This can relax the LES, allowing stomach contents to flow into the esophagus.

When you are upright, gravity helps keep your stomach contents from moving upward.

When you lie down, corrosive stomach contents can easily enter the esophagus.

By waiting two to three hours after eating before lying down, you can use gravity to help control GERD.

Gastroesophageal reflux disease (GERD), often also called reflux esophagitis, is manifested by regularly recurring episodes of reflux of acidic stomach contents (sometimes and / or duodenal ulcer) into the esophagus, causing damage to the lower esophagus by hydrochloric acid and protein-digesting enzyme pepsin.

Reflux causes

The causes of reflux are damage or functional insufficiency of special locking mechanisms located at the border of the esophagus and stomach. The factors contributing to the development of the disease are stress; work associated with a constant downward bending of the trunk; obesity; pregnancy; as well as taking certain medicines, fatty and spicy foods, coffee, alcohol and smoking. GERD often develops in people with a hiatal hernia.

Reflux Disease Symptoms

The main symptom of GERD is heartburn, the second most frequent manifestation is pain behind the sternum, which radiates (gives) to the interscapular region, neck, lower jaw, left half of the chest and can mimic angina pectoris. Unlike angina pectoris, pain in GERD is associated with food intake, body position and is relieved by taking alkaline mineral waters, soda, or antacids. Back pain can also occur in the back, in which case it is often considered a symptom of a spinal disorder.

Complications

Regular reflux of stomach contents into the esophagus can cause erosions and peptic ulcers of its mucous membrane, the latter can lead to perforation of the esophageal wall and bleeding (in half of the cases, severe). Another serious complication of GERD is stricture - a narrowing of the lumen of the esophagus due to the formation of cicatricial structures that disrupt the process of swallowing solid, and in severe cases even liquid food, a significant deterioration in health, loss of body weight. A very dangerous complication of GERD is the degeneration of stratified squamous epithelium into a cylindrical one, which is designated as Barrett's esophagus and is a precancerous condition. The frequency of adenocarcinomas in patients with Barrett's esophagus is 30-40 times higher than the average among the adult population.

In addition, GERD can cause chronic inflammatory processes in the nasopharynx, lead to chronic pharyngitis or laryngitis, ulcers, granulomas and polyps of the vocal folds, stenosis of the larynx below the glottis, otitis media, rhinitis. Complications of the disease can be chronic recurrent bronchitis, aspiration pneumonia, lung abscess, hemoptysis, atelectasis of the lung or its lobes, attacks of paroxysmal nocturnal cough, and reflux-induced bronchial asthma. With GERD, tooth damage (enamel erosion, caries, periodontitis) also occurs, and halitosis (bad breath) and hiccups are common.

Diagnostic examinations

To identify the reflux of gastric contents into the esophagus, a number of diagnostic studies are performed. The main one is endoscopic, it allows not only to confirm the presence of reflux, but also to assess the degree of damage to the mucous membrane of the esophagus and monitor their healing during treatment. Also, daily (24-hour) pH-metry of the esophagus is used, which makes it possible to determine the frequency, duration and severity of reflux, the effect of body position, food intake and medications on it. This method allows a diagnosis to be made before damage to the esophagus occurs. Less commonly, scintigraphy of the esophagus with a radioactive isotope of technetium and esophagomanometry (to diagnose disorders of peristalsis and tone of the esophagus) are performed. If you suspect Barrett's esophagus, a biopsy of the esophagus is performed, followed by a histological examination, since epithelial degeneration can only be diagnosed with this method.

Treatment and prevention of GERD

GERD is treated conservatively (with lifestyle changes and medications) or surgically. For drug treatment of GERD, antacids are prescribed (reduce the acidity of gastric contents); drugs that suppress the secretory function of the stomach (blockers of H2-histamine receptors and proton pump inhibitors); prokinetics that normalize the motor function of the gastrointestinal tract. If there is a throwing of not only gastric contents, but the duodenum 12 (as a rule, in patients with cholelithiasis), a good effect is achieved by taking ursodeoxyfolic acid preparations. Patients are advised to stop taking medications that provoke reflux (anticholinergic, sedative and tranquilizers, calcium channel blockers, β-blockers, theophylline, prostaglandins, nitrates), avoid forward bending and horizontal body position after eating; sleep with the head end of the bed raised; do not wear tight clothes and tight belts, corsets, bandages, leading to an increase in intra-abdominal pressure; stop smoking and drinking alcohol; reduce body weight with obesity. It is also important not to overeat, eat in small portions, with a break of 15-20 minutes between meals, and do not eat later than 3-4 hours before bedtime. It is necessary to exclude from your diet fatty, fried, spicy foods, coffee, strong tea, coca-cola, chocolate, as well as beer, any carbonated drinks, champagne, citrus fruits, tomatoes, onions, garlic.

Surgical treatment is carried out in the presence of a pronounced narrowing of the lumen of the esophagus (stricture) or in case of severe bleeding due to perforation of its wall.

Gastroesophageal reflux disease or GERD (abbreviated) is a pathology of the digestive system in which frequent backward movement of gastric contents leads to irritation of the esophageal walls. In this case, the development of an inflammatory process (esophagitis) is possible in the case of a prolonged absence of proper treatment. The main symptoms of GERD are sour belching and heartburn.

When contacting a gastroenterologist, a thorough diagnosis is carried out. Therapy of the disease is carried out depending on the degree of development of the pathology with the use of drugs that lower the acidity of gastric juices, as well as protect the esophagus from the effects of an acidic environment. Depending on the main symptoms of GERD and appropriate treatment is prescribed. Maintaining a certain diet is of no small importance when performing therapy.

The reflux of gastric contents irritates the mucous membranes of the esophagus. As a result, an inflammatory process develops. To prevent this development in the body, protective mechanisms are provided:

1. The presence of a circular muscle - gastroesophageal sphincter. It functions as a check valve. Its contraction leads to the fact that the lumen in the esophagus narrows, and the reverse flow of food becomes impossible.
2. The walls of the esophagus are covered with a mucous membrane that is resistant to hydrochloric acid.
3. The esophagus is "endowed" with the ability to self-purify from food debris.

These mechanisms prevent the possibility of irritation of the mucous membrane during the physiological manifestation of reflux. In this case, the following symptoms arise:

• reverse ejection occurs most often after eating;
• there are no accompanying symptoms;
• the daily frequency of reflux is insignificant;
• at night, reverse food refusals are rare.

In this case, gastroesophageal reflux occurs without esophagitis, that is, severe irritation, and even more so inflammation does not occur. When the defense mechanisms are violated, a pathological course of the disease develops. Signs of GERD include the following factors:

• refluxes appear regardless of food intake;
• reverse casts occur frequently and have a significant duration;
• their manifestation is possible at night;
• clinical symptoms appear;
• in the mucous membrane of the esophagus, an inflammatory process develops.

In this case, gastroesophageal reflux with esophagitis is quite common.

Classification

Normal acidity in the esophagus is six to seven units. Reverse casting can cause the pH to drop. The appearance of such refluxes is called sour. If the acidity level is in the range from 7.0 to 4.0, then in this case we are talking about a weakly acid backfill. At a pH value below four units, one speaks of acidic superreflux.

When thrown into the esophagus, not only gastric, but also intestinal contents, acidity may increase. The pH then rises above 7.0. This is alkaline reflux. The cast contains bile pigments and lysolecithin.

Causes

The causes of reflux are as follows:

1. Increased intra-abdominal pressure. This manifestation occurs in the presence of overweight or obesity, flatulence or constipation, the occurrence of ascites (accumulation of fluid in the peritoneum). It should be borne in mind that pregnancy also leads to an increase in intra-abdominal pressure.
2. Diaphragmatic hernia. With hiatal hernia (hernia of the esophageal opening of the diaphragm), the organs from the peritoneum are displaced into the chest area. This pathology occurs quite often in people who have reached the age of 50.
3. Decreased clearance (an indicator of the rate at which tissue is cleared) of the esophagus. May develop due to a decrease in the neutralizing effect of saliva.
4. Insufficiency of the cardia of the stomach. This pathology is manifested due to incomplete closure of the valve.
5. Frequent use of caffeinated beverages. This is not only coffee, but also tea or Coca-Cola.
6. Drinking large quantities of alcoholic beverages.
7. Taking some medications. Among them are Verapamil (used for cardiac disorders), Papaverine (widely used for muscle spasms), Theophylline (prescribed for asthma or peptic ulcer diseases).
8. Duodenal ulcer.
9. Frequent stress and nervous tension.

GERD is also diagnosed during pregnancy. During this period, due to the growth of the uterus, intra-abdominal pressure increases, which contributes to the appearance of reverse food refusals.

It should be remembered that figuring out the etiology of GERD is not an easy process. It is quite difficult for an ignorant person to clarify the mechanism of the origin of pathology - its pathogenesis.

The development of the disease is also influenced by the habits associated with the consumption of food. The nature of the diet is also important. The rapid absorption of food in large quantities leads to excessive swallowing of air. Because of this, intragastric pressure increases, the lower sphincter relaxes and food is thrown back. The constant use of fatty, fried meat and flour products, seasoned in abundance, leads to a slow digestion of the food coma. Decay processes develop, which leads to an increase in intra-abdominal pressure.

The consequences of pathology

In the absence of timely treatment, pathology can have rather unpleasant consequences. The following complications of GERD are common:

• strictures (narrowing) of the esophagus appear;
• erosion and ulcers occur;
• bleeding appears.

With the development of GERD complications can be more formidable. So, during the formation of Barett's esophagus in the esophageal mucosa, the flat multilayer epithelium is replaced by a cylindrical one, which is inherent in the gastric surface layers. Such metaplasia (persistent replacement) significantly increases the risk of cancerous tumors. Development of adenocarcinoma of the esophagus is possible. In this case, surgery using esophageal stenting is often necessary.

How does the disease manifest

It is necessary to start treatment and thus finally get rid of GERD as soon as possible. Otherwise, the disease leads to undesirable consequences.

With the development of GERD, symptoms are possible:

• frequent manifestation of heartburn;
• cough accompanied by a hoarse voice;
• chest pains (they can occur when eating rough food);
• bleeding of the esophagus (occurs when erosions and ulcers occur);
• dysphagia;
• strictures develop.

With GERD, heartburn is possible, which often indicates gastritis with high acidity.

If there is a slight bleeding, then they are found in the stool, which turns black. With severe manifestations, blood can come out through the mouth. In some cases, patients experience gagging, profuse salivation, and a feeling of pressure in the chest. In this case, pain can be given to the back, arm, neck or shoulder.

Masks for gastroesophageal reflux disease can be both typical and atypical. The main symptoms are heartburn due to acidic belching. In this case, the burning sensation behind the breastbone can be permanent. Its manifestation is possible only due to a certain position of the body, for example, when bending or in a lying position.

In addition to esophageal symptoms, there are also signs of an extraesophageal nature. It is often difficult to recognize them correctly. In some cases, all symptoms indicate a completely different problem, for example, bronchial asthma. Extraesophageal manifestations of GERD can be roughly divided into four groups. This division depends on which organs are affected by the refluxate. These manifestations include otorhinolaryngological and bronchopulmonary, cardiac and dental syndromes.

Respiratory problems caused by reverse reflux include asthma, chronic cough, and recurrent pneumonia. Cardiac syndrome is manifested by chest pain, heart rhythm disturbances. In addition, the development of diseases such as pharyngitis or laryngitis is possible. Frequent eructations with a sour taste can deteriorate your teeth.

In patients who suffer from bronchial asthma, in most cases, gastroesophageal reflux is diagnosed. At the same time, in a quarter of patients, the use of drugs to reduce acid production leads to an improvement in the condition, the deterioration of which was, apparently, due to asthma.

Diagnostics

GERD is diagnosed using the following methods and procedures:

1. Typical symptoms are sufficient for a preliminary diagnosis. However, to confirm the correctness of this definition, a special test is carried out. The appointment of drugs such as Omeprazole or Pantoprazole is performed. These are proton pump inhibitors that are taken over two weeks in standard doses. If the treatment is effective, the diagnosis is confirmed.
2. Daily intraoesophageal pH monitoring. This method of diagnosis is the main one for confirming the diagnosis. It allows you to determine not only the duration of refluxes and their number during the day, but also the total time during which the pH is below 4.0.
3. Fibroesophagogastroduodenoscopy. The examination allows you to visually assess the state of the gastrointestinal tract.
4. Chromoendoscopy. It is carried out to identify areas prone to metaplasia.
5. ECG. The study reveals violations of the functioning of the heart.
6. Ultrasound allows you to identify pathologies of the digestive system or heart.
7. X-rays are used to detect abnormalities in the respiratory tract, diaphragmatic hernia, or narrowing of the esophagus.
8. Delivery of tests includes a CBC (general blood test), a study for sugar. It is also necessary to determine the liver test and the delivery of feces. After the blood test is deciphered, it becomes possible to draw a conclusion about the presence of inflammation.
9. Performing a test for the presence of the bacteria Helicobacter pylori. When it is determined, therapy is prescribed, aimed at destroying the microorganism.

These are the most effective diagnostic methods. They allow you to identify, including cardia insufficiency.

Differential diagnosis includes not only the above research methods, but also the collection of anamnesis and a detailed examination of the patient.

Treatment

When GERD is detected, the treatment of pathology should begin with the fact that it is necessary to radically change the way of life. To fulfill this requirement and answer the question of how to cure GERD, you must:

Treatment of gastroesophageal reflux is carried out according to two main principles. It is necessary to quickly stop the main symptoms of the disease, and then create the necessary conditions to prevent not only complications, but also relapses. Often, patients wonder if GERD in adults can be completely and permanently cured. With the timely diagnosis of the disease, the prognosis for a cure is favorable. Pathology therapy usually lasts no more than eight weeks. However, in some cases, with complications, it takes up to six months. GERD without esophagitis is often amenable to therapy with traditional medicines that have proven medicinal properties. A strict diet is required to progress through the healing phase more quickly.

Once a diagnosis of GERD is made, a generally accepted therapy strategy is used. Antisecretory drugs are prescribed by the gastroenterologist. These are both proton pump inhibitors that suppress the production of hydrochloric acid by the mucous membrane (Rabeprazole, Omeprazole, Esomeprazole or Pantoprazole), and histamine receptor blockers (for example, Famotidine).

In the case of a backflow of bile into the lumen of the esophagus, the treatment regimen involves the use of Ursofalk (ursodeoxycholic acid) and prokinetics to stimulate the movement of the food coma through the digestive system (Domperidone). The choice of the drug, as well as the appointment of doses and duration of administration, is carried out by the attending physician, depending on the characteristics of the course of the disease, age and related manifestations. This allows you to cure GERD quickly enough.

Depending on what symptoms appear, and the treatment can be adjusted. For short-term use in order to relieve unpleasant symptoms of belching and heartburn, antacids are used to neutralize excessive acidity by a chemical reaction. The drug Gaviscon Forte is used in the amount of two teaspoons half an hour after a meal, as well as before bedtime. Phosphalugel is prescribed a maximum of two sachets three times a day after meals.

It should be borne in mind that the decision on how to treat gastroesophageal reflux disease is at the discretion of the attending physician. Self-administration of drugs, especially when GERD worsens, can cause serious harm to health.

In cases where conservative therapy does not give the desired effect (from 5 to 10% of cases), as well as with HHH or due to the development of complications, surgical treatment of GERD is performed. Gastrocardiopexy, radiofrequency ablation, or laparoscopic fundoplication can be used. Other modern techniques can also be used for the surgical treatment of GERD.

Leading a healthy lifestyle is the foundation for preventing GERD. This is the answer to the question of how to live with such a pathology.