Gastroesophageal reflux disease treatment drugs. Gastroesophageal reflux - is it a norm or a disease? Stimulants of peristaltic activity

one of the most common diseases digestive system. If the disease is combined with an inflammatory process that affects lower section esophagus, gastroesophageal reflux with esophagitis develops.

A disease such as GERD with esophagitis, the treatment of which should be timely, is caused by frequently repeated reflux of the contents of the stomach, as well as enzymes involved in digestive process into the esophagus.

If such a throw occurs after eating, then this normal phenomenon and is not pathological. But when such reflux of stomach contents occurs, regardless of food intake, then these are already prerequisites for the disease.

The mucous membrane of the esophageal tube is susceptible to the acidic environment of the secretion of the stomach, so it becomes inflamed with the corresponding symptoms.

Gastroesophageal reflux disease is a disease of the esophagus characterized by inflammatory process mucosa of the distal esophagus. It is also called reflux esophagitis, Barrett's esophagus, gastroesophageal reflux.

Normally, there should be no gastric contents in the esophagus, as well as its secret, which has an acidic environment, negatively affects the epithelium of the esophageal tube. With frequent ingestion of these substances into the esophagus, irritation, swelling and inflammation of the mucous membrane of the organ first occurs.

With further progression of the disease on the mucous membrane erosive and ulcerative defects , which subsequently lead to the formation of scars and stenosis of the esophageal tube.

If such a disease is not treated for a long time, then the development of Barrett's esophagus is possible. This is a very serious complication of esophagitis, in which there is a replacement of multilayer flat cells epithelium of the esophagus single-layer cylindrical.

Such a gullet requires serious treatment and constant monitoring, since it is considered a precancerous condition.

Frequent reflux of gastric secretions into the distal esophagus occurs as a result of insufficient function of the cardia, the muscular ring that separates the stomach from the esophageal tube. Through a not tightly closed sphincter, the secret is thrown back into the esophagus.

GERD is not independent disease, and a consequence of other disorders in the body.

The causes of such an ailment as gastroesophageal reflux disease with esophagitis are:

• hernia of the esophagus;
• stomach ulcer and 12 duodenal ulcer;
• congenital pathology of the development of the esophagus;
• increased body weight;
• cholecystitis;
• surgical interventions.

Provoking development factors this disease are:

• stress;
• work associated with a constant tilt of the body forward;
• pregnancy;
• spicy, fatty foods;
• smoking;
• pregnancy.

Gastroesophageal disease has two types of course: with and without esophagitis. Quite often, gastroesophageal reflux with esophagitis is diagnosed, which is described below.

GERD with reflux esophagitis

GERD with esophagitis: what is it, we have already figured it out. It is important to know that the disease has an acute and chronic course accompanied by damage to the mucous membrane of the esophageal tube. There are such degrees of damage to the mucosa of the esophagus.

Degree 1- characterized by the presence of single ulcers or erosive defects. They are small and do not exceed half a centimeter in size. Only the lower part of the esophagus is affected.

Degree 2- has more extensive lesions, in which not only the upper layer of the epithelium is involved in the process, but also the tissues lying under it. Ulcerations are single or multiple, can merge. Erosions or ulcers are larger than half a centimeter. In this case, the lesion is within the same fold. Symptoms appear after eating.

Degree 3- erosive or ulcerative defects go beyond one fold, spread around the circumference inner wall esophagus, but do not affect more than 75% of the mucosa in a circle. Symptoms do not depend on whether the patient took food or not.

Degree 4- ulcers and erosions can spread around the entire circumference of the esophagus. This is a very severe degree of the disease, which causes complications in the form of stenosis, bleeding, suppuration, development of Barrett's esophagus.

Depending on the degree of pathological changes in the epithelium of the esophagus, the disease has the following classification by type.

Catarrhal view- hyperemia of the epithelium without ulcers and erosions. Develops when exposed to coarse food, spicy, hot food, strong drinks. May occur after mechanical injuries(fish and fruit bones).

Hydropic- the presence of edema of the esophagus, accompanied by a narrowing of the lumen of the organ.

erosive- on the inflamed areas of the epithelium, erosions and ulcers appear, the esophageal glands increase, cysts form. A characteristic symptom of this period is a cough with a mucous secretion.

pseudomembranous- fibrous formations appear on the mucosa. After their separation, ulcers and erosions form on the mucosa of the esophagus. characteristic symptom: cough and vomiting with an admixture of fibrin films.

exfoliative- separation of fibrin films from the walls of the esophagus. This causes the patient coughing, pain, spotting.

Necrotic- necrosis of parts of the tissues of the esophagus, a precancerous condition.

phlegmatic – purulent inflammation caused by infection in nearby organs.

Symptoms of GERD with Esophagitis

The clinical picture of this disease is esophageal and non-esophageal symptoms. The first category includes:

• dysphagia;
• pain;
• heartburn;
• belching.

Most characteristic manifestation exophagitis is heartburn, which is accompanied by a painful syndrome localized behind the sternum. Such discomfort appear when physical work associated with a constant tilt of the body forward, as well as in a supine position, with reflex contraction of the esophagus, due to nerve spasm.

Soreness and burning appear as a result of a negative action acid environment on the mucosa of the esophagus when the secretion of the stomach is thrown back into the distal region of the esophageal tube.

But often patients do not pay attention to this symptom attention and see a doctor. Then the disease passes into the second phase of development.

With further progression of the disease, patients may experience belching, which indicates dysfunction of the sphincter located between the stomach and esophagus. Most often it occurs during sleep.

Such a symptom is dangerous because food masses can enter the respiratory tract and lead to suffocation. Also, the ingestion of food into the respiratory tract provokes the development of aspiration pneumonia.

Dysphagia appears on more later dates development of the disease and is characterized by a violation of the process of swallowing.

Non-esophageal symptoms are the appearance of:

• caries;
• reflux laryngitis and pharyngitis;
• sinusitis.

In GERD, chest pain is of a “cardiac” type and can be confused with an angina attack, but it will not be relieved by nitroglycerin, and the appearance of pain is not associated with physical activity or stress.

If the symptoms include shortness of breath, cough, suffocation, then the disease develops according to the bronchial type.

Treatment of GERD with Esophagitis

What is the scheme GERD treatment with esophagitis? The treatment for this disease consists of:

• medical treatment;
• surgical intervention;
• non-medical treatment.

How to treat GERD reflux esophagitis? Treatment with drugs is aimed at reducing the negative impact acid environment on the mucous membrane of the esophagus, acceleration of regenerative processes and prevention of recurrence of the disease.

Alginates- form a protective film on the surface of the food mass, which neutralizes hydrochloric acid, which is part of gastric juice. With the return of food into the esophagus, there is no irritation of the epithelium by gastric contents ( gaviscon).

Prokinetics- improve the contractile function of the esophagus, contribute to the fastest movement of food through the esophageal tube, increase the force of contraction of the sphincter muscles, which prevents the contents of the stomach from being thrown back (cerucal, motylium).

Inhibitors proton pump - reduce the production of gastric juice, which will reduce the negative impact on the mucous membrane of the esophagus (omez, omeprazole, pantoprazole).

For the speedy recovery of the affected epithelium, solcoseryl, allanton.

After carrying out it is necessary to carry out endoscopy, to confirm positive effect from the therapy.

Surgical treatment

If, after the treatment, the symptoms persist, and there are other indications for surgical intervention, then an operation is performed.

Surgical treatment is carried out in the presence of:

• stenosis;
• Barrett's esophagus;
• frequent bleeding;
• ineffectiveness of conservative therapy;
• frequent aspiratory pneumonia.

Surgical intervention is carried out by the classical method (the incision is made on the abdomen or chest), as well as by the laparoscopy method (a minimally invasive method that minimally affects healthy tissues).

Gastroesophageal reflux without esophagitis: what is it and how to treat it? It should be noted that a disease such as gastroesophageal reflux disease without esophagitis develops due to the reflux of the contents of the stomach into the esophagus, but there are no erosive and ulcerative lesions mucous.

The clinical picture with a disease such as reflux without esophagitis is marked by the following symptoms:

The causes of GERD without esophagitis are:

• malnutrition;
• frequent vomiting (toxicosis, poisoning, medication);
• obesity;
• bad habits;
• addiction to coffee.

The main methods of treating this disease are taking medications (antacids and alginates) and dieting.

Useful video: how to treat GERD reflux esophagitis

Basics of dietary nutrition

• dairy products (exclude sour-milk products);
• meat and fish are not fatty varieties;
• boiled vegetables (exclude legumes);
• fruit jelly (not sour).

You can not eat spicy, spicy, fatty and fried foods. It is necessary to exclude acidic foods, alcohol, strong tea and coffee.

conclusions

The positive effect of the treatment of GERD is achieved with the patient's steady adherence to the doctor's recommendations. With frequently recurring heartburn, you should definitely contact a gastroenterologist, because this is a symptom of developing GERD. Timely treatment help prevent the development of complications.

Synonyms: gastroesophageal reflux, gastrointestinal esophageal reflux(GPR). Incorrect names: esophageal reflux, gastroesophageal reflux, gastroesophageal reflux. Sometimes, based on English-speaking traditions, gastroesophageal reflux is called gastroesophageal reflux disease(GERD).

Gastroesophageal reflux in healthy people

Normally, to prevent damage to the esophageal mucosa by gastric contents, the following mechanisms are activated: the barrier function of the gastroesophageal junction and the lower esophageal sphincter, resistance of the esophageal membrane, esophageal clearance (self-purification of the esophagus from particles of food, liquid and reflux).

Disturbances in the coordination of these mechanisms, the presence of frequent and / or prolonged episodes of gastroesophageal reflux, especially at night, the occurrence of damage to the esophageal mucosa leads to the development of gastroesophageal reflux disease.

Fig.1. pH-gram of the esophagus of a healthy person with physiological gastroesophageal refluxes

Acid, subacid and alkaline refluxes

In 2002, in Porto (Portugal), a classification was adopted, according to which refluxes detected by pH impedancemetry of the esophagus were divided into acid refluxes (pH< 4), сверхрефлюксы (кислые рефлюксы, возникшие в период осуществления пищеводного клиренса, когда рН в пищеводе еще сохраняется ниже 4), слабокислые - когда уровень рН в пищеводе во время эпизода рефлюкса не опускается ниже 4 (4 < рН < 7) и слабощелочные (рН >7) (Kaibysheva V.O., Storonova O.A., Trukhmanov A.S., Ivashkin V.T.).

Classification of refluxes according to the level of acidity*)

Rice. 2. Impedance-pH-metry of the esophagus. 4 types of reflux are shown: (A) mild acid reflux, (B) acid reflux, (C) mild alkaline reflux, and (D) hyperreflux ( Yu Kyung Cho)

Rice. 3. Daily pH-gram of the esophagus of a child with pathological acid refluxes

Rice. 4. Daily pH-gram of the esophagus of a child with alkaline refluxes

Gastroesophageal reflux in children

Pathological gastroesophageal reflux in young children is characterized by frequent regurgitation and vomiting, accompanied by insufficient weight gain, anemia, impaired general condition. The criteria for pathological gastroesophageal reflux in infants is the occurrence of reflux three times within 5 minutes, or if, according to daily pH-metry, the time of acidification of the esophagus less than 4.0 is more than 8% of the total study time.

Pathological gastroesophageal reflux is more common in premature babies and in newborns with brain pathology. The cause of pathological gastroesophageal reflux may be a violation of the regulation of the activity of the esophagus from the autonomic nervous system, most often caused by the action of damaging factors of hypoxic-traumatic genesis during unfavorable pregnancies and childbirth. Pulmonary aspiration caused by gastroesophageal reflux can be the cause of sudden death in young children, which is based on central apnea or reflex bronchospasm (Gnusaev S.F., Ivanova I.I., Apenchenko Yu.S.).

Examination of gastroesophageal refluxes

At the first stage, daily monitoring of the pH of the esophagus is usually carried out, during which the period of time is set during which the mucous membrane of the esophagus is exposed to hydrochloric acid and the effectiveness of cleaning (clearance) of the esophagus from acid refluxate is assessed.

Often the cause of reflux disease is the ineffective functioning of the lower esophageal sphincter. Esophageal manometry is required to assess its obturator ability and detect defects in esophageal motility.

The cause of diseases of the esophagus can be not only acid refluxes, damaging factors for its mucous membrane is bile acids, lysolecithin, etc. To study this kind of reflux, impedance-pH-metry of the esophagus is used.

Anti-reflux mode

• in the presence of excessive body weight - its reduction
• to give up smoking
• lack of physical activity associated with bending, swinging the press, lifting weights and other exercises that increase intra-abdominal pressure
• exclusion or restriction of the consumption of products with an acid-stimulating effect, in particular citrus fruits, chocolate, pastries, fresh white bread, black bread, broths, spices, mushrooms, fried and fatty foods, radish, radish
• refusal of carbonated drinks, coffee, strong tea, cold and hot food, overeating
• sleeping on a bed with the head end raised by 15 cm
• sleep no earlier than two hours after eating
• reception restriction medicines that increase gastroesophageal reflux.

Drugs that aggravate gastroesophageal reflux

Data from foreign studies show that more than 30% of the US population experience heartburn, according to at least, 1 time per month. In other countries, this figure ranges from 21% to 44%. At the same time, only a small part of patients seek medical help, preferring to self-medicate or not pay attention to their condition. Many people take antacids on their own to relieve the symptoms of heartburn.

Non-specific treatment

Self-help principles:

• The last meal should be at least 3 hours before bedtime (as hydrochloric acid is produced in the stomach during meals).
• Try not to lie down during the day, especially after meals.
• Raise the head of the bed about 15 cm using the footrests (do not use a second pillow for this purpose). This will help prevent reflux while you sleep.
• Do not eat too large portions (this increases the amount of acid produced in the stomach to digest food). Eat small meals more often.
• Eliminate from the diet fatty foods, chocolate, caffeinated drinks, products containing menthol, spicy food, citrus fruits and products containing tomatoes (ketchup, tomato paste).
• Avoid alcohol (alcohol contributes to reflux).
• Try to stop smoking (smoking weakens the tone of the lower esophageal sphincter and promotes reflux).
• Try to lose weight.
• Try to correct your posture and not slouch - with proper posture, food and acid move faster through the stomach into the intestines and are not thrown into the esophagus.
• Tell your doctor if you are taking pain medications such as aspirin, ibuprofen (Brufen), or osteoporosis medications - in some cases, taking these drugs can cause reflux.

Lifestyle changes can significantly reduce the symptoms of the disease. This will help reduce the duration of esophageal clearance and the frequency of reflux.

You can raise the headboard by 15-20 cm by substituting something under the legs of the bed or by placing a special plastic device under the mattress. However, this method does not always help patients who have reflux at night.

It is necessary to quit smoking, because the duration of esophageal clearance increases due to the decrease in salivation during smoking. In addition, smoking contributes to an increase in the frequency of reflux due to a decrease in the tone of the lower esophageal sphincter and an increase in intra-abdominal pressure during coughing in chronic smokers.

Reflux due to increased intra-abdominal pressure can also be reduced by avoiding tight clothing and by reducing weight.

Changes in the diet include changing the nature of food, the number of meals or its volume. Some foods reduce the tone of the lower esophageal sphincter and should be excluded from the diet. You should not lie down after eating, the last meal should be at least 3 hours before bedtime. In addition, moderate heartburn can be relieved by increasing salivation (such as chewing gum or sucking on hard candies).

OTC drugs for the treatment of GERD

These drugs can really help relieve some GERD symptoms especially heartburn. Try to check with your doctor before taking them.

Antacids.

These drugs relieve the symptom of heartburn if taken within an hour after meals and at bedtime, as they neutralize the action of the already secreted acid in the stomach.

• Pharmacies sell the following drugs from the group of antacids (some also have an enveloping effect, that is, they envelop the mucous membrane, preventing the effects of acid): maalox, almagel, de-nol, phosphalugel and others.
• Antacids are quite safe drugs for daily use within a few weeks. However, when long-term use they can cause such side effects, such as diarrhea (diarrhea), a violation of calcium metabolism and an increase in the concentration of magnesium (drugs containing magnesium) in the blood, which can disrupt the functioning of the kidneys.
• If you have been using antacids for more than 3 weeks, be sure to check with your doctor.

Histamine H2 receptor blockers (H2 blockers).

Some patients take these drugs on their own, however, we strongly recommend that you consult a doctor before taking them.

• These medicines are only effective when taken at least 1 hour before a meal, as they inhibit the production of stomach acid but do not neutralize the acid already formed.
• The most common drugs in this group are ranitidine (Zantac), famotidine (Kvamatel, Famosan), nizatidine, and cimetidine (Histodil).

Essential drugs for the treatment of GERD

proton pump inhibitors.

• The main drugs in this group are omeprazole (omez), esomeprazole (nexium), lansoprazole (lanzap, lancid) and rabeprazole (pariet).
• These drugs prevent the formation of a substance necessary for the production of hydrochloric acid in the stomach.
• The drugs of this group prevent the secretion of hydrochloric acid to a greater extent than H2-blockers.

Sucralfate (venter, ulgastran).

This tool has an enveloping effect and additionally protects the mucous membrane from the effects of gastric acid.

Prokinetics.

• The main drugs in this group are metoclopramide (raglan) and bethancol (urabet).
• The main action is to increase the tone of the lower esophageal sphincter and increase the speed of food moving through the stomach into the intestines.
• They are prescribed infrequently, as the drugs have serious side effects.
• Most often, drugs in this group are less effective than proton pump inhibitors.

Drugs that reduce the secretion of hydrochloric acid

Although it is rare for GERD to increase gastric acid secretion, therapy to reduce acid secretion is usually quite effective. Antisecretory drugs include H2 blockers and proton pump inhibitors. aim given treatment is a decrease in acidity in the esophagus, especially during an increase in the frequency of reflux. With a fixed increase in the time of exposure to acid in the esophagus, it is necessary to increase the dose of antisecretory drugs.

H2-blockers suppress the secretion of hydrochloric acid and work best outside meals and during sleep. The disadvantages of these drugs are rapid decline therapeutic effect during therapy (and thus the need for a constant increase in the dose of drugs), as well as the impossibility of suppressing the secretion of hydrochloric acid during meals (normally, during meals, the secretion of hydrochloric acid increases to improve food digestion).

Proton pump inhibitors suppress the secretion of hydrochloric acid much more effectively than H2-blockers. For best results, they should be taken 30 minutes before a meal. Taking omeprazole at 20-30 mg per day for a week reduces the production of hydrochloric acid by more than 90%, in contrast to ranitidine (70% at a dose of 300 mg per day).

It should be noted that the effectiveness of GERD treatment depends on the severity of the disease. So proton pump inhibitors are more effective, the greater the severity of esophagitis, and the more more dose drug, unlike H2-blockers. Sometimes long-term therapy of severe esophagitis with H2-blockers has only a slight effect, while the appointment of omeprazole leads to a relatively rapid decrease in the symptoms of the disease.

However, proton pump inhibitors also have their drawbacks: after discontinuation of the drug, a reverse increase in the secretion of hydrochloric acid is possible, which is associated with an increase in the concentration of the hormone gastrin in the blood. In addition, the activity of the drug varies significantly in different patients. The main points to be considered when prescribing proton pump inhibitors: 1) the effectiveness of the drug increases with increasing dose; 2) it is necessary to take the drug 2 times a day, since a single dose does not have the desired effect.

The found differences in the effectiveness of proton pump inhibitors in different patients are explained by several reasons. The presence of Helicobacter pylori infection contributes to the drug suppression of hydrochloric acid secretion, which is possibly associated with the development of atrophy of the gastric mucosa, in which the cells responsible for acid production, are located during this infection. In addition, genetic features also play a certain role.

Prokinetics

As noted above, in GERD, there is a violation of the antireflux protective barrier, an increase in the duration of esophageal clearance and a delay in food masses in the stomach. Therefore, ideally, therapy should be aimed not only at suppressing the secretion of hydrochloric acid, but also at reducing the impact of these factors. Previously, metoclopramide and cisapride have been used for this purpose, however, these drugs have had minimal effect on motor function esophagus and had serious side effects (metoclopramide: central nervous system disorders; cisapride: toxic effect on the heart). Nevertheless, today the search for new, more effective and safe drugs from this group for the treatment of GERD remains relevant.

Spontaneous relaxation of the lower esophageal sphincter is one of the main causes of gastroesophageal reflux. Therefore, therapy for GERD should also be aimed at changing the tone of the lower esophageal sphincter. Currently, the cause of spontaneous relaxation of the sphincter is considered to be associated with vagus nerve reflex: stretching of the stomach affects specific, mechanically responsive, nerve endings in the stomach. Morphine and atropine were the first drugs to reduce the rate of spontaneous relaxation of the lower esophageal sphincter in patients with GERD. Although these drugs were not intended for use in routine medicinal purposes, the study of their action has helped in the development of new experimental drugs. Although it is still unknown how these drugs act on the tone of the lower esophageal sphincter, most likely this is due to the relaxation of the muscular structures of the stomach. It has been shown that drugs such as baclofen and gamma-aminobutyric acid, reduce the frequency of spontaneous relaxation of the lower esophageal sphincter. Baclofen was first tested in a clinical setting. This drug is also used to treat diseases accompanied by spasms, as well as to treat chronic hiccups.

Supportive care

Research on the development and use of proton pump inhibitors for the treatment of GERD has helped in understanding the nature of the development and various manifestations of the disease. However, although these drugs are effective in the treatment of severe esophagitis in almost all cases, in almost 80% of patients, the disease progresses again after discontinuation of the drugs. Therefore, in such cases, maintenance therapy is usually required, i.e. permanent reception certain drugs.

In the case of esophagitis, the effectiveness of maintenance therapy with proton pump inhibitors has been shown, although the use of H2-blockers and cisapride is also possible (they are less effective). It has been shown that in these cases, omeprazole has the best effect, possibly in combination with cisapride. The combination of ranitidine + cisapride is less effective. The average dose of omeprazole is calculated individually.

Currently, maintenance therapy is used very often, especially in patients with severe esophagitis or pronounced manifestations GERD. Therefore, the issue of the safety of the drugs used is becoming especially relevant. So proton pump inhibitors are fairly safe agents for a short course of therapy. Side effects of proton pump inhibitors - headache and diarrhea - with great severity, they are easily removed by the additional appointment of certain drugs. In addition, these side effects occur only in 5% of cases.

It has been hypothesized for some time that long-term treatment with proton pump inhibitors can cause hypergastrinemia (an increase in the concentration of the hormone gastrin in the blood) with subsequent possible development of a stomach tumor, as well as atrophy of the gastric mucosa in patients with Helicobacter pylori infection. However, studies have shown that the use of these drugs even for 11 years, although it caused gastritis in some cases, did not lead to such changes that could later develop into a stomach tumor. Studies have also been conducted in which the effect of long-term use of omeprazole on the development of atrophic gastritis in patients with the presence of Helicobacter pylori (which can subsequently lead to stomach cancer). However, it has been shown that the presence of infection does not affect the development of precancerous changes in the gastric mucosa in long-term use omeprazole.

Treatment of GERD not accompanied by the development of erosive esophagitis

Despite not a large number of research on GERD therapy not accompanied by development erosive esophagitis, it was found that in the absence of esophagitis, however, at least intensive treatment. These studies have refuted the hypothesis that this type of disease is easier and faster to treat than GERD with esophagitis. However, for the treatment of GERD without esophagitis, as well as esophagitis medium degree severity, requires less intensive therapy (shorter duration and possibly in lower doses) than for severe esophagitis, namely, sometimes a single course of treatment or several courses is enough to achieve the disappearance of symptoms, while severe esophagitis often requires many years maintenance therapy.

Gastroesophageal reflux is a disease of the esophagus caused by improper diet. There are many reactions that take place in the stomach to digest food. And without an acidic environment in the cavity of the stomach, a person could not live. But if the acid enters the esophagus, the walls begin to collapse, ulcers form. And, of course, this is not very good for the body, as it can end in cancer without proper treatment.

Reflux is a simplified name for the disease. In medicine, it has a full name - gastroesophageal reflux disease or GERD. It is one of the most common gastrointestinal problems in the world.

Symptoms

What are the symptoms of gastroesophageal reflux in adults? GERD is the most common severe heartburn. It intensifies when performing exercises in a prone position, or when a person is engaged in physical activity.

There are others non-specific symptoms. These are dysphagia (painful swallowing), frequent laryngitis, bronchospasm, nausea and belching after eating. Because acid enters oral cavity and destroys tooth enamel, such a patient will have frequent problems with teeth. There are also otolaryngological symptoms. Frequent inflammation of the middle ear may also indicate this disease.

Concomitant symptoms of gastroesophageal reflux - belching with sour taste in the mouth, frequent hiccups, pain when swallowing food. With serious complications, esophageal vomiting develops, that is, vomiting of still undigested stomach contents through relatively short period time after eating.

Reasons for the development of reflux

The main cause of gastroesophageal reflux is malnutrition, smoking and eating at a fast pace. When a person takes in air through the mouth, the pressure in the stomach rises.

What else could be the cause?

• Disruption of the muscle sphincter.
• Increased body weight.
• Alcohol consumption.
• Wrong diet.
• Diaphragmatic hernia.

Among the substances that complicate the course of the disease is the frequent use of coffee, smoking. According to some reports, chocolate is also harmful. Such a stomach problem as gastroesophageal reflux often accompanies pregnant women.

Can damage the gastrointestinal tract medical preparations. It's about about nitrates, anticholinergics, beta-blockers.

Why is the sphincter broken?

The sphincter itself or cardia is a muscular ring that closes immediately after food arrives. This ensures its one-way movement along the gastrointestinal tract. When this gastric valve does not close completely, hydrochloric acid immediately opens "access" to the esophagus. The valve ceases to perform its functions for one or more reasons:

• problems with the thyroid and, consequently, with hormones;
• binge eating;
• psychological stress;
• ingestion of such aggressive mucous substances as alcohol into the stomach, hot peppers, coffee;
• some medications that have side effects;
• prolonged severe cough.

Still, the most important factor is overeating, and it is the use of fat. When the stomach cavity is greatly stretched, the angle between the esophagus and the stomach itself changes, and food can accidentally enter the esophageal mucosa. Over time, the process gets worse.

One of the most unpleasant consequences of stretching the muscular cardia is achalasia. Such a person cannot eat normally at all. Therefore, you need to understand that gastroesophageal reflux is not just an unpleasant disease. It can lead to very serious consequences.

Types of GERD

As a disease, gastroesophageal reflux, the degrees of which are given below, has some features. Firstly, the first degree - non-erosive reflux - occurs in almost every inhabitant of the Earth from time to time. And at night, due to the horizontal position of the body, acid reflux is an absolutely normal phenomenon. And secondly, the disease is very well treatable.

According to medical classification There are 3 types of disease:

1. non-erosive reflux. The mildest type, without complications of esophagitis. Occurs most frequently.
2. Erosive-ulcerative form - reflux is complicated by ulcers or streaks.
3. Barrett's esophagus.

As for the stages of development, then everything is simple. Nonerosive reflux is the mildest disease. Ulcerative form- medium in severity, and the most severe final - precancerous stage - this is the 3rd item on our list.

What is Barrett's esophagus?

A long course of the disease with an increase in the intensity of acid reflux outside the stomach invariably leads the patient to a doctor. Sometimes, along with acids, pancreatic and bile enzymes also enter the esophagus. These substances further injure the mucosa. Due to the action of bile on the walls of the esophagus, cyclooxygenase-2 is activated. The presence of this substance is already a harbinger of Barrett's esophagus.

When the distal esophagus becomes covered with new connective cells, which means - the 3rd stage of a disease such as gastroesophageal reflux has come.

During examination with an endoscope, columnar epithelium is found with special goblet cells instead of stratified squamous epithelium. it last stage development of GERD and is, in fact, a precancerous condition. The diagnosis is confirmed only after histological examination.

Cell changes occur in the body as an adaptive response to strong stimuli, that is, acids and alkalis. After all, the cylindrical epithelium is much "stronger", it is harder to burn it. But when protective cells develop too rapidly, this is already a harbinger of cancer.

The chance of adenocarcinoma is very high, even after a course of treatment with proton pump blockers, and this drug is very powerful.

Forecasts

At the first stage, the disease is completely harmless. However, do not allow reflux to become more frequent and painful. Approximately 10-15% of people who already have reflux develop serious complications. This may be the development of ulcers, esophageal bleeding and adenocarcinoma.

What else to notice about the danger of gastroesophageal reflux? Treatment of the disease is effective if it is started on time.

Disease in children

Not only adults, but children are also susceptible to GERD. There are several features of gastroesophageal reflux in children. Treatment, in fact, is the same as in adults.

Why do children get sick? If one of the parents has chronic stomach problems, and there were others in his family who also suffered from reflux of various origins, then the child is likely to have problems too.

There may be other reasons as well:

• autonomic dysfunction;
• helminthic invasion;
• gastritis, gastroduodenitis;
• incipient hernia of the esophagus;
• the use of medicines containing barbiturates or nitrates;
• excessive consumption of chips, crackers, energy drinks.

Not less than important reason development of gastroesophageal disease in a child is the lifestyle of the mother during pregnancy. If during the period of carrying the fetus, and then during feeding, the woman did not get rid of the habit of smoking, most likely the child will have deviations. For example, deformation of the stomach, diaphragmatic hernia from birth, and more.

Provoke GERD since childhood such diseases:

• asthma, bronchitis;
• constipation;
• cystic fibrosis;

According to statistics, boys suffer from GERD more often than girls. Perhaps because they work out more on the sports grounds. And if both parents have chronic gastritis, we can conclude with a high degree of probability that the boy will begin to experience the first symptoms of reflux before adolescence.

Diagnosis of GERD

• round-the-clock monitoring of intraesophageal acidity;
• egophagoscopy;
• x-ray examination with the help of barium;
• pH-metry to change the acidity;
• general blood analysis.

An x-ray with contrast is used to see if there is a herniated diaphragm. If it is, treatment already involves surgery, since conventional antacids will not help.

Gastroesophageal reflux. Treatment

If an adult is diagnosed with either a weak non-erosive form or already ulcerative, then this is a signal for an immediate change in diet and the whole lifestyle. The main rule is to eat moderately and by the hour so as not to overstrain the stomach. abundant reception food. Pain, belching and heartburn are relieved by some medicines. This, for example, "Phosfalugel", "Almagel", "Maalox". This is a group of antacids. However, their use only brings temporary relief.

Most often, treatment comes down to a simple lifelong intake of pills that help with acute pain. Now there is such a series of drugs as proton pump inhibitors. These include "Rabeprazole". This medicine is good alternative conventional painkillers, as it helps prevent more serious complications.

How do these drugs work? Such a drug from this series, like Omeprazole, simply reduces the production of stomach acid, and the disease stops progressing. However, this does not mean that you can continue to smoke. Smoke from cigarettes not only enters the lungs, but also harms absolutely the entire body.

Surgery

If the problems in the body are more serious, a simple diet is not limited. Might need surgical intervention to improve the condition.

During the operation, doctors adjust the openings of the diaphragm. No medication can cure this pathology. Also, the operation helps to speed up the passage of food from the stomach to the intestines due to an increase in the tone of the muscle sphincters.

Disease prevention

So, how to treat gastroesophageal reflux, we know. But how to prevent the development of GERD? You need to eat 4 times a day a little. If there are erosive manifestations in the stomach, then 6 times. Do not do anything after eating physical exercises. Dinner should be three hours before going to bed. By following these well-known elementary rules, you will protect yourself from the risk of getting cancer of the esophagus.

One more rule. Sleep on a bed with a slightly raised headboard. When the head is raised about 15-20°, the esophagus is less affected by sphincter relaxation and acid reflux.

What rules are important to follow if reflux disease is increasingly making itself felt in the form of unpleasant belching, pain and heartburn? The very first thing is to stop using too spicy, fatty meals. Eliminate coffee and chocolate from your diet. For the sake of health, you will have to eat cereals, vegetables and fruits.

Conclusion

What can be summed up? Gastroesophageal reflux, the symptoms and treatment of which we examined in this material, is not dangerous until it kills the epithelial cells of the esophageal wall and does not lead to a clear deterioration in well-being. Fast poor-quality nutrition and stress in many ways provoke diseases, especially when there is a hereditary predisposition. And this means that you need to follow the diet even more carefully.

Gastritis, ulcers and duodenitis are the most common causes gastroesophageal reflux. Treatment must be selected, taking into account the real situation. So, it is necessary to go through all the examinations, be sure to do egophagoscopy and pH-metry.

Gastroesophageal reflux disease is a pathological process that is the result of deterioration motor function upper divisions GIT. If the disease lasts a very long time, then this is fraught with the development of an inflammatory process in the esophagus. This pathology is called eophaginitis.

Reasons for the development of the disease

Distinguish the following reasons development of gastroesophageal reflux disease:

1. Rise in intra-abdominal pressure. Its rise is associated with overweight, the presence of ascites, flatulence, pregnancy.
2. Diaphragmatic hernia. Here all conditions are created for the development of the presented disease. There is a decrease in pressure on the lower part of the esophagus in the sternum. Hernia esophageal opening diaphragm is diagnosed in old age in 50% of people.
3. Decreased tone of the lower esophageal sphincter. This process is facilitated by the use of drinks that contain caffeine (tea, coffee); medicines (Verapamil, Papaverine); toxic effect nicotine on muscle tone, the use of strong drinks that affect the mucous membrane of the esophagus; pregnancy.
4. Eating food in a hurry and in large quantities. In such a situation, a large amount of air is swallowed, and this is fraught with an increase in intragastric pressure.
5. Peptic ulcer of the duodenum.
6. Eating large amounts of food containing animal fats, transverse mint, fried foods, spicy spices, carbonated drinks. The entire list of presented products contributes to a prolonged retention of food masses in the stomach and an increase in intragastric pressure.

How does the disease manifest itself?

The main symptoms of gastroesophageal reflux are as follows:

• heartburn;
• belching acid and gas;
• acute sore throat;
• discomfort in the stomach;
• pressure that occurs after eating, which increases after eating food that promotes the production of bile and acid. Therefore, it is worth giving up alcohol, fruit juices, soda, radishes.

Often, the symptoms of gastroesophageal reflux disease are manifested in the form of belching of semi-digested food masses in bile. AT rare case Patients suffering from esophagitis experience the following symptoms:

• vomiting or urge to it;
• copious salivary secretions;
• dysphagia;
• feeling of pressure in the chest.

Often, patients with esophagitis have retrosternal pain giving in the shoulder, neck, arm and back. If these symptoms occur, then you need to go to the clinic for a heart examination. The reason is that these manifestations can occur in people suffering from angina pectoris. Pain syndrome behind the breastbone with reflux disease can provoke eating a large amount of food or sleeping on a very low pillow. You can eliminate these symptoms with the help of alkaline mineral water and antacids.

Gastroesophageal reflux disease and its symptoms are more pronounced under the following conditions:

Gastroesophageal reflux disease can provoke the formation of cardiac, dental, bronchopulmonary and otolaryngological syndromes. At night, a patient suffering from esophagitis experiences unpleasant symptoms from the following diseases:

• Chronical bronchitis;
• pneumonia;
• asthma;
• pain in the chest;
• violation of the heart rhythm;
• development of pharyngitis and laryngitis.

During the intake of chyme into the bronchi, there is a possibility of bronchospasm. According to statistics, 80% of people suffering from bronchial asthma are diagnosed with gastroesophageal reflux. Often, to relieve the symptoms of asthmatics, it is only necessary to reduce the production of acid in the stomach. Approximately 25% of people get better after such events.

An external examination of a patient suffering from esophagitis cannot give detailed information about this disease. Each person has their own symptoms: someone has fungiform papillae at the root of the tongue, and someone has insufficient production of saliva to supply the oral mucosa.

Disease classification

To date, experts have developed a certain classification of the disease. It does not imply the presence of complications of reflux disease, which include ulcers, strictures, metaplasia. According to this classification, gastroesophageal reflux is of 3 types:

1. The non-erosive form is the most common type of the disease. This group includes reflux without manifestations of esophagitis.
2. The erosive-ulcerative form includes pathological processes complicated by ulcer and stricture of the esophagus.
3. Barrett's esophagus is a type of disease that is diagnosed in 60% of cases. It is a metaplasia of stratified squamous epithelium, provoked by esophagitis. The presented form of the disease refers to precancerous diseases.

Diagnostics

Gastroesophageal reflux can be diagnosed using the following methods:

1. A test containing a proton pump inhibitor. The initial diagnosis can be based on typical manifestations experienced by the patient. After that, the doctor will prescribe him a proton pump inhibitor. As a rule, Omeprazole, Pantoprazole, Rabeprazole, Esomeprazole are used according to the standard dosage. The duration of such events is 2 weeks, after which it is possible to diagnose the presented disease.
2. Intra-food pH monitoring, the duration of which is a day. Thanks to this study, it is possible to understand the number and duration of refluxes in 24 hours, as well as the time during which the pH level drops below 4. This diagnostic method is considered the main one in confirming gastroesophageal reflux disease. It is possible to determine the relationship of typical, atypical manifestations with gastroesophageal reflux.
3. Fibroesophagogastroduodenoscopy. This diagnostic method for detecting esophagitis helps to identify cancerous and precancerous diseases of the esophagus. Conduct a study in the defeat of patients suffering from esophagitis, alarming symptoms, with a prolonged course of the disease, as well as in the case when there is a controversial diagnosis.
4. Chromoendoscopy of the esophagus. Such a study is advisable for people who have gastroesophageal reflux disease for a long time and is accompanied by constant relapses.
5. ECG allows you to determine arrhythmia and diseases of the cardiovascular system.
6. Ultrasound of the heart organs abdominal cavity helps to detect diseases of the digestive system and exclude pathologies of the cardiovascular system.
7. X-ray of the esophagus, chest and stomach. Assign it to patients to detect pathological changes in the esophagus, hiatal hernia.
8. Complete blood count, stool examination occult blood, detect baked samples.
9. Test for Helicobacter pylori. If its presence is confirmed, then radiation treatment is prescribed.

In addition to the described diagnostic methods, it is important to visit the following specialists:

• cardiologist;
• pulmonologist;
• otorhinolaryngologist;
• surgeon, his consultation is necessary in case of ineffectiveness of the ongoing medical treatment, the presence of diaphragmatic hernias large sizes, in the formation of complications.

Effective Therapy

Treatment of gastroesophageal reflux disease is based on fast elimination manifestations of the disease and prevent the development of severe consequences.

Taking medication

It is allowed to carry out such therapy only after the appointment of medicines by a specialist. If you take certain drugs prescribed by other doctors to eliminate absent ailments, this can lead to a decrease in the tone of the esophageal sphincter. Such medicines include:

• nitrates;
• calcium antagonists;
• beta blockers;
• theophylline;
• oral contraceptives.

There are cases when the presented group of medicines caused pathological changes in the mucous membrane of the stomach and esophagus.

Patients suffering from esophagitis are prescribed antisecretory drugs, which include:

• proton pump inhibitors - Pantoprazole, Omeprazole, Rabeprazole, Esomeprazole;
• drugs that block H2-histamine receptors - Famotidine.

If there is a bile reflux, then it is necessary to take Ursofalk, Domperidone. The choice of a suitable medicine, its dosage should be carried out strictly on an individual basis and under constant control specialist.

Antacids may be used to relieve symptoms for a short time. It is effective to use Gaviscon forte in the amount of 2 teaspoons after meals or Phosphalugel - 1-2 sachets after meals.

Treatment of gastroesophageal reflux in children involves the use of drugs, taking into account the severity of the manifestation of the disease and inflammatory changes esophagus. If there are no bright severe symptoms, then it is advisable to take only drugs aimed at normalizing gastrointestinal motility. Metoclopramide and domperidone are currently effective drugs for children. Their action is aimed at enhancing the motility of the antrum of the stomach. Such activities have a rapid emptying of the stomach and increase the tone of the esophageal sphincter. If metoclopramide is taken in young children, then extrapyramidal reactions occur. For this reason, medication should be taken with extreme caution. Domperidone has no side effects. The duration of such treatment is 10-14 days.

Diet

Diet in gastroesophageal reflux disease is one of the main areas of effective treatment. Patients suffering from esophagitis should adhere to following recommendations in nutrition:

1. Meals are taken 4-6 times a day, in small portions, in a warm form. After a meal, it is forbidden to immediately take a horizontal position, tilt the torso and perform physical exercises.
2. Limit the use of foods and drinks that cause activation of the formation of acid in the stomach and reduce the tone of the lower esophageal sphincter. Such products include: alcoholic beverages, cabbage, peas, spicy and fried foods, black bread, legumes, carbonated drinks.
3. Consume as much as possible more vegetables, cereals, eggs and oils plant origin, which contain vitamins A and E. their action is aimed at improving the renewal of the mucous membrane of the esophagus.

Surgical treatment

When conservative treatment presented disease did not give the desired effect, there were severe complications, carry out surgical intervention. Surgical treatment of gastroesophageal reflux disease can be carried out by the following methods:

1. Endoscopic plication of the gastroesophageal junction.
2. Radiofrequency ablation of the esophagus.
3. Laparoscopic Nissen fundoplication and gastrocardiopexy.

ethnoscience

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

1. A decoction of flaxseed. Such therapy with folk remedies is aimed at increasing the stability of the esophageal mucosa. It is necessary to pour 2 large spoons of ½ liter of boiling water. Infuse the drink for 8 hours, and take 0.5 cups of nitrogen 3 times a day before meals. The duration of such therapy with folk remedies is 5-6 weeks.
2. Milk shake. Drinking a glass of cold milk is considered an effective folk remedy for eliminating all manifestations of gastroesophageal reflux disease. Therapy with such folk remedies is aimed at getting rid of the acid in the mouth. Milk has a soothing effect on the throat and stomach.
3. Potato. Such folk remedies can also achieve a positive result. You just need to peel one small potato, cut it into small pieces and chew it slowly. After a few minutes, you will feel relief.
4. A decoction of the root of marshmallow. Therapy with folk remedies, including this drink, will help not only get rid of unpleasant manifestations, but also have a calming effect. For cooking medicinal product you need to put 6 g of crushed roots and add a glass warm water. Infuse the drink in a water bath for about half an hour. Treatment with folk remedies, including the use of marshmallow root, includes taking a chilled decoction of ½ cup 3 times a day.
5. In the treatment of folk remedies, celery root juice helps effectively. It should be taken 3 times a day, 3 large spoons.

Alternative medicine involves a large number of recipes, the choice of a particular one depends on the individual human body. But treatment with folk remedies cannot act as a separate therapy, it is included in the general complex of therapeutic measures.

Prevention measures

To the main preventive measures GERD should include the following:

1. Exclude the use of alcoholic beverages and tobacco.
2. Limit the intake of fried and spicy foods.
3. Don't lift weights.
4. You can not stay in an inclined position for a long time.

In addition, prevention includes modern measures to detect violations of the motor skills of the upper sections. digestive tract and therapy for diaphragmatic hernia.