Reflux esophagitis - symptoms, causes and treatment. What is gastroesophageal reflux

Reflux esophagitis is inflammation of the lining of the esophagus. It is formed due to the injection of pH from the stomach. It instantly begins to corrode the mucous membrane that protects the esophagus from an aggressive environment. In the absence of such protection, a person begins to feel pain. There are erosions, ulcers, complications.

Causes of the disease

Most common causes the occurrence of reflux - esophagitis - is an unhealthy diet, prolonged alcohol consumption and very spicy food. With improper treatment or its absence, scars form on the walls of the esophagus. And also reflux can occur against the background of weakening of the muscles, when the valve begins to pass gastric juice.

The most common causes of esophagitis are:

• high pressure and bursting in the peritoneum;
• wrong diet;
• spicy, smoked and fatty meals;
• stress;
• chemical factors;
• obesity;
• ulcers;
• the period of bearing a child;
• excessive drinking;
• smoking.

Any of these factors can lead to an exacerbation and return of the disease. For this, even a simple tilt forward is enough.

Types of esophagitis

Classification of esophagitis is divided into 2 main forms - acute and chronic. They, in turn, are divided into:

• pseudomembranous;
• (otherwise superficial);
• necrotic;
• exfoliative;
• hydropic;
• phlegmonous (may be limited or diffuse).

Spicy esophagitis occurs in the lower esophagus, often associated with stomach ailments. Pathology occurs against the background of vitamin deficiency, gastrointestinal disorders, infections. Acute reflux causes soreness when eating or drinking liquids.

Appears as individual disease or is formed as a complication after an acute form. Accompanied by a stable inflammation of the esophagus. Pain appears in the chest. Often the chronic form is supplemented by gastritis

Stages of development

Esophagitis develops in stages. In the first stage (A) of the disease, the affected area is 4-5 millimeters in diameter. There may be several such places on the mucosa. In this case, the affected zones do not touch.

In the second stage (B) of the disease, several defective areas expand and become more than 5 mm in diameter. At the same time, the affected areas begin to merge. Large defective areas are formed. However, they do not apply to the entire mucosa.

Her third is affected in the 3rd stage (C). The last stage - the fourth is accompanied by extensive ulcers on the mucosa. The sites of lesions occupy from 75 percent of the surface. Stenosis may be diagnosed.

Symptoms

The first signs appear general malaise And fever. A person is tormented by pain behind the sternum, along the entire tube of the esophagus. An additional symptom of reflux esophagitis may be heartburn, vomiting, or.


Pathology can proceed secretly. Sometimes esophagitis is accompanied by signs that are uncharacteristic for this disease. Each form has the same symptoms:

• lump in the throat;
• heartburn;
• burning or pain in the chest;
• nausea.

An hour and a half after eating, pain in the esophagus begins. This is already a pronounced inflammation. The symptoms are aggravated when the person lies down. Symptoms of reflux esophagitis may vary depending on the stage and type of disease:

1. Pulmonary caused by heartburn and unpleasant belching. Bronchial obstruction appears - a prolonged cough, nocturnal suffocating attacks, lack of air. This can trigger the formation of asthma.
2. cardinal accompanied by symptoms inherent in angina pectoris, due to the proximity of nerve endings. Pain always occurs after sour or spicy food, fried or fatty foods, overeating.
3. Otolaryngological, in addition to belching and heartburn, accompanied by sore throat, perspiration. Nasal congestion and discharge from it in the form of clear mucus may appear.
4. dental form is accompanied by the appearance of caries. This is facilitated by gastric juice, which corrodes tooth enamel.

Symptoms of subtypes of chronic reflux esophagitis

The hemorrhagic form is a type of acute esophagitis. It appears very rarely, against the background of severe erosive inflammation. Accompanied by bloody vomiting and chalky (tarry stool).

Note! Without timely treatment disease can last for years. Over time, the symptoms will intensify, and eventually irreversible changes in the mucosa occur, scars appear on it.

Diagnosis of the disease

When diagnosing esophagitis, the degree of mucosal damage and the form of the disease are determined. For this, an x-ray is used, the pictures of which clearly show whether the valve passes gastric juice. During endoscopy, the entire length of the esophagus is examined.

Before treating reflux, a scintigraphy is performed. It shows the presence or absence of abnormalities in the work of the gastrointestinal tract. A biopsy is taken for histological analysis. The pH-metry procedure determines the degree of acidity in the stomach.

Treatment

Treatment of esophagitis is always complex. The scheme includes medicines, diet, physiotherapy, exercise therapy and other methods. Initially, therapy is aimed at eliminating the causes of the disease.

General events

Treatment of gastric reflux begins with general measures aimed at correcting the quality of life. This greatly reduces muscle damage, which helps in a quick recovery:

1. Stop smoking, as nicotine increases acidity and relaxes the digestive muscles.
2. After eating food, you can’t immediately lie down, it’s better to sit quietly or go outside. walking tour. Fast walk and running are excluded.
3. Restriction of physical activity helps to reduce the symptoms of the disease. You can not lift anything more than 3 kilograms.
4. A couple of hours before bedtime, food and alcohol are excluded.
5. It is necessary to sleep on a raised (15-20 cm) pillow.
6. Avoid wearing tight clothing.

If there are additional diseases (obesity, ulcers, etc.), you need to treat them. Otherwise, reflux esophagitis therapy will have no effect.

Medical

When making a diagnosis of reflux esophagitis, the treatment regimen is prescribed depending on the type of development of the disease:

1. To reduce the activity of AP-enzymes, "Pantoprazole", "Rabeprazole" is used.
2. After the 13th week of bearing a child, Lansoprazole is prescribed.
3. With bronchial asthma, "Omeprazole", "Esomeprazole" are indicated.
4. If liver function is impaired, any PPI (inhibitors proton pump), but Rabeprazole is preferred.
5. For a quick and stable decrease in acidity, Pantoprazole or Lansoprazole is used.

If PPI therapy was ineffective, then histamine blockers are prescribed. However, they are used in large dosages, so they are used only when absolutely necessary - Nizatidine, Famotidine, Roxatidine and their analogues.

To reduce the aggressive effects of refluxes and their number, prokinetics are prescribed. They improve digestion and facilitate the passage of food. The most effective include:

• "Domperidone";
• "Cisapride";
• "Metoclopramide".

For fast elimination pain in the esophagus or heartburn are prescribed antacids. They do not cure the disease, but partially alleviate the symptoms of reflux. Can be assigned:

• "Maalox";
• "Renny";
• "Gaviscon";
• "Megalac".

These drugs act quickly, retain their effect for a long time, and significantly reduce acidity. For the treatment of cardia insufficiency (incomplete closure of valves), Ranitidine, Omeprazole, Solpadein, Regidron are used. For complications, antibiotics are prescribed.

Diet Features

- one of the main directions in the treatment of esophagitis. Food can be cooked in only a few ways:

Attention! The risk of esophagitis is increased by malnutrition, smoking, consumption large doses coffee, undiluted fruit juices and spirits.

With intestinal esophagitis, the use of mayonnaise or oil in dishes is excluded, or they are added to minimum quantities. Do not use ketchups, hot sauces, horseradish and mustard for dressings. They will irritate the mucous membrane even more and increase acidity. gastric juice. Too hot or cold food is prohibited.

When diagnosing reflux esophagitis, therapy includes strict dietary restrictions.

The menu includes vegetables and fruits, but it is not recommended to eat them raw, it is advisable to bake or stew. You need to eat every three hours, in small portions. The last dinner should be 4 hours before bedtime.

Physiotherapy

GERD can be treated with physical therapy. It is prescribed for severe symptoms, pain syndrome. Types of physiotherapy procedures for esophagitis:

• TCEA (transcranial electroanalgesia);
• aerotherapy;
• electrosleep therapy;
• electrophoresis with antispasmodics;
• baths with sodium chloride;
• galvanization;
• interference therapy;
• UHF (ultra high frequency inductothermy);
• cryotherapy in the epigastric region;
• magneto and laser therapy;
• coniferous and iodine baths;
• galvanization of the brain of the head.

Physiotherapy depends on the form of the disease, its severity, the presence or absence of complications. It helps to restore the functionality of the vegetative nervous system, partially heeds inflammation, accelerates the healing process. Simultaneously improves performance digestive system and relieves spasms.

exercise therapy

With esophagitis physical exercise help speed up the healing process, help strengthen the body.

Workouts and exercises are selected depending on. In this case, the maximum load tolerance should be taken into account. Exercise helps to get rid of heartburn, develop muscular system, strengthen the sphincter, promote rapid healing ulcers.

The main direction is breathing exercises. The main methods include diaphragmatic, according to Strelnikova. Separately, exercises for holding the breath are worked out, aerobic training is carried out.

Surgery

Surgical treatment of esophagitis - last resort, used for serious complications. Surgical intervention may be prescribed for severe bleeding in the esophagus, persistent stricture, irreversible damage to the sphincter.

Also, the operation is prescribed in case of a precancerous condition of the mucosa, with active reproduction and degeneration of cells. Surgery is indicated for oncology of the 1st and 2nd degree. During surgical intervention complete or partial removal esophageal tube, the integrity of the organ is restored, the tumor is excised.

Folk methods

The treatment regimen for reflux esophagitis includes as adjuvant therapy. In this case, decoctions of herbs, healing baths and teas are used.

One popular treatment for heartburn reflux is baking soda. However, this brings additional harm. During the first passage through the esophagus, the mucosa is irritated even more. In response to alkalization occurs strong highlight acids, refluxes become even more aggressive. Therefore, instead of soda, it is desirable to use antacids.

Reflux esophagitis, caused by spicy, fatty or smoked foods, is treated in the initial stage simple herbs. Herbal decoctions of motherwort, licorice, lemon balm and flax seeds help relieve inflammation.

Esophagitis in adults often causes. Rose hips, valerian, dandelion flowers and calamus powder save them from them. Plantain juice has a strong healing effect. However, it is contraindicated in people with acid reflux.

For the treatment of chronic esophagitis of the esophagus, decoctions of chamomile are made. They can be combined with flax seeds. The remedy is drunk three times a day. Flax seeds simultaneously have an enveloping effect, reduce hyperacidity. This good prevention cancer and reduce the symptoms of the disease.

Honey should be consumed a couple of hours before meals. It is desirable not in whole form, but diluted with a small amount of liquid. You can not use honey during an exacerbation of esophagitis. This will irritate the lining of the esophagus.

Sea buckthorn oil has a healing effect, improves secretory function and digestion. potato juice envelops the mucous membrane, creating an additional protective film. It helps reduce heartburn and chest pain.

Can reflux esophagitis be completely cured?

On initial stages it is possible. However, despite the successful conservative therapy reflux esophagitis, it is not completely treated. Any deviation from the diet and symptoms may return. This often leads to an exacerbation of the disease.

Exclusion from the life and diet of provoking factors helps prevent serious complications in the form of perforation of an ulcer, oncology.

Reflux esophagitis is a chronic disease of the gastrointestinal tract, which is caused by the constant discharge of contents from the human stomach into the esophagus. According to statistics, about 50% of the total population suffer from such a disease, and the numbers have been actively increasing recently. Many people do not yet realize how potentially dangerous gastroesophageal reflux with esophagitis is, therefore they turn to doctors only at the very advanced stages, accompanied by serious complications.

Features of the digestive tract

To talk about GERD with esophagitis, the danger of reflux and their potential consequences, you first need to understand the features of the human esophagus and gastrointestinal tract (gastrointestinal tract).

The esophagus is hollow organ, which is located directly behind the trachea. In an average person, the length of the esophagus is about 24 cm or 25-30 cm in women and men, respectively. The esophagus has several layers - muscular, mucous, and also external. The main function of the esophagus is to carry food to our stomach. Up to a dozen folds are formed from the mucosa, which stimulate the esophagus to carry human food.

The esophagus also contains glands that secrete special mucus or mucous fluid. She participates in the processes of movement of food and does not allow the esophagus to be damaged from contact with it.

As for the muscle layer, it speeds up the process of passage of consumed products through our esophagus. The muscle layer has two valves - lower and upper. The lower valve is located directly between the human esophagus and directly his stomach. If a person does not eat food in this moment, this valve goes into the closed state until next appointment food. When the swallowing process begins, the valve opens and allows food to pass through. If the work of the lower esophageal valve is disrupted, this will lead to symptoms of esophagitis reflux and the development of this unpleasant disease.

When people eat, the stomach begins to actively produce gastric juice. It is a mixture of various aggressive enzymes and of hydrochloric acid, which are responsible for the digestion of our food with you. Stimulates the process of processing peristalsis, that is, the movements made by the stomach.

What is reflux or gastroesophageal reflux? This is the reflux of contents from our stomach into the esophagus. IN normal condition peristalsis advises about 20-30 refluxes, that is, it throws the contents from our stomach into the esophagus. At the same time, such refluxes do not cause any discomfort, because they are not a disease, but are a normal process of the gastrointestinal tract. But when protective functions and the mechanisms of the esophagus are violated, a person begins to feel pain with reflux esophagitis, since pathology is already developing.

Defense mechanisms of the esophagus

There are three in total. The first mechanism is the mucous membrane. It does not allow mechanical damage to the esophagus and protects against the effects of hydrochloric acid that enters as a result of reflux.

The second mechanism of the human esophagus is the sphincter, that is, the valve. Due to it, the contents from the stomach do not enter the esophagus too often.

The third mechanism is the blood supply. It stimulates the rapid recovery of the mucous layer, if it is damaged under one or another influence.

All of them together provide protection against such an ailment as gastroesophageal reflux disease or reflux esophagitis.

Types of disease

In many ways, the choice of treatment regimen depends on what type of disease the patient has encountered. GERD with esophagitis is of several types:

• Spicy. It is observed when gastroesophageal refluxes intensify and develop into pathology. It is characterized by inflammatory processes on the surface and in the depth of the esophagus. These are non-erosive refluxes of esophagitis, which can appear unexpectedly and, with proper treatment, pass without complications.
• Chronic. Chronic reflux esophagitis, caused by regular gastroesophageal reflux, is characterized by long-term inflammatory processes that occur on the walls of the stomach. This form can lead to irreversible consequences, capable of fully disrupting the entire work of the digestive tract.
• fibrinous. It's also pseudomembrane. At the beginning of the course of the disease, yellow effusions form, after which mucous layer thick films appear in the esophagus. They can be easily removed. IN rare cases the fibrinous type of the disease is accompanied by a severe course.
• Surface. Most mild form diseases, since the damage is weak and the tissues are practically not destroyed.
• Biliary. It develops as a result of regular emissions from the stomach and duodenum. The inflammatory process of the tube through which food passes begins.

Forms

It is also worth noting several forms of the disease in which an ailment provoked by gastroesophageal reflux can occur.

Gastroesophageal refluxes are the norm for the digestive tract. But at the same time, certain disturbances in his work may occur, which entails a diagnosis of reflux esophagitis.

There are several forms of the course of the disease:

• Acute esophagitis. In such reflux esophagitis, the symptoms are accompanied by painful sensations when eating. Moreover, they are observed at the top of the chest and in the esophagus. Also a characteristic feature is a disturbed process of swallowing and weakness of the whole organism.
• catarrhal. If gastroesophageal refluxes, together with disorders in the esophagus, lead to catarrhal form, then it is accompanied by swelling of the mucous layer of the esophagus. When swallowing, a person feels severe pain and the presence of a foreign object in the throat.
• The erosive form of reflux-esophagitis requires intervention in the treatment of a specialist. This is a complicated form, accompanied by the formation of ulcers, that is, erosion, on the mucous walls of the esophagus. This form is accompanied by increased symptoms of the previous forms. Unpleasant sensations aggravated after every meal.

What is the danger of such a disease? The likelihood of transition to a chronic form and serious complications. The chronic form is characterized by a constant increase unpleasant symptoms, which periodically go into a state of rest. On the background chronic esophagitis gastritis develops.

Stages of the disease

If disturbed gastroesophageal refluxes provoked esophagitis, in the absence of appropriate treatment, the disease begins to progress and move from one stage to another.

The first stage or grade 1 reflux esophagitis is characterized by the presence of punctate erosions on the esophageal walls. And with reflux-esophagitis, 2 degrees of erosion merge, burning activity in the chest and heartburn increase. After meals in the chest, there is unpleasant discomfort and pain.

When the disease passes into the third stage or to the 3rd degree, extensive erosion is observed and the symptoms of the disease manifest themselves even in between meals.

The most dangerous stage is 4. It is characterized chronic ulcer esophagus and persistent sensations of unpleasant aftertaste. What it is? This stage is usually accompanied by complications, swallowing becomes an extremely difficult process. If the disease is not treated, a person may even face a malignant tumor.

Causes of the disorder

There can be many reasons for reflux esophagitis. This includes insufficiency of the cardia, and a hernia of the esophagus and a number of other reasons. Define real reasons and treatment should only be a qualified specialist. Do not self-diagnose and even more so independently treat the disease.

Insufficiency of the cardia or a cardiac defect, that is, impaired work of cardio-vascular system, is far from the only reason for the development of reflux esophagitis.

The main cause of the disease is a violation of the tone or normal operation esophageal valve. To provoke it and the development of the disease can:

• long-term medication;
• recent operations on the gastrointestinal tract;
• hiatal hernia;
• insufficiency of the cardia;
• overweight and obesity;
• an ulcer affecting the stomach or intestines;
• lifestyle, accompanied by low mobility;
• malnutrition;
• constant habit of eating before bed;
• gastritis;
• sedentary lifestyle, etc.

Symptoms

This article will not be complete if we do not tell you about the main symptoms and signs that may indicate the development of reflux esophagitis. If you notice these signs, be sure to contact a specialist immediately. Should not be underestimated potential danger ailment. You already know what it is and what serious consequences esophagitis can lead to.

As the frequency of occurrence, the symptoms of reflux esophagitis can manifest themselves in the following:

• heartburn sensations when eating almost any food;
• constant heaviness in the stomach;
• feeling full even when eating a small portion of food;
• lump in the throat;
• frequent belching, accompanied by the release of air or a sour taste;
• bouts of nausea;
• pain in the epigastrium;
• problematic bowel movements;
• complications when swallowing food and even saliva;
• hoarse voice;
• pain in the region of the heart.

The disease can proceed and develop for many years. In this case, the symptoms increase gradually, if no measures are taken to eliminate them. Lack of treatment is accompanied by complications and increased manifestations of the disease.

It is important to note that reflux esophagitis is quite easy to treat if you strictly follow the doctor's recommendations and adjust your lifestyle. But after the completion of treatment and the return to a destructive lifestyle, the symptoms return, that is, there is a relapse of the disease.

If you do not pay attention to the symptoms of reflux-esophagitis in time, or at least do not visit a doctor in order to confirm or refute possible diagnosis, the disease can lead to complications. But if malignant tumors are rare, complications such as esophageal ulcers, esophageal stenosis, and Barrett's esophagus are quite common problems that reflux esophagitis entails.

Therefore, be extremely attentive to the signals that your body gives you. Check any suspicions and treat the disease on the outskirts.

1. What is gastroesophageal reflux (gastroesophageal reflux - GER)? How common is this disease?

The term "gastroesophageal reflux" (GER) is used to describe a pathological condition characterized by clinical symptoms or histopathological signs of damage to the esophagus caused by the "throwing" of the contents of the stomach and duodenum into it. GER is quite common. When examining hospital workers, it turned out that 7% of them experience heartburn daily and 36% at least once a month. As a result of further research, it was found that gastroesophageal reflux occurs in 3-4% of the entire human population, and its prevalence in people over 55 years of age increases to about 5%. Pregnant women most often suffer from heartburn - 48-79%. The disease affects both men and women with the same frequency, but men are more likely to develop complications of GER: esophagitis (2-3: 1), Barrett's esophagus (Barrett) (10: 1).

2. List the typical clinical symptoms of gastroesophageal reflux.

Heartburn can be described as a burning sensation in the chest that radiates to the neck and sometimes to the shoulder blade. Patients usually put their palm on the site of the projection of the sternum and make up and down movements with the brush to show the nature and localization of the symptoms that bother them. Mild heartburn often resolves within 3-5 minutes after taking milk or antacids. Other symptoms of gastroesophageal reflux are listed below:
Regurgitation is the reflux of gastric juice or stomach contents into the throat and is often accompanied by bad aftertaste in the mouth. Regurgitation, as a rule, occurs after a heavy meal, when bending forward and in the supine position.
Dysphagia is difficulty swallowing. In patients with long-standing gastroesophageal reflux, dysphagia is usually caused by benign esophageal strictures. Often, dysphagia occurs only when swallowing solid foods, such as meat and bread. Violation of swallowing occurs with a significant narrowing of the lumen of the esophagus (less than 13 mm). Long-term dysphagia, in which the patient cannot even swallow saliva, requires careful evaluation and often endoscopic surgery (see the chapter on foreign body ingestion).
Gastrointestinal bleeding with gastroesophageal reflux is quite rare. During endoscopic examination in patients with bleeding from upper divisions of the gastrointestinal tract, only in 2-6% of cases, the cause of bleeding is ezozivny esophagitis, resulting from gastroesophageal reflux.
Odynophagia is pain in the chest when swallowing; the disease should not be confused with dysphagia. Odynophagia rarely occurs with gastroesophageal reflux, but often with infections (caused by fruit molds, herpes simplex virus, cytomegalovirus), ingestion of irritants or drugs (tetracyclines, vitamin C, quinidine, estrogens, aspirin, or nonsteroidal anti-inflammatory drugs), and cancer . Fluid belching is a rare but very common symptom of gastroesophageal reflux. Patients develop foam in their mouths as the salivary glands begin to produce up to 10 ml of saliva per minute in response to the esophago-salivary reflex that occurs with GER.
Uncharacteristic complaints and symptoms of gastroesophageal reflux include hoarseness, neck tension, asthma, cough, hiccups, recurrent otitis media in children, and erosions on the tongue at tooth contact.

3. What symptoms characteristic of gastroesophageal reflux can be detected during an objective examination of patients?

Severe kyphosis is often accompanied by the development of a hernia. esophageal opening diaphragm and gastroesophageal reflux, especially when wearing a corset.
A tight corset or clothing can lead to an increase in intra-abdominal pressure and the development of stress reflux.
In case of phonation disorders, the presence of high gastroesophageal reflux with damage to the vocal cords cannot be ruled out. When hoarseness is associated with high GER, the voice usually becomes rough and hoarse, which is especially noticeable in the morning, while with hoarseness associated with other causes, deterioration usually occurs in the late afternoon.
Stridor breathing, asthma, and pulmonary fibrosis may be associated with gastroesophageal reflux. Patients often report afternoon or nocturnal regurgitation with episodes of coughing or choking caused by aspiration.
Thinning of the enamel on the inner surface of the teeth may be a sign of severe gastroesophageal reflux, although it is more common in patients with ruminant syndrome (rumination) or bulimia.
Esophageal dysfunction may be the leading symptom in clinical picture scleroderma or other systemic connective tissue diseases. The patient should be evaluated for signs of Raynaud's syndrome, sclerodactyly, and calcification.
Patients with gastroesophageal reflux often have cerebral paralysis, Down syndrome and mental retardation.
Children who make specific head movements during swallowing may have Sandifer's syndrome.
Some patients unconsciously swallow air (aerophagia), which causes heartburn and loud belching. The doctor can observe this during the interview and conduct an objective examination of the patient.

4. Can gastroesophageal reflux occur in healthy people?

Yes. In healthy people, reflux of acid or gastric contents into the esophagus may occur, especially after a heavy meal. Normally, a person has protective mechanisms, which include the lower esophageal sphincter and the so-called "self-cleaning" of the esophagus, which prevent the appearance of symptoms of gastroesophageal reflux and the development of specific damage to the esophagus. Outpatient esophageal pH studies have shown that less than 2% of healthy people experience gastroesophageal reflux during the daytime (during vertical position) and less than 0.3% - at night (in the supine position).

5. How is gastroesophageal reflux related to swallowing and saliva production?

The reflux of gastric contents into the esophagus often stimulates salivation and increases the frequency and intensity of swallowing movements. Saliva has a neutral pH, which helps to neutralize acidic gastric contents that have entered the esophagus. Moreover, swallowed saliva initiates the development of peristaltic waves in the esophagus, which leads to its purification from the acidic gastric contents that have entered it. During wakefulness, a person performs approximately 72 swallowing movements per hour and up to 192 during meals. During sleep, the number of swallowing movements decreases to 7 per hour; the number of awakenings to swallow in patients with gastroesophageal reflux may be reduced by sedatives and alcohol. In patients with Sjögren's syndrome and in smokers, saliva production may decrease, and the time to clear the esophagus may increase.

6. Name two anatomical mechanisms that are disturbed in patients with gastroesophageal reflux.

Inadequate cleansing of the esophagus and violation of the gastroesophageal barrier.
1. Purification
Esophageal. Usually, when gastric contents are thrown into the esophagus, a secondary, or so-called cleansing, peristaltic wave occurs, which removes damaging agents. Things are much worse in patients with "scleroderma" esophagus. They have a broken barrier function of the lower esophageal sphincter, there are no primary and secondary peristaltic waves, and therefore, there is no cleansing of the esophagus.
Gastric. Paresis of the stomach leads to excessive accumulation and stagnation of the contents in the stomach and duodenum. This, in turn, is a predisposing factor in the development of esophageal reflux.
2. Gastroesophageal barrier
Normally, the length of the lower esophageal sphincter (LES) is 3-4 cm, and at rest it maintains a pressure of 10-30 mm Hg. Art. The lower esophageal sphincter acts as a protective barrier against the entry of gastric contents into the esophagus. With a decrease in the pressure of the LES below 6 mm Hg. Art. gastroesophageal reflux occurs frequently; however, even "normal" LES pressure does not guarantee against the occurrence of GER. Recent studies have shown that transient relaxation of the lower esophageal sphincter (tRNPS) is an important pathogenetic factor in the development of gastroesophageal reflux. At the time of tRNPS, the sphincter relaxes and gastric contents are refluxed into the esophagus. The normal LES is sensitive to many factors that affect its pressure at rest.

Factors affecting the tone of the LES

7. What is the natural clinical course of gastroesophageal reflux?

Most patients have symptoms of gastroesophageal reflux for several years before they see a doctor. Prior to the advent of antireflux drugs that inhibit the work of the gastric proton pump, patients often had symptoms of the disease even during therapy with antacids, prokinetic drugs and histamine H 2 receptor blockers. Currently, gastroesophageal reflux is successfully treated in most cases with gastric proton pump inhibitors (omeprazole or lansoprazole). However, in more than 80% of patients, the disease recurs within 30 weeks after stopping the drugs.
Erosive gastroesophageal reflux is considered chronic disease. The likelihood of its recurrence after discontinuation drug therapy very high. The goal of drug therapy is to reduce the severity of symptoms and prevent the development of complications: strictures of the esophagus, Barrett's esophagus and bleeding.

8. What pathological conditions can simulate the symptoms of gastroesophageal reflux?

Differential diagnosis of gastroesophageal reflux should be carried out with coronary heart disease, gastritis, gastric paresis, infectious and medicinal esophagitis, gastric and duodenal ulcers, diseases of the biliary tract and esophageal dysmotility.
When examining patients who complain of retrosternal pain, the doctor should keep in mind that the life of a patient suffering from gastroesophageal reflux is out of danger, and a patient with an attack of angina pectoris or acute infarction myocardium, simulating an attack of GER, may die. Chest pain associated with cardiac pathology radiates to the neck, lower jaw, left shoulder blade or left hand; accompanied by increased respiration and profuse sweating; provoked by physical activity. When taking nitroglycerin under the tongue, a decrease in pain is characteristic. On auscultation of the heart, murmurs or a galloping rhythm may be heard. There is also a violation of the rhythm of heart contractions. Although, when examining patients complaining of chest pain, the detection of changes on the electrocardiogram (ECG) is in favor of cardiac pathology, it cannot be completely excluded even in the absence of such changes.

9. How should patients with gastroesophageal reflux be examined?

The volume of examination of patients with gastroesophageal reflux is determined by the severity of symptoms. Patients without evidence of severe gastroesophageal reflux (aspiration or choking) or dysphagia should be given advice on lifestyle changes and a diagnostic course of treatment with histamine H 2 receptor blockers, followed by evaluation of their clinical condition. If symptoms persist or recur 2-3 months after discontinuation of therapy, further investigation is required. First of all, an x-ray examination of the esophagus and upper gastrointestinal tract with barium suspension should be performed. It is safe, economically justified, useful in the differential diagnosis of gastroesophageal reflux with other diseases, and also allows you to identify various anatomical disorders, such as hiatal hernia. However, this study is not sensitive enough to determine the degree (depth) of damage to the mucosa of the esophagus. The presence of a hiatal hernia is by no means an absolute predisposing factor in the development of gastroesophageal reflux; more than 33% of volunteers who underwent X-ray examination of the upper gastrointestinal tract were diagnosed with hiatal hernia, and the frequency of their detection increased sharply with age (in some groups up to 70%). The presence of spontaneous reflux of barium suspension to the level of the upper hole chest is a sign of gastroesophageal reflux. This study sometimes reveals minor strictures of the esophagus, invisible during endoscopic examination.
A more expensive, but also more sensitive method is esophagogastroduodenoscopy (EGDS). When conducting endoscopy, more than 50% of patients with gastroesophageal reflux do not show macroscopic signs of esophagitis, which is an indication for the use of more sensitive studies in this group of patients; you should also think about the possible presence of other diseases. The following is an endoscopic classification of esophagitis in gastroesophageal reflux.

Endoscopic classification of esophagitis in gastroesophageal reflux

10. List some of the modern methods for studying the function of the esophagus. What are the indications for their use in patients with gastroesophageal reflux?

Clinical methods for assessing gastroesophageal reflux can be divided into 3 categories.

Tests to assess the function of the esophagus are not indicated for all patients, but only for those in whom drug therapy has been ineffective or for whom the association of symptoms with gastroesophageal reflux is in doubt. Bernstein test links existing clinical symptoms With hypersensitivity esophageal mucosa to acid. It consists in the alternate introduction of sterile water and 0.1 N hydrochloric acid solution into the distal esophagus. 24-hour esophageal pH monitoring on an outpatient basis is an informative method in the examination of patients who are not amenable to standard drug therapy. Patients with gastroesophageal reflux often have increased secretion of hydrochloric acid in the stomach, so monitoring the pH of the esophagus helps to establish the appropriate dose of proton pump blockers (PBPs) for treatment. The presence of acid reflux into the esophagus, even with the appointment of sufficient doses of BPP, is highly likely to indicate the patient's unwillingness to follow the doctor's recommendations or the development of Zollinger-Ellison syndrome (Zollinger-Ellison). Esophageal manometry allows you to evaluate the barrier function of the lower esophageal sphincter and the motor function of the esophagus. Severe esophagitis may be the only and early manifestation scleroderma. Some studies provide data that indicate the feasibility of outpatient pH monitoring using electrodes installed in the proximal and distal departments esophagus, when examining patients with atypical symptoms reflux, such as hoarseness, neck tension, asthma, and interstitial lung disease. If outpatient monitoring of esophageal pH is not possible, it is indicated to perform scintigraphy.

11. Can medications not prescribed by a doctor help patients with gastroesophageal reflux?

Yes they can. Population studies have shown that about 40% of Americans suffer from heartburn at least once a month and 25% of American adults take antacids more than twice a month. In patients with recurrent, not pronounced heartburn, the use of antacid tablets is a justified and quite effective method of treatment. It is also advisable to change lifestyle: for example, do not wear tight clothing; reduce or completely stop drinking alcohol and smoking; exclude certain foods from the diet (chocolate, mint, products containing tomatoes, hyperosmolar fluids such as orange and pineapple juice); avoid eating chewing gums or sucking sweets, and also refrain from eating 2-4 hours before sleeping or taking a lying position. Some authors recommend elevating the head of the bed with 4 to 6 inch blocks to stimulate clearing of the esophageal mucosa for nocturnal reflux. For patients with gastroesophageal reflux, weight loss is the most difficult but also the most rewarding lifestyle change.

12. Describe the different types of drug therapy for gastroesophageal reflux and justify the prescription of drugs for patients with long-term gastroesophageal reflux.

Medical therapy for gastroesophageal reflux

Stage 1 Lifestyle modification Use of antacids, prokinetics, or sucralfate
Stage 2 Treatment with H2-blockers of histamine receptors Radical change in lifestyle
Stage 3 Treatment with proton pump blockers (omeprazole or lansoprazole) Radical lifestyle changes
Stage 4 Anti-reflux surgery
Many authors believe that radical lifestyle changes (especially weight loss and dietary changes) and drug therapy (usually omeprazole, 20-40 mg 2 times a day) can lead to endoscopically verified cure of esophagitis. After healing of esophagitis, proton pump blockers can be replaced with H 2 -histamine receptor blockers with moderate activity. The patient should be informed about the risks, benefits, and alternative options for long-term drug therapy. Surgery It is indicated for patients requiring lifelong treatment with high doses of drugs, or those who do not wish to take drugs.

14. Do patients who are scheduled for antireflux surgery need complex tests to assess functional state esophagus before surgery

There is no single answer to this question. However, it makes sense to conduct a study of the motor function of the esophagus before the operation to make sure that there are no violations of it. In patients with scleroderma esophagus, the number of systemic manifestations may be minimal, and the diagnosis cannot be made without esophageal manometry. In most cases, antireflux surgery is not performed in such patients or is performed in a modified form. In addition, esophageal motility testing and 24-hour ambulatory esophageal pH monitoring can detect symptoms of gastroesophageal reflux prior to surgery.

15. The most serious late complications of gastroesophageal reflux include esophageal strictures and Barrett's esophagus. How to treat these complications?

Esophageal strictures
Prevention of the development of peptic strictures of the esophagus with early start drug therapy or early surgery is especially important for patients with scleroderma.
In patients suffering from dysphagia caused by peptic strictures, dilatation of the esophagus is an effective treatment. This manipulation can be performed using Maloney mercury-filled polyvinyl bougies, Savary-Gulliard full dilators, or American wire-guided dilators, or pneumatic balloons inserted through a fiberscope. Typically, the esophagus is dilated to a diameter of 14 mm, or 44 F. After successful dilatation of a peptic esophageal stricture, patients are given active treatment with histamine H2 receptor blockers or proton pump blockers to prevent recurrence.
Surgical intervention - effective method treatment of peptic strictures of the esophagus. Usually pre- and intraoperative dilatation of the esophagus is combined with certain antireflux measures. Barrett's esophagus
Barrett's esophagus is a metaplastic degeneration of the esophageal mucosa that is replaced by precancerous, specialized columnar epithelium. Such metaplasia occurs in 5-7% of patients with uncomplicated gastroesophageal reflux and increases to 30-40% in patients with scleroderma or dysphagia.
There is currently no successful treatment for this disease. It seems promising to remove the metaplastic area of ​​the mucous membrane using a laser or diathermocoagulation, followed by alkalization of the gastric contents thrown into the esophagus.

Heartburn and a feeling of discomfort in the throat are among the main signs of inflammatory processes in the esophageal mucosa, and they need to be treated by qualified specialists. Moreover, the symptoms and treatment of reflux esophagitis should be constantly monitored by doctors. This the only way avoid irreversible changes in the tissues of the esophagus, and the development of complications requiring surgical intervention.

Reflux esophagitis: what is it?

Let's try to figure out what reflux esophagitis is. "Esophagitis" is an ancient Greek word meaning esophagus. The term "reflux" is borrowed from Latin and translates as "flow back".

Thus, both concepts reflect the process that occurs during the development of the disease - food masses, gastric juice and enzymes move backward from the stomach or intestines, penetrate into the esophagus, irritating the mucous membrane and causing inflammation.

At the same time, the lower esophageal sphincter, which separates the esophagus and stomach, does not properly prevent the movement of acidic masses.

IN official medicine Reflux esophagitis is a complication of gastroesophageal reflux disease, which is characterized by the reflux of acidic contents of the stomach or intestines into the esophagus.

Periodically repeated aggressive action gradually destroys the mucosa and epithelium of the esophagus, contributing to the formation of erosive foci and ulcers - potentially dangerous pathological formations that threaten to degenerate into malignant tumors.

Causes

Under certain circumstances, gastroesophageal reflux can also occur in healthy people. Frequent cases of the onset of the disease indicate the development of inflammatory processes in the gastroduodenal region.

Among the possible causes of reflux, gastroenterologists distinguish the following pathological changes in the structure and functionality of the digestive tract:

• decreased tone and barrier potential of the lower esophageal sphincter;
• violation of esophageal cleansing, redistribution and withdrawal of biological fluids from the intestine;
• violation of the acid-forming mechanism of the stomach;
• decrease in mucosal resistance;
• narrowing of the lumen of the esophagus (stenosis);
• an increase in the size of the esophageal opening of the diaphragm (hernia);
• violation of gastric emptying;
• high level of intra-abdominal pressure.

Most often, reflux esophagitis occurs as a result of weakening the tone of the muscles of the esophagus against the background of a full stomach.

Provoking factors

There are several etiological varieties of factors that provoke the reflux of acidic masses into the esophagus: physiological features organism, pathological conditions, lifestyle.

Reflux is promoted by:

• pregnancy;
• allergic to certain types products;
• binge eating;
• obesity;
• smoking and alcohol;
• poisoning;
• unbalanced diet;
• stress;
• work associated with frequent torso bending;
• autoimmune diseases;
• taking medications that weaken the muscles of the cardiac sphincter.

In addition, reflux disease can occur as a consequence long-term use nosogastric tube.

In men, gastroesophageal reflux is observed more often than in women, although science has not established a direct relationship between the disease and the gender of a person.

Symptoms and signs of the disease

When gastric masses get on the surface of the mucosa, a burning sensation occurs in the esophagus, since exposure to acid causes tissue burns.

With a long course of the disease, the symptoms of esophagitis reflux become more pronounced, and other pathological manifestations are added to heartburn:

• belching sour. May indicate the development of stenosis of the esophagus against the background of erosive and ulcerative lesions of the mucosa. The appearance of belching at night is fraught with acidic masses entering the respiratory tract;
• pain in the sternum, often radiating to the neck and the area between the shoulder blades. Usually occurs when bending forward. According to clinical characteristics, it resembles the symptoms of angina pectoris;
• difficulty swallowing solid foods. In most cases, the problem occurs against the background of a narrowing of the lumen of the esophagus (stenosis), which is considered as a complication of the disease;
• bleeding is a sign of an extreme degree of development of the disease, requiring urgent surgical intervention;
• foam in the mouth is the result of increased productivity of the salivary glands. Rarely observed.

In addition to the standard clinical signs, the development of the disease may be indicated by extraesophageal symptoms.

Signs of an extraesophageal nature

The occurrence of pathological processes in areas of the body that are not directly related to the gastrointestinal tract is not always associated with pathological processes in the esophagus - especially in the absence of severe heartburn.

In the absence of full-fledged diagnostic studies, adequate treatment of reflux esophagitis is not possible.

Extraesophageal symptoms of inflammatory processes on the esophageal mucosa differ not only in the nature of severity, but also in localization:

• ENT organs. In the early stages of the disease, rhinitis, laryngitis and pharyngitis develop, there is a feeling of a lump or spasms in the throat. As the pathology develops, it is possible to develop ulcers, granulomas and polyps in the area of ​​the vocal cords, as a result of which the patient's voice changes, becomes hoarse and rough. In the later stages of the disease, a cancerous lesion of the ENT organs is possible;
• oral cavity. On fabrics oral cavity when gastric juice enters, erosive foci appear, periodontitis, caries and salivation develop. Pathological processes are accompanied by bad breath;
• bronchi. There may be nocturnal attacks of suffocation or severe coughing;
• chest, heart. Pain in the sternum is identical to the manifestations of coronary heart disease. Possible occurrence additional features indicating cardiac pathology - hypertension, tachycardia. Without special diagnostic studies, it is almost impossible to establish the cause of the disease;
• back. Back pain is caused by innervation with the gastrointestinal tract, the source of which is located in the sternal spine.

In addition, symptoms may appear that indicate a violation of the functionality of the stomach - nausea, vomiting, bloating, a quick feeling of fullness.

Degrees of reflux esophagitis

The level of complexity of the course of the disease is determined by the stages of its development. In most cases, the development of gastroesophageal reflux disease takes about three years, during which the pathology acquires one of the four forms classified by WHO.

Reflux esophagitis of the 1st degree is characterized by intense reddening of the epithelium of the esophagus and a relatively small, up to 5 mm, area of ​​the mucosal lesion zone with point erosions.

The second degree of the disease is diagnosed in the presence of erosions and ulcerative areas against the background of edema, thickening and bruising of the mucosa. With vomiting, partial rejection of minor fragments of the mucosa is possible. The total area of ​​lesions occupies about 40% of the surface of the esophagus.

For the third degree of reflux esophagitis is characterized by an increase in the area of ​​the lesion up to 75% of the surface of the esophagus. Wherein ulcer formations gradually merge into one.

The development of the fourth degree of the disease is accompanied by an increase in the size of ulcerative areas. Pathological formations occupy more than 75% of the mucosal surface and affect the esophageal folds.

In the absence of treatment, necrotic processes develop in the tissues of the esophagus, leading to the degeneration of cells into malignant ones.

Types of disease

The development of reflux esophagitis can take place in acute or chronic form

The acute form of reflux is the result of a mucosal burn under the influence of gastric juice. Most often seen in lower section esophagus and responds well to treatment.

The chronic form can occur both against the background of an untreated exacerbation, and as an independent primary process. For chronic course The disease is characterized by periodic exacerbations and remissions.

Diagnostic measures

Despite the possible severity of the clinical manifestations of reflux esophagitis, additional information is needed to make an accurate diagnosis, which is obtained through examination.

The most informative are such studies as:

• blood analysis;
• Analysis of urine;
• radiography of the organs of the sternum;
• endoscopy - a procedure that allows you to identify erosive and ulcerative formations, as well as other pathological changes in the state of the esophagus;
• biopsy;
• manometric analysis of the state of sphincters;
• scintigraphy - a method for assessing esophageal self-purification;
• pH-metry and impedance pH-metry of the esophagus - methods to assess the level of normal and retrograde peristalsis of the esophagus;
• daily monitoring of the level of acidity in the lower esophagus.

Reflux esophagitis is diagnosed in the presence of histological and morphological changes in the esophageal mucosa.

Treatment of reflux esophagitis

Successful treatment of reflux esophagitis involves A complex approach- the use of drug therapy against the background of changes in the patient's lifestyle.

Drug treatment with drugs

The prescription of medications for gastroesophageal reflux disease has several objectives - improving the self-purification of the esophagus, eliminating the aggressive effects of gastric masses, and protecting the mucosa.

The following drugs are most effective for treating reflux:

• antacids - Phosphalugel, Gaviscon, Maalox;
• antisecretory agents - Omeprazole, Esomeprazole, Rabeprazole;
• prokinetics - Domperidone, Motilium, Metoclopramide.

In addition, vitamin preparations are indicated - pantothenic acid, stimulating peristalsis and contributing to the restoration of the mucosa, as well as methylmethionine sulfonium chloride, which reduces the production of gastric secretion.

Surgical intervention

With the development of reflux esophagitis of the third and fourth degree, surgical methods treatment - an operation that restores the natural state of the stomach, as well as putting on a magnetic bracelet on the esophagus, which prevents the reflux of acidic masses.

Folk remedies

For the treatment of reflux folk remedies it is recommended to use decoctions and infusions from vegetable raw materials.

A teaspoon of crushed dill seeds brewed with boiling water effectively eliminates heartburn and stops inflammatory processes in the esophagus.

During the day, you should take decoctions of herbal preparations from the rhizomes of the mountaineer, plantain leaves, yarrow, oregano and chamomile. Before going to bed, teas from mint leaves, fireweed, calendula flowers and calamus root are shown to be taken.

The rule for preparing decoctions is to pour one tablespoon of the plant mixture with a glass of boiling water and incubate in a water bath for 15 minutes.

Diet for sickness

Clinical nutrition is designed to eliminate from the diet foods that have irritant on the mucous membrane, as well as enhancing the production of gastric secretion.

Good results are brought by a diet for reflux esophagitis, which includes the following products:

• soft-boiled eggs;
• low-fat dairy products;
• liquid and semi-liquid cereals;
• steam fish and meat;
• baked apples;
• white bread crumbs.

Under the ban - coffee, alcohol, soda, any acidic drinks, beans and peas, spicy, fried, smoked and salty foods, chocolate and black bread.

Prevention

Of great importance for recovery and prevention of relapse of reflux is correct image life. Patients are advised to maintain physical activity, monitor weight, do not overeat, and after eating take walks in the fresh air.

In addition, any load on the stomach area, including tight clothing and tight belts, should be avoided. Bending after eating is not allowed. The head of the bed for a night's rest must be raised by 10-15 cm.

And most importantly - you need to regularly visit a gastroenterologist and pass all the scheduled examinations in a timely manner.

The presence of bile in the cavity of the stomach signals the development of a dangerous disease, namely gastroduodenal reflux. When the digestive system does not function properly, bile penetrates from the liver into the duodenum, then moves into the intestines. If there are violations and malfunctions of the pylorus, there is high pressure in the duodenum, bile is thrown into the stomach. As a result of this phenomenon, reflux is formed. The release of bile can cause dangerous consequences, because it contains a large amount of acids that have a detrimental effect on the gastric mucosa.

Between the stomach and the esophagus there is a special muscular valve that is responsible for letting food into the stomach but not back out. With reflux against the background of adverse factors, the penetration of gastric juice, food back into the esophagus. A similar disease is called gastroesophageal reflux. If the gastric walls are well protected from the effects of hydrochloric acid, damage occurs, inflammation of the esophagus, resulting in symptoms such as heartburn and pain.

According to data medical practice, about 10% of patients with this disease are affected by Barrett's syndrome. Pathology is accompanied by an anatomical change in the esophageal walls, which as a result become similar to the walls of the intestine. The reason is irritation of the mucous membrane with gastric juice.

Prolonged bouts of gastroesophageal reflux increase the risk of esophageal cancer. To avoid complications, it is recommended not to delay the examination and, if necessary, start treatment.

One of the complications of gastroduodenitis reflux is narrowing of the esophagus, which can lead to difficulty swallowing. In this case, the treatment will consist of surgical intervention and subsequent rehabilitation, adherence to a sparing diet. Useful articles on the topic - and how it is treated.

Causes of Reflux

Before prescribing treatment, the doctor must find out the cause that provokes malfunctions in the gastrointestinal tract. The reflux of bile into the stomach is often referred to as heartburn, which is experienced by one in three people, according to medical history statistics. At normal functioning Gastrointestinal tract food should move in one direction. Sphincters prevent it from being thrown back into the esophagus.

There are several causes that provoke gastroesophageal reflux. One of them is considered poor quality. surgical intervention, in which a certain part of the pylorus muscles is affected, which provokes a constant reflux of bile. Sometimes pathology occurs after the removal of the gallbladder.

The reason may be pregnancy. In this case, the phenomenon is due to strong pressure fetus to the duodenum.

Reflux can occur while taking certain medications, namely antispasmodics, muscle relaxants that reduce the tone of the pylorus muscle fibers, resulting in a lumen.

Chronic duodenitis is capable of provoking bile reflux (reflux), when there is swelling of the duodenal intestine, an inflammatory process. As a result, the pressure inside the organ increases, so the contents of the cavity can be thrown back into the stomach. In addition to bile, the following components can enter the stomach cavity: enzymes, bile acids, duodenal juice, and lysolicetin. When these substances come into contact with the mucous membrane, necrobiotic, dystrophic transformations occur. As a result, the risk of developing cancer increases.

In some cases, the cause of esophageal reflux is not related to the pathologies of the gastrointestinal tract. This phenomenon can occur due to constant overeating, improper diet, abuse of alcoholic and carbonated drinks, the predominance of harmful, fatty and heavy foods in daily diet. To eliminate unpleasant symptoms, it is necessary to adhere to the principles of medical, balanced nutrition, use folk remedies.

The clinical picture of reflux

Considering that ¾ of bile consists of bile acids, when thrown into the stomach cavity, it instantly neutralizes gastric juice and breaks down fats. In addition, bile acids greatly injure, irritate the mucous membrane, which provokes inflammation, ulcers, erosion, gastritis. In the acute form of reflux, there is a danger of degeneration of epithelial cells.

Symptoms of this disease: intense thirst, fatigue and malaise, vomiting and nausea, the presence of pulling pain in the abdomen, eructation with liquid, yellowish coating on the tongue, and the presence of bitterness in the mouth.

If symptoms appear, it is urgent to contact a general practitioner, a gastroenterologist, in order to undergo a diagnosis and start medical therapy. It is forbidden to self-medicate!

Treatment course

During reflux therapy, it should be remembered that bile reflux acts as a secondary symptom. To get rid of the underlying disease, it is necessary to identify the cause of the development of reflux and eradicate it. You will also need symptomatic therapy which will help eliminate the unpleasant symptoms of the disease. The effectiveness of medication should be combined with strict adherence to diet therapy. Without medical nutrition difficult to achieve desired results.

the best pharmacological preparations are:

• antacids to reduce the acidity of gastric juice - Almagel, Maalox;
• selective prokinetics, which significantly increase the tone of the sphincter, restore full peristalsis - Cisapride, Motiium, Cerucal;
• proton pump inhibitors that cannot be combined with antacids - esomeprazole, rabeprozole.

In some cases, one cannot do without surgical intervention, namely laparoscopic correction, as well as laparotomy. Important role diet therapy plays a role in the treatment, which can alleviate the patient's condition. Recommended fractional nutrition in small portions at least six times a day. Fried, spicy, smoked, fatty foods, sausages and sausages, alcohol and soda are removed from the diet. Smoking is prohibited during the rehabilitation period. Nutritionists recommend introducing honey, vegetables and fruits, boiled and stewed dishes, lean meat and fish into the diet.

There is no need to neglect reliable folk remedies that have proven themselves in reflux therapy. You can use chamomile, St. John's wort, yarrow, and peppermint. Herbs must be brewed with boiling water, taken twice a day with a small amount natural honey. Preparation: 2 tablespoons medicinal herb you need a liter of boiling water. Insist for at least an hour, drink fifty milliliters.

The reflux of bile into the stomach cavity is a very serious disease that requires an urgent combined therapeutic course. It is important to note that pathology can provoke serious complications of a gastroduodenal nature, so you need to seek medical help in time.