Duodeno-gastric reflux: what is it and why is it dangerous, how is it diagnosed. Types and features of the classification of herb according to the severity of the disease Gastroesophageal reflux code according to the ICD 10

GERD or gastroesophageal reflux disease has the ICD code K21. Gastroesophageal reflux disease develops with periodic and spontaneous releases of biomass into the upper gastrointestinal tract - the esophagus. Regular reflux of components of the contents of the human stomach or substances from the lumen of the duodenum 12 provoke damage to the sphincter. Such phenomena are often accompanied by inflammatory processes, and lead to damage to the mucous membrane.

The main cause of damage to the esophagus, the consequence of which is gastroesophageal reflux disease, is hydrochloric acid. It enters the esophagus as part of gastric juice;
the functionality of the lower sphincter worsens;
the speed of cleaning the gastrointestinal tract is reduced;
the epithelium has insufficiently strong protective properties;
the masses accumulated in the stomach are removed incompletely or out of time;
components of gastric juice have increased aggressiveness;
the esophagus has an abnormal narrowing;
intra-abdominal pressure rises.

Symptoms of the disease

In the case of a diagnosis of GERD, the doctor may refer the patient for laparoscopic treatment of gastroesophageal reflux disease, prescribe certain drugs and medications.

But before you start medical or physiotherapy treatment, you need to familiarize yourself with the symptoms of the disease. This will help to fully compose a picture of the disease, draw up specific recommendations for treatment or refer to appropriate procedures.

GERD symptoms and signs fall into two categories - esophageal and extraesophageal. Their identification is important for the appointment of effective treatment for GERD.

Symptoms of gastroesophageal reflux disease are:

heartburn;
difficulty in swallowing;
pain in the esophagus;
regurgitation;
eructations in refractory;
bad breath;
pain in the chest and behind the sternum;
increased body temperature;
hiccups
gagging;
sour taste in the mouth;
feeling of having a lump behind the chest.

If we talk about extra-esophageal symptoms or extra-esophageal manifestations of GERD, then they can be as follows:

Shortness of breath and coughing occur mainly when a person is in a horizontal position. Illness accompanied by reflux cough can cause bouts of vomiting. Therefore, with such phenomena, vomiting and the corresponding masses often appear. An unpleasant ailment reflux cough provokes breathing complications, therefore. Coughing with GERD in itself brings discomfort during the illness, therefore, in the treatment of this symptom, you should immediately try to eliminate and get rid of such attacks.
Otitis, rhinitis, laryngitis or pharyngitis develops.
There are so-called dental syndromes. They manifest themselves in the form of caries, periodontal disease. In more rare cases, stomatitis occurs.
As the disease progresses, the mucosa becomes eroded, which may be accompanied by chronic blood loss.
Cardinal syndromes are the most dangerous, as they are characterized by arrhythmia and pain in the region of the heart. Pain in GERD is common and extremely unpleasant.

What exacerbates symptoms

To aggravate cough and other symptoms in gastroesophageal reflux disease, certain conditions can:

increased physical activity caused by playing sports or the peculiarities of the profession;
frequent forward bending of the body, which provokes a strong cough and can cause vomiting;
excessive consumption of foods high in sugar;
improper diet, including a lot of so-called heavy food;
frequent use of alcoholic products.

The psychosomatic aspect plays an important role in the course and development of such a disease as GERD. Therefore, in addition to traditional measures aimed at treatment, experts recommend paying attention to their psychological state, environment and the influence of society. By getting rid of a number of unpleasant psychological problems that impede recovery, you will recover much faster.

Classification

As we have already noted, the international disease code for GERD according to ICD 10 is K21.

At the same time, gastroesophageal reflux disease is divided into two subtypes, depending on the presence of inflammatory processes.

By 21.0. This is the disease code for esophagitis. Refractory GERD, which is accompanied by the presence of erosive inflammation of the walls of the sphincter.
By 21.9. This is a disease without esophagitis. GERD without esophagitis is called NERD. It is a negative condition, which is accompanied by the absence of damage to the internal surfaces of the esophagus.

non-erosive disease

Separately, let's talk about what is a fairly common non-erosive form, called endoscopically negative GERD.

This is one of the varieties of GERD disease, the psychosomatics of which is accompanied by clinical symptoms, but with no tissue damage in the esophagus. Relevant data about stomach disease can be obtained if diagnostics are carried out.
Also, diagnostics show that with GERD without heartburn, the mucous surface of the esophagus changes minimally.
The gastroenterologist is able to identify that this form of the disease is usually accompanied by a thickening of the basal layers and an increase in the length of the papilla. Also a characteristic phenomenon is the infiltration of cells of the mucosa of the esophagus. Unlike chronic GERD with esophagitis, the considered form does not have ulcerative and dangerous lesions of the esophagus that are always characteristic of GERD.
The diagnosis demonstrates that NERD should be considered a syndrome rather than a separate form of gastric disease. Not surprisingly, many experts do not classify this disease. But this is due rather to the lack of necessary equipment in clinics and the difficulty in diagnosing the disease.
NERD is characterized by back pain, heartburn, narrowing of the esophagus, and belching. There is also pain when swallowing. Bad odors may be emitted from the mouth. In general, bad breath is relevant if refractory GERD is observed.
Not infrequently, the diagnosis of NERD is accompanied by caries, erosion of the surface of the tongue, and modifications of the spine. Because of this, the back arches backward, which causes a stoop. To correct the problem, the patient is advised to wear a corset during treatment.

Stages of GERD

The basic classification of GERD is based on several different approaches. Different specialists use different classifications. This allows you to determine exactly what form or feature of GERD a person had to face.

In GERD, stages are distinguished depending on which classification option is used. The most common are:

Los Angeles.
Savary.
Savary-Miller.

Each of the classifications has its own characteristics, and they are used for certain situations. Therefore, what stages are with GERD should be discussed separately.

Los Angeles Classification

When the diagnosis allows to confirm the diagnosis of GERD, most doctors use this classification to determine the current state of the patient. The lettered grade indicates how severe the extent of the esophageal mucosal injury is. Diagnosis is carried out using endoscopic equipment.

Based on the Los Angeles classification system, it is possible to determine the degree of development of the disease and the dynamics of the increase in lesions:

Degree A. The degree with the designation A is characterized by one or more shallow lesions such as erosion. That is, such lesions do not affect areas of the epithelium, and when they heal, incisors do not form. The length of the lesions is up to 5 mm.
Degree IN. In grade B, a characteristic feature is one or more affected zones with features similar to those in grade A. In this case, the length of the lesions is more than 5 millimeters.
Degree WITH. It is characterized by damage to at least two folds of the longitudinal type, but the total area affected by erosion is maximizing 75% of all existing inner layers of the esophagus.
Degree D. It is characterized by structural changes in the esophageal longitudinal folds, affecting the area of more than 75%.

Savary

What is the Savary classification? In order to determine the nature of lesions in GERD during examinations and to analyze the rate of complications of the disease in subsequent diagnostics, the Savary or Savary-Viku classification is used.

Based on this classification, a specialist can draw up a general clinical picture of GERD:

Zero stage. Not accompanied by serious consequences. There is no complication of gastroesophageal reflux disease. The inner layers of the esophagus are not damaged and do not take part in pathological processes. The establishment of this diagnosis gives an excellent prognosis for the patient regarding recovery.
First stage or stage 1. Examination with a special endoscopic apparatus shows the presence of edema and abnormal reddening of the epithelium.
Second stage. Confirms the presence of superficial or erosive lesions that are accompanied by shallow and small esophageal defects.
Third stage. Endoscopic diagnostics shows the presence of strong and deep changes of an erosive nature, having a rounded shape. The relief of the mucous membrane changes, resembling the convolutions of the brain. This is due to the heterogeneity and roughness of the surface.
Fourth stage. Here we are talking about pronounced and clearly visible in the diagnosis of lesions and destructive changes, including ulcers. This diagnosis does not bode well for the patient. An exacerbation is accompanied by a complication of symptoms.

Complications of GERD are potentially extremely dangerous and require immediate attention from the attending physician. In such situations, traditional drug treatment may not give the expected result, so surgical intervention is required.

Savary-Miller

Another classification that is relevant among representatives of the medical field, called Savary-Miller.

Based on this principle of classification, several degrees of severity of the disease are distinguished. In this case, a forecast is also made regarding the probable outcome of the disease:

First degree. It is characterized by single and separately located foci of erosion, which are not interconnected. The forecast is the most optimistic, since it allows you to quickly and effectively eliminate problems. The first degree according to the Savary-Miller classification is the most preferable if a woman still had to deal with a similar disease.
Second degree. In the second degree of GERD, phenomena of destruction of the epithelium are observed. They are combined, but are quite small in size.
Third degree. In the zone of the lower sphincter, full-fledged changes are observed over the entire surface of the epithelium. Structural changes are taking place.
Fourth degree. The most undesirable, which is quite logical. It is distinguished by pronounced ulcerative neoplasms in the lower part of the esophageal tubes, which is accompanied by a change in the tissue structure. The main danger is that this stage is a precancerous condition. Therefore, surgical intervention is required.

Diagnostic methods

There are several basic methods that allow you to diagnose GERD and determine its stage based on one or another classification.

proton pump inhibitor. This is a special test that is prescribed during a preliminary diagnosis aimed at identifying typical signs of the disease.
pH monitoring. It is carried out during the day, that is, 24 hours. Using this method, you can identify long-term daily refluxes, their number. It also determines the time when the pH level drops to an undesirable level below 4. This is the most relevant method to confirm the diagnosis. It determines whether atypical and typical symptoms are associated with GERD.
Method based on FEGDS. It is needed to identify esophagitis, as well as precancerous or cancerous complications. This technique is relevant if the disease lasts for more than 5 years in a person, it is not possible to determine a controversial diagnosis, or there are alarming signals of the disease.
Chromoendoscopic examination of the esophagus. Such a measure is taken if the patient has a long course of the disease, accompanied by relapses. First, the likelihood of a precancerous condition is determined and a biopsy is performed.
ECG. Allows you to determine if there is an arrhythmia and if there are problems with the cardiovascular system.
ultrasound. Not only the organs in the patient's abdominal cavity are examined, but also the heart. This allows you to detect pathological changes in the digestive system and helps to eliminate problems with the cardiovascular system.
X-ray. The condition of the stomach, esophagus and organs behind the chest is checked. X-ray makes it possible to timely identify a hernia, pathology of the esophagus, ulcers or problems with the respiratory system.

GERD is an extremely unpleasant disease, accompanied by many symptoms that cause discomfort and disrupt the usual way of life. It is recommended to contact specialists at the slightest suspicion. This allows you to identify the disease in time and proceed to its surgical treatment with sparing methods. How exactly to deal with GERD can only be determined by the attending physician on the basis of examinations and tests.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

What is GERD and the ICD-10 disease code?

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

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

1 Types of pathology

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

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

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

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

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

2 European classification

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

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

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

Causes and treatment of chronic gastritis in adults

Gastroesophageal reflux disease

K21.0 Gastroesophageal reflux with esophagitis.

Gastroesophageal reflux disease (GERD) is a chronic relapsing disease characterized by esophageal and extraesophageal clinical symptoms and various morphological changes in the esophageal mucosa due to retrograde reflux of gastric or gastrointestinal contents,

The incidence of GERD in children with lesions of the gastroduodenal zone in Russia ranges from 8.7 to 49%.

Etiology and pathogenesis

GERD is a multifactorial disease directly caused by gastroesophageal reflux (acid reflux is a decrease in pH in the esophagus to 4.0 or less due to acidic gastric contents entering the organ cavity; alkaline reflux is an increase in pH in the esophagus to 7.5 or more when it enters the organ cavity duodenal contents, more often bile and pancreatic juice).

There are the following forms of reflux.

Physiological gastroesophageal reflux,

not causing the development of reflux esophagitis:

occurs in completely healthy people of any age;

observed more often after meals;

characterized by low intensity (no more than 20-30 episodes per day) and short duration (no more than 20 s);

has no clinical equivalents;

does not lead to the formation of reflux esophagitis.

Pathological gastroesophageal reflux (provokes damage to the mucous membrane of the esophagus with the development of reflux esophagitis and related complications):

occurs at any time of the day;

often independent of food intake;

characterized by a high frequency (more than 50 episodes per day, the duration is at least 4.2% of the recording time according to daily pH monitoring);

leads to damage to the mucous membrane of the esophagus of varying severity, the formation of esophageal and extraesophageal symptoms is possible.

Leading factor in the occurrence of gastroesophageal reflux

violation of the "locking" mechanism of the cardia due to the following causes.

Immaturity of the lower esophageal sphincter in children under 12-18 months.

Disproportion of increase in body length and esophagus (heterodynamics of organ development and growth).

Relative insufficiency of the cardia.

Absolute insufficiency of the cardia due to:

malformations of the esophagus;

surgical interventions on the cardia and esophagus;

connective tissue dysplasia;

morphofunctional immaturity of the autonomic nervous system (ANS), CNS lesions;

taking certain medications, etc.

Violation of the regimen and quality of nutrition, conditions accompanied by an increase in intra-abdominal pressure (constipation, inadequate physical activity, prolonged inclined position of the body, etc.); respiratory pathology (bronchial asthma, cystic fibrosis, recurrent bronchitis, etc.); some drugs (anticholinergics, sedatives and hypnotics, p-blockers, nitrates, etc.); smoking, alcohol; sliding hernia of the esophageal opening of the diaphragm; herpesvirus or cytomegalovirus infection, fungal infections.

The pathogenesis of GERD is associated with an imbalance of aggression and defense factors.

Factors of aggression: gastroesophageal reflux (acid, alkaline); hypersecretion of hydrochloric acid; aggressive effects of lysolecithin and bile acids; medications; some food.

Protective factors: antireflux function of the lower esophageal sphincter; mucosal resistance; effective clearance (chemical and volume); timely evacuation of gastric contents.

The severity of gastroesophageal reflux:

with esophagitis (I-IV degree).

The severity of clinical symptoms: mild, moderate, severe.

Extraesophageal symptoms of GERD:

Diagnosis example

The main diagnosis: gastroesophageal reflux disease (reflux esophagitis II degree), moderate form.

Complication: posthemorrhagic anemia.

Concomitant diagnosis; bronchial asthma, non-atopic, moderate form, interictal period. Chronic gastroduodenitis with increased acid-forming function of the stomach, Helicobacter pylori, in the stage of clinical subremission.

Esophageal symptoms: heartburn, regurgitation, “wet spot” symptom, belching with air, sour, bitter, periodic chest pain, pain or discomfort when food passes through the esophagus (odynophagia), dysphagia, halitosis.

Bronchopulmonary - bronchial asthma, chronic pneumonia, recurrent and chronic bronchitis, protracted bronchitis, cystic fibrosis.

Otorhinolaryngological - constant coughing, a feeling of "stuck" food or a "lump" in the throat, developing as a result of increased pressure in the upper esophagus, a feeling of itching and hoarseness, ear pain.

Cardiovascular signs - arrhythmias due to the initiation of the esophagocardiac reflex.

Dental - erosion of tooth enamel and the development of caries. Young children often vomit, are underweight

body, regurgitation, anemia, respiratory disorders up to apnea and sudden death syndrome are possible.

In older children, complaints are predominantly esophageal, respiratory disorders and posthemorrhagic anemia are possible.

Conduct research? ^ '^ oitekogtya and zhelugsk ^ with bapium in direct and lateral projection? ‘small compression of the abdominal cavity. The esophagus patency, diameter, mucosal relief, wall elasticity, the presence of pathological narrowing, ampoule-like extensions, and the nature of esophageal peristalsis are assessed. With obvious reflux, the esophagus and stomach radiologically form an “elephant with a raised trunk” figure, and on delayed radiographs, a contrast agent is again found in the esophagus, which confirms the presence of reflux.

Below is a system of endoscopic signs of gastroesophageal reflux in children (according to J. Tytgat, modified by V.F. Privorotsky and others).

I degree - moderate focal erythema and / or friability of the mucous membrane of the abdominal esophagus.

II degree - total hyperemia of the abdominal esophagus with focal fibrinous plaque, single superficial erosions may occur, more often of a linear form, located on the tops of the mucosal folds.

III degree - the spread of inflammation to the thoracic esophagus. Multiple (sometimes merging) erosions located non-circularly. Increased contact vulnerability of the mucous membrane is possible.

IV degree - ulcer of the esophagus. Barrett's syndrome. Esophageal stenosis.

Moderate motor disturbances in the region of the lower esophageal sphincter (rise of the 2nd line up to 1 cm), short-term provoked subtotal (along one of the walls) prolapse to a height of 1-2 cm, decreased tone of the lower esophageal sphincter.

Distinct endoscopic signs of cardia insufficiency, total or subtotal provoked prolapse to a height of more than 3 cm with possible partial fixation in the esophagus.

Severe spontaneous or provoked prolapse above the crura of the diaphragm with possible partial fixation.

An example of an endoscopic conclusion: reflux esophagitis P-B degree.

A targeted biopsy of the mucous membrane of the esophagus in children with subsequent histological examination of the material is carried out according to the following indications:

discrepancy between radiological and endoscopic data in unclear cases;

atypical course of erosive and ulcerative esophagitis;

suspicion of a metaplastic process in the esophagus (Barrett's transformation);

suspicion of malignant tumor of the esophagus.

To reliably determine the condition of the esophagus, it is necessary to take at least two biopsies 2 cm proximal to the 2nd line.

"gold standard" definition of pathological gastroesophageal reflux.

According to T.R. DeMeester (1993) normal daily pH monitoring values are:

maximum gastroesophageal reflux (time) - 00:19:48.

For young children, a separate normative

scale (J. Bua-Oshoa et al., 1980). The indicators of 24-hour pH monitoring in children under one year of age differ from those in adults (fluctuations of ±10%, Table 1).

The method of intraesophageal impedancemetry is based on registering changes in intraesophageal resistance as a result of reflux, restoring the initial level as the esophagus clears. A decrease in the impedance in the esophagus below 100 ohms indicates the fact of gastroesophageal reflux.

Esophageal manometry is one of the most accurate methods for studying the function of the lower esophageal sphincter, allowing

Table 1. Normal daily pH monitoring values

in children according to J. Bua-Oshoa et al. (1980) Indicators Mean value Upper limit of normal Total pH time

Classification of GERD according to ICD code 10 and other parameters

Before you know how GERD is classified according to the ICD 10 code, you need to consider what kind of disease it is.

It is a lesion of the mucous membrane of the esophagus. The abbreviation can be deciphered as follows: gastroesophageal reflux disease.

It is characterized by periodic reflux of stomach contents back into the esophagus. In this case, the sphincter is affected, inflammation develops.

Features of the classification according to the ICD code

Reflux esophagitis is a complex disease characterized by unpleasant symptoms and painful sensations. A person cannot eat what he wants, because after that there is severe discomfort.

Pathology is manifested by heartburn, regurgitation, bad breath. In some cases, there is an increase in temperature, the urge to vomit, the inability to swallow food.

Classification of esophagitis will help determine the direction of treatment. The international disease code is K21.

However, this pathology can have various forms, which also need to be considered:

ICD K-21. This is refractory GERD, in which the patient not only develops an inflammatory process in the sphincter area. Erosions appear on this part of the organ.
K-21.2. In this case, the esophageal component is absent. That is, there are unpleasant symptoms, but they are not associated with damage to the inner surface of the esophagus, since they are not.

Clinical manifestations of the disease are present in both cases, but they are different. In the second case, there is no threat to life.

Important! The cause of GERD can be both a physiological factor and a psychosomatic one. The cause of the development of pathology must be clarified before treatment is carried out.

Classification of pathology according to the degree of development

If the pathology is not treated, it will progress. It has several stages in its development. The classification of GERD in this case is as follows:

first degree - the last areas are characterized by reddening of tissues, slight erosions, although sometimes such signs cannot be detected);
the second stage - damage extends to more than 20% of the esophagus, the patient develops persistent heartburn;
third degree - not only the upper layer of the mucous membrane is destroyed, but also deeper tissues; ulcers appear that affect the muscles. The stage is characterized by burning, pain in the chest, aggravated at night;
the fourth - is characterized by damage to almost the entire surface of the mucous membrane, while the symptoms are significantly enhanced;
the fifth stage is the most severe form of pathology, in which various complications of GERD already appear.

Note! This classification is the most common and understandable. On its basis, therapeutic measures are prescribed to help eliminate damage to the mucous membrane and symptoms.

Los Angeles Classification

This classification was proposed in the last century in Los Angeles. It has its own characteristics. The Los Angeles classification proposes to define the disease by the parameter of how extensive the lesion is.

With any type of lesion according to this classification, various complications are possible.

Any classification of GERD according to the ICD code or other parameters provides for easier diagnosis for doctors. They have the opportunity to quickly begin treatment and eliminate the cause of the development of pathology.

Gastroesophageal reflux mcb 10

GERD classifications

Home > What is GERD

In therapy, much depends on the stages of the course of the disease. Such information affects the duration of treatment and the choice of certain drugs. In the case of GERD, the first thing that matters is how deeply the mucosa of the esophagus is affected. In medicine, the classification of gastroesophageal reflux disease is more often used, which is detected by such a research method as FGDS (fibrogastroduodenoscopy).

What symptoms will bother a person at each stage of the disease? Today we have to answer not only this question. There are several options for classifying GERD, consider the most common of them.

Classification of GERD according to ICD-10

The simplest classification is written in one of the classic medical books called ICD-10 (this is the tenth revision of the international classification of the disease). Here, the clinical variant of the division of GERD is as follows.

GERD with esophagitis (inflammation of the mucous membrane of the esophagus) - ICD-10 code: K-21.0.
GERD without esophagitis - ICD-10 code: K-21.9.

Endoscopic classification of GERD

Endoscopic classification was proposed in the late 80s by Savary and Miller, and is quite widely used in our time.

It has long been known that the mechanism for the development of GERD is a dysfunction of the lower esophageal sphincter (a muscle located on the border between the esophagus and stomach, which limits the reverse movement of food). When this muscle is weakened, gastric contents, including hydrochloric acid, are thrown into the esophagus. And over time, almost all of its shells undergo changes. So they served as the basis for this classification.

It can be presented in detail as follows.

First stage. In the last section of the esophagus, the one that is closer to the stomach, there are areas with erythema (redness of the mucous membrane due to capillary expansion), single erosions are possible (places of the mucous membrane with tissue defects). In some not far advanced cases of the manifestation of the disease, there may not be such changes, and the diagnosis is based either only on symptoms or, in their absence, on other research methods.
At the second stage of the endoscopic classification of GERD, erosions already occupy about 20% of the circumference of the esophagus. With such lesions, heartburn comes first among the manifestations of the disease.
The third stage of the disease process is characterized by damage not only to the mucous layer of the esophagus and the lower esophageal sphincter in the form of erosions. Ulcerative defects already appear here, which also affect the muscle layer of the organ. Such changes occupy more than half of the circumference of the esophagus. At the same time, a person is disturbed by burning sensations, pain behind the sternum, nocturnal manifestations are layered.
In the presence of the fourth stage of the development of the disease, thanks to FGDS, you can see that the entire mucous membrane is damaged, the defects occupy almost 100% of the circumference of the esophagus. Clinically, at this stage of the lesion, a person can feel all the symptoms characteristic of this disease.
The last fifth and most unfavorable is the stage of development of complications. Narrowing and shortening of the esophagus, deep bleeding ulcers, Barrett's esophagus (areas of replacement of the mucous membrane of this section with intestinal epithelium) are revealed.

In their practice, gastroenterologists often use this endoscopic classification to determine the stages of GERD development. Therapists also resort to it more often, considering it easier to understand and more exhaustive. But this is not the only division of GERD.

At the end of the 20th century, European Gastroenterology Week proposed the use of lesion extent. This is how the Los Angeles classification of GERD was born. Here's what it includes.

Grade A - there is one or more lesions of the esophageal mucosa (erosions or ulcers), each of which is not more than 5 mm, within only one mucosal fold.
Grade B - changes also affect only one fold, but one of the lesions may extend beyond 5 mm.
Grade C - the process has already spread to 2 folds or more, areas with changes of more than 5 mm. At this stage, the lesion of the esophagus reaches 75%.
Grade D - most of the esophagus is affected. The circumference of the lesions is at least 75%.

According to the Los Angeles classification, complications in the form of ulcers and narrowing may be present at any of the above stages.

The disease progression units were created to make the work of physicians easier. Thanks to classifications, it becomes easier to understand the manifestations of the process and better select methods for its treatment. Only a doctor can determine at what stage of the development of the disease each person suffering from GERD is. Therefore, at the first signs of illness, to speed up recovery, contact a specialist.

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Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is the development of inflammatory changes in the distal esophagus and / or characteristic symptoms due to regularly repeated reflux of gastric and / or duodenal contents into the esophagus.

ICD-10 K21.0 Gastroesophageal reflux with esophagitis K21.9 Gastroesophageal reflux without esophagitis.

EXAMPLE FORMULATION OF THE DIAGNOSIS

EPIDEMIOLOGY The true prevalence of the disease is not known due to the large variability in clinical symptoms. Symptoms of GERD upon careful questioning are found in 20–50% of the adult population, and endoscopic signs in more than 7–10% of the population. In the US, heartburn, the main symptom of GERD, is experienced by 10–20% of adults weekly. There is no complete epidemiological picture in Russia. The true prevalence of GERD is much higher than the statistics, including because only less than 1/3 of GERD patients go to the doctor. Women and men get sick equally often.

CLASSIFICATION There are currently two forms of GERD. ■ Endoscopically negative reflux disease, or non-erosive reflux disease, in 60-65% of cases. ■ Reflux esophagitis - 30-35% of patients. ■ Complications of GERD: peptic stricture, esophageal bleeding, Berrett's esophagus, adenocarcinoma of the esophagus. For reflux esophagitis, it is recommended to use the classification adopted at the X World Congress of Gastroenterologists (Los Angeles, 1994) (Table 4-2).

Table 4-2. Los Angeles classification of reflux esophagitis

DIAGNOSIS Diagnosis of GERD should be suspected if the patient has characteristic symptoms B: heartburn, belching, regurgitation; in some cases, extraesophageal symptoms are observed B.

HISTORY AND PHYSICAL EXAMINATION

GERD is characterized by the absence of dependence of the severity of clinical symptoms (heartburn, pain, regurgitation) on the severity of changes in the mucosa of the esophagus. Symptoms of the disease do not allow differentiating non-erosive reflux disease from reflux esophagitis. The intensity of clinical manifestations of GERD depends on the concentration of hydrochloric acid in the refluxate, the frequency and duration of its contact with the mucosa of the esophagus, hypersensitivity of the esophagus.

ESOPHAGEAL GERD SYMPTOMS

ESOPHAGEAL GERD SYMPTOMS ■ Heartburn is a burning sensation of varying intensity that occurs behind the sternum (in the lower third of the esophagus) and/or in the epigastric region. Heartburn occurs in at least 75% of patients, occurs due to prolonged contact of the acidic contents of the stomach (pH less than 4) with the mucosa of the esophagus. The severity of heartburn does not correlate with the severity of esophagitis. It is characterized by its increase after eating, taking carbonated drinks, alcohol, with physical exertion, bending over and in a horizontal position. ■ Sour eructation, as a rule, increases after eating, taking carbonated drinks. Regurgitation of food, observed in some patients, is aggravated by exercise and a position that promotes regurgitation. ■ Dysphagia and odynophagia (pain when swallowing) are less common. The appearance of persistent dysphagia indicates the development of esophageal stricture. Rapidly progressive dysphagia and weight loss may indicate the development of adenocarcinoma. ■ Pain behind the sternum can radiate to the interscapular region, neck, lower jaw, left half of the chest; often mimic angina pectoris. Esophageal pain is characterized by a connection with food intake, body position and their relief by taking alkaline mineral waters and antacids.

EXTRAESophAGEAL GERD SYMPTOMS

EXTRA-ESophageal GERD SYMPTOMS: ■ bronchopulmonary - cough, asthma attacks; ■ otolaryngological - hoarseness, dry throat, sinusitis; ■ dental - caries, erosion of tooth enamel.

LABORATORY EXAMINATION There are no laboratory symptoms pathognomonic for GERD. Recommended examination methods: complete blood count, blood type, Rh factor.

INSTRUMENTAL STUDIES OBLIGATORY EXAMINATION METHODS SINGLE STUDIES ■ FEGDS: allows to differentiate between non-erosive reflux disease and reflux esophagitis, to identify the presence of complicationsA. ■ Biopsy of the mucous membrane of the esophagus in complicated GERD: ulcers, strictures, Berrett's esophagusC. ■ X-ray examination of the esophagus and stomach: if a hernia of the esophageal opening of the diaphragm, stricture, adenocarcinoma of the esophagus is suspected.

RESEARCH IN DYNAMICS

■ FEGDS: it is possible not to carry out again with non-erosive reflux disease. ■ Biopsy of the mucous membrane of the esophagus in complicated GERD: ulcers, strictures, Berrett's esophagus.

ADDITIONAL EXAMINATION METHODS

SINGLE STUDIES ■ 24-hour intraesophageal pH monitoring: increased total reflux time (pH less than 4.0 more than 5% per day) and duration of reflux episode (greater than 5 minutes). The method allows you to evaluate the pH in the esophagus and stomach, the effectiveness of drugs; the value of the method is especially high in the presence of extraesophageal manifestations and the absence of the effect of therapy. ■ Intraesophageal manometry: carried out to assess the functioning of the lower esophageal sphincter, the motor function of the esophagus. ■ Ultrasound of the abdominal organs: with GERD without changes, it is carried out to identify concomitant pathology of the abdominal organs. ■ ECG, bicycle ergometry: used for differential diagnosis with IBSA, GERD does not show changes. ■ Proton pump inhibitor test B: relief of clinical symptoms (heartburn) while taking proton pump inhibitors.

DIFFERENTIAL DIAGNOSIS With a typical clinical picture of the disease, differential diagnosis is usually not difficult. In the presence of extraesophageal symptoms, it should be differentiated from ischemic heart disease, bronchopulmonary pathology (bronchial asthma, etc.). For differential diagnosis of GERD with esophagitis of a different etiology, a histological examination of biopsy specimens is performed.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

INDICATIONS FOR OTHER SPECIALIST CONSULTATION The patient should be referred for specialist advice if the diagnosis is uncertain, atypical or extraesophageal symptoms are present, or complications are suspected. You may need to consult a cardiologist, pulmonologist, otorhinolaryngologist (for example, a cardiologist - in the presence of retrosternal pain that does not stop while taking proton pump inhibitors).

TREATMENT OBJECTIVES OF THERAPY ■ Relief of clinical symptoms. ■ Healing of erosions. ■ Better quality of life. ■ Prevention or elimination of complications. ■ Prevention of recurrence.

INDICATIONS FOR HOSPITALIZATION

INDICATIONS FOR HOSPITALIZATION ■ Carrying out antireflux treatment in case of complicated course of the disease, as well as in case of ineffectiveness of adequate drug therapy. ■ Conducting surgery (fundoplication A) in case of failure of drug therapy and endoscopic or surgical interventions in the presence of complications of esophagitis: stricture, Berrett's esophagus, bleeding.

NON-DRUG TREATMENT ■ Lifestyle and dietary recommendations that have limited effect in the treatment of GERD. ✧ Avoid large meals. ✧Limit consumption of foods that reduce the pressure of the lower esophageal sphincter and have an irritating effect on the mucous membrane of the esophagus: foods rich in fats (whole milk, cream, cakes, pastries), fatty fish and meat (goose, duck, as well as pork, lamb, fatty beef), alcohol, drinks containing caffeine (coffee, cola, strong tea, chocolate), citrus fruits, tomatoes, onions, garlic, fried foods, avoid carbonated drinks. ✧After eating, avoid bending forward and horizontal position; the last meal - no later than 3 hours before bedtime. ✧Sleep with the head end of the bed elevated. ✧Exclude loads that increase intra-abdominal pressure: do not wear tight clothes and tight belts, corsets, do not lift weights of more than 8–10 kg on both hands, avoid physical exertion associated with overexertion of the abdominal press. ✧ Quit smoking. ✧Maintain normal body weight. ■ Do not take drugs that cause reflux B (sedatives and tranquilizers, calcium channel inhibitors, β-blockers, theophylline, prostaglandins, nitrates).

DRUG THERAPY Terms of treatment for GERD: 4-6 weeks for non-erosive reflux disease and at least 8-12 weeks for reflux esophagitis, followed by maintenance therapy for 26-52 weeks. Drug therapy includes the appointment of prokinetics, antacids and antisecretory agents. ■ Prokinetics: domperidone 10 mg 4 times a day. ■ The goal of antisecretory therapy for GERD is to reduce the damaging effect of acidic gastric contents on the esophageal mucosa in gastroesophageal reflux. The drugs of choice are proton pump A inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole). ✧GERD with esophagitis (8-12 weeks): -omeprazole 20 mg 2 times a day, or -lansoprazole 30 mg 2 times a day, or -esomeprazole 40 mg / day, or - rabeprazole 20 mg / day. The criterion for the effectiveness of treatment is the relief of symptoms and the healing of erosions. If the standard dose of proton pump inhibitors is ineffective, the dose should be doubled. ✧ Non-erosive reflux disease (4-6 weeks): -omeprazole 20 mg/day, or -lansoprazole 30 mg/day, or -esomeprazole 20 mg/day, or -rabeprazole 10-20 mg/day. The criterion for the effectiveness of treatment is the persistent elimination of symptoms. ■ The use of histamine H2 receptor blockers as antisecretory drugs is possible, but their effect is lower than that of proton pump inhibitors. ■ Antacids can be used as a symptomatic treatment for infrequent heartburn B, but in this case, preference should be given to taking proton pump inhibitors on demand. Antacids are usually prescribed 3 times a day 40-60 minutes after a meal, when heartburn and chest pain most often occur, as well as at night. ■ With reflux esophagitis caused by the reflux of duodenal contents (primarily bile acids) into the esophagus, which is usually observed in cholelithiasis, a good effect is achieved by taking ursodeoxycholic acid at a dose of 250-350 mg / day. In this case, it is advisable to combine ursodeoxycholic acid with prokinetics at the usual dose. Maintenance therapy A is usually carried out with proton pump inhibitors in accordance with one of the following regimens. ■ Continuous use of proton pump inhibitors in a standard or half dose (omeprazole, esomeprazole - 10 or 20 mg / day, rabeprazole - 10 mg / day). ■ On-demand therapy - taking proton pump inhibitors when symptoms appear (on average once every 3 days) for endoscopically negative reflux disease.

SURGICAL TREATMENT The purpose of operations aimed at eliminating reflux (fundoplications, including endoscopic ones) is to restore the normal function of the cardia. Indications for surgical treatment: ■ failure of adequate drug therapy; ■ complications of GERD (stricture of the esophagus, repeated bleeding); ■ Berrett's esophagus with high-grade epithelial dysplasia due to the risk of malignancy.

APPROXIMATE TERMS OF TEMPORARY INABILITY TO WORK

APPROXIMATE TERMS OF TEMPORARY DISABILITY Are determined by the relief of clinical symptoms and the healing of erosions during the control FEGDS.

FURTHER MANAGEMENT

FURTHER MANAGEMENT OF THE PATIENT In the case of non-erosive reflux disease with complete relief of clinical symptoms, a control FEGDS is not necessary. Remission of reflux esophagitis should be confirmed endoscopically. When the clinical picture changes, in some cases FEGDS is performed. Maintenance therapy is mandatory, since without it the disease recurs in 90% of patients within 6 months (see the section "Drug therapy"). Dynamic monitoring of the patient is carried out to monitor complications, identify Berrett's esophagus and drug control of the symptoms of the disease. Monitor for symptoms suggestive of complications: ■ dysphagia and odynophagia; ■ bleeding; ■ weight loss; ■ early satiety; ■ chest pain; ■ frequent vomiting. In the presence of all these signs, consultations of specialists and further diagnostic examination are indicated. Intestinal epithelial metaplasia serves as the morphological substrate of asymptomatic Berrett's esophagus. Risk factors for Berrett's esophagus: ■ heartburn more than twice a week; ■ male gender; ■ duration of symptoms for more than 5 years. Once the diagnosis of Berrett's esophagus is established, endoscopic examinations with biopsy should be performed annually on the background of continuous maintenance therapy with a full dose of proton pump inhibitors. If low-grade dysplasia is detected, repeated FEGDS with biopsy and histological examination of the biopsy is performed after 6 months. If low-grade dysplasia persists, a repeat histological examination is recommended after 6 months. If low-grade dysplasia persists, repeated histological examinations are carried out annually. In the case of high-grade dysplasia, the result of the histological examination is evaluated independently by two morphologists. When the diagnosis is confirmed, the issue of endoscopic or surgical treatment of Berrett's esophagus is decided.

EDUCATION OF THE PATIENT The patient should be explained that GERD is a chronic condition, usually requiring long-term maintenance therapy with proton pump inhibitors to prevent complications. The patient must follow the recommendations for lifestyle changes (see the section "Non-drug treatment"). The patient should be informed about the possible complications of GERD and advised to consult a doctor if symptoms of complications occur (see the section "Further management of the patient"). Patients with prolonged uncontrolled reflux symptoms should be explained the need for endoscopic examination to detect complications (such as Berrett's esophagus), and in the presence of complications, the need for periodic FEGDS with biopsy.

PROGNOSIS With non-erosive reflux disease and mild reflux esophagitis, the prognosis is generally favorable. Patients retain their ability to work for a long time. The disease does not affect life expectancy, but significantly reduces its quality during the period of exacerbation. Early diagnosis and timely treatment prevent the development of complications and preserve the ability to work. The prognosis worsens with a long duration of the disease, combined with frequent long-term relapses, with complicated forms of GERD, especially with the development of Berrett's esophagus, due to an increased risk of developing adenocarcinoma of the esophagus.

Gastroesophageal reflux disease (GERD) (help for doctors)

EGDS is necessary for the diagnosis of GERD with reflux esophagitis. With endoscopy, the severity of reflux esophagitis is determined. Esophagogastroduodenoscopy is performed to identify Barrett's esophagus, perform a biopsy, and determine the severity of esophageal stricture.

About 50-60% of patients with GERD have no endoscopic signs of the disease. This is the so-called EGDS-negative form of GERD (GERD without reflux esophagitis).

Rice. During esophagogastrodenoscopy, an eroded, hyperemic mucosa of the esophagus (esophagitis) is visualized. To confirm the diagnosis, a histological examination of the biopsy is performed, since endoscopic data do not always correlate with the results of histology.

Oh degree. Mild focal or diffuse hyperemia and friability of the mucosa of the esophagus at the level of the gastroesophageal junction (cardia), slight flattening of the cardia, disappearance of the luster of the mucosa of the distal esophagus, hyperemia and swelling of the mucosa of the distal esophagus, individual erosions.

Rice. Histological picture (in the study using transmission electron photomicroscopy) of the biopsy of the esophagus is normal

Rice. Histological picture (in the study using transmission electron photomicroscopy) of the biopsy of the esophagus with non-erosive esophagitis. Expansion of intercellular spaces is visualized.

I degree. The presence of one or more superficial erosions with or without exudate, often linear in shape, located on the tops of the folds of the esophageal mucosa. They occupy less than 10% of the mucosal surface of the distal esophagus.

II degree - confluent erosive lesions, occupying 10-50% of the circumference of the distal esophagus.

III degree. Confluent erosions covered with exudate or shedding necrotic masses that do not spread by circulation. The volume of damage to the mucosa of the distal esophagus is less than 50%.

Rice. Histological picture of the biopsy (in the study using transmission electron photomicroscopy) of the esophagus with erosive esophagitis.

IV degree. Circulatory confluent erosions or exudative-necrotic lesions occupying a five-centimeter zone of the esophagus above the cardia with spread to the distal esophagus.

V degree. Deep ulceration and erosion of various parts of the esophagus, stricture and fibrosis of its walls, short esophagus. Deep ulcers, stenosis of the esophagus, cylindrical metaplasia of the epithelium of the mucosa of its distal section indicate the occurrence of Barrett's esophagus. Barrett's esophagus is diagnosed in 8-15% of patients with GERD and may malignize into adenocarcinoma.

Rice. Histopathological picture of the mucosal biopsy in Barrett's esophagus.

Based on the endoscopic picture, 4 degrees of severity of narrowing of the esophagus are distinguished. When determining the degree, the extent of cicatricial stenosis of the esophagus is taken into account, since the success of non-surgical expansion of the stricture and adequate restoration of oral nutrition and clinical manifestations of dysphagia depend on this:

0 degree - normal swallowing.
1 degree - periodic difficulties in the passage of solid food.
Grade 2 - eating semi-liquid food.
Grade 3 - eating only liquid food.
Grade 4 - inability to swallow saliva.

In therapy, much depends on the stages of the course of the disease. Such information affects the duration of treatment and the choice of certain drugs. In the case of GERD, the first thing that matters is how deeply the mucosa of the esophagus is affected. In medicine, the classification of gastroesophageal reflux disease is more often used, which is detected by such a research method as FGDS (fibrogastroduodenoscopy).

What symptoms will bother a person at each stage of the disease? Today we have to answer not only this question. There are several options for classifying GERD, consider the most common of them.

Classification of GERD according to ICD-10

GERD with esophagitis (inflammation of the mucous membrane of the esophagus) - ICD-10 code: K-21.0.
GERD without esophagitis - ICD-10 code: K-21.9.

Endoscopic classification of GERD

Endoscopic classification was proposed in the late 80s by Savary and Miller, and is quite widely used in our time.

esophageal lesions

It can be presented in detail as follows.

First stage. In the last section of the esophagus, the one that is closer to the stomach, there are areas with erythema (redness of the mucous membrane due to capillary expansion), single erosions are possible (places of the mucous membrane with tissue defects). In some not far advanced cases of the manifestation of the disease, there may not be such changes, and the diagnosis is based either only on symptoms or, in their absence, on other research methods.
At the second stage of the endoscopic classification of GERD, erosions already occupy about 20% of the circumference of the esophagus. With such lesions, heartburn comes first among the manifestations of the disease.
The third stage of the disease process is characterized by damage not only to the mucous layer of the esophagus and the lower esophageal sphincter in the form of erosions. Ulcerative defects already appear here, which also affect the muscle layer of the organ. Such changes occupy more than half of the circumference of the esophagus. At the same time, a person is disturbed by burning sensations, pain behind the sternum, nocturnal manifestations are layered.
In the presence of the fourth stage of the development of the disease, thanks to FGDS, you can see that the entire mucous membrane is damaged, the defects occupy almost 100% of the circumference of the esophagus. Clinically, at this stage of the lesion, a person can feel all the symptoms characteristic of this disease.
The last fifth and most unfavorable is the stage of development of complications. Narrowing and shortening of the esophagus, deep bleeding ulcers, Barrett's esophagus (areas of replacement of the mucous membrane of this section with intestinal epithelium) are revealed.

Los Angeles classification of GERD

At the end of the 20th century, European Gastroenterology Week proposed the use of lesion extent. This is how the Los Angeles classification of GERD was born. Here's what it includes.

Grade A - there is one or more lesions of the esophageal mucosa (erosions or ulcers), each of which is not more than 5 mm, within only one mucosal fold.
Grade B - changes also affect only one fold, but one of the lesions may extend beyond 5 mm.
Grade C - the process has already spread to 2 folds or more, areas with changes of more than 5 mm. At this stage, the lesion of the esophagus reaches 75%.
Grade D - most of the esophagus is affected. The circumference of the lesions is at least 75%.

According to the Los Angeles classification, complications in the form of ulcers and narrowing may be present at any of the above stages.

Home > What is GERD

What symptoms will bother a person at each stage of the disease? Today we have to answer not only this question. There are several options for classifying GERD, consider the most common of them.

Classification of GERD according to ICD-10

GERD with esophagitis (inflammation of the mucous membrane of the esophagus) - ICD-10 code: K-21.0.
GERD without esophagitis - ICD-10 code: K-21.9.

Endoscopic classification of GERD

Endoscopic classification was proposed in the late 80s by Savary and Miller, and is quite widely used in our time.

esophageal lesions

It can be presented in detail as follows.

First stage. In the last section of the esophagus, the one that is closer to the stomach, there are areas with erythema (redness of the mucous membrane due to capillary expansion), single erosions are possible (places of the mucous membrane with tissue defects). In some not far advanced cases of the manifestation of the disease, there may not be such changes, and the diagnosis is based either only on symptoms or, in their absence, on other research methods.
At the second stage of the endoscopic classification of GERD, erosions already occupy about 20% of the circumference of the esophagus. With such lesions, heartburn comes first among the manifestations of the disease.
The third stage of the disease process is characterized by damage not only to the mucous layer of the esophagus and the lower esophageal sphincter in the form of erosions. Ulcerative defects already appear here, which also affect the muscle layer of the organ. Such changes occupy more than half of the circumference of the esophagus. At the same time, a person is disturbed by burning sensations, pain behind the sternum, nocturnal manifestations are layered.
In the presence of the fourth stage of the development of the disease, thanks to FGDS, you can see that the entire mucous membrane is damaged, the defects occupy almost 100% of the circumference of the esophagus. Clinically, at this stage of the lesion, a person can feel all the symptoms characteristic of this disease.
The last fifth and most unfavorable is the stage of development of complications. Narrowing and shortening of the esophagus, deep bleeding ulcers, Barrett's esophagus (areas of replacement of the mucous membrane of this section with intestinal epithelium) are revealed.

At the end of the 20th century, European Gastroenterology Week proposed the use of lesion extent. This is how the Los Angeles classification of GERD was born. Here's what it includes.

Grade A - there is one or more lesions of the esophageal mucosa (erosions or ulcers), each of which is not more than 5 mm, within only one mucosal fold.
Grade B - changes also affect only one fold, but one of the lesions may extend beyond 5 mm.
Grade C - the process has already spread to 2 folds or more, areas with changes of more than 5 mm. At this stage, the lesion of the esophagus reaches 75%.
Grade D - most of the esophagus is affected. The circumference of the lesions is at least 75%.

According to the Los Angeles classification, complications in the form of ulcers and narrowing may be present at any of the above stages.

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Gastroesophageal reflux disease

ICD-10 K21.0 Gastroesophageal reflux with esophagitis K21.9 Gastroesophageal reflux without esophagitis.

EXAMPLE FORMULATION OF THE DIAGNOSIS

EPIDEMIOLOGY

CLASSIFICATION

Table 4-2. Los Angeles classification of reflux esophagitis

DIAGNOSTICS

DIAGNOSIS Diagnosis of GERD should be suspected if the patient has characteristic symptoms B: heartburn, belching, regurgitation; in some cases, extraesophageal symptoms are observed B.

HISTORY AND PHYSICAL EXAMINATION

ESOPHAGEAL GERD SYMPTOMS

EXTRAESophAGEAL GERD SYMPTOMS

EXTRA-ESophageal GERD SYMPTOMS: ■ bronchopulmonary - cough, asthma attacks; ■ otolaryngological - hoarseness, dry throat, sinusitis; ■ dental - caries, erosion of tooth enamel.

LABORATORY EXAMINATION

LABORATORY EXAMINATION There are no laboratory symptoms pathognomonic for GERD. Recommended examination methods: complete blood count, blood type, Rh factor.

INSTRUMENTAL STUDIES

RESEARCH IN DYNAMICS

■ FEGDS: it is possible not to carry out again with non-erosive reflux disease. ■ Biopsy of the mucous membrane of the esophagus in complicated GERD: ulcers, strictures, Berrett's esophagus.

ADDITIONAL EXAMINATION METHODS

DIFFERENTIAL DIAGNOSIS

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

TREATMENT OBJECTIVES OF THERAPY ■ Relief of clinical symptoms. ■ Healing of erosions. ■ Better quality of life. ■ Prevention or elimination of complications. ■ Prevention of recurrence.

INDICATIONS FOR HOSPITALIZATION

NON-DRUG TREATMENT

DRUG THERAPY

SURGERY

APPROXIMATE TERMS OF TEMPORARY INABILITY TO WORK

APPROXIMATE TERMS OF TEMPORARY DISABILITY Are determined by the relief of clinical symptoms and the healing of erosions during the control FEGDS.

FURTHER MANAGEMENT

EDUCATION OF THE PATIENT

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