Herb classifications. Duodeno-gastric reflux: what is it and why is it dangerous, how is it diagnosed Therapy: different approaches

Publication date: 26-11-2019

What is GERD and the ICD-10 disease code?

The ICD-10 code for GERD stands for International Classification of Diseases 10th revision and gastroesophageal reflux disease. For therapeutic purposes, diseases are divided into stages, which makes it possible to determine the choice of drugs and the duration of therapy.

If we talk about GERD, then it all depends on the degree of damage to the mucous membrane of the esophagus. Fibrogastroduodenoscopy is used to examine the lower part of the intestine, due to which the disease is classified, since the procedure clearly shows how deeply the organ is affected and what changes have occurred as a result of the disease.

Types of pathology

The simplest description of the types of gastroesophageal reflux disease is given in a document called ICD-10. According to clinical signs, the disease in it is divided into the following types:

• gastroesophageal reflux disease with esophagitis (presence of inflammation on the mucous membrane of the esophagus) - ICD-10 code K21;
• GERD without the presence of esophagitis - K21.9.

The endoscopic method for classifying GERD began to be used in the early 1990s and is still successfully used in modern medicine. How does GERD develop? On the border of the esophagus and stomach there is a muscle - the lower esophageal sphincter, which prevents the reverse reflux of digested foods into the esophagus. When it weakens, there is a violation of the functionality of the muscle, as a result of which the gastric contents, together with hydrochloric acid, are thrown back.

In the esophagus, due to such a violation, a number of changes occur, in which the mucous membrane is affected.

These changes formed the basis for the classification of the disease.

1. So, at the first stage, the part of the mucosa, which is located closer to the stomach, is affected. It becomes inflamed, reddens, small erosive changes may appear on it. At the initial stage of the disease, such changes may be absent, and the diagnosis will be made on the basis of the patient's symptoms or using other diagnostic methods.
2. The second stage of the disease is characterized by a large part of the lesion of the esophagus (more than 18%). Heartburn is the main symptom that accompanies the disease.
3. In the third stage, the mucous membrane of the esophagus and the lower esophageal sphincter are affected by erosion. Without proper treatment, ulcers appear at the site of erosion. The main symptoms in this case will be burning, pain in the stomach, which most often occur at night.
4. The fourth stage manifests itself in the form of damage to the entire mucous membrane, erosive changes are observed around the entire circumference of the esophagus. Symptoms at this stage will appear acutely, in full.
5. At the last stage, irreversible changes occur in the organ - narrowing and shortening of the esophagus, ulceration, intestinal epithelium replaces the mucous membrane.

European classification

This classification is otherwise called Los Angeles. It appeared in the late 90s and includes the following degrees of GERD:

• A (the organ is slightly affected, and the size of erosive changes does not exceed 6 mm, while they are located only on one fold of the mucosa);
• B (erosive changes are not extensive, but the size of the erosions themselves is from 6 mm and above);
• C (more than 70% of the esophagus is affected by erosions or ulcers, the size of which is more than 6 mm);
• D (esophagus is almost completely affected).

According to this classification, erosive changes can be at any of the stages. All of these species have been classified into stages in order to make it easier for practitioners to understand the progression of the disease and to correctly select the appropriate treatment. It is impossible to independently classify the disease only by symptoms, therefore, if unpleasant symptoms appear, you should consult a doctor. Delaying a visit to the doctor will cost more money and take longer.

Gastroesophageal reflux disease (GERD) is a gastroenterological disease characterized by the development of inflammatory changes in the mucous membrane of the distal esophagus and / or characteristic clinical symptoms due to repeated reflux of gastric and / or duodenal contents into the esophagus.

Incompetence of the lower esophageal sphincter promotes reflux of gastric contents into the esophagus, causing acute pain. Prolonged reflux can lead to esophagitis, stricture, and rarely metaplasia. The diagnosis is established clinically, sometimes with endoscopy and the study of gastric acidity. Treatment for gastroesophageal reflux disease (GERD) includes lifestyle changes, reducing stomach acid with proton pump blockers, and sometimes surgery.

ICD-10 code

• K21.0 Gastroesophageal reflux with esophagitis
• K21.9 Gastroesophageal reflux without esophagitis.

ICD-10 code

K21 Gastroesophageal reflux

K21.0 Gastroesophageal reflux with esophagitis

K21.9 Gastroesophageal reflux without esophagitis

Epidemiology of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is common and occurs in 30-40% of adults. It is also quite common in infants and usually appears after birth.

The ever-increasing relevance of the problem of gastroesophageal reflux disease is associated with an increase in the number of patients with this pathology worldwide. The results of epidemiological studies show that the frequency of reflux esophagitis in the population is 3-4%. It is detected in 6-12% of persons who undergo endoscopic examination.

Studies conducted in Europe and the USA have shown that 20-25% of the population suffers from symptoms of gastroesophageal reflux disease, and 7% have symptoms on a daily basis. In general practice settings, 25-40% of people with GERD have esophagitis on endoscopy, but most people with GERD do not have endoscopic findings.

According to foreign researchers, 44% of Americans suffer from heartburn at least once a month, and 7% have it every day. 13% of US adults use antacids two or more times a week, and 1/3 once a month. However, among the respondents, only 40% of the symptoms were so severe that they were forced to see a doctor. In France, gastroesophageal reflux disease (GERD) is one of the most common diseases of the digestive tract. As the survey showed, 10% of the adult population had symptoms of gastroesophageal reflux disease (GERD) at least once a year. All this makes the study of GERD one of the priority areas of modern gastroenterology. The prevalence of GERD is comparable to the prevalence of peptic ulcer and gallstone disease. It is believed that each of these diseases affects up to 10% of the population. Daily symptoms of GERD are experienced by up to 10% of the population, weekly - 30%, monthly - 50% of the adult population. In the US, 44 million people have symptoms of gastroesophageal reflux disease (GERD).

What causes gastroesophageal reflux disease (GERD)?

The appearance of reflux suggests a leak in the lower esophageal sphincter (LES), which may be the result of a general decrease in sphincter tone or recurrent transient relaxations (not associated with swallowing). Transient relaxation of the LES is induced by gastric expansion or subthreshold pharyngeal stimulation.

Factors that ensure the normal functioning of the gastroesophageal junction include: the angle of the gastroesophageal junction, diaphragmatic contractions, and gravity (i.e., vertical position). Factors contributing to reflux include weight gain, fatty foods, caffeinated sodas, alcohol, tobacco smoking, and medications. Medications that lower LES tone include anticholinergics, antihistamines, tricyclic antidepressants, Ca-channel blockers, progesterone, and nitrates.

Gastroesophageal reflux disease (GERD) can cause esophagitis, peptic ulcer of the esophagus, esophageal stricture, and Berrett's esophagus (a precancerous condition). Factors contributing to the development of esophagitis include: the caustic nature of the refluxate, the inability of the esophagus to neutralize it, the volume of gastric contents and the local protective properties of the mucous membrane. Some patients, especially infants, aspirate when they have reflux.

Symptoms of gastroesophageal reflux disease (GERD)

The most striking symptom of gastroesophageal reflux disease (GERD) is heartburn, with or without regurgitation of gastric contents into the oral cavity. Infants present with vomiting, irritability, anorexia, and sometimes signs of chronic aspiration. Adults and infants with chronic aspiration may present with cough, hoarseness, or stridor.

Esophagitis can cause pain when swallowing and even esophageal bleeding, which is usually occult but can sometimes be massive. Peptic stricture causes gradually progressive dysphagia with solid foods. Peptic ulcers of the esophagus cause pain, as with a stomach or duodenal ulcer, but the pain is usually localized in the xiphoid process or high retrosternal region. Peptic ulcers of the esophagus heal slowly, tend to recur, and usually scar as they heal.

Diagnosis of gastroesophageal reflux disease (GERD)

A detailed history usually indicates the diagnosis. Patients with typical signs of GERD may be given trial therapy. In case of treatment failure, prolonged symptoms of the disease or signs of complications, a patient examination is necessary. Endoscopy with cytological examination of scrapings from the mucosa and biopsy of the altered areas is the method of choice. Endoscopic biopsy is the only test that consistently detects the appearance of columnar mucosal epithelium in Berrett's esophagus. Patients with questionable endoscopy results and persistence of symptoms despite treatment with proton pump inhibitors should undergo a pH study. Although barium swallow fluoroscopy indicates esophageal ulcers and peptic stricture, this study is less informative for choosing a treatment that reduces reflux; in addition, most patients with identified pathology require follow-up endoscopy. Esophageal manometry can be used as a guide for transducer placement in pH testing and assessment of esophageal motility prior to surgery.

Treatment of gastroesophageal reflux disease (GERD)

Treatment for uncomplicated gastroesophageal reflux disease (GERD) consists of raising the head of the bed 20 centimeters and avoiding the following: eating at least 2 hours before bedtime, strong gastric stimulants (eg, coffee, alcohol), certain medications (eg. ., anticholinergics), certain foods (eg fats, chocolate) and smoking.

Drug treatment for gastroesophageal reflux disease (GERD) includes proton pump blockers. For adults, omeprazole 20 mg, lansoprazole 30 mg, or esomeprazole 40 mg can be given 30 minutes before breakfast. In some cases, proton pump blockers need to be prescribed 2 times a day. Infants and children can be given these drugs at a lower dose, respectively, once daily (i.e. omeprazole 20 mg for children over 3 years of age, 10 mg for children under 3 years of age; lansoprazole 15 mg for children under 30 kg, 30 mg for children over 30 kg ). These drugs can be used for a long time, but the minimum dose necessary to prevent symptoms should be selected. H2 blockers (eg, ranitidine 150 mg at bedtime) or motility stimulants (eg, metoclopramide 10 mg orally 30 minutes before meals at bedtime) are less effective.

Antireflux surgery (usually laparoscopic) is performed on patients with severe esophagitis, bleeding, strictures, ulcers, or severe symptoms. For strictures of the esophagus, repeated sessions of balloon dilatation are used.

Berrett's esophagus may regress (sometimes treatment fails) with medical or surgical treatment. Because Berrett's esophagus predisposes to adenocarcinoma, endoscopic monitoring for malignancy every 1 to 2 years is recommended. Observation is of little value in patients with mild dysplasia, but is important in patients with severe dysplasia. Surgical resection or laser ablation can be considered as an alternative to conservative treatment of Berrett's esophagus.

How is gastroesophageal reflux disease (GERD) prevented?

Preventive measures have not been developed, so gastroesophageal reflux disease (GERD) is not prevented. Screening studies are not carried out.

History reference

A disease characterized by the reflux of gastric contents into the esophagus has long been known. Some of the symptoms of this pathology, such as heartburn and sour belching, are mentioned in the writings of Avicenna. Gastroesophageal reflux (GER) was first described by H.Quinke in 1879. Since that time, many terms characterizing this nosology have changed. A number of authors refer to gastroesophageal reflux disease (GERD) as peptic esophagitis or reflux esophagitis, but it is known that more than 50% of patients with similar symptoms have no esophageal mucosal involvement at all. Others call gastroesophageal reflux disease simply reflux disease, but reflux can also occur in the venous, urinary systems, various parts of the gastrointestinal tract (GIT), and the mechanisms of occurrence and manifestation of the disease in each case are different. Sometimes there is the following wording of the diagnosis - gastroesophageal reflux (GER). It is important to note that GER itself can be a physiological phenomenon and occur in completely healthy people. Despite the widespread prevalence and long "history" until recently, GERD, according to the figurative expression of E.S. Ryssa, was a kind of "Cinderella" among therapists and gastroenterologists. And only in the last decade, the widespread dissemination of esophagogastroscopy and the emergence of daily pH-metry made it possible to diagnose this disease more thoroughly and try to answer many accumulated questions. In 1996, the term (GERD) appeared in the international classification, which most fully reflects this pathology.

According to the WHO classification, gastroesophageal reflux disease (GERD) is a chronic relapsing disease caused by a violation of the motor-evacuation function of the gastroesophageal zone and characterized by spontaneous or regularly repeated throwing of gastric or duodenal contents into the esophagus, which leads to damage to the distal esophagus.

Diseases of the digestive system are far from uncommon today, as modern people prefer fast food and a sedentary lifestyle.

GERD gastroesophageal reflux disease is one of the most common pathological processes of the digestive system. Over the past few years, a similar diagnosis has become diagnosed several times more often.

In this regard, the following questions have become relevant: “Is it possible to cure GERD forever, how this or that patient was cured, what causes and signs of the disease exist?”

What is a disease

Gastroesophageal disease is a chronic pathology characterized by a large number of symptoms, frequent relapses.

The disease is caused by a systematic, spontaneous throwing of part of the contents of the stomach directly into the esophagus.

Reflux provokes damage under the influence of hydrochloric acid and pepsin in the lower parts of the esophagus. In modern traditional medicine, the disease is also called reflux esophagitis.

An increased amount of hydrochloric acid has a negative effect on the mucous part of the esophagus and causes inflammation.

This process is hindered by several main mechanisms:

1. The function of self-purification of the esophagus;
2. Gastroesophageal sphincter, which prevents the passage of food in the opposite direction;
3. Good resistance of the mucous membranes of the organ to acid.

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If a violation occurs, then we can talk about the development of reflux and an increase in acidity, an inflammatory process.

This phenomenon is called pathological gastroesophageal pathology. However, physiological reflux is also isolated at the moment.

In order to distinguish one form of GERD from another, it is necessary to know the main symptoms and features.

Symptoms of pathological reflux:

• accompanied by clinical signs;
• reflux does not depend on food intake, it can occur at night;
• the attack is long and intense.

If such signs appear or if a pathological form is suspected, you can and should contact a specialist as soon as possible.

Physiological reflux is accompanied by the following symptoms:

• there is an unpleasant sensation only after eating;
• not accompanied by any clinical signs;
• practically does not occur at night, during the day the number of refluxes is extremely low.

In this case, the diagnosis of gastroesophageal pathology is absent, so it is not necessary to treat this condition.

The main thing at the same time to observe preventive measures and over time, such phenomena will come to naught. Also, during a physiological examination, it is possible and necessary to undergo regular preventive examinations.

Reflux and its classification

The patient was completely cured after long-term therapy largely depends on whether the form of the disease was determined or not.

At the moment, there is one main classification, which is based on the amount of acid in the esophagus.

The acidity limit in the esophagus is from 6 to 7. If food accompanied by acid enters the esophagus, then the indicator drops to 4. And such a reflux form is called acidic.

If the acidity ranges from 4 to 7 - weak reflux. Superreflux develops at rates less than 4.

It should be noted that reflux pathology can be not only acidic, but also alkaline in nature. This condition occurs if lysolecithin and bile pigments enter the esophagus.

Competent complex therapy should be based on a variety of reflux.

Causes of pathology

The disease can be formed against the background of both a single factor and a combination of conditions. In addition, reflux disease can develop as a complication of other pathologies.

The main causes of GERD:

• A significant decrease in the protective abilities of the esophageal mucosa.
• Violation of the functionality of the sphincter. In this case, food, together with the contents of the stomach, enters the esophagus. Thus, there is a mechanical effect on the mucosa, its injury and inflammation.
• Failures of indicators of intra-abdominal pressure.
• Problems with emptying the stomach.
• Decreased self-cleaning function of the esophagus.
• The inability of the esophagus to come to a balanced state, due to which acidity increases and, as a result, herb occurs.

Among the diseases that provoke the development of pathology include:

• chronic endocrine diseases: diabetes mellitus of various etiologies;
• overweight, that is, obesity of various stages;
• peptic ulcer of the stomach.

The reasons for which the development of the disease occurred play a huge role in the appointment of treatment.

Finding out and eliminating the conditions that provoke grab is a guarantee of therapy that will help to completely get rid of negative feelings.

Factors provoking development

In addition to the main reasons, modern gastroenterologists identify a list of factors that increase the risk of developing GERD several times. These include:

1. prolonged stay in stressful situations;
2. abuse of bad habits: smoking, alcohol;
3. passive lifestyle;
4. taking medications: nitrates, alpha-, beta-blockers.

Eliminating the above items can significantly reduce the risk of developing herb.

Symptoms of the disease

Signs of GERD is one of the important topics when considering this disease. Knowing the main symptoms, the patient can note them in time and seek help from a gastroenterologist.

A timely visit to a specialist is an early diagnosis, which means the ability to cure the disease completely and in a short period of time.

Symptoms of GERD:

1. Unpleasant sensations behind the sternum, burning sensation is heartburn, which is often one of the first symptoms of the development of the disease. A characteristic burning sensation, as a rule, develops an hour - an hour and a half after eating. In this case, pain is given to the area between the shoulder blades, the neck. The intensity of heartburn increases after sports, overeating, drinking coffee or carbonated drinks.
2. Pain in the sternum and difficulty swallowing food. Similar signs, most often, appear with the development of complications: narrowing and the presence of neoplasms. These symptoms are due to the presence of constant inflammatory processes within the damaged mucous membrane.
3. Acid belching is also one of the first signs of a grab, indicative of digestive problems. This symptom is explained by the fact that the contents of the stomach enter the esophagus, oral cavity. Belching, most often, manifests itself in the supine position, when bending over.
4. Regular, prolonged hiccups also develop with grabbing. Indicates irritation of the nerve, which provokes an increase in the amount of contraction of the diaphragm.
5. Vomiting from the esophagus is included in the symptoms that appear as a result of complications of herb. In this case, the vomit is absolutely undigested food.

The symptoms of the onset of the disease in this case acquire a brighter intensity after physical exercise, when bending over and when the patient is in a horizontal position.

It should be noted that the symptoms disappear after drinking milk or mineral water.

Diagnostic studies

No matter how brightly the symptoms appear, it is impossible to independently diagnose herb. That is why when symptoms appear, you need to contact a specialist.

A gastroenterologist, based on the preliminary data and complaints of the patient, can make a preliminary diagnosis.

However, for the correct and accurate detection of the disease, it is necessary to undergo a series of mandatory diagnostic studies. As a rule, diagnostics is carried out in the department of gastroenterology.

Gerb diagnosis:

• Esophagogastroduodenoscopy allows you to visualize the condition of the esophagus as accurately as possible, in addition, during this test, as a rule, a sample is taken for histology. Such a study allows you to make the most accurate diagnosis.
• Taking proton pump inhibitors for two weeks, if the reaction is positive, then GERD is confirmed.
• X-ray also allows you to visualize the esophagus, identify erosions, ulcers, various hernias.
• Ultrasound examination is usually used to clarify the identified disease. Diagnostics of this type can replace x-rays.
• The main diagnosis of GERD is daily intraesophageal acid-base control. Such a study allows you to determine the duration of refluxes and their frequency.

Diagnosis is one of the main stages of therapy, only after all the studies have been carried out, it is possible to identify the cause of pain. Whether the patient is cured forever or not depends largely on this step.

Pathology therapy

Treatment of GERD is currently divided into several main areas: conservative, surgical and non-drug therapeutic effects.

Please note that whether a patient is cured of GERD largely depends directly on him. Therefore, we can safely say that the result of treatment is a combination of medical work and the responsibility of the patient.

Can GERD be cured conservatively?

The treatment of GERD with medications is aimed at solving two main problems: stabilizing the level of acidity and improving motor skills.

Conservative therapy involves taking several groups of drugs. Among them:

• Reparants whose activity is aimed at accelerating the regeneration of erosive and ulcerative areas.
• Prokinetics for GERD are prescribed to improve the tone of the lower esophagus, reduce the number of refluxes.
• GERD is treated with antisecretory drugs, which reduce the effect of hydrochloric acid on the mucous membranes of the esophagus.
• Antacids, thanks to which not a single patient was cured. These drugs neutralize alkali and acid.

Reflux pathology requires complex and competent treatment. Where one of the decisive factors is the timely diagnosis of GERD.

In this case, it is possible to avoid not only the transition of the disease to the chronic stage, but also the development of various dangerous complications.

Operative therapy

Gastroesophageal pathology in the later stages is not amenable to conservative therapy. The only way to cure the disease is through surgery.

In this case, as a rule, late diagnosis is observed.

In this regard, in no case can you independently look for answers on how someone was cured of GERD. It is extremely important to contact a specialist in time.

To date, among the operations used for GERD, there are: endoscopic plication, radiofrequency ablation of the esophagus, gastrocardiopexy.

Which surgical intervention can be used in a particular case is decided only by the surgeon, based on the personal data of the patient.

Non-pharmacological methods for GERD

If the diagnosis confirmed the presence of a pathology, then a revision of the lifestyle and following certain recommendations plays a huge role. Whether the patient is cured or not will largely depend only on him.

Non-drug therapy includes several basic rules:

• normalization of nutrition and body weight;
• rejection of bad habits;
• avoidance of heavy physical exertion and sedentary work;
• give preference to sleeping on an orthopedic mattress, head raised by 15 centimeters;
• medicines that have a negative effect on the esophagus.

GERD cannot be cured with lifestyle changes alone. However, in the therapeutic complex, this component plays a huge role.

In order for the patient to be cured, it is necessary to observe and include all directions of the complex.

Complications of the disease

It is quite difficult to cure GERD in the later stages. In addition, according to world statistics, not every patient has recovered from this pathology.

In some cases, GERD leads to serious complications, which significantly worsens the course of the disease and the general condition of the body.

In some cases, an exacerbation also occurs and the disease becomes chronic.

Complications of GERD in adults include the following deformities:

• stricture of the esophagus;
• erosion and ulcers on the walls of the esophagus;
• hemorrhages;
• development of Barrett's esophagus.

The last complication of GERD can be classified as a precancerous condition, since it is against the background of Barrett's esophagus that malignant neoplasms in the esophagus very often develop.

Gastroesophageal reflux disease is a pathology that can rightly be considered one of the most common.

The disease has many common symptoms, so it is impossible to independently identify the disease. In this regard, it is important to contact a gastroenterologist in time and start treatment.

It should also be noted that it is impossible to use on your own the methods by which this or that acquaintance was cured.

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Diseases of the stomach are unpleasant and painful ailments that affect appetite, good mood and active performance. They cause inconvenience in everyday life and cause severe and painful complications.

One of these types of gastrointestinal diseases is erosive gastritis (classification and code according to ICD-10 will be discussed in this article). You will also find answers to important and interesting questions. What are the causes of the disease? What are the symptoms of the disease? And what are the methods of its treatment?

However, before learning more about the disease, let's get acquainted with the International Classification of Diseases and determine which code is assigned to erosive gastritis (according to ICD-10).

World systematization

The International Classification of Diseases is a normative document that ensures the worldwide unity of methods and materials. In the Russian Federation, the healthcare system made the transition to the international classification back in 1999.

Is the ICD-10 code assigned to erosive gastritis? Let's find out.

Classification of gastritis

According to this systematization, recognized both in our homeland and throughout the world, diseases of the digestive organs are classified according to the following designations: K00-K93 (ICD-10 code). Erosive gastritis is listed under the code K29.0 and is diagnosed as an acute hemorrhagic form.

There are other forms of this disease, and here are the designations assigned to them:

• K29.0 (ICD-10 code) - erosive gastritis (another name is acute hemorrhagic);
• K29.1 - other acute forms of the disease;
• K29.2 - alcoholic (provoked by alcohol abuse);
• K29.3 - superficial gastritis in chronic manifestation;
• K29.4 - atrophic in a chronic course;
• K29.5 - chronic course of antral and fundic gastritis;
• K29.6 - other chronic diseases of gastritis;
• K29.7 - unspecified pathology.

The above classification indicates that each type of disease has its own ICD-10 code. Erosive gastritis is also included in this list of international ailments.

What is this disease and what are the causes of its occurrence?

Briefly about the main disease

As mentioned above, erosive gastritis of the stomach (ICD-10 code: K29.0) is a fairly common disease of the gastrointestinal tract, characterized by the occurrence of a large number of erosions (rounded red formations) on the mucosa.

This pathology most often manifests itself in an acute form and is complicated by internal bleeding. However, chronic erosive gastritis is also diagnosed (ICD-10 code: K29.0), which can manifest itself in a sluggish form of the disease or be not accompanied by symptoms at all.

This type of ailment of the gastrointestinal tract is considered the longest, given the time spent on treatment. It is most often observed in adult patients, especially in men.

What are the reasons for its origin?

Disease provocateurs

According to medical research, erosive gastritis (ICD-10 code: K29.0) may be the result of factors such as:

• the influence of bacteria (for example, Helicobacter pylori) or viruses;
• long-term use of certain drugs, including non-steroidal anti-inflammatory drugs;
• long-term alcohol or drug abuse;
• prolonged stress;
• diabetes;
• pathological changes in the thyroid gland;
• chronic diseases of the heart, respiratory organs, blood vessels, kidneys, liver;
• malnutrition, violations of the regime;
• harmful working conditions or places of residence;
• oncology of the stomach;
• violation of blood circulation in this organ;
• hormonal disbalance;
• mucosal injury.

Classification of the disease

Depending on what caused the disease, erosive gastritis (ICD-10 code: K29.0) is divided into:

• primary, occurring in practically healthy people;
• secondary, which is a consequence of serious chronic diseases.

The following are the forms of this disease:

• Acute ulcerative. May occur due to injuries and burns of the stomach. Manifested in bloody impurities in vomit and feces.
• Chronic erosive gastritis (ICD-10 code: K29.0) is characterized by a change in exacerbations and remissions of the disease. Erosive neoplasms reach five to seven millimeters.
• Antral. It affects the lower part of the stomach. Caused by bacteria and pathogens.
• Reflux. A very severe form of the disease, accompanied by the release of exfoliated tissues of the organ through vomiting. Ulcers can reach one centimeter.
• Erosive hemorrhagic. It is complicated by severe and profuse bleeding, leading to a probable lethal descent.

How does the underlying disease manifest itself?

Symptoms of the disease

In order to seek qualified medical help in time, it is very important to recognize the first symptoms of erosive gastritis as early as possible (ICD-10 code: K29.0). The main symptoms of this disease are listed below:

1. Sharp spasmodic pain in the stomach, aggravated by the formation of new ulcers.
2. Pronounced heartburn (or burning in the chest), not associated with meals.
3. Constant feeling of heaviness in the stomach.
4. Sudden and severe weight loss.
5. Intestinal upset (alternation of constipation with diarrhea, admixture of blood in feces, black feces - indicates gastric bleeding).
6. Belching.
7. Bitter taste in the mouth.
8. Lack of appetite.

These manifestations are characteristic of acute erosive gastritis (ICD-10 code: K29.0). If you have several of the symptoms mentioned above, even the most insignificant, then you should immediately contact a medical institution.

However, it must be remembered that chronic (chr.) erosive gastritis (ICD-10 code: K29.0) is almost asymptomatic. Its first visible manifestations may be bloody discharge during vomiting and bowel movements.

How is the disease diagnosed?

Definition of an ailment

The symptoms of erosive gastritis are in many ways similar to the manifestations of such diseases as oncology, stomach ulcers, varicose veins in this organ.

Therefore, it is very important to conduct a correct diagnosis of the disease in order to establish the real diagnosis as accurately as possible. What will the medical examinations include?

A possible next step in the diagnosis will be an x-ray of the abdominal organs. This examination is performed in several projections, taking into account the different position of the patient's body (standing and lying). Half an hour before the procedure, the patient will need to put several Aeron tablets under the tongue to relax the organ under study.

It may also be necessary to conduct an ultrasound examination of the gastrointestinal tract, carried out in two stages on an empty stomach. Initially, an examination of the internal organs at rest will be carried out. Then the patient will be asked to drink a little more than half a liter of water, and the ultrasound will continue.

All of the above manipulations are very important. However, the most effective diagnostic method is endoscopy.

Gastroscopy

The essence of this procedure is as follows: inside, through the mouth opening, an endoscope is lowered - a flexible tube, at the ends of which there is a camera and an eyepiece.

Thanks to what he saw, the specialist will be able to assess the full picture of the disease, recognize all the subtleties of the disease and prescribe the only correct treatment.

What will it consist of?

Medical therapy

Treatment of erosive gastritis (ICD-10 code: K29.0) is based on the following basic principles:

• destruction of the pathogenic bacteria (“Clarithromycin”, “Pylobact Neo”, “Metronidazole”, “Amoxicillin”);
• lowering the aggression of hydrochloric acid (Almagel, Maalox, Rennie);
• promoting proper digestive processes (“Mezim”, “Pangrol”, “Festal”);
• acidity normalization (“Famotidine”, “Omez”, “Controllok”);
• stop bleeding (“Etamzilat”, “Vikasol”);
• use of antibiotics;
• removal of pain spasms and sensations.

These drugs are also used for exacerbation of erosive gastritis (ICD-10 code: K29.0). The attending physician will prescribe individual therapy, which will need to be applied in accordance with the prescribed dosage and schedule for taking the drugs.

However, any drug treatment will be ineffective if you do not follow proper nutrition.

Diet

Here are the basic principles of the diet for patients with gastritis:

• do not eat fatty, fried and smoked foods;
• it is forbidden to use flour, sweets, spices;
• balanced use of vitamins;

• it is recommended to cook dishes for a couple;
• meals should be frequent (about six times a day);
• portions should be small;
• dishes should be consumed warm and mushy;
• cook food on water, not on broths.

Is it possible to use traditional medicine as a treatment for erosive gastritis?

Folk recipes

There are effective and effective traditional medicine recipes that will help not only alleviate the symptoms, but also cure the disease. They can be used as part of complex therapy, after consultation with your doctor.

What are these funds?

First of all, an infusion of calendula. It can be prepared as follows: pour one tablespoon of flowers with a glass of boiling water, insist for an hour, strain and drink a tablespoon three times a day. This medicine will reduce the inflammatory process, reduce acidity and neutralize bacteria.

Also very effective will be an infusion of several herbs taken in two tablespoons (St. John's wort, yarrow, chamomile) and celandine (one tablespoon). Pour the mixture with seven cups of boiling water and insist for half an hour. Drink half a glass four times a day.

An effective treatment for erosive gastritis can be freshly squeezed juices beets, cabbage, carrots or potatoes, which you can drink one hundred milliliters four times a day half an hour before meals.

An interesting recipe of traditional medicine is aloe mixed with honey. To do this, take ten leaves of the plant (having previously held them in the refrigerator at night), crushed with a blender and boiled in a water bath for ten minutes. Then honey is added (from a one-to-one ratio) and boiled for another minute. Take one tablespoon on an empty stomach. The mixture should be stored in the refrigerator.

And here is another effective remedy: mix half a kilogram of honey with fifty grams of lard and thirty grams of propolis, chop, melt and simmer until everything dissolves. Take one tablespoon half an hour before meals.

And finally

As you can see, erosive gastritis is a very serious disease, accompanied by unpleasant symptoms and manifestations. To recover from the disease, it is important to consult a doctor in time and strictly adhere to the prescribed treatment.

Good health to you!

What is heartburn - an innocent discomfort, or a symptom of a serious illness? Gastroenterologists note that it occurs when the digestive system malfunctions. Reflux gastroesophageal disease is currently diagnosed in 40% of the population. Doctors insist on the seriousness of the disease and the dangers of ignoring symptoms. Having become acquainted with valuable first-hand information from doctors, you can detect and cure the disease in time.

What is gastroesophageal reflux disease

The contents of the stomach can be thrown into the lumen of the esophagus: hydrochloric acid, pepsin (gastric juice enzyme), bile, pancreatic juice components. In this case, unpleasant sensations appear, these elements have aggressive properties, therefore, they damage the mucous membrane of the esophagus. Often occurring heartburn makes the patient go to the clinic, where reflux esophagitis of the esophagus is diagnosed. Over the past decade, this disease has become the most common among diseases of the digestive tract.

Causes of reflux

The risk group for reflux gastroesophageal disease is headed by men. Women are seven times less likely to suffer from esophageal disease. This is followed by older people who have crossed the fifty-year milestone. There are many unexplored factors that affect how the valve works between the stomach and the food transporter. It is known that esophagitis of the esophagus occurs when:

• obesity
• recurrent gastritis;
• alcohol abuse, smoking;
• sedentary lifestyle;
• the predominance of fatty, protein foods in the diet;
• pregnancy;
• intensive sports, when there is a strong load on the press;
• increased acidity of the stomach;
• valve prolapse between the stomach and the alimentary canal;
• hereditary predisposition.

Symptoms of GERD

Reflux disease is a very serious disease. According to the code in the ICD (International Classification of Diseases) 10 revision, a disease such as bronchial asthma can be the result of the aggressive acidic contents of the stomach being thrown into the esophagus and even into the respiratory tract. Signs of GERD:

• belching;
• pain in the larynx;
• bursting sensations in the chest and esophagus;
• morning cough;
• frequent diseases of ENT organs: sore throat;
• erosion on the surface of the teeth;
• heartburn in the throat;
• painful swallowing (dysphagia).

Diagnostic methods

If for more than five years a person does not know the cause of heartburn, then he needs to visit a gastroenterologist. The main and most reliable ways to detect the disease:

1. Gastroscopy. During the study of the esophagus, the doctor may see erosive lesions or changed epithelium. The problem is that 80% of patients do not experience heartburn so often, so they do not seek help from a doctor.
2. Daily PH meter. With this diagnostic method, a thin probe is inserted into the lumen of the esophagus, which during the day fixes the reflux of acid into the lower esophageal region.

How to Treat GERD

Heartburn sufferers take baking soda, milk, or other antacids the old-fashioned way. If you have repeated discomfort after eating for several years, you should not self-medicate. It is not recommended to take medications on your own to relieve the symptoms of the disease, this can only harm your health and lead to irreversible processes in the esophagus. It is recommended not to ignore the doctor's prescriptions, but to fulfill all his prescriptions.

medicines

Modern medicine treats gastroesophagitis of the esophagus by influencing the secretion of hydrochloric acid. Patients with reflux disease are prescribed prokinetic drugs that block its release in the stomach, reducing the aggressiveness of gastric juice. It continues to be thrown into the esophagus, but does not have such a negative effect. Such treatment has a downside: with a decrease in acidity, pathogenic microflora begins to develop in the stomach, but side effects develop slowly and cannot harm a person in the same way as regular acid reflux into the esophagus.

Surgical treatment

Surgical intervention for esophageal disease is inevitable in such cases:

• when medical treatment fails to overcome the disease. With prolonged exposure to drugs, there are cases of addiction to them, then the result of the treatment is zero;
• progression of reflux esophagitis;
• with complications of the disease, such as heart failure, bronchial asthma;
• in the presence of ulcers of the stomach or esophagus;
• the formation of malignant tumors of the stomach.

Treatment of GERD with folk remedies

Natural methods of struggle can successfully cope with reflux disease, not only at the initial stage, but in a chronic, neglected degree. For the treatment of the esophagus, it is necessary to regularly take decoctions of herbs that lower the acidity of the stomach. Here are some recipes:

1. Crushed plantain leaves (2 tbsp.), St. John's wort (1 tbsp.) Place in an enameled container, pour boiling water (500 ml). After half an hour, the tea is ready to drink. You can take a drink for a long time, half a glass in the morning.
2. Fill a teapot with centaury herb (50 gr.), pharmacy chamomile flowers with boiling water (500 ml). Wait ten minutes, take instead of tea three times a day.

Diet for GERD

One of the important components of the treatment and exclusion of recurrence of GERD disease is dietary nutrition. The diet for reflux esophagitis of the esophagus should be based on the following principles:

1. Eliminate fatty foods from the diet.
2. To maintain a healthy esophagus, avoid fried and spicy foods.
3. With a disease of the esophagus, it is not recommended to drink coffee, strong tea on an empty stomach.
4. People prone to diseases of the esophagus are not recommended to eat chocolate, tomatoes, onions, garlic, mint: these products reduce the tone of the lower sphincter.

Possible Complications

Reflux disease is dangerous for its complications. The body reacts negatively to the constant damage to the walls of the esophagus by the mucous acid. With a long course of reflux disease, the following consequences are possible:

1. One of the most severe consequences is the replacement of the esophageal epithelium from flat to cylindrical. Experts call this state of affairs a precancerous condition. The name for this phenomenon is Barrett's esophagus. The patient does not feel any symptoms of such a complication. The worst thing is that when the epithelium changes, the severity of symptoms decreases: the surface of the esophagus becomes insensitive to acid and bile.
2. The child may develop narrowing of the esophagus.
3. Oncology of the esophagus leads to high mortality: patients seek help too late, when it is impossible to cope with the tumor. This is due to the fact that signs of cancer appear only in the last stages.
4. The risk of developing bronchial asthma, pulmonary disease is high.

Prevention

To avoid reflux gastroesophageal disease of the esophagus, you need to monitor your health, treat it with care and great responsibility. Many methods of prevention will help prevent the development of the disease. It:

• giving up bad habits: smoking, alcohol;
• exclusion of fatty, fried, spicy foods;
• in case of esophageal disease, it is necessary to limit the intake of hot food and drinks;
• exclude work in an inclined position, load on the press;
• men need to replace the belt that pinches the stomach with suspenders.

Find out what duodenogastric reflux is - symptoms, treatment and prevention of the disease.

Video about gastroesophageal reflux

Encoded as K21 in ICD 10, GERD is a pathological condition in which substances in the stomach enter the esophagus. The condition is fixed quite often, regularly repeats, occurs spontaneously. Pathology is chronic.

general information

Known as K21 in the ICD, GERD is an acronym for a rather long official name: gastroesophageal reflux disease. The pathological condition is characterized by a regular alternation of remissions, exacerbations. The pathogenesis is due to reflux - it is this term that refers to the entry of gastric contents into the esophagus.

Frequent repetition of reflux provokes a violation of the integrity and functionality of the mucous membranes of the esophagus. This is due to the chemical activity of the duodenal contents. If the ICD code K21 (GERD) is indicated in the patient's card, it is highly likely that the pathological condition most strongly affects the lower esophagus. Chronic violation of the integrity of the mucous membranes is accompanied by problems of motility, failure of gastric evacuation functionality. These phenomena are accompanied by rather characteristic symptoms, unpleasant enough to consult a doctor without delaying an appointment.

Nuances and features

The GERD code in ICD 10 is K21. It is he who is indicated in the patient's card, if the diagnosis is confirmed. You can suspect GERD by specific symptoms that appear in the digestive system. The symptomatology of this pathological condition does not always indicate the transformation of the structure of the organic tissues that form the esophagus. A number of symptoms are characteristic of GERD, regardless of the stage, form, and nuances of the course of the disease. In this case, the level of severity of the manifestations of the disease varies from case to case. Often, the strength of the symptoms allows you to fairly accurately assume how strongly the tissue of the mucous membrane covering the esophagus has histologically degenerated.

Types and forms

In medicine, a classification system for reflux varieties has been developed. GERD is a general concept, within which separate categories are distinguished based on the specific features of the case. The most convenient system for dividing all patients into groups is based on an assessment of the presence of the level of transformation of the tissues covering the esophagus.

The first type is non-erosive. At the appointment, the doctor will definitely explain what kind of disease it is - GERD of a non-erosive type. It will be recorded on the patient's chart as NERD. This is a pathological condition, accompanied by specific symptoms, while violations of the integrity of the mucous membranes cannot be detected. To confirm the diagnosis, an endoscopic examination is prescribed.

Another type is erosive. With this pathology, symptoms are observed against the background of erosion of the esophagus, ulceration, pronounced changes in the structure of the mucous membranes.

Finally, there is a form of the disease called Barrett's esophagus. It is considered the most difficult.

Classification of symptoms

Finding out the features of GERD, what kind of disease it is, what are its manifestations, consequences, how to deal with it, specialists in the field of gastroenterology have done a lot of research and practical work. As part of the generalization of experience, a world congress was organized. Montreal was chosen as the venue for the event. It was there that it was proposed to divide all the symptoms of the disease into three types. Groups of esophageal symptoms and extraesophageal symptoms were identified: clearly associated with reflux and presumably caused by it. The proposed option turned out to be the most convenient of all existing ones, as it helped to distribute the totality of manifestations of pathology based on the level, strength, type of flow, form and nuances of the case.

Explaining to the patient what GERD is, what kind of diagnosis it is, what manifestations in a particular case helped to suspect a pathology, the doctor will definitely pay attention to the presence of heartburn and narrowing of the esophagus among the patient's complaints. It has been established that GERD can be indicated by a runny nose, inflammation in the throat, larynx. Sometimes the pathology manifests itself as a cough, asthma, liquid belching and soreness in the sternum, behind it. Among the symptoms of the disease are a tendency to caries, frequent relapses of otitis media. In some cases, GERD is associated with cancerous processes in the gastrointestinal tract.

Relevance of the issue

Doctors have long been engaged in clarifying what it is - GERD. Symptoms, treatment, consequences, dangers, causes of a pathological condition are an urgent problem of modern medicine. This pathology is most typical for people living in developed countries - the frequency of occurrence is many times higher than that characteristic of lower-level societies.

Some time ago, at the ongoing world congresses of gastroenterologists, as part of the reflection of the current situation, doctors agreed that the most common disease of the last century was a stomach ulcer. For the current century, the most urgent problem is GERD. This forces us to pay special attention to the study of the causes and mechanisms of the development of the pathological condition. Since it is known that GERD can provoke malignant degeneration of cells, it is important to develop new methods to combat pathology, ways to prevent it, detect and correct it in a timely manner.

Where did the trouble come from?

Doctors study in detail the nuances of the disease, its causes, symptoms and treatment of GERD. What it is, where it comes from, how it is formed, what are the triggering factors - all these aspects are still being clarified, although even today scientists have a considerable amount of knowledge about pathology. It was found that GERD can be provoked by a decreased tone of the esophageal sphincter and a weakening of the ability of this organ to independently cleanse itself of food elements. A categorically negative effect has gastric, intestinal contents that enter the esophagus during reflux.

In some cases, they learn from their own experience what GERD is, people whose esophageal mucosa weakens, loses the ability to neutralize the negative effects of substances that accidentally enter the organ from the stomach. Perhaps the formation of a pathological condition, if the ability of the stomach to empty is disturbed, the pressure in the abdominal cavity increases.

Factors and dangers

You are more likely to find out for yourself what GERD is, how it manifests itself and what troubles it brings if a person regularly encounters stress factors. The negative aspect is the forced position of the body for many hours every day, if you have to constantly be leaning forward.

Studies have shown that GERD is more often diagnosed in people who are overweight, as well as in people who tend to be addicted to smoking. Certain dangers are associated with the period of bearing a child. GERD is characteristic of those whose menu is dominated by food that is dangerous for the gastric mucosa. These are a variety of products, from chocolate and spirits to spicy dishes, roasted, strong coffee. By themselves, people who are forced to take medications that affect the concentration of dopamine in the circulatory system can find out what GERD is. The transformation products of phenylethylamine, the preparations "Pervitin", "Phenamine" can provoke a pathological condition.

How about more details?

The weakening of the esophageal sphincter, which closes the organ from below, is one of the common causes of GERD. The main task of this element is to distinguish between the esophagus and stomach. Muscle tissue should close tightly immediately behind the food bolus that has moved from the esophagus into the gastric cavity. Due to various reasons, loose closure of this ring is possible. It is with such a phenomenon that a person learns by himself what GERD is. Food from the gastric cavity gets the opportunity to penetrate back into the esophagus, the integrity and health of the mucous membranes are disturbed, and the inflammatory process starts. If studies confirm the preliminary diagnosis, the patient is prescribed treatment for esophagitis.

The development of insufficient functionality of the esophageal sphincter, located in the lower part of the organ, causes an increase in pressure in the abdominal cavity. This is especially common in patients who are overweight, as well as in women who are expecting a child. The menu for GERD is another important risk factor. If the diet is wrong, unbalanced, a person does not follow the diet, conditions suitable for the pathological condition are formed, and the body's defenses weaken, resources are depleted.

Manifestations and their nuances

As can be seen from the reviews, GERD for patients suffering from pathology becomes a real test. Most often, people turn to the doctor because of heartburn - this complaint is the most typical. An unpleasant burning sensation is localized behind the sternum, especially strongly soon after a meal or during a night's rest. Heartburn is aggravated by drinking carbonated water, playing sports, leaning forward. In this position of the body, as in a horizontal position, geometric conditions are formed that cause the contents of the gastric cavity to enter the esophagus.

GERD can be suspected by a violation of the ability to swallow. This is due to spasms of the esophagus. At first, difficulties are observed with the absorption of solid food, gradually spreading to soft food. As the condition progresses, dysphagia creates problems with fluid intake. In some cases, symptoms indicate the development of complications, a neoplasm.

Cases and forecasts

If the manifestations of GERD are observed for several months with a frequency of more than twice a week, you should visit a gastroenterologist to clarify the condition. As part of the research, it is established how large the damage to the esophageal mucosa is. For this, an endoscope is used. It is customary to divide all cases into positive and negative. The first suggests esophagitis, in which ulceration and erosion can be seen in the lower half of the organ. The negative form is not accompanied by esophagitis, visible damage cannot be detected.

The prolonged course of the disease can cause the formation of Barrett's esophagus. The term refers to the state of metaplasia of epithelial cell structures. Pathology is considered a precancerous condition. Its detection requires a particularly responsible approach to the issue of treatment, proper nutrition, lifestyle changes, since the probability of a malignant neoplasm in the esophagus is high.

Establishing diagnosis

Clarification of the state requires determining the type and type of GERD, the level of severity of the pathology. If there are complications, they need to be clarified and evaluated. The preliminary diagnosis is formulated based on the patient's complaints and medical history. Diagnosis of GERD involves tests and instrumental examinations. The first and main measure is gastroscopy. Through the endoscope, the condition of the esophageal mucosa is examined, narrowed areas are revealed. To confirm the diagnosis, tissue samples may be taken for histological laboratory testing.

In order to formulate adequate clinical recommendations for the identified form of GERD, it is necessary to do manometry. The term refers to such a study, during which the pressure indicators of the esophageal sphincter of the lower zone of the organ are determined. As part of the analysis, the lack of work or adequate functioning is confirmed.

Continuing the study

If GERD is suspected, the doctor will refer the patient for an x-ray. Such a picture is especially important if there are manifestations of dysphagia. As part of the study, tumor processes, strictures are determined. In the presence of a hernia, you can clarify its features and position.

Daily acidity control is another study that is mandatory if GERD is suspected. The analysis is needed to assess the level of acidity and the number of refluxes in 24 hours. Even if the acidity is within adequate limits, such a daily analysis helps to clarify GERD.

What to do?

After confirming the diagnosis, the doctor will explain how to treat GERD. The therapeutic course will be delayed for a long time, it will consist of several successive steps. It is important to practice complex adjustment of the condition. The first step is the relief of the most pronounced manifestations, then an optimal program for suppressing inflammatory processes is prescribed. In parallel, the doctor is working on a course to prevent complications of the condition.

In GERD, clinical recommendations include the use of medications. First of all, antacids and drugs to control secretory function are prescribed. Useful substances that stimulate the kinetics of food in the digestive tract. If the reflux is acidic, proton pump inhibitors are prescribed. If a conservative approach does not have the desired effect, surgery may be prescribed.

Aspects of therapy

If the disease is just beginning to develop, positive results can be obtained without even resorting to a medication course: it is enough to adhere to the diet recommended for GERD, give up bad habits and reconsider the lifestyle and rhythm of life. You will have to restructure your daily routine in such a way as to create optimal conditions for the normal functioning of the digestive tract.

The main health prescription for GERD is the complete rejection of alcohol and tobacco. Smoking and alcohol are strictly prohibited for life. If you are overweight, you should also consider a body shaping program. It is important to rationalize nutrition, normalize the regimen, eat food often and in small quantities. Completely refuse food that negatively affects the mucous or muscle tissue of the sphincter.

Everyday life as a guarantee of health

If the diagnosis of GERD is confirmed, you will have to think about changing the bed. Persons suffering from such a pathology are recommended to sleep on an inclined bed - the head should be slightly higher than the foot. Eating before bed is strictly prohibited. Do not lie down immediately after eating.

Physical activity or exercise immediately after a meal is contraindicated. You can not lift weights, bend over. Doctors recommend giving up tight clothing, not using belts and bandages.

After completing the therapeutic course, you will have to undergo regular examinations to prevent complications and relapses. Often, the doctor sends the patient to a sanatorium or spa treatment to consolidate the primary results of the therapeutic program. Do not neglect such recommendations.

Therapy: different approaches

As medical practice shows, with GERD, physiotherapy gives a good result. In particular, electrophoresis is prescribed using Cerucal. Electrosleep and decimeter procedures have proven themselves well.

You should drink weak mineral alkaline water. If gas is present, it should be removed before drinking. The liquid is heated, consumed in small portions 30 minutes before the meal. The course is at least a month. After drinking mineral water, you can lie down a bit so that the chemically active liquid contacts the mucous membranes of the diseased organ longer. Maximum efficiency can be achieved if mineral water is consumed in a supine position, sipping through a straw.

Herbs for GERD

For the treatment of the disease, you can take a couple of glasses daily of an infusion prepared on chamomile inflorescences mixed in equal proportions, yarrow, St. John's wort, celandine. Another option: calendula inflorescences and coltsfoot leaves are taken in a tablespoon, chamomile inflorescences - a quarter of a teaspoon, everything is mixed and poured with boiling water. Ready infusion is used for food in a tablespoon four times a day for a quarter of an hour before a meal.

You can try the recipe with plantain and St. John's wort, taken in equal proportions. They are mixed with chamomile inflorescences (4 times less than any other component), brewed with boiling water and allowed to brew. The finished drink is used four times a day for a tablespoon half an hour before a meal.

Diseases of the digestive system are ubiquitous both among the adult population and among children. Such a pathology as duodenogastric reflux causes a lot of discomfort and contributes to the development of serious complications from the stomach and esophagus.

A timely visit to the doctor will allow you to recognize the disease in the early stages and prevent its progression.

What is duodenogastric reflux (DGR): this term refers to the pathological reflux of bile, gastric and pancreatic juices into the stomach and lumen of the esophagus due to weakness of the obturator sphincters.

Normally, digested and crushed food (chyme) enters the lumen of the small intestine through the pyloric section of the stomach, which is represented by a powerful circular muscle - the pyloric sphincter. Its contraction prevents the reverse flow of intestinal contents.

Many scientists are inclined to believe that biliary or biliary reflux is not an independent disease, but a syndrome that occurs against the background of existing pathologies of the gastrointestinal tract. In some cases, it is considered to be a gastroesophageal reflux disease, in which the reflux of bile into the stomach is quite common.

The urgency of the problem lies not only in the high prevalence, but also in the fact that the presence of duodenogastric bile reflux contributes to the development of concomitant pathologies, a deterioration in the quality of life. With untimely diagnosis, GHD acquires a chronic course with frequent relapses, which ultimately leads to an increase in the duration and cost of treatment.

ICD-10 code

According to the tenth revision of the International Classification of Diseases Board, biliary reflux does not have its own ICD code, which once again confirms the secondary nature of its occurrence. The syndrome may be part of such diagnoses:

• Gastroesophageal reflux disease(K.21).
• Duodenitis(K.29).
• Gastritis(K.29.3).
• Gastroduodenitis of unknown etiology(K.29.9).

Causes of the disease and risk factors

An independent course of gastroduodenal reflux occurs in 25% of cases of all violations of the valvular apparatus of the digestive system. Otherwise, the pathology is due to the presence of other diseases of the gastrointestinal tract in the patient.

These include:

• chronic gastroduodenitis, gastritis;
• chronic pancreatitis and cholecystitis;
• functional dyspepsia and irritable bowel syndrome;
• peptic ulcer of the duodenum, stomach;
• giardiasis, helminthic invasion;
• congenital anomalies of the gastroduodenal zone.

The main causes of bile (alkaline) reflux also include:

Among the provoking factors, it is worth noting old age, irregular rough nutrition, overeating, alcohol abuse, smoking, long-term and uncontrolled use of NSAIDs (non-steroidal anti-inflammatory drugs). An important role in the genesis of reflux is played by the high acidity of gastric juice, undergone operations on the stomach, intestines.

The mechanism of development of duodenogastric reflux

The work of the digestive organs is a complex and multi-stage mechanism that is implemented through nervous regulation, the effects of hormones and neuropeptides. The work of the pyloric sphincter is influenced by the branches of the vagus nerve, the autonomic nervous and endocrine systems.

The stomach, in turn, produces a hormone - gastrin, which regulates the peristalsis of the organ and has a direct effect on the tone of the pyloric sphincter. Normalizes the motility of gastric sphincter glucagon, cholecystokinin, secretin, histamine. The work of the muscular apparatus of the digestive tube depends on their concentration.

Hormonal imbalance, disturbed nervous regulation - all this contributes to the occurrence of pathological reflux of duodenal contents into the stomach cavity, often into the lumen of the esophagus.

Pregnancy is another common factor in pathology. An enlarged uterus leads to an increase in intra-abdominal pressure in the abdominal cavity and compression of the duodenum, contributing to the regurgitation of bile, digestive enzymes up and the appearance of symptoms.

Useful video

What is the danger: possible complications of the disease

The most common complication of duodenogastric reflux is erosive gastritis. This is a chronic inflammation of the gastric mucosa with the appearance of small shallow defects on it - erosions. This consequence is due to the action of aggressive bile acids with hydrochloric acid.

Pictured is Barrett's esophagus.

The inflammatory process that covers the mucous membrane of the esophagus with the formation of erosions and ulcers on it is called erosive esophagitis. This disease is equally common in men and women. According to the international classification of diseases, the ICD-10 pathology is code K 22.1, and when GERD is added, it is K 22.0.

The erosive form requires immediate treatment, since it can cause serious complications, up to malignant neoplasms. Therefore, when heartburn and burning sensation behind the sternum appear, you need to contact a gastroenterologist to receive special treatment.

We found out which erosive esophagitis has ICD code 10, we follow further. Esophagitis causes inflammation of the mucous membrane of the esophagus and develops in acute and chronic types. An acute course occurs when:

• fungal infections;
• alkalis;
• acids;
• salts of heavy metals;
• hot food or steam;
• alcohol.

Also, discomfort in the form of heartburn causes overeating, physical work immediately after eating. In addition, esophagitis can be caused by reflux, that is, the reflux of stomach contents back into the esophagus. The hydrochloric acid contained in the gastric secretion irritates the epithelium of the esophageal tube. When affected by these factors, the mucous membrane of the esophagus becomes inflamed, reddens and swells. So what are the typical symptoms? Erosive esophagitis causes the patient:

• heartburn;
• burning in the chest;
• sore throat.

This condition is treated with a sparing diet, and if the disease is caused by an infectious factor, then antibiotic therapy is added.

If treatment is not started in time, then erosion will appear on the mucous membrane in addition to hyperemia, hence the name erosive esophagitis. It develops in the chronic course of the disease.

Necrotizing esophagitis

This is a form of the acute course of the disease, which is not very common and occurs in people with reduced immunity against the background of infectious diseases (scarlet fever, sepsis, measles, mycosis). The disease is characterized by a sharp inflammation of the esophageal mucosa, forming necrotic (dead) areas, which, when rejected, form deep ulcers. During the healing of ulcers, the epithelium of the esophagus becomes covered with purulent or bloody exudate.

Against the background of symptoms corresponding to the underlying disease, there are:

• chest pain;
• vomiting with an admixture of necrotic tissues;
• dysphagia (impaired swallowing).

This form of the disease often causes complications in the form of bleeding, acute purulent inflammation of the mediastinum, retrosternal abscess.

Treatment of necrotizing esophagitis takes a long time and requires the patient to be patient and strictly follow all the doctor's instructions. After healing of ulcers in the esophagus, scarring is formed, which brings the patient discomfort.

Chronic erosive esophagitis of the esophagus

The chronic course of the disease occurs due to the following reasons:

Gastroesophageal reflux disease results in chronic inflammation of the esophageal epithelium. Due to insufficient closure of the muscular ring of the sphincter that separates the esophagus and stomach, food can fall back into the esophageal tube, irritating the mucous membrane. Hyperemia and edema of the epithelium of the walls of this internal organ is determined first stage diseases. Symptoms during this period are not pronounced, mainly heartburn. If GERD is not treated, then the membrane will not only turn red, but erosions will form on it. it second stage illness.

It is she who is diagnosed by doctors when patients come to them with complaints of heartburn and burning sensation along the esophagus. In endoscopic examination of the walls of the internal organ on the epithelium of the walls, the presence of single or multiple erosions is noted, which do not merge and form defects on the mucosa in the region of one fold. The walls of the esophagus are covered with fibrous plaque.

Third stage characterized by the degeneration of erosion into ulcers. This is erosive ulcerative esophagitis. At this stage, not only the surface layer of the epithelium is affected, but also the underlying tissues. Defects extend beyond one fold and may be observed around the mucosa of the esophagus. With further progression, the muscle tissue of the esophageal tube is damaged. The condition worsens as persistent symptoms are added to the above symptoms. cough, vomit mixed with blood pain along the esophagus occurring regardless of food intake.

This stage is dangerous for the development of complications:

• bleeding;
• stenosis;
• Barrett's esophagus.

In addition, when an infectious factor is attached against the background of erosive esophagitis, purulent inflammation of the esophagus may develop. Such conditions lead to a deterioration in the general condition of the patient, and in case of bleeding, they require urgent hospitalization. Erosive fibrinous esophagitis should not be allowed to develop.

Therapeutic measures

Therapy for the erosive form of the disease is similar in principles of treatment to other types of esophagitis and GERD. It consists of:

• medical treatment;
• diet food;
• preventive measures.

Medical therapy

1. Drugs that reduce the acidity of gastric juice - antacids. In combination with them, drugs are prescribed that create a protective film on the surface of the gastric mucosa, as well as on the food bolus, which reduces the harmful effects of hydrochloric acid on the walls of the esophagus - alginates. The drugs of choice are Rennie, Gaviscon, Phosphalugel.
2. Prokinetics- drugs that help food move faster through the esophagus into the stomach and thereby reduce the irritant effect of food on the lining of the esophageal tube ( Cyrucal, Metaclopramide, Motylium).
3. If erosion occurs as a result of reflux caused by insufficient function of the cardia, then prescribe IPP. These are drugs that increase the contractility of the sphincter that separates the esophagus from the stomach ( Omez).
4. For better regeneration of epithelial cells of the esophageal mucosa, Solcoseryl, Alanton.
5. In the presence of infectious inflammation, add to the above drugs vitamins and antibiotics.

If complications arise or drug therapy is ineffective, then surgery is performed. This can be a traditional technique (an incision in the chest or abdomen) or a laparoscopy method, which is less traumatic.

Diet

Diet plays a big role. The diet for erosive esophagitis is aimed at reducing the irritating effect of foods on the esophageal mucosa. The following dishes are excluded from the diet:

As well as products:

• fresh vegetables;
• fruits of sour varieties;
• legumes;
• black bread;
• mushrooms.

Alcohol and smoking are strictly prohibited.

Patients should eat small meals at least 5-6 times a day so as not to overload the stomach and cause reflux. After eating, you can’t lie down to rest, but you need to walk around a bit, but not do physical work, especially requiring the torso to bend forward. After the last meal and before sleep should go at least 3 hours.

Patients can use steamed food, baked or boiled. Also, do not take very hot or cold food. During the meal, you need to chew food well, do not eat coarse food, so as not to injure the esophageal mucosa.

When GERD with erosive esophagitis is diagnosed, the diet must be followed.

Useful video

Some more useful information on how to properly treat and eat can be found in this video.

Prevention

After the treatment, patients need to monitor not only nutrition, but also change their lifestyle. Such people should not play sports associated with abdominal tension. You also need to reduce physical and emotional stress. If the work is related to the position - tilting the torso forward, then this type of activity must be changed. Do not wear tight clothing, tight belts and corsets.

A good result is given by walking before going to bed, as well as taking tea ( mint, melissa, calendula,chamomile), which has a sedative and anti-inflammatory effect.

It must be remembered that when the first signs of the disease appear, you need to consult a doctor, since self-medication or the use of alternative methods will not be able to completely cure the disease, and in some cases leads to exacerbations. Once a year, such patients need to visit a gastroenterologist with mandatory endoscopic examination. If the patient's condition worsens, then consultation is needed immediately.