Gastroesophageal reflux disease: diagnosis, therapy and prevention. Gerb: treatment with medications and folk remedies. modern treatment of gastroesophageal reflux disease

Familiar to many discomfort heartburn, belching after eating, abdominal pain or slightly higher after a heavy holiday meal. Can they be ignored or are they a sign of a serious illness?

GERD - what is it?

Gastroesophageal reflux disease is a disease caused by frequent reflux of semi-digested food from the stomach or small intestine into the esophagus. In this case, the mucous membrane of the latter is irritated by aggressive digestive components (hydrochloric acid, enzymes, bile, pancreatic juice), causing inflammation and unpleasant subjective symptoms.

The exact prevalence of the disease has not yet been established. After all, its main manifestation – heartburn – occurs with varying frequency both among adults and children. And the severity and severity of the process do not correlate with the intensity of symptoms. This means that a patient with serious damage to the esophagus may not experience any discomfort at all, have no complaints and not seek medical help.

Causes of gastroesophageal reflux disease

Damage to the mucous membrane occurs due to several factors:

• weakening of the anatomical antireflux barrier;
• decreased ability of the esophagus to quickly evacuate food to the underlying sections gastrointestinal tract;
• decline protective properties lining of the esophagus (production of mucus, alkaline components);
• one or another stomach disease with excessive production of hydrochloric acid, reflux of bile from the intestines up the digestive system.

Nature has provided many devices that protect against this disease. The esophagus “flows” into the stomach at an angle, it is covered by ligaments and muscle fibers diaphragm so that it is tightly fixed. From the inside, the mucous membrane has a special fold that acts as a valve that does not allow gastric contents to pass upward. In addition, the gas bubble is located in the stomach in such a way that food reflux does not occur.

U healthy person The muscle ring surrounding the junction of the esophagus and the stomach opens only occasionally for a few seconds to release excess trapped air. Gastroesophageal reflux is not the release of air, but rather the reflux of liquid contents; normally it should not exist. Defense Mechanisms fail for various reasons.

• Excess food containing caffeine (coffee, tea, chocolate, Coca-Cola), citrus fruits, tomatoes, alcoholic and carbonated drinks, fatty foods.
• A hasty and large meal, during which large volumes of air are swallowed.
• Smoking.
• Some drugs: antispasmodics (No-spa, Papaverine), painkillers, nitrates, calcium antagonists.
• Defeat vagus nerve(for example, when diabetes mellitus or after surgical dissection).
• Dysfunction of chemical regulation of function digestive system(excessive production of glucagon, somatostatin, cholecystokinin or other substances).
• Other diseases - hernia hiatus diaphragm, short esophagus, scleroderma.
• Conditions accompanied by increased intra-abdominal pressure: pregnancy, overweight, chronic constipation, flatulence, ascites, prolonged cough, regular lifting of weights.

Symptoms of GERD

The patient’s sensations can vary from a complete absence of signs of the disease to excruciating pain reminiscent of heart pain. Any combination of symptoms is possible.

• Heartburn is a burning sensation behind the breastbone that occurs when the mucous membrane of the esophagus comes into contact with the acidic contents of the stomach. As a rule, it also appears in healthy people if you lie down immediately after eating.
• Belching of air and regurgitation of food, increasing after an error in diet.
• Pain behind the sternum, spreading to the neck, jaw, shoulder, interscapular area, left half chest. The sensations can be very similar to the pain of angina pectoris.
• Difficulty or painful swallowing food, sensation of a “lump” in the esophagus.
• Obsessive hiccups and occasional vomiting are possible, which is usually a symptom of stomach or intestinal diseases.

There are so-called extraesophageal symptoms - signs of the disease associated with the involvement of other organs in the disease. Thus, the contents of the stomach can be thrown quite high, up to oral cavity, and end up in the respiratory tract. In this case, dryness and soreness in the throat, hoarseness of the voice, and a suffocating cough appear. If, during night sleep, digestive juices flow far into the respiratory tract, bronchitis or pneumonia develops.

Classification of GERD

According to the results additional examination distinguish:

• non-erosive reflux disease (no visible change in the esophagus),
• GERD with esophagitis (inflammation of the esophageal mucosa caused by regular reflux from the stomach).

Depending on the volume of affected tissue, 4 degrees of the disease are distinguished, from A to D.

Diagnosis confirmation

To distinguish GERD from other diseases, your doctor will order an examination.

1. FEGDS (fibroesophagogastroduodenoscopy) – examination of the esophagus, stomach and parts duodenum using a special camera. In this case, a biopsy of the changed areas is necessarily taken (a small fragment of tissue is excised and examined under a microscope).
2. X-ray examination allows you to clearly examine the contours of the esophagus and identify existing anatomical abnormalities.
3. Daily pH-metry – 24-hour monitoring of esophageal acidity. Makes it possible to judge the frequency of reflux and its intensity.
4. Scintigraphy of the esophagus helps assess the rate of evacuation contrast agent(and, accordingly, food) down the gastrointestinal tract.
5. Manometry measures the strength of the muscle ring surrounding the junction of the esophagus and the stomach.
6. Impedance measurement of the esophagus allows you to assess the intensity and direction of peristalsis (pushing muscle contractions).

It is not necessary that the person seeking help will go through all of the listed procedures. Depending on the manifestations of the disease, only some of them and some others may be prescribed.

Do gastroesophageal reflux need to be treated?

Even if not unpleasant symptoms, the disease must be treated, as it threatens serious complications. Peptic ulcers are large and deep defects in the wall of the esophagus that occur due to constant exposure to aggressive substances. Ulcers can penetrate through the wall and cause inflammation in the surrounding tissues. Treatment of such extensive inflammation is complex and lengthy and necessarily requires hospitalization.

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Bleeding occurs if, along the path of a developing ulcer, it encounters blood vessel, and the esophagus is surrounded by several large broad veins. Bleeding can be very intense and quickly lead to death. Strictures are durable connective tissue scars at the site of chronic inflammation. They change the shape of the esophagus, narrow its lumen, and make it significantly more difficult to swallow even liquids.

Barrett's esophagus is a disease in which the lining of the esophagus changes its epithelium to gastric or intestinal. It is a precancerous condition.

Treatment of GERD

As with any chronic disease, when GERD is detected, it is important to adjust your lifestyle. Otherwise, it will not be possible to cure reflux with medications, and the time intervals between exacerbations will be short.

• Eliminate possible increase intra-abdominal pressure – heavy lifting, tight belts, girdles and corsets.
• Sleep on a high headboard.
• Avoid overeating, especially in the evening. The latest meal should be 3 hours before bedtime.
• After eating, do not lie down or bend over. Try to be in vertical position and don't slouch. Short walks of 30 minutes are ideal.
• Follow a GERD diet. Give up fatty foods(whole milk, cream, pork, duck, lamb). Avoid caffeinated and carbonated drinks. Don't drink alcohol. Reduce the amount of citrus fruits, tomatoes, onions, garlic and fried foods on the menu. Do not overuse legumes, white cabbage and black bread - they increase gas formation.
• Discuss with your doctor all the medications you take regularly.
• Stop smoking.
• Control your body weight.

In addition to these measures, the doctor will tell you how to treat the disease with medications. They will help to establish the passage of food in the gastrointestinal tract from top to bottom, reduce the content of hydrochloric acid in gastric juice, and accelerate the healing of existing defects. In uncomplicated cases, surgical treatment is usually not required.

Treatment with folk remedies

Included complex therapy They use herbal treatment that accelerates the healing of epithelial defects and reduces the acidity of gastric juice.

Mix 6 tbsp. dry plantain leaves, 1 tbsp. chamomile flowers and 4 tbsp. St. John's wort herb. Pour the resulting dry collection with 1 liter of boiling water and simmer over low heat for a quarter of an hour. Let the broth brew, cool and strain. Use 1 tbsp. ready-made medicine half an hour before meals three times a day.

1 tbsp. dried centaury herb is poured into 500 ml of boiling water, sealed tightly, wrapped in a towel and left for at least half an hour. Healing infusion Take 1/4 cup morning and evening.

Do not engage in self-diagnosis and self-medication! Without specialist supervision traditional methods may not only be useless, but also dangerous to health!

Gastroesophageal reflux disease (GERD) questions and answers

Originally written by Joel Richter, Philip O. Katz, and J. Patrick Waring, edited by William F. Norton. In 2010, an updated version was prepared by Ronnie Fass.

Even a little knowledge can make a big difference

Introduction

GERD - chronic illness. Her treatment must be on a long-term basis, even after her symptoms are under control. Due attention must be paid to changing habits in Everyday life and long-term medication use. This can be done by dispensary observation and patient education.

GERD is often characterized painful symptoms, which can significantly worsen a person’s quality of life. For effective treatment GERD is used various methods: ranging from lifestyle changes to application medicines and surgical operations. For patients suffering from chronic and recurrent symptoms of GERD, it is important to obtain an accurate diagnosis and receive the most effective treatment available.

What is GERD?

GERD is often accompanied by symptoms such as heartburn and sour belching. But sometimes GERD occurs without visible symptoms and is detected only after complications become obvious.

What causes reflux?

What Causes GERD?

Surgery . Surgical treatment may be indicated in the following cases:

• the patient is not interested in long-term drug therapy;
• symptoms cannot be controlled by methods other than surgery;
• symptoms return despite treatment;
• serious complications develop.

How long do you need to take medication to keep GERD from getting out of control?

Is taking long-term medications to treat GERD harmful?

H2 blockers have been used to treat reflux disease since the mid-1970s. Since 1995, they have been available over the counter in reduced doses to treat rare heartburn. They have proven to be safe, although they sometimes cause side effects such as headache and diarrhea.

Inhibitors proton pump Omeprazole and lansoprazole have been regularly used by patients with GERD for many years (omeprazole was approved in the US in 1989 and worldwide a few years after that). Side effects from these drugs are rare and mainly include occasional diarrhea, headache or upset stomach. These side effects are generally no more common than with placebo and usually occur when starting to use the drug. If none of these side effects have appeared after months or years of taking proton pump inhibitors, they are unlikely to appear later.

Patients with heart disease who are taking clopidogrel (Plavix) should avoid taking proton pump inhibitors such as omeprazole and esomeprazole. Moreover, recent studies have shown that long-term use PPIs, especially more than once daily, can cause osteoporosis, bone fractures, pneumonia, gastroenteritis, and hospital-acquired colitis. Patients should discuss this with their healthcare provider.

When is surgery an alternative to therapeutic treatment for GERD?

Side effects or complications associated with surgery occur in 5-20% of cases. The most common is dysphagia, or difficulty swallowing. It is usually temporary and goes away after 3-6 months. Another problem that occurs in some patients is their inability to burp or vomit. This is because the operation creates a physical barrier to any type of backflow of any stomach contents. A consequence of the inability to belch effectively is “gas-bloat” syndrome - bloating and discomfort in the abdomen.

The surgically created anti-reflux barrier can “break” in much the same way as a hernia penetrates other parts of the body. The recurrence rate has not been determined, but may be in the range of 10-30% within 20 years after surgery. Factors that may contribute to this “breakdown” include: weightlifting, strenuous exercise, sudden changes in weight, severe vomiting. Any of these factors can increase blood pressure, which can lead to weakening or disruption of the anti-reflux barrier created as a result of surgery.

In some patients, even after surgery, symptoms of GERD may persist and medication will need to be continued.

Living with GERD

It is important to understand that GERD can have serious consequences. The complications that can arise, as well as the discomfort or pain from acid reflux, can affect all aspects of a person's daily life - emotional, social and professional.

In studies that measure emotional condition Individuals with untreated GERD often report worse scores than those with other chronic diseases, such as diabetes, high blood pressure, peptic ulcers, or angina. However, almost half of those suffering from acid reflux do not recognize it as a disease.

GERD is a disease. It is not a consequence of an incorrect lifestyle. It is usually accompanied by obvious symptoms, but can occur in the absence of them. Ignoring them or incorrect treatment may lead to more serious complications.

Most people with GERD have light form a disease that can be controlled with lifestyle changes and medications. If you suspect you have GERD, the first step is to see your doctor for an accurate diagnosis. Once recognized, GERD is usually treatable. By partnering with your doctor, you can determine the best treatment strategy available to you.

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The views of the authors do not necessarily reflect the position of the International Foundation for Functional Gastrointestinal Diseases (IFFGD). IFFGD does not warrant or endorse any product in this publication or any claims made by the author and does not accept any liability regarding such matters.

This brochure is in no way intended to replace medical advice. We recommend visiting a doctor if your health problem requires an expert opinion.

This is inflammation of the walls lower section esophagus, which occurs as a result of regular reflux (backward movement) of gastric or duodenal contents into the esophagus. Manifested by heartburn, belching with a sour or bitter taste, pain and difficulty swallowing food, dyspepsia, chest pain and other symptoms that worsen after eating and physical activity. Diagnostics includes FGDS, intraesophageal pH-metry, manometry, radiography of the esophagus and stomach. Treatment involves non-drug measures and the prescription of symptomatic therapy. IN in some cases surgical interventions are recommended.

For early detection changes in the mucous membrane of the Barrett's disease type are recommended for all patients suffering from chronic heartburn endoscopic examination(gastroscopy) with a biopsy of the esophageal mucosa. Patients often report coughing and hoarseness. In such cases, consultation with an otolaryngologist is necessary to identify inflammation of the larynx and pharynx. If the cause of laryngitis and pharyngitis is reflux, antacids are prescribed. After this, the signs of inflammation subside.

Treatment of GERD

Non-drug therapeutic measures for gastroesophageal disease include normalizing body weight, following a diet (small portions every 3-4 hours, eating no later than 3 hours before bedtime), avoiding foods that help relax the esophageal sphincter (fatty foods, chocolate, spices, coffee, oranges, tomato juice, onions, mint, alcohol-containing drinks), increasing the amount of animal protein in the diet, avoiding hot food and alcohol. It is necessary to avoid tight clothing that pinches the torso.

It is recommended to sleep on a bed with the head of the bed raised by 15 centimeters, and quit smoking. It is necessary to avoid prolonged work in an inclined position and heavy physical exertion. Medicines that negatively affect esophageal motility are contraindicated (nitrates, anticholinergics, beta-blockers, progesterone, antidepressants, blockers calcium channels), as well as non-steroidal anti-inflammatory drugs that have a toxic effect on the mucous membrane of the organ.

Drug treatment of gastroesophageal reflux disease is carried out by a gastroenterologist. Therapy takes from 5 to 8 weeks (sometimes the course of treatment reaches a duration of up to 26 weeks), is carried out using the following groups drugs: antacids (aluminum phosphate, aluminum hydroxide, magnesium carbonate, magnesium oxide), H2-histamine blockers (ranitidine, famotidine), proton pump inhibitors (omeprazole, rebeprazole, esomeprazole).

In cases where conservative GERD therapy does not have an effect (about 5-10% of cases), if complications or diaphragmatic hernia develop, surgical treatment. The following apply surgical interventions: endoscopic plication of the gastroesophageal junction (sutures are placed on the cardia), radiofrequency ablation of the esophagus (damage to the muscular layer of the cardia and gastroesophageal junction, in order to scar and reduce reflux), gastrocardiopexy and laparoscopic Nissen fundoplication.

Prognosis and prevention

Prevention of the development of GERD is maintaining a healthy lifestyle with the exception of risk factors that contribute to the occurrence of the disease (quitting smoking, alcohol abuse, fatty and spicy food, overeating, lifting heavy objects, being in an inclined position for a long time, etc.). Timely measures to identify motor skills disorders are recommended upper sections digestive tract and treatment of diaphragmatic hernia.

With timely identification and compliance with lifestyle recommendations (non-drug treatment measures for GERD), the outcome is favorable. In the case of a prolonged, often relapsing course with regular refluxes, the development of complications, and the formation of Barrett's esophagus, the prognosis noticeably worsens.

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

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

Reflux as a physiological or pathological process

Reverse reflux of gastric contents has an irritating effect on the mucous membranes of the esophagus. As a result, it develops inflammatory process. To prevent such development, the body has protective mechanisms:

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

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

• reverse release occurs most often after eating;
• there are no associated symptoms;
• the daily frequency of reflux is insignificant;
• At night, return deliveries of food rarely occur.

In this case, gastroesophageal reflux occurs without esophagitis, that is, severe irritation, and especially without inflammation. When defense mechanisms are violated, it develops pathological course diseases. Signs of GERD the following factors include:

• reflux occurs independently of food intake;
• return casts occur frequently and last a considerable duration;
• their manifestation is also possible at night;
• clinical symptoms appear;
• An inflammatory process develops in the mucous membrane of the esophagus.

In this case, gastroesophageal reflux with esophagitis quite often occurs.

Classification

Normal acidity in the esophagus is six to seven units. When refilling, the pH level may drop. The appearance of such refluxes is called acidic. If the acidity level is in the range from 7.0 to 4.0, then in this case we are talking about a weakly acidic reverse cast. When the pH value reaches below four units, we speak of acidic superreflux.

When not only gastric but also intestinal contents are thrown into the esophagus, acidity may increase. The pH value then becomes higher than 7.0. This is alkaline reflux. The contents of the cast include bile pigments, as well as lysolecithin.

Causes

The causes of reflux are as follows:

1. Increased intra-abdominal pressure. This manifestation occurs when there is overweight or obesity, flatulence or constipation, the occurrence of ascites (fluid accumulation in the peritoneum). It should be borne in mind that pregnancy also leads to an increase in intra-abdominal pressure.
2. Diaphragmatic hernia. With hiatal hernia (hiatal hernia), organs from the peritoneum are displaced into the chest area. This pathology occurs quite often in people over 50 years of age.
3. Decreased clearance (an indicator indicating the rate of tissue cleansing) of the esophagus. May develop due to a decrease in the neutralizing effect of saliva.
4. Insufficiency of the gastric cardia. This pathology occurs due to incomplete closure of the valve.
5. Frequent consumption of caffeinated drinks. This is not only coffee, but also tea or Coca-Cola.
6. Drinking large quantities of alcohol-containing drinks.
7. Reception of some medications. Among them are Verapamil (used for cardiac disorders), Papaverine (widely used for muscle spasms), Theophylline (prescribed for asthma or peptic ulcers).
8. Duodenal ulcer.
9. Frequent stress and nervous tension.

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

It should be remembered that determining the etiology of GERD is a rather difficult process. It is quite difficult for an ignorant person to clarify the mechanism of the origin of pathology - its pathogenesis.

The development of the disease is also influenced by habits that are associated with food consumption. The nature of nutrition is also important. Rapid absorption of food in large quantities leads to excessive swallowing of air. Because of this, intragastric pressure increases, the lower sphincter relaxes and reverse reflux of food occurs. Constant consumption of fatty, fried meats and flour products, flavored with an abundance of seasonings, leads to slow digestion of the food coma. Rotting processes develop, which leads to an increase in intra-abdominal pressure.

Consequences that pathology leads to

With absence timely treatment pathology can have quite unpleasant consequences. The following complications of GERD are common:

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

With the development of GERD, complications can be even more serious. Thus, during the formation of Barrett's esophagus in the esophageal mucosa, the flat stratified epithelium to cylindrical, which is inherent in the gastric surface layers. Such metaplasia (persistent replacement) significantly increases the risk of cancer. Possible development of adenocarcinoma of the esophagus. In this case, surgery using esophageal stenting is often necessary.

How does the disease manifest itself?

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

When GERD develops, symptoms may include:

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

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

If minor bleeding occurs, it is detected in the stool, which turns black. In severe cases, blood may escape through the mouth. In some cases, patients experience vomiting, copious discharge saliva, feeling of pressure in the chest. In this case, pain can radiate to the back, arm, neck or shoulder.

Masks for gastroesophageal reflux disease can be either typical or atypical. The main symptoms are heartburn, which occurs due to sour belching. In this case, the burning sensation behind the sternum can be permanent. It may only appear due to a certain body position, for example, when bending over or lying down.

Besides esophageal symptoms There are also signs of an extraesophageal nature. Recognizing them correctly is often quite difficult. In some cases, all the symptoms indicate a completely different problem, for example, bronchial asthma. Extraesophageal manifestations of GERD can be divided into four groups. This division depends on which organs are exposed to refluxate. Such manifestations include otorhinolaryngological and bronchopulmonary, cardiac and dental syndromes.

Respiratory problems caused by reverse reflux include bronchial asthma, chronic cough and recurrent pneumonia. Cardiac syndrome is manifested by chest pain and heart rhythm disturbances. In addition, diseases such as pharyngitis or laryngitis may develop. Due to the frequent occurrence of belches with a sour taste, teeth can deteriorate.

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

Diagnostics

Diagnosis of GERD is performed using the following methods and procedures:

1. Typical symptoms are sufficient to make a preliminary diagnosis. However, to confirm the correctness of this determination, a special test is carried out. Drugs such as Omeprazole or Pantoprazole are prescribed. These are proton pump inhibitors that are taken for two weeks in standard doses. If the treatment is effective, the diagnosis is confirmed.
2. 24-hour intraesophageal pH monitoring. This diagnostic method is the main one to confirm the diagnosis. It allows you to determine not only the duration of refluxes and their number during the day, but also total time, during which the pH is below 4.0.
3. Fibroesophagogastroduodenoscopy. The examination allows you to visually assess the condition of the gastrointestinal tract.
4. Chromoendoscopy. It is carried out to identify areas susceptible to metaplasia.
5. ECG. The study reveals disturbances in the functioning of the heart.
6. Ultrasound can detect pathologies of the digestive organs or heart.
7. X-rays are used to identify pathologies respiratory organs, diaphragmatic hernia or narrowing of the esophagus.
8. Testing includes OAC ( general analysis blood), testing for sugar. It is also necessary to define liver test and donation of feces. After the blood test is deciphered, it becomes possible to draw a conclusion about the presence of inflammation.
9. Performing a test for the presence of the bacterium Helicobacter pylori. When it is determined, therapy is prescribed aimed at destroying the microorganism.

These are the most effective methods diagnostic examination. They make it possible to identify, among other things, cardia insufficiency.

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

Treatment

When GERD is detected, treatment of the pathology should begin with a radical change in lifestyle. To fulfill this requirement and answer the question of how to cure GERD, you must:

Treatment of gastroesophageal reflux is carried out in accordance with two main principles. It is necessary to quickly stop the main symptoms of the disease, and then create the necessary conditions to prevent not only complications, but also relapses. Patients often wonder whether GERD in adults can be cured completely and permanently. If the disease is diagnosed in a timely manner, the prognosis for cure is favorable. Pathology therapy usually lasts no more than eight weeks. However, in some cases, with complications, it takes up to six months. GERD without esophagitis can often be treated with medications traditional medicine, which have proven medicinal properties. To get through the healing phase faster, a strict diet is required.

Once a diagnosis of GERD is made, a generally accepted treatment strategy is used. The gastroenterologist prescribes antisecretory drugs. These are both proton pump inhibitors, which suppress the production of hydrochloric acid by the mucous membrane (Rabeprazole, Omeprazole, Esomeprazole or Pantoprazole), and blockers histamine receptors(eg Famotidine).

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

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

It should be borne in mind that the decision on how to treat gastroesophageal reflux disease rests with the attending physician. Self-prescription of medications, especially during exacerbation of GERD, can cause serious harm to health.

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

News healthy image life - this is the basis for the prevention of GERD. This is also the answer to the question of how to live with such a pathology.

Gastroesophageal reflux with esophagitis, or gastroesophageal reflux disease (GERD) is one of the most common chronic diseases in gastroenterology. Doctors have already called it the disease of the third millennium, since the frequency of its occurrence has increased significantly in the last decade. This article will describe the causes and symptoms of GERD, the principles of its diagnosis and treatment.

What is GERD

Gastroesophageal reflux with esophagitis is a chronic disease in which gastric contents reflux into the esophagus. Due to the action of hydrochloric acid, inflammation of the wall of the esophagus itself occurs, and esophagitis develops.

The classification of GERD is presented in the table:

Causes and mechanisms of disease development

Esophagitis causes hydrochloric acid stomach, which enters the esophagus during reflux. In a healthy person, the sphincter, which separates the esophagus from the stomach itself, does not allow it to pass there.

When the esophageal sphincter is insufficient and the acidity of the gastric juice is high, the contents are refluxed into the esophagus. There are factors that can trigger the development of this disease:

• Diaphragmatic hernia– this is the main anatomical cause malfunction of the esophageal sphincter and the development of reflux and esophagitis.
• Pregnancy, especially in the third trimester, when the fetus props up the diaphragm.
• Smoking. Tobacco smoke damages the mucous wall of the esophagus and sphincter.
• Chronic diseases of the digestive system, such as gastritis, cholecystitis, pancreatitis, cholangitis. In these conditions, a large number of inflammatory factors are released.
• Reception medications , which reduce the tone of smooth muscle muscles.
  These include:
  • calcium antagonists;
  • nitrates;
  • theophylline;
  • adrenergic blockers;
  • antispasmodics.
• Systemic connective tissue diseases.

Clinical picture of GERD

The main symptoms of reflux and esophagitis are:

1. heartburn– a burning sensation in the esophagus that rises up;
2. acid regurgitation– sensations of food eaten rising up the esophagus, and the presence sour taste in the mouth.

Heartburn with reflux has the following characteristics:

• appears 1-1.5 hours after eating;
• often occurs during sleep if the patient sleeps on a low pillow;
• may appear almost immediately after eating if the meal was very large and the food itself was fatty;
• As a rule, heartburn increases when bending over and decreases when standing.

The non-erosive form is more common in young people, women, and patients without excess body weight. There are atypical symptoms that are more common in people with a non-erosive clinical form:

Very often, patients with such atypical symptoms for a long time undergo treatment for precisely these complications, not knowing about their original cause. They permanent patients from an ENT specialist, pulmonologist, therapist. As a rule, these doctors do not help them in any way.

Basic principles for diagnosing GERD

If you suspect the presence of reflux and esophagitis, your doctor may prescribe an invasive or non-invasive examination.

Invasive diagnostic methods are prescribed to patients who have at least one alarming symptom:

• swallowing disorders, dysphagia;
• disruption of the tongue;
• weight loss;
• episodes of gastrointestinal bleeding;
• anemia;
• presence of nausea and vomiting.

These symptoms may be signs peptic ulcer, or development oncological process. The invasive method includes:

1. Endoscopy of the esophagus with taking pieces of the mucous membrane for biopsy.
2. Daily intraesophageal pH control.
3. Gastric pH measurements.

Non-invasive diagnostics is used for patients who do not have any alarming symptom. Non-invasive examination methods include:

1. Plain radiography of the esophagus– with its help you can see defects in it, a diaphragmatic hernia.
2. Video capsule endoscopy. The patient swallows a special capsule with a built-in video camera. This camera takes detailed video with great separation power, and then the doctor views the video it recorded. This is absolutely new method. Its only drawback is its high cost.
3. Proton pump inhibitor test (PPI test)– in this case, the patient is prescribed a trial treatment with Omeprazole. Its duration is 2 weeks. If during this period all symptoms disappear, the diagnosis of GERD is confirmed.

According to new international medical protocols, the diagnosis of GERD can only be made based on the patient's symptoms young who do not have alarming symptoms.

Lifestyle changes for GERD

Lifestyle modification and diet are the main components of treatment of this disease. If the patient neglects these rules, drug treatment will not bring any effect.

1. You need to sleep on high pillows. The head should be elevated during sleep by no less than 15-20 centimeters.
2. Avoid wearing tight belts and tight, constrictive clothing.
3. Do not lift heavy objects, try not to bend over often.
4. Eat in small portions, but often.
5. Try not to eat 3-4 hours before bedtime.
6. Completely avoid fatty foods, strong alcohol, coffee and chocolate, or at least reduce the consumption of these products to a minimum.
7. Get rid of excess weight.
8. If possible, quit smoking.

Drug therapy

Changes in lifestyle and nutrition are not enough for this disease. They are the basis for the main treatment.

TO drug treatment include the drugs presented in the table:

Proton pump inhibitors are considered basic therapy. They are prescribed for a long course. These are the most safe drugs, among all the others.

First, the patient receives a therapeutic dose, and then, during remission, continues to drink their minimum dose to maintain and preserve their long-term effect and prevent exacerbation.

Surgery

Surgical treatment is necessary for patients with erosive form a disease in which large ulcers and gastrointestinal bleeding. Also, it is prescribed when high risk development of a malignant tumor, namely in Barrett's esophagus.

Most often, the operation is performed endoscopically, in which the esophageal sphincter is strengthened. For Barrett's esophagus, treatment should consist of excision of the altered tissue.

Complications of the disease

In the absence of a timely diagnosis and prescribed treatment, gastroesophageal reflux can lead to the following complications:

• narrowing the diameter of the esophagus;
• malignant processes;
• deep ulcers;
• gastrointestinal bleeding;
• anemia;
• cachexia.

Gastroesophagoreflux disease is quite dangerous. It requires timely treatment. If heartburn occurs, which occurs several times a month or more often, you should immediately consult a gastroenterologist. Thanks to modern methods diagnostics, such as PPI test, video capsule endoscopy, diagnostics will be painless for you, and you will forget about heartburn for a long time!