Gerb: treatment with medications and folk remedies. modern treatment of gastroesophageal reflux disease. Modern treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a condition that is accompanied by unpleasant symptoms (heartburn, belching, dysphagia) and/or pathological changes in the esophagus (erosions, ulcers, columnar cell metaplasia - Barrett's esophagus), which are caused by gastroesophageal reflux.

In a broad sense, the term “gastroesophageal reflux disease” applies to all patients with symptoms suggestive of reflux, while “reflux esophagitis” refers to a subgroup of patients with symptoms of GERD who, along with this, have endoscopically and histologically proven the presence of an inflammatory process in the esophagus

The socioeconomic costs of GERD are significant. From an economic perspective, the high prevalence of GERD coupled with the cost of acid-reducing medications gastric juice, is costly to the healthcare system. Moreover, GERD greatly affects the quality of life. Studies have shown that the quality of life and health status in connection with reflux disease in those suffering from this disease, compared with the general population, significantly worsens. A recent systematic review concluded that patients with persistent symptoms, even despite the use of PPIs, experience significant discomfort that negatively affects the person's physical and mental well-being, comparable to that experienced by patients who do not receive treatment for GERD. .

Epidemiology of gastroesophageal reflux disease (GERD)

More than a third of the total US population reports GERD symptoms Once a month or more often. The situation is complicated by the fact that many patients with GERD do not have a clinic. There is an increase in cases of the disease in all regions of the world, and the number of complicated forms is increasing.

Epidemiologists estimate the prevalence of GERD mainly by recording the typical symptoms of heartburn and belching. This approach has some limitations and does not reflect the true prevalence because there are patients with endoscopically confirmed GERD (eg, esophagitis and Barrett's esophagus) who have neither heartburn nor regurgitation. Moreover, some people complain of both, but do not have GERD.

Symptoms that make one think about GERD are noted by many people, and the older the population, the more common the manifestations. A 2005 systematic review found that the prevalence of GERD (defined as a minimum of weekly heartburn and/or sour regurgitation) in the Western world was 10-20%, while in Asia it was lower (5%). The incidence in Western countries is approximately 5 cases per 1000 person-years, which appears to be lower than the prevalence, but accounts for the chronicity of the disease.

Without treatment, this very common condition can lead to many esophageal complications, including erosive esophagitis, peptic strictures, Barrett's esophagus, and esophageal adenocarcinoma. Complications of GERD are believed to occur more often in men with white skin and in older people. In patients with classic symptoms of GERD, if endoscopic examination is performed, erosive esophagitis is detected in approximately 1/3 of cases, benign strictures in 10% and Barrett's esophagus in 20%. Fortunately, adenocarcinoma of the esophagus is found only in a few patients.

Causes of gastroesophageal reflux disease (GERD)

The main damaging factor in the pathogenesis of GERD is the entry of stomach contents into the esophagus. Normally, such aggression towards the inner lining of the esophagus is prevented by several mechanical barriers and physiological mechanisms.

The role of the main barrier is assigned to NPS. The LES is a segment of smooth muscle capable of tonic contraction in the distal part of the esophagus. The sphincter relaxes during swallowing and when the stomach stretches. This helps the air to escape. The LES relaxes from time to time outside of the swallowing process. These relaxations are called “transient relaxations of the lower esophageal sphincter” (TRLES). They are characterized by a longer duration than the relaxation of the LES caused by swallowing. In patients with GERD, during TRNS, not only air, but also liquid gastric contents have time to return to the esophagus - this is how acid reflux is formed. In most patients with GERD, an increased incidence of TRNS is considered to be the main mechanism of pathology, and it appears that TRNS are even more common in obese patients, although the reason for this is unclear.

Another mechanism that leads to gastroesophageal junction failure is a decrease in LES tone, although only a small proportion of patients with GERD have severe LES hypotension. There are many factors that weaken NPS. These include distension of the stomach, the entry of certain types of food into the stomach (fat, chocolate, caffeine and alcohol, etc.), smoking, and many medications (CBK, nitrates, albuterol, etc.).

The third factor is hiatal hernia. There are two main mechanisms explaining why the presence of a hernia leads to the development of GERD. The first is associated with the loss of the influence of the diaphragm legs, that is, the gain that they provide to the LES under normal conditions. The second is realized through a decrease in the threshold for the occurrence of TRNS in response to gastric distension.

Other important mechanisms that deserve attention include natural mucosal factors that protect the esophageal mucosa from normal acid reflux (mucus on the surface and bicarbonate as its component, lining the surface with stratified squamous epithelium, tight intercellular junctions, blood flow), esophageal peristalsis and neutralization of residual acid with bicarbonate-containing saliva. Any defects in these mechanisms, including motor impairment and decreased salivary flow, can lead to the development of GERD.

As for extraesophageal manifestations of GERD, the mechanism of their occurrence most likely lies in direct aspiration of incoming contents with damage to the lining respiratory tract and/or the vagal reflex, triggered by pathological acid reflux from the mucous membrane of the distal esophagus.

Symptoms and signs of gastroesophageal reflux disease (GERD)

The symptoms of GERD are extensive. A typical symptom complex includes heartburn and sour regurgitation (the feeling of sour stomach contents rising up into the throat). Atypical symptoms, such as a feeling of fullness, heaviness, epigastric pain, nausea, bloating and belching, usually indicate GERD, but they can also overlap with other conditions, so in the differential diagnosis there is a whole list: peptic ulcer, achalasia, gastritis, dyspepsia , gastric paresis. In addition, there is a known set of symptoms that are not related to the esophagus, but are characteristic of GERD. These include cough, dry wheezing when breathing, hoarseness and sore throat, but these are all nonspecific for GERD.

Rarely, dysphagia and hypersalivation, a “wet pillow” symptom, occur. Serious complications of the disease include peptic ulcer of the esophagus. The development of esophageal stenosis is accompanied by the appearance of dysphagia. Bitterness in the mouth indicates duodenogastroesophageal reflux with the reflux of bile and alkaline contents.

Diagnosis of gastroesophageal reflux disease (GERD)

The diagnosis of GERD is established based on a combination of a certain set of patient complaints, the results of an objective examination, including endoscopy and esophageal pH-metry and/or antisecretory therapy. To formulate a preliminary diagnosis, recording symptoms such as heartburn and regurgitation is sufficient. This symptom complex is the most reliable, that is, the preliminary diagnosis is based only on anamnestic data, so in practice there is no need to perform an exhaustive list of studies for each patient with heartburn and regurgitation.

When GERD is suspected in a patient with typical symptoms in the absence of warning signs, it is recommended to prescribe a PPI at the first stage of treatment. A positive response to a PPI confirms the diagnosis to some extent, although it cannot be considered a diagnostic criterion. Along with this, some patients deserve a more in-depth examination. Indications that make it necessary to continue the diagnostic search include:

1. the need to confirm the diagnosis of GERD in patients refractory to drug therapy;
2. the presence of a reason to begin identifying complications of GERD;
3. the likelihood of a change in diagnosis to an alternative one;
4. 4 preoperative examination.

Endoscopic examination upper sections The gastrointestinal tract complements the diagnosis, especially if signs are found that suggest erosive esophagitis, peptic strictures, or Barrett's esophagus. However, the majority of patients with typical GERD symptoms (approximately 70%) do not have such symptoms. Endoscopic examination should not be performed in patients with alarming symptoms. These include dysphagia, anemia, melena and weight loss. It is extremely important to exclude complications of GERD such as peptic strictures and esophageal malignancy.

Outpatient reflux monitoring is the only method that allows one to assess the intensity of the effect of acid on the esophagus, the frequency of reflux reflux, and the relationship of reflux with clinical manifestations. IN outpatient setting reflux is monitored in two ways: by using a telemetry capsule, which is either fixed in the distal esophagus (wireless pH capsule), or lowered on a transnasal probe (catheter-type), or by performing a test with a combined impedance-pH-metric probe. The telemetry capsule is fixed to the mucous membrane of the lower part of the esophagus during endoscopic examination of the upper gastrointestinal tract. The advantage of the capsule is that it allows data to be recorded for 48 hours (up to 96 hours if necessary). Monitoring using a catheter allows information to be collected over a 24-hour period and, if complemented by the use of impedance monitoring with an appropriate sensor, it is possible to detect weakly acidic and non-acidic reflux. Both methods can be used with or without therapy. Experts continue to argue which method should be called optimal.

They also often resort to other additional techniques, but it is not recommended to carry them out routinely to evaluate GERD and rely solely on them. For example, an X-ray examination of the esophagus with a barium swallow can be undertaken in cases where the patient complains of dysphagia or strictures and annular narrowings need to be identified, but in other cases of GERD there are no indications for it. Esophageal manometry for GERD as a single diagnostic study is also not suitable, since neither low LES pressure nor movement disorders are signs specific to GERD. The main purpose of esophageal manometry for GERD is to exclude achalasia or changes in the esophagus similar to those observed with scleroderma before prescribing antireflux surgery, since both nosologies are included in the list of contraindications.

The diagnosis is based on typical complaints (heartburn, sour belching), endoscopy data (hyperemia, erosion, etc.) and daily intraesophageal pH-metry.

An informative alginate test is a single dose of Gaviscon that relieves heartburn in patients with GERD with a sensitivity of 97% and a specificity of 88%.

A frequent serious complication of GERD is Barrett's esophagus - replacement of the columnar epithelium of the esophagus in the lower third of the esophagus. Diagnosis of Barrett's esophagus is carried out using a biopsy, narrow-spectrum endoscopy (Narrow Band Imaging), which provides optical enhancement of the image of the surface structure of the mucous membrane, 150-fold magnifying endoscopy, and fluorescent endoscopy.

Differential diagnosis of gastroesophageal reflux disease

• Peptic ulcer of the stomach and duodenum (peptic ulcer)
• Non-ulcer dyspepsia
• Esophageal motility disorders
• Esophagitis of infectious nature
• Drug-induced esophagitis
• Eosinophilic esophagitis
• Cardiovascular pathology
• Biliary tract diseases
• Esophageal carcinoma

It is most important to distinguish between GERD accompanied by burning pain, from angina pectoris. With GERD, symptoms are associated with eating, bending, the pain can be long-lasting, and relieved after drinking water. With angina, pain is caused by physical activity or stress, may have a typical irradiation, and goes away after stopping the exercise and taking nitroglycerin. Verified using instrumental studies (ECG, stress tests and esophageal examination methods).

GERD is differentiated from chronic gastritis and peptic ulcer.

Characteristic clinical manifestations of esophageal cancer are dysphagia in the form of unpleasant sensations. Analyzes reveal acceleration of ESR and anemia. The tumor is detected using barium X-ray of the esophagus, esophagoscopy with biopsy, and CT.

The number of patients with infectious esophagitis is increasing, which is due to the spread of immunodeficiencies. Esophageal candidiasis develops in patients with hematological malignancies, AIDS, and with long-term treatment with steroids and antibiotics. It is often combined with oropharyngeal candidiasis, which manifests itself as pain during chewing and swallowing, when trying to put on dentures, and loss of taste. Candida esophagitis is diagnosed by identifying white plaques and deposits on the esophageal mucosa during esophagoscopy and detecting yeast fungi with pseudohyphae during histological examination. If it is difficult to carry out these studies, for example in patients with AIDS, diagnostics are carried out with trial therapy with systemic antifungal drugs.

Complications of GERD

Benign esophageal stricture

Fibrous strictures develop as a consequence of long-term esophagitis. In most cases, they occur in elderly patients with poor peristaltic activity of the esophagus. Symptoms of dysphagia appear, more pronounced for solid foods. Obstruction by a piece of unchewed food, for example, when eating meat, causes absolute dysphagia. A history of heartburn is common, but not necessary: ​​many older patients with strictures have no known history of heartburn.

The diagnosis is made by endoscopy, during which a biopsy can be taken to rule out malignancy. Endoscopic ballooning or bougienage of the esophagus is effective. After this, long-term treatment with H + , K + -ATPase inhibitors in a full therapeutic dose is necessary to reduce the risk of relapse of esophagitis and re-formation of a stricture. Patients are advised to chew food thoroughly, and for this it is important to have a sufficient number of teeth.

Gastric volvulus

Sometimes a large intrathoracic hiatal hernia can twist through either the organoaxial or lateral axis, resulting in gastric volvulus. This results in complete esophageal or gastric obstruction and is manifested by severe chest pain, vomiting and dysphagia. Diagnosis is made by chest X-ray (gas bubbles in the chest) and contrast study after swallowing barium sulfate. Many cases resolve spontaneously, but there is a tendency to recur, so it is indicated surgical intervention after nasogastric decompression.

Management of a patient with gastroesophageal reflux disease

Management of a patient with GERD first of all requires clarification of the diagnosis using FEGDS and identification of esophagitis (to make the latter diagnosis, as a rule, one has to resort to a trial prescription of drugs that suppress acid formation). A biopsy of the esophagus (its mucous membrane) usually does not prove reflux disease, but it can be used to characterize the inflammatory process and identify changes in the esophagus.

For patients who respond poorly to treatment and who also complain of chest pain, intraesophageal pH monitoring is indicated for 24 hours.

Treatment of gastroesophageal reflux disease (GERD)

Treatment goals:

• elimination of symptoms of the disease;
• prevention and treatment of complications;
• relapse prevention.

To prevent the occurrence of gastroesophageal reflux, it is necessary to follow dietary recommendations. Significantly limit fatty foods, including whole milk and cream, irritants stimulating gastric secretion: alcohol, coffee, strong tea, chocolate, citrus fruits, onions, garlic, spicy, canned, smoked foods, carbonated drinks, sour fruit juices.

Pathogenetic therapy involves reducing the damaging effects of acidic gastric juice. For rare attacks of heartburn, you can use antacids (Almagel, Maalox, phosphalugel).

Alginates (Gaviscon) are effective, forming a gel barrier that floats in the stomach and creates a pH of about 7, and significantly reduces the frequency of reflux episodes.

To improve motility and prevent regurgitation, prokinetics are prescribed.

In refractory forms of GERD, alkaline reflux should be excluded, in the treatment of which prokinetics are effective.

Severe esophagitis and bleeding force us to consider the possibility of fundoplication surgery, the effectiveness of which is not high enough due to relapses during the first year and the possible development of persistent dysphagia.

Barrett's esophagus may regress with effective therapy. However, the presence of intestinal metaplasia is considered a potentially precancerous condition. In this case, an annual endoscopic examination should be performed.

Most patients respond well to treatment with drugs that reduce or eliminate gastric acid secretion:

• Drug therapy eliminates esophagitis and reflux symptoms, but medications do not restore or normalize the anti-reflux barrier at the level of the transition between the stomach and esophagus. In this regard, stopping medication usually leads to a surge in acid secretion (the “rebound” phenomenon) and, accordingly, to the development of relapse.
• Surgical interventions are offered as an alternative to conservative therapy and as a way that supposedly provides a clearer effect. However, modern methods surgical treatment are not ideal, since surgery is always associated with certain health consequences, and it, as a rule, does not relieve the patient from the need to continue taking medications.
• Currently, a number of endoscopic manipulations have been developed to improve the barrier function of the lower esophagus.

The treatment program for GERD involves changes in lifestyle and diet, drug therapy, and for a very specific group of patients, surgical intervention. Depending on the severity of the disease, an approach is justified both in the direction of intensifying treatment and gradually reducing the severity of measures and their cancellation.

So, in the first case, they start with changing lifestyle and prescribing BHRH. This tactic is suitable for patients with mild symptoms in the absence of signs of erosive esophagitis during endoscopic examination. On the contrary, an approach in the form of a gradual reduction in the intensity of therapy, which begins with the use of PPIs, is more acceptable for patients with a moderate or severe clinical picture of erosive esophagitis.

Antacids and alginates also provide symptomatic improvement. H2 receptor blockers also reduce the severity of symptoms, but do not cure esophagitis.

The drugs of choice for severe symptoms are H + , K + -ATPase inhibitors. Symptoms resolve almost completely and esophagitis is cured in most patients.

When treatment is stopped, relapses of the disease often occur, and some patients need to take the drug for life at the lowest effective dose.

Antireflux surgery should be considered if drug therapy is ineffective in patients who refuse to take H + , K + -ATPase inhibitors for a long time, and in patients whose main symptom is severe regurgitation. The operation can be performed open or laparoscopically.

New ones have recently been developed endoscopic methods performing fundoplication.

Drug treatment of gastroesophageal reflux disease: “H + , K + -ATPase inhibitors are more effective than H 2 receptor blockers in treating esophagitis and reducing the severity of symptoms”

Possibilities in the treatment of gastroesophageal reflux disease

Changes in lifestyle and dietary principles traditionally include the following measures: weight loss, raising the head of the bed, eliminating late evening meals and eliminating dietary components that become reflux triggers (chocolate, caffeine and alcohol). A 2006 systematic review of 16 randomized trials examining the effectiveness of lifestyle interventions on GERD found that weight loss and head elevation alone improved esophageal pH and reduced GERD symptoms.

Decisive element of conservative GERD treatment- elimination of the acid factor. This usually provides excellent results both in terms of healing of the esophagus and elimination of clinical manifestations. BHRs suppress histamine-induced stimuli acting on gastric parietal cells. The effectiveness of these drugs is moderate, they are sometimes used to enhance PPI therapy, in which case BHR2 is prescribed to be taken before bed in order to block nighttime acid reflux. Unfortunately, tachyphylaxis very often develops against this background, which limits the long-term effectiveness of such tactics. PPIs are more powerful suppressors of acid-forming function and, compared to BHR 2, heal the esophagus faster and reduce the frequency of relapses. The action of PPI is to irreversibly suppress the pump in the form of H+-K+-adenosine triphosphatase at the final stage of acid production. There are currently seven known representatives of the PPI group without any proven difference in their clinical effectiveness. I would like specialists to thoroughly discuss the problem and be able to propose the most optimal regimen for prescribing PPIs that can provide the best results. Today, PPI therapy begins with a single daily dose 30-60 minutes before breakfast. If only a partial effect was achieved, then to more deeply suppress the symptoms of GERD, the drug is prescribed in two doses or one PPI is replaced with another. Long-term maintenance therapy should be recommended for patients with resumption of symptoms after discontinuation of PPIs and in cases where the disease proceeds with complications. On the other hand, a number of studies have shown that patients without reflux with erosions and other complications of GERD can be successfully treated with PPIs using medication on an event-by-event basis, although there is no pharmacokinetic justification for this approach yet.

Finally, there is a subgroup of patients with symptoms characteristic of GERD, but who do not respond to optimal conservative therapy. In this category of patients, it is important to undertake a more in-depth examination to differentiate patients with persistent acid reflux, which remains despite the use of PPIs, from those with other pathological processes other than GERD. The first step in treatment is to ensure the optimal dosage of PPIs and ensure that the patient accurately follows the prescribed drug regimen. After this, it makes sense to increase the dose, switch to a double dose of medication, or change PPIs. If the clinical picture does not change, in order to exclude other possible pathologies, an endoscopy is performed. When negative results endoscopic examination, pH monitoring is indicated (using a wireless capsule or transnasal probe). This will help ensure that GERD is diagnosed correctly. On the other hand, pH-metry is a method that will document the insufficient effectiveness of PPI and indicate the need for increasing therapeutic measures(for example, in a trial of additional administration of BHR2, the addition of |3-GABA agonists, baclofen, which reduces the number of TRNPS and thereby reduces the number of reflux episodes) and will help decide the feasibility of surgical intervention. If there are no signs of GERD in a patient with characteristic symptoms, including heartburn, it can be stated that “functional heartburn” has been identified.

According to the Rome III recommendations, in order to make a diagnosis of functional heartburn, all symptoms from the following list must be present: discomfort in the form of a burning sensation in the chest or pain; absence of obvious signs of gastroesophageal acid reflux as a cause of heartburn; exclusion of histopathological changes that can disrupt esophageal motility. In such patients, it is advisable to consider the use of visceral analgesics such as TCAs, selective serotonin reuptake inhibitors, or trazodone, since the theoretical cause of functional heartburn is increased sensitivity esophagus.

Surgery is another treatment option for GERD. Before deciding to undergo surgery, it is necessary to obtain objective confirmation of GERD by performing esophageal pH-metry or endoscopy, since the most pronounced positive effect of surgical treatment is observed in patients with typical symptoms in whom PPIs are effective, and in the case where pH results are altered -metry shows a clear correlation of this indicator with the manifestations of the disease. Good surgical results are less likely in patients with atypical clinical presentation and extraesophageal manifestations.

According to the recommendations of the Society of American Gastroenterological Surgeons and Endoscopists, for some patients, surgical treatment must be insisted upon immediately upon receipt of objective confirmation of the diagnosis of GERD. This category includes patients who do not respond to conservative therapy (insufficient control of symptoms or manifestations of side effects medications); patients in need of surgical treatment, despite the success of conservative methods - due to the need for lifelong medication, the high cost of medications, and the presence of complications of GERD; as well as patients with extraesophageal manifestations (cough, cases of aspiration, chest pain, etc.). Preoperative evaluation to select patients for optimal results includes upper gastrointestinal endoscopy, esophageal pH and manometry, X-ray with contrast, and in selected patients, a four-hour gastric emptying scan.

The most popular surgical intervention for GERD is laparoscopic Nissen fundoplication, however, in case of GERD against the background of severe obesity (body mass index - more than 35 kg/m2), it is recommended to apply a gastric bypass, since "Nissen fundoplication is often ineffective. And finally, For some patients, the optimal solution is an intervention such as strengthening the LES using the LINX Reflux system. The operation consists of placing a titanium bead bracelet with a magnetic core around the LES through a laparoscopic approach. It can be considered that there is a basis to begin the scientific study of a method that promises great prospects. And lastly: a method has been developed endoscopic treatment GERD, which involves performing a fundoplication without incisions with access through the mouth, but there is still virtually no data on the long-term effectiveness of this intervention.

Key aspects of patient management

• Patients with typical manifestations of GERD in the absence of warning symptoms (for example, dysphagia) and symptoms indicating possible complications GERD, it is advisable to prescribe empirical therapy.
• Ambulatory pH-metry (using a catheter or capsule) - the only way objective assessment of the degree of pH decrease in the esophagus and the ability to compare the patient’s symptoms in time with episodes of acid reflux.
• Before talking about surgical treatment, it is necessary to document the fact of gastroesophageal reflux, since the greatest effect from surgical treatment can be achieved in patients with typical symptoms who respond to PPI therapy, and in patients with pathological pH values ​​that clearly correlate with symptoms.

Esophageal dysfunction causing disturbances acid balance, has a negative effect not only on the upper gastrointestinal tract. Information about atypical clinical manifestations of gastroesophageal reflux disease (GERD) will help to choose adequate therapeutic tactics and prevent the development of complications.

Reflux is the physiological act of stomach contents entering or gastric juice flowing into the lower esophagus. A portion of liquid or food slurry that has not been used for its intended purpose is called reflux. This phenomenon provokes excess pressure created in the stomach by food masses and (or) gases.

In normal physiological conditions gastric contents are securely held by a special muscular valve at the border with the esophagus, the so-called lower esophageal sphincter (LES). The tone of the LES is regulated by fluctuations in the acidity of gastric juice: alkalization promotes its opening and vice versa.
The main causes of reflux and the development of gastroesophageal reflux disease are:

• weakening of motor functions of the esophagus;
• short muscle tone NPS;
• redundant intra-abdominal pressure;
• disturbances of gastric motility;
• increased acidity of gastric juice.

These circumstances cause prolonged “acidification” of the esophagus, especially its lower section, and damage to the mucosa. A feeling of constant heartburn or regularly recurring attacks suggest the development of GERD.

Symptoms of pathology

Insufficiency of the LES is the root cause of painful symptoms of GERD: both typical (heartburn, belching and damage to the esophageal walls), clearly associated with the digestive tract, and atypical, associated with respiratory dysfunction - the so-called pulmonary symptoms GERD.

Heartburn

The mucous membranes of the esophagus and stomach, although called the same, have completely different structures and purposes. Acid gastric juice getting into the esophageal walls is not a physiological norm. On the contrary, it becomes a sharp traumatic factor, leading to a burn.

A burning sensation in the sternum - heartburn - is a classic symptom of GERD, evidence of persistent damage to the esophageal walls, and the more extensive it is, the stronger and longer the attacks of heartburn. In some cases, the course of GERD does not cause inflammatory changes in the esophageal mucosa. The acidity of the reflux is crucial.

Prolonged irritation of the walls of the esophagus, causing constant heartburn, is an alarming symptom of GERD. In the future, it can lead to the formation of ulcerative lesions, gradual thinning of the esophageal walls and their perforation (rupture). In such cases, urgent surgery is the only chance to save a person’s life.

Belching

Often, disorders of the LES function are accompanied by the release of gastric gases from the esophagus. This phenomenon occurs when the larynx is closed and is called belching. The volume of gas reflux is much larger than liquid reflux, as is the pressure it creates in the stomach. Gas reflux can cause the upper esophageal sphincter to open, reach the larynx and even oral cavity. This causes symptoms of GERD that at first glance have nothing to do with the digestive system.

In case of reflux of gastric contents, the belching has a pronounced sour taste. When reflux occurs from the duodenum, the bitter taste of belching is due to the presence of bile acids and trypsin (pancreatic secretion).

Bile reflux is evidence of insufficiency of the lower valve of the stomach (pylorus), separating duodenum from the stomach, as well as diseases of the biliary tract.

Heartburn and chronic belching are typical, but not the only symptoms of GERD. Adaptive reaction In the body, prolonged irritation of the mucous membrane causes degeneration of the tissues of the esophageal walls: their thickening, scar formation, leading to a narrowing of the lumen of the esophagus, cellular metaplasia.

Esophageal obstruction

The consequence of inflammatory processes is tissue scarring and narrowing (stricture) of the esophagus, which impedes the passage of food masses and causes swallowing disorders (dysphagia). Over time, the movement of the bolus of food begins to cause discomfort and pain when swallowing (odynophagia).

The causes of odynophagia, in addition to GERD, may also be:

• esophagitis of an infectious nature (fungal or viral lesions);
• esophageal tumors;
• chemical injuries of the esophageal walls.

In some cases, obstruction of the esophagus develops, leading to fatal outcome from starvation.

Diverticulum formation

In some cases, a local expansion forms above the narrowing of the esophagus, where food begins to accumulate. The greater the volume of accumulated food mass, the more the esophagus expands and its walls stretch. Part of the wall, consisting of submucosal and mucous tissue, protrudes in the form of a hernia - a diverticulum.

Which has a thin muscle layer, sometimes completely absent. Most often, diverticula form on back wall esophagus. Food accumulates in the protruding part of the wall and an inflammatory process develops, which is accompanied by painful sensations, bad breath and periodic regurgitation. If a diverticulum ruptures, the contents enter the surrounding tissues and the chest cavity, leading to tragic consequences.

Barrett's esophagus

Degeneration (metaplasia) of cells is the body’s protective reaction to regular damage to the upper layer of the esophageal mucosa. The lower third of the esophageal tube is most often affected.

The mucosal cells formed as a result of regeneration (restoration) are not identical to the previous cells typical of this type of tissue. They are called atypical cells. The presence of such cells is a symptom of Barrett's esophagus, the first step towards the occurrence malignant tumors, such as adenocarcinoma of the esophagus or stomach.

Congestion in the stomach: cause and effect of GERD

Digestive disorders in the stomach are caused by disorders of its motor activity. Depending on the nature of these disorders, the release of the stomach from food mass may slow down or accelerate.

Reasons for slower evacuation of food and congestion in the stomach:

1. pyloric spasm caused by disturbances nervous regulation his muscles;
2. pyloric spasm caused by reflex irritations from other organs;
3. organic changes in the pylorus (presence of ulcers, scars, tumors, compression);
4. increased acidity of gastric juice;
5. relaxation of the stomach (atony).

Stagnation of food masses causes their bacterial decomposition. The accumulation of gases and decay products irritates the gastric mucosa, causing heartburn, a feeling of heaviness and bloating, and reflux phenomena. Abnormally rapid satiety, bloating, foul-smelling belching, nausea - gastric symptoms of GERD.

Gastric peristalsis depends on the nature of the food, its temperature, consistency, and the presence of components that irritate the mucous membranes. For example, fatty acids and fat reduce the intensity of peristaltic waves, leading to a decrease in gastric tone.

Achalasia

Insufficient relaxation (persistent spasm of the LES) is a chronic disease - achalasia. It also leads to disturbances in the patency of the esophagus and the expansion of certain areas of it. Progressive achalasia leads to the development of inflammation of the esophageal mucosa (esophagitis) and heartburn. Heartburn in in this case is not associated with GER, but with the formation of lactic acid as a result of the decomposition of food blocked in the esophagus.

Paradoxically, both under- and over-relaxation of the LES cause similar symptoms:

• heartburn;
• rotten burp;
• chest pain;
• nausea;
• discomfort in the epigastric region;
• increased salivation.

Increased salivation

Increased salivation (hypersalivation) can cause inflammatory processes in the oral cavity. But more often it is observed with reflex irritation of special secretory nerves by reflux products, and is a companion to inflammatory processes in the gastrointestinal tract, especially the abdominal organs.

Excessive salivation affects the formation of a bolus (bolus of food) and its impregnation with salivary mucus. A pathological increase in the amount of saliva neutralizes the acidic reaction of gastric juice, reduces the intensity of gastric digestion, stimulates the development of fermentation and putrefaction processes and further complicates the course of GERD.

Similar clinical symptoms: diagnostic difficulties

Chest pain due to obstruction of the esophagus appears in approximately half of the cases. It is associated with spasms of the muscular layer of the esophagus or the pressure of voluminous food lumps in its expanded part. Sometimes the pain is localized between the shoulder blades, simulating angina. Sometimes pain also radiates to the lower jaw and neck. Difference chest pain GERD-related symptoms are different from cardiac ones in that they depend on body position, food intake and are copied by soda or alkaline mineral water.

Coronary heart disease (CHD) occurs due to a lack of blood supply to the main heart muscle - the myocardium. One of the main symptoms is shortness of breath and chest pain of varying intensity and location. The general innervation of the chest organs explains the similar nature of pain in GERD and ischemic heart disease and makes it difficult differential diagnosis, choice of therapeutic regimen and preventive measures.

The course of GERD may be accompanied by symptoms that at first glance are not related to the gastrointestinal tract. Chronic (so-called gastric) cough, discomfort when inhaling, dry wheezing in the lungs, shortness of breath and other breathing disorders are a manifestation of the esophagotracheobronchial (for simplicity, let's call it cough) reflex caused by the entry of gastric contents into the respiratory tract.

Additional Information! Vagal receptors “react” to an irritant only in the presence of inflammatory changes in the mucous membrane, therefore the cough reflex and asthma attacks are not stimulated by physiological reflux.

To establish the cause of cough and determine treatment methods, a complete history is key. Today, two main causes of the cough reflex are known:

1. Irritation by gastric contents of special (vagal) receptors located in the lower esophagus. A cough of this etiology precedes the appearance of “classic” symptoms of GERD; it is dry, long-lasting (up to several years) and greatly complicates the course of ARVI.
2. Irritation of the receptors of the larynx, trachea and bronchi when reflux microparticles enter them (microaspiration). In this case, typical symptoms of GERD occur more often and precede respiratory disorders. As a result of irritation of the mucous membranes, signs of inflammation of the larynx and damage to the vocal cords appear: hoarseness, weak voice, falsetto.

See a doctor immediately

The reason for visiting a doctor is regular attacks of heartburn, pain, foul-smelling belching, prolonged cough of unknown origin, frequent pneumonia.

As well as cough, vomiting blood, progressive weakness, weight loss, black stool.

Only a qualified specialist can assess the benign nature of the symptoms.

Note! Dysfunction of the immune system sometimes provokes the development of eosinophilic esophagitis, which is similar in symptoms to GERD. Under these conditions, therapy using drugs that regulate secretion becomes ineffective.

Positive dynamics of the disease are caused by hormonal antiallergic drugs and a strict diet.

Treatment

Diagnosis of GERD involves antireflux therapy. The most informative and sensitive diagnostic method is daily pH-metry.

The main directions of drug therapy for GERD:

• restoration of esophageal motility (self-cleaning ability);
• reducing acidity reflux;
• protection of the esophageal mucosa (anti-inflammatory therapy);
• reducing the number and duration of reflux.

Drugs called histamine H2 receptor blockers are not intended to prevent the phenomenon of reflux, but to reduce the acidity of the food mass at the time of its reflux into the esophagus. Before the advent of proton pump inhibitors (PPIs), they were the mainstay of treatment for GERD.

The most used blockers are cimetidine, ranitidine, nizatidine, famotidine. The effectiveness of drugs reduces their selective effect on one type of receptor, while acid production is stimulated by three of their types.

Attention! Abrupt withdrawal of blockers can provoke a “recoil” - a jump in acidity.

Prokinetics are drugs that stimulate the motility of the esophagus and stomach. Domperidone, cisapride, metoclopramide are more effective in initial stage diseases, especially in combination with blockers.

Long-term and effective suppression of gastric acidity is provided by PPIs, so they are the basis of the therapeutic regimen: these are rabeprazole, lansoprazole, omeprazole, esomeprazole (Nexium). The regimen and dosage depend on the set and severity of symptoms, but the first daily dose is indicated half an hour before meals. Drugs of this group maintain a long-term therapeutic concentration in the blood, and the maximum healing effect is achieved on the 2-3rd day of administration.

The function of protecting mucous membranes is performed by antacid drugs (Maalox, Almagel, Phosphalugel), intended for quick removal unpleasant symptoms GERD in case of poor diet or excessive physical activity, to relieve occasional attacks of heartburn.

Medications are widely used to reduce the frequency and duration of GERD symptoms. alginic acid- alginates. Reacting with stomach acid, alginates form a gel-like viscous mass, making reflux impossible. It envelops the walls of the stomach and has a neutral reaction. One of the most popular drugs in this group is Gaviscon Forte.

When drug treatments do not bring results, as well as in the event of complications that are life-threatening to the patient, surgical methods treatment - gastric fundoplication (laparoscopic or open), as well as elimination of anatomical defects in the form of hiatal hernia as a cause of GERD.

Prevention

Prevention of GERD, like its treatment, is long-term and requires integrated approach. Long-term remission of the disease is possible only with strict adherence to diet and a radical change in lifestyle: necessary complete failure from smoking, reasonable physical activity. Losing weight reduces the risk of developing a hiatal hernia.

A high-protein diet and minimal (about 45 g per day) fat intake are recommended. Products that irritate the gastric mucosa and stimulate acidity should be excluded from the diet. These are alcohol, spices, chocolate, coffee, carbonated drinks, sour fruits.

You should eat food in small portions and no later than 2 hours before bedtime.

Tight, uncomfortable clothing and excessive physical activity after meals impede gastrointestinal motility and reduce the function of the LES as one of the regulators of the balance of the digestive system.

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

Reasons for the development of the disease

Distinguish following reasons development of gastroesophageal reflux disease:

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

How does the disease manifest itself?

The main symptoms of gastroesophageal reflux are as follows:

• heartburn;
• belching acid and gas;
• acute sore throat;
• discomfort in the pit of the stomach;
• pressure that occurs after eating, which increases after eating food that promotes the production of bile and acid. Therefore, you should give up alcoholic drinks, fruit juices, carbonated water, and radishes.

Often, the symptoms of gastroesophageal reflux disease manifest themselves in the form of belching of semi-digested food masses with bile. In rare cases, patients suffering from esophagitis experience the following symptoms:

• vomiting or urge to vomit;
• profuse salivation;
• dysphagia;
• feeling of pressure behind the sternum.

Often, patients suffering from esophagitis experience retrosternal pain, radiating to the shoulder, neck, arm and back. If the presented symptoms occur, then you need to go to the clinic for a heart examination. The reason is that these symptoms can occur in people suffering from angina. Pain syndrome behind the sternum with reflux disease can be triggered by eating large amounts of food or sleeping on a very low pillow. These symptoms can be eliminated with the help of alkaline mineral waters and antacids.

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

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

• Chronical bronchitis;
• pneumonia;
• asthma;
• painful sensations in the chest;
• heart rhythm disturbance;
• development of pharyngitis and laryngitis.

During the collection of chyme into the bronchi, there is a possibility of bronchospasm. According to statistics, 80% of people suffering from bronchial asthma are diagnosed with gastroesophageal reflux. Often, to relieve the symptoms of asthmatics, all you need to do is reduce the production of acid in the stomach. Approximately 25% of people feel better after such activities.

An external examination of a patient suffering from esophagitis cannot provide detailed information about this disease. Each person has their own symptoms: some have fungiform papillae on the root of the tongue, while others have insufficient production of saliva to supply the oral mucosa.

Classification of the disease

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

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

Diagnostics

Gastroesophageal reflux can be diagnosed using the following methods:

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

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

• cardiologist;
• pulmonologist;
• otorhinolaryngologist;
• surgeon, his consultation is necessary in case of ineffectiveness of the carried out drug treatment, the presence of large diaphragmatic hernias, with the formation of complications.

Effective therapy

Treatment of gastroesophageal reflux disease is based on quickly eliminating the manifestations of the disease and preventing the development of severe consequences.

Taking medications

Such therapy is permitted only after medications have been prescribed by a specialist. If you take certain medications prescribed by other doctors to eliminate missing ailments, this can lead to a decrease in the tone of the esophageal sphincter. These medications include:

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

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

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

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

If bile reflux occurs, then it is necessary to take Ursofalk, Domperidone. The choice of a suitable medicine, its dosage should be carried out strictly in individually and under the constant supervision of a specialist.

For short-term relief of symptoms, antacids are allowed. It is effective to use Gaviscon forte in the amount of 2 teaspoons after meals or Phosphalugel - 1-2 sachets after meals.

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

Diet

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

1. Food is taken 4–6 times a day, in small portions, warm. It is forbidden to take immediately after a meal horizontal position, bend your torso and perform physical exercises.
2. Limit the consumption of foods and drinks that increase the formation of acid in the stomach and reduce the tone of the lower esophageal sphincter. These products include: alcoholic drinks, cabbage, peas, spicy and fried foods, brown bread, legumes, carbonated drinks.
3. Consume as many vegetables, cereals, eggs and oils of plant origin as possible, which contain vitamins A and E. Their action is aimed at improving the renewal of the mucous membrane of the esophagus.

Surgical treatment

When conservative treatment of the presented disease did not produce the required effect, severe complications arose, and surgical intervention was performed. Surgical treatment of gastroesophageal reflux disease can be carried out using the following methods:

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

ethnoscience

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

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

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

Prevention measures

The main preventive measures for GERD include the following:

1. Eliminate the use of alcoholic beverages and tobacco.
2. Limit your intake of fried and spicy foods.
3. Do not lift heavy objects.
4. You cannot stay in an inclined position for a long time.

In addition, prevention includes modern measures to detect motility disorders of the upper digestive tract and treat hiatal hernia.

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, an inflammatory process develops. 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 of hydrochloric acid.
3. The esophagus is “endowed” with the ability to self-cleanse from food debris.

These mechanisms prevent the possibility of mucosal irritation during physiological manifestation 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, a pathological course of the disease develops. Signs of GERD include the following factors:

• 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. Taking certain 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, intra-abdominal pressure increases, 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 squamous multilayer epithelium is replaced by a cylindrical one, which is inherent in the gastric surface layers. Such metaplasia (persistent replacement) significantly increases the risk of developing cancerous tumors. 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 from bronchial asthma, gastroesophageal reflux is diagnosed in most cases. 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 the total time during which the pH is below 4.0.
3. Fibroesophagogastroduodenoscopy. The examination allows you to visually assess the condition 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 a CBC (complete blood count) and a blood sugar test. A liver test and stool donation are also necessary. 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 histamine receptor blockers (for example, 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 may be used, radiofrequency ablation or laparoscopic fundoplication. Other modern techniques can be used for surgical treatment of GERD.

Leading a healthy lifestyle is the basis for preventing GERD. This is also the answer to the question of how to live with such a pathology.

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 is a chronic disease. Her treatment must be on a long-term basis, even after her symptoms are under control. Proper attention must be paid to changes in daily life habits and long-term medication use. This can be done by dispensary observation and patient education.

GERD is often characterized by painful symptoms that can significantly impair a person's quality of life. Various methods are used to effectively treat GERD, ranging from lifestyle changes to 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.

The proton pump inhibitors 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 stomach upset. 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.

Studies that measure the emotional state of individuals with untreated GERD often report worse scores than others 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.