Gerb symptoms treatment. What is gastroesophageal reflux disease or reflux esophagitis?

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 mucosa according to the type of Barrett's disease, all patients suffering from chronic heartburn are recommended to have an endoscopic examination (gastroscopy) with a biopsy of the esophageal mucosa. Patients often report coughing and hoarseness. IN similar 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), inhibitors proton pump(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 esophagus (damage to the muscular layer of the cardia and gastroesophageal junction, with the aim of scarring and reducing reflux), gastrocardiopexy and laparoscopic Nissen fundoplication.

Prognosis and prevention

Prevention of the development of GERD is the management healthy image life with the elimination of risk factors that contribute to the onset of the disease (cessation of smoking, alcohol abuse, fatty and spicy foods, overeating, heavy lifting, prolonged exposure to an inclined position, etc.). Timely measures are recommended to identify disorders of upper motor skills digestive tract and treatment of diaphragmatic hernia.

With timely identification and compliance with lifestyle recommendations (non-drug measures GERD treatment) 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 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. Climb 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 bottom part esophagus in the sternum area. Hernia hiatus diaphragm 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 case 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 substernal painful sensations 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 ulcer and stricture of the esophagus.
3. Barrett's esophagus is a type of disease that is diagnosed in 60% of cases. It represents metaplasia of a multilayered squamous epithelium, provoked 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 organs abdominal cavity helps to detect diseases of the digestive system and exclude pathologies of the cardiovascular system.
7. X-ray of the esophagus, chest and stomach. 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, presence of diaphragmatic hernia large sizes, in the formation of complications.

Effective therapy

Treatment of gastroesophageal reflux disease is based on quick elimination 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. For today effective drugs Metoclopramide and Domperidone are available for children. Their action is aimed at enhancing motor skills antrum 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. At Domperidone side effects are missing. The duration of such treatment is 10–14 days.

Diet

Diet for gastroesophageal reflux disease occupies one of the main directions 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. After a meal, it is forbidden to immediately take a horizontal position, tilt the body 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. Such products include: alcoholic drinks, cabbage, peas, spicy and fried foods, brown bread, legumes, carbonated drinks.
3. Eat as many vegetables, cereals, eggs and oils as possible plant origin, which contain vitamins A and E. Their action is aimed at improving the renewal of the mucous membrane of the esophagus.

Surgical treatment

When conservative treatment of the presented disease did not give the required effect, severe complications arose, carry out surgery. Surgery gastroesophageal reflux disease can be treated by the following methods:

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

ethnoscience

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

1. 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 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 individual special human body. But treatment with folk remedies cannot act as a separate therapy; it is included in the general complex of therapeutic measures.

Prevention measures

To the main preventive measures GERD should include the following:

1. 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.

This disease is characterized by the reverse passage of food from the stomach into the esophagus. Everyone has healthy people From time to time this condition systematically manifests itself. But, if it is repeated frequently, then progression of gastroesophageal reflux disease and reflux esophagitis is possible. According to statistics, men are more prone to this pathology than women.

Types and symptoms of the disease

Gastroesophageal reflux is of two types:

• sour (return of acidic contents from the stomach to the esophagus);
• alkaline (in this case, alkaline contents enter duodenum.)

This disease is divided into two types: physiological and pathological reflux. Let's look at each of them in more detail.
Physiological gastroesophageal reflux, symptoms:

• appears only after eating food;
• does not bring much discomfort;
• The duration and number of refluxes during the day and night are small.

Pathological gastroesophageal reflux, symptoms:

• reflux occurs not only after eating, but also during the day and even at night;
• throughout the day, reflux appears frequently and for a long time;
• causes obvious painful discomfort to a person;
• the mucous membrane of the esophagus becomes inflamed.

The main causes of the disease are the following:

• the initial cause is an overfilling of the stomach and a weakening of the group of muscles responsible for preventing the movement of food from the stomach back into the esophagus;
• pregnancy in women;
• obesity, overweight;
• improperly balanced diet, overeating;
• alcohol abuse, cigarette smoking;
• receiving a series medical supplies leads to a decrease in sphincter tone;
• allergic reaction to consumption certain products nutrition;
• frequent vomiting due to poisoning, anorexia, etc.

Gastroesophageal reflux also often causes discomfort in young children. In this case, reflux manifests itself as regurgitation in infants after feeding. Regurgitation in babies early age are considered normal occurrence and pass before the age of one year. Regurgitation is the process of passively throwing a small amount of previously consumed food from the stomach into the pharynx and oral cavity.

The development of gastroesophageal reflux in infants is influenced by such aspects as:

• relatively small stomach volume;
• slow emptying of stomach contents;
• underdevelopment, immaturity of the esophagus;
• gastric juice has low acidity and others.

In cases where reflux is pathological, gastroesophageal reflux disease may occur. Gastroesophageal reflux disease (GERD), also referred to as reflux esophagitis, is a chronic disease that progresses as a result of a sudden and periodically repeated return of contents from the gastrointestinal tract to the esophagus, which entails inflammatory processes in the tissues of the mucous membrane of the esophagus.

The disease can occur in infants, provided that hydrochloric acid has damaged the mucous membrane of the esophagus.

During illness, young children experience the following symptoms:

• restless behavior, tearfulness;
• frequent regurgitation, especially after feeding;
• Possible vomiting, even with blood;
• periodic cough;
• lack of appetite, refusal to eat;
• poor weight gain as a child.

In older children, GERD manifests itself with the following symptoms:

• pain syndrome in upper section chest;
• swallowing becomes uncomfortable - food seems to get stuck in the esophagus;
• heartburn, sour belching.

Symptoms of the disease are divided into two types: esophageal and extraesophageal.

Esophageal symptoms of GERD:

• heartburn and belching, worse when lying down;
• the presence of a sour taste in the mouth;
• impaired swallowing, periodic regurgitation;
• pain in the esophagus;
• hiccups, possible vomiting;
• feeling of a lump in the chest area.

If reflux occurs in respiratory tract extraesophageal lesions develop.

Extraesophageal symptoms of GERD:

• the appearance of cough, shortness of breath, mainly in supine position, feeling of lack of air;
• possible development of diseases such as: laryngitis, pharyngitis, otitis media;
• dental damage: caries, enamel damage, stomatitis;
• the occurrence of erosions on the surface of the mucous membrane of the esophagus, accompanied by periodic blood loss of small volumes.
• symptoms similar to angina pectoris, presence of heart pain, arrhythmia.

Causes of the disease, treatment

GERD can develop due to the following reasons:

• deterioration in the performance of the lower esophageal sphincter;
• decreased clearance of the esophagus;
• increased level of hydrochloric acid in the contents of the gastrointestinal tract;
• imbalance of gastric emptying function;
• increased intra-abdominal pressure;
• pregnancy;
• bad habits;
• being overweight;
• the use of medications that reduce smooth muscle tone.

The nature of a person’s diet and the way they eat food also significantly influence the development of reflux. If you quickly consume a large amount of food, you may swallow air. How does the result arise high blood pressure in the stomach. As a result, the lower esophageal sphincter relaxes and food is thrown back. Frequent consumption fatty varieties meat, lard, flour products, spicy and fried foods provokes retention of stomach contents. And this in turn affects the increase in intra-abdominal pressure.

If you experience frequent heartburn after eating, especially during horizontal position body when performing bending or physical activity. Also, if you have other symptoms listed earlier, you should urgently consult a doctor to undergo an examination. Don't put it off until later!

Possible complications during the course of gastroesophageal reflux disease:

• intestinal metaplasia;
• peptic ulcer of the esophagus;
• pharyngolaryngeal reflux;
• bleeding in the gastrointestinal region;
• esophageal carcinoma.

Diagnosis of the disease:

• The main method for diagnosing gastroesophageal reflux is endoscopic examination.
• twenty-four-hour (24-hour) pH-metry of the esophagus;
• scintigraphy of the esophagus with a radioactive isotope of technetium and esophagomanometry;
• tissue biopsy followed by histological examination;

Disease prevention:

• implementation of a rationally balanced regime, proper nutrition, avoiding overeating;
• it is necessary to give up all bad habits;
• getting rid of excess weight;
• systematic visits and examinations by a gastroenterologist.

As we see, gastroesophageal reflux has become a serious problem of our time. Everyone should know what this disease is and what its symptoms are. In order to visit a doctor in a timely manner and, if necessary, take a course of treatment. Be attentive to your body. Drive healthy and active image life. Eat right. Don't be nervous or overextended. Be always healthy!

Gastroesophageal reflux disease (GERD) is a chronic relapsing disease caused by spontaneous, regularly repeated reflux of gastric and/or duodenal contents into the esophagus Duodenal contents - the contents of the lumen of the duodenum, consisting of digestive juices secreted by the mucous membrane of the duodenum and pancreas, as well as bile, mucus, impurities gastric juice and saliva, digested food, etc.
, which leads to damage to the lower esophagus.
Often accompanied by the development of inflammation of the mucous membrane of the distal esophagus - reflux esophagitis, and (or) the formation of peptic ulcers and peptic stricture of the esophagus Peptic stricture of the esophagus is a type of cicatricial narrowing of the esophagus that develops as a complication of severe reflux esophagitis as a result of the direct damaging effect of hydrochloric acid and bile on the esophageal mucosa.
, esophageal-gastric bleeding and other complications.

GERD is one of the most common diseases of the esophagus.

Classification

A. Distinguish two clinical variants of GERD:

1. Gastroesophageal reflux without signs of esophagitis. Non-erosive reflux disease (endoscopically negative reflux disease).
A share of this clinical variant accounts for about 60-65% of cases (“Gastroesophageal reflux without esophagitis” - K21.9).

2. Gastroesophageal reflux, accompanied by endoscopic signs of reflux esophagitis. Reflux esophagitis (endoscopically positive reflux disease) occurs in 30-35% of cases (Gastroesophageal reflux with esophagitis - K21.0).

For reflux esophagitis, the recommended classification adopted at the 10th World Congress of Gastroenterologists (Los Angeles, 1994):
- Grade A: One or more mucosal lesions (erosion or ulceration) less than 5 mm in length, limited to a mucosal fold.
- Grade B: One or more mucosal lesions (erosion or ulceration) more than 5 mm in length, limited to a mucosal fold.
- Grade C: Mucosal lesions extend to two or more folds of the mucous membrane, but occupy less than 75% of the circumference of the esophagus.
- Grade D: Damage to the mucous membrane extends to 75% or more of the circumference of the esophagus.

In the USA, the following classification, which is simpler for everyday use, is also common:
- Level 0: There are no macroscopic changes in the esophagus; signs of GERD are detected only by histological examination.
- Level 1: Above the esophagogastric junction, one or more limited foci of inflammation of the mucous membrane with hyperemia or exudate are detected.
- Level 2: Merging erosive and exudative foci of inflammation of the mucous membrane, not covering the entire circumference of the esophagus.
- Level 3: Errosive-exudative inflammation of the esophagus along its entire circumference.
- Level 4: Signs chronic inflammation esophageal mucosa (peptic ulcers, esophageal strictures, Barrett's esophagus).

The severity of GERD does not always depend on the type of endoscopic picture.

B. Classification of GERD according to international scientifically based agreement(Montreal, 2005)

Etiology and pathogenesis

The following reasons contribute to the development of gastroesophageal reflux disease:

I. Decreased tone of the lower esophageal sphincter (LES). There are three mechanisms for its appearance:

1. Occasional relaxation of the NPC in the absence of anatomical abnormalities.

2. Sudden increased intra-abdominal and intragastric pressure higher pressure in the LES area.
Causes and factors: concomitant gastric ulcer (gastric ulcer), duodenal ulcer (duodenal ulcer), disorder motor functions stomach and duodenum, pylorospasm Pylorospasm is a spasm of the pyloric muscles of the stomach, causing the absence or difficulty of emptying the stomach.
, pyloric stenosis Pyloric stenosis is a narrowing of the pylorus of the stomach, making it difficult to empty it
, flatulence, constipation, ascites Ascites - accumulation of transudate in the abdominal cavity
, pregnancy, wearing tight belts and corsets, painful cough, lifting weights.

3. Significant decrease in basal tone of the LES and equalization of pressure in the stomach and esophagus.
Causes and factors: hiatal hernia; operations for diaphragmatic hernias; resection Resection - surgery to remove part of an organ or anatomical education, usually with the connection of its preserved parts.
stomach; vagotomy Vagotomy - surgical operation of crossing vagus nerve or its individual branches; used for treatment peptic ulcer
; long-term use medicines: nitrates, β-blockers, anticholinergic drugs, slow calcium channel blockers, theophylline; scleroderma Scleroderma is a skin lesion characterized by diffuse or limited thickening with subsequent development of fibrosis and atrophy of the affected areas.
; obesity; exogenous intoxication (smoking, alcohol); congenital anatomical disorders in the area of ​​the LES.

Also, reduction of additional mechanical support from the diaphragm (dilation of the esophageal opening) helps reduce the basal tone of the LES.

II. Decreased ability of the esophagus to cleanse itself.
Prolongation of esophageal clearance (the time required to clear the esophagus of acid) leads to increased exposure to hydrochloric acid, pepsin and other aggressive factors, which increases the risk of developing esophagitis.

Esophageal clearance is determined by two defense mechanisms:
- normal peristalsis of the esophagus (release from the trapped aggressive environment);
- normal functioning salivary glands(dilute the contents of the esophagus and neutralize hydrochloric acid).

The damaging properties of the refluxant, that is, the contents of the stomach and/or duodenum thrown into the esophagus:
- resistance of the mucous membrane (inability of the mucous membrane to resist the damaging effects of the refluxant);
- impaired gastric emptying;
- increased intra-abdominal pressure;
- drug-induced damage to the esophagus.

There is evidence of induction of GERD (when taking theophylline or anticholinergic drugs).

Epidemiology

There is no exact information on the prevalence of GERD, which is associated with the large variability of clinical symptoms.
According to studies conducted in Europe and the USA, 20-25% of the population suffers from GERD symptoms, and 7% experience symptoms daily.
25-40% of patients with GERD have esophagitis according to the results endoscopic studies However, in most people, GERD has no endoscopic manifestations.
Symptoms appear equally in men and women.
The true prevalence of the disease is greater, since less than one third of patients with GERD consult a doctor.

Risk factors and groups

It should be remembered that the development of gastroesophageal reflux disease is influenced by the following factors and lifestyle features:
- stress;
- work associated with an inclined position of the body;
- obesity;
- pregnancy;
- smoking;
- nutritional factors ( fatty food, chocolate, coffee, fruit juices, alcohol, spicy food);
- taking drugs that increase the peripheral concentration of dopamine (phenamine, pervitin, other phenylethylamine derivatives).

Clinical picture

Clinical diagnostic criteria

Heartburn, belching, dysphagia, odynophagia, regurgitation, regurgitation, cough, hoarseness, kyphosis

Symptoms, course

Main clinical manifestations GERD are heartburn, belching, regurgitation, dysphagia, odynophagia.

Heartburn
Heartburn is the most characteristic symptom GERD. Occurs in at least 75% of patients; its cause is prolonged contact of the acidic contents of the stomach (pH<4) со слизистой пищевода.
Heartburn is perceived as a burning or hot sensation in the area of ​​the xiphoid process, behind the breastbone (usually in the lower third of the esophagus). Most often appears after eating (especially spicy, fatty foods, chocolate, alcohol, coffee, carbonated drinks). The occurrence is facilitated by physical activity, lifting heavy objects, bending the body forward, horizontal position of the patient, as well as wearing tight belts and corsets.
Heartburn is usually relieved with antacids.

Belching
Belching is sour or bitter, occurs as a result of gastric and (or) duodenal contents entering the esophagus and then into the oral cavity.
As a rule, it occurs after eating, drinking carbonated drinks, and also in a horizontal position. May worsen with exercise after eating.

Dysphagia andodynophagia
They are observed less frequently, usually with complicated GERD. Rapid progression of dysphagia and weight loss may indicate the development of adenocarcinoma. Dysphagia in patients with GERD often occurs when consuming liquid foods (paradoxical dysphagia Dysphagia is the general name for swallowing disorders
).
Odynophagia is pain that occurs when swallowing and passing food through the esophagus; usually localized behind the sternum or in the interscapular space, may radiate Irradiation is the spread of pain beyond the affected area or organ.
in the shoulder blade, neck, lower jaw. Starting, for example, in the interscapular region, it spreads to the left and right along the intercostal spaces, and then appears behind the sternum (inverted dynamics of pain development). The pain often mimics angina pectoris. Esophageal pain is characterized by a connection with food intake, body position and its relief by drinking alkaline mineral waters and antacids.

Regurgitation(regurgitation, esophageal vomiting)
Occurs, as a rule, with congestive esophagitis and is manifested by the passive flow of esophageal contents into the oral cavity.
In severe cases of GERD, dysphagia is associated with heartburn Dysphagia is the general name for swallowing disorders
, odynophagia, belching and regurgitation, and also (as a result of microaspiration of the airways with the contents of the esophagus) the development of aspiration pneumonia is possible. In addition, when the mucous membrane is inflamed with acidic contents, a vagal reflex may occur between the esophagus and other organs, which can manifest as chronic cough, dysphonia Dysphonia is a voice disorder in which the voice remains but becomes hoarse, weak, and vibrating.
, asthma attacks, pharyngitis Pharyngitis - inflammation of the mucous membrane and lymphoid tissue of the pharynx
, laryngitis Laryngitis - inflammation of the larynx
, sinusitis Sinusitis - inflammation of the mucous membrane of one or more paranasal sinuses
, coronary spasm.

Extraesophageal symptoms of GERD

1. Bronchopulmonary: cough, asthma attacks. Episodes of nocturnal suffocation or respiratory discomfort may indicate the occurrence of a special form of bronchial asthma, pathogenetically associated with gastroesophageal reflux.

2. Otorhinolaryngological: hoarseness, symptoms of pharyngitis.

3. Dental: caries, thinning and/or erosion of tooth enamel.

4. Severe kyphosis Kyphosis is a curvature of the spine in the sagittal plane with the formation of a convexity facing posteriorly.
, especially if it is necessary to wear a corset (often combined with a hiatal hernia and GERD).

Diagnostics

Mandatory studies

One-time:

1.X-ray examination chest, esophagus, stomach.
It is necessary to identify signs of reflux esophagitis and other complications of GERD, accompanied by significant organic changes in the esophagus (peptic ulcer, stricture, hiatal hernia, and others).

2. Esophagoscopy(esophagogastroduodenoscopy, endoscopic examination).
Necessary to identify the degree of development of reflux esophagitis; the presence of complications of GERD (peptic ulcer of the esophagus, esophageal stricture, Barrett's esophagus, Schatzky rings); exclusion of esophageal tumor.

3.24-hour intraesophageal pH-metry(intraesophageal pH-metry).
One of the most informative methods for diagnosing GERD. Allows you to evaluate the dynamics of the pH level in the esophagus, the relationship with subjective symptoms (food intake, horizontal position), the number and duration of episodes with pH below 4.0 (reflux episodes more than 5 minutes), the ratio of reflux time (with GERD pH<4.0 более чем 5% в течение суток).

(Note: the normal pH of the esophagus is 7.0-8.0. When acidic gastric contents reflux into the esophagus, the pH drops below 4.0)

4. Intraesophageal manometry(esophagomanometry).
Allows you to identify changes in the tone of the lower esophageal sphincter (LES), motor function of the esophagus (body peristalsis, resting pressure and relaxation of the lower and upper esophageal sphincters).

Normally, LES pressure is 10-30 mmHg. Reflux esophagitis is characterized by a decrease to less than 10 mHg.

Also used for differential diagnosis with primary (achalasia) and secondary (scleroderma) lesions of the esophagus. Manometry helps to correctly position the probe for pH monitoring of the esophagus (5 cm above the proximal edge of the LES).
The most informative and physiological is the combination of 24-hour esophageal manometry with esophageal and gastric pH monitoring.

5.Ultrasound abdominal organs to determine concomitant pathology of the abdominal organs.

6. Electrocardiographic study, bicycle ergometry for differential diagnosis with ischemic heart disease. With GERD, no changes are detected. When identifying extraesophageal syndromes and determining indications for surgical treatment of GERD, consultations with specialists (cardiologist, pulmonologist, ENT, dentist, psychiatrist, etc.) are indicated.

Provocative tests

1. Standard test for GERD using acid.
The test is carried out by placing the pH electrode 5 cm above the upper edge of the LES. Using a catheter, 300 ml is injected into the stomach. 0.1 N HCl solution, after which the pH of the esophagus is monitored. The patient is asked to breathe deeply, cough, and perform Valsalva and Müller maneuvers. Research is carried out by changing body position (lying on your back, on your right side, on your left side, lying with your head down).
Patients with GERD experience a decrease in pH below 4.0. In patients with severe reflux and impaired esophageal peristalsis, the decrease in pH persists for a long time.
The sensitivity of such a test is 60%, specificity is 98%.

2.Bernschein acid perfusion test.
Used to indirectly determine the sensitivity of the esophageal mucosa to acid. A decrease in the acid sensitivity threshold is typical for patients with GERD complicated by reflux esophagitis. Using a thin probe, a 0.1 N solution of hydrochloric acid is injected into the esophagus at a rate of 6-8 ml per minute.
The test is considered positive and indicates the presence of esophagitis if, 10-20 minutes after the end of HCl administration, the patient develops symptoms characteristic of GERD (heartburn, chest pain, etc.), which disappear after perfusion of isotonic sodium chloride solution into the esophagus or taking antacids.
The test is highly sensitive and specific (from 50 to 90%) and, in the presence of esophagitis, can be positive even with negative results of endoscopy and pH measurements.

3. Test with an inflatable balloon.
An inflatable balloon is placed 10 cm above the LES and gradually inflated with air in 1 ml portions. The test is considered positive when typical symptoms of GERD appear simultaneously with gradual distension of the balloon. The tests induce spastic motor activity of the esophagus and reproduce chest pain.

4. Therapeutic test with one of the proton pump inhibitors in standard dosages, for 5-10 days.

Also, according to some sources, the following methods are used as diagnostics:
1. Scintigraphy of the esophagus - a functional imaging method that involves injecting radioactive isotopes into the body and obtaining an image by measuring the radiation they emit. Allows you to evaluate esophageal clearance (time to clear the esophagus).

2. Impedancemetry of the esophagus - allows you to study normal and retrograde peristalsis of the esophagus and refluxes of various origins (acid, alkaline, gas).

3. According to indications - assessment of disorders of the evacuation function of the stomach (electrogastrography and other methods).

Laboratory diagnostics

There are no laboratory signs pathognomic for GERD.

GERD and Helicobacter pylori infection
It is currently believed that H. pylori infection is not the cause of GERD, however, against the background of significant and long-term suppression of acid production, Helicobacter spreads from the antrum to the body of the stomach (translocation). In this case, it is possible to accelerate the process of loss of specialized gastric glands, which leads to the development of atrophic gastritis and, possibly, stomach cancer. In this regard, those patients with GERD who require long-term antisecretory therapy need to be diagnosed with Helicobacter; if an infection is detected, eradication is indicated.

Differential diagnosis

In the presence of extra-esophageal symptoms, GERD should be differentiated from coronary heart disease, bronchopulmonary pathology (bronchial asthma, etc.), esophageal cancer, gastric ulcer, bile duct diseases, and esophageal motility disorders.

For a differential diagnosis with esophagitis of other etiologies (infectious, drug-induced, chemical burns), endoscopy, histological examination of biopsy specimens and other research methods (manometry, impedance measurement, pH monitoring, etc.) are performed, as well as diagnostics of suspected infectious pathogens using the methods adopted for this.

Complications

One of the serious complications of GERD is Barrett's esophagus, which develops in patients with GERD and complicates the course of this disease in 10-20% of cases. The clinical significance of Barrett's esophagus is determined by the very high risk of developing adenocarcinoma of the esophagus. In this regard, Barrett's esophagus is classified as a precancerous condition.
GERD may be complicated by stridor breathing, fibrosing alveolitis, due to the frequent development of regurgitation Regurgitation is the movement of the contents of a hollow organ in the direction opposite to the physiological one as a result of contraction of its muscles.
after eating or during sleep and subsequent aspiration.

Treatment

Non-drug treatment

Patients with GERD are recommended to:
- weight loss;
- stopping smoking;
- refusal to wear tight belts or corsets;
- sleep with the head of the bed raised;
- eliminating unnecessary stress on the abdominals and work (exercises) associated with bending the body forward;
- refrain from taking medications that promote reflux (sedatives and tranquilizers, calcium channel inhibitors, alpha or beta blockers, theophylline, prostaglandins, nitrates).

Reducing or avoiding foods that weaken the tone of the LES: spicy and fatty foods (including whole milk, cream, cakes, pastries, fatty fish, goose, duck, pork, lamb, fatty beef), coffee, strong tea, orange and tomato juice, carbonated drinks, alcohol, chocolate, onions, garlic, spices, too hot or cold food.
- split meals in small portions and refusal to eat at least 3 hours before bedtime.

However, as a rule, following these recommendations is not enough to completely relieve symptoms and complete healing of erosions and ulcers of the esophageal mucosa.

Drug treatment

The goal of drug treatment is to quickly relieve the main symptoms, heal esophagitis, and prevent relapses of the disease and its complications.

1. Antisecretory therapy
The goal is to reduce the damaging effect of acidic gastric contents on the esophageal mucosa. The drugs of choice are proton pump blockers (PPIs).
Prescribed once a day:
- omeprazole: 20 mg (in some cases up to 60 mg/day);
- or lansoprazole: 30 mg;
- or pantoprazole: 40 mg;
- or rabeprazole: 20 mg;
- or esomeprazole: 20 mg before breakfast.
Treatment is continued for 4-6 weeks for non-erosive reflux disease. For erosive forms of GERD, treatment is prescribed for a period of 4 weeks (single erosions) to 8 weeks (multiple erosions).
If the healing dynamics of erosions are not fast enough or in the presence of extraesophageal manifestations of GERD, a double dose of proton pump blockers should be prescribed and the duration of treatment should be increased to 12 weeks or more.
The criterion for the effectiveness of therapy is persistent elimination of symptoms.
Subsequent maintenance therapy is carried out at a standard or half dose on demand when symptoms appear (on average, once every 3 days).

Notes
The most powerful and long-lasting antisecretory effect is rabeprazole (Pariet), which is currently considered the “gold standard” for drug treatment of GERD.
Taking histamine H2 receptor blockers as antisecretory drugs is possible, but their effect is lower than that of proton pump inhibitors. The combined use of proton pump blockers and histamine H2 receptor blockers is inappropriate. Histamine receptor blockers are justified if PPIs are intolerant.

2. Antacids. At the beginning of the course of treatment for GERD, a combination of PPIs with antacids is recommended until stable control of symptoms (heartburn and regurgitation) is achieved. Antacids can be used as a symptomatic remedy to relieve infrequent heartburn, but preference should be given to taking proton pump inhibitors, incl. "on demand". Antacids are prescribed 3 times a day 40-60 minutes after meals, when heartburn and chest pain most often occur, and also at night.

3. Prokinetics improve the function of the LES, stimulate gastric emptying, but are most effective only as part of combination therapy.
Preferably use:
- domperidone: 10 mg 3-4 times/day;
- metoclopramide 10 mg 3 times a day or before bedtime - less preferable, as it has more side effects;
- bethanechol 10-25 mg 4 times/day and cesapride 10-20 mg 3 times/day are also less preferable due to side effects, although they are used in some cases.

4. For reflux esophagitis caused by the reflux of duodenal contents (primarily bile acids) into the esophagus, a good effect is achieved by taking ursodeoxycholic acid at a dose of 250-350 mg per day. In this case, it is advisable to combine the drug with prokinetics in the usual dose.

Surgery
Indications for antireflux surgery for GERD:
- young age;
- absence of other severe chronic diseases;
- ineffectiveness of adequate drug therapy or the need for lifelong PPI therapy;
- complications of GERD (esophageal stricture, bleeding);
- Barrett's esophagus with the presence of high-grade epithelial dysplasia - obligate precancer;
- GERD with extraesophageal manifestations (bronchial asthma, hoarseness, cough).

Contraindications to antireflux surgery for GERD:
- elderly age;
- presence of severe chronic diseases;
- severe disturbances in esophageal motility.

An operation aimed at eliminating reflux is fundoplication, including endoscopic one.

The choice between conservative and surgical tactics depends on the patient’s health status and his preferences, the cost of treatment, the likelihood of complications, the experience and equipment of the clinic and a number of other factors. Non-drug therapy is considered strictly mandatory for any treatment strategy. In routine practice, with moderate heartburn without signs of complications, complex and expensive methods are poorly justified and trial therapy with H2-blockers is sufficient. Some experts still recommend starting treatment with radical lifestyle changes and the use of PPIs until endoscopic symptoms are relieved, then switching to H2-blockers with the patient's consent.

Forecast

GERD is a chronic disease; 80% of patients experience relapses after stopping medication, so many patients require long-term drug treatment.
Non-erosive reflux disease and mild reflux esophagitis, as a rule, have a stable course and a favorable prognosis.
The disease does not affect life expectancy.

Patients with severe forms may develop complications such as esophageal stricture Esophageal stricture is a narrowing, reduction in the lumen of the esophagus of various nature.
or Barrett's esophagus.
The prognosis worsens with a long duration of the disease in combination with frequent long-term relapses, with complicated forms of GERD, especially with the development of Barrett's esophagus due to the increased risk of developing adenocarcinoma Adenocarcinoma is a malignant tumor originating and built from glandular epithelium.
esophagus.

Hospitalization

Indications for hospitalization:
- in case of complicated course of the disease;
- if adequate drug therapy is ineffective;
- carrying out endoscopic or surgical intervention in case of ineffectiveness of drug therapy, in the presence of complications of esophagitis (esophageal stricture, Barrett's esophagus, bleeding).

Prevention

The patient should be explained that GERD is a chronic disease that usually requires long-term maintenance therapy.
It is advisable to follow recommendations for lifestyle changes (see section “Treatment”, paragraph “Non-drug treatment”).
Patients should be informed about the possible complications of GERD and recommended to consult a doctor if symptoms of the disease occur.

Information

Sources and literature

1. Ivashkin V.T., Lapina T.L. Gastroenterology. National leadership. Scientific and practical publication, 2008
   1. pp 404-411
2. McNally Peter R. Secrets of gastroenterology / translation from English. edited by prof. Aprosina Z.G., Binom, 2005
   1. p.52
3. Roytberg G.E., Strutynsky A.V. Internal illnesses. Digestive system. Textbook, 2nd edition, 2011
4. wikipedia.org (Wikipedia)
   1. http://ru.wikipedia.org/wiki/Gastroesophageal_reflux_disease
   2. Maev I.V., Vyuchnova E.S., Shchekina M.I. Gastroesophageal reflux disease M. Journal “Treating Doctor”, No. 04, 2004 - -
   3. Rapoport S.I. Gastroesophageal reflux disease. (Manual for doctors). - M.: Publishing House "MEDPRACTIKA-M". - 2009 ISBN 978-5-98803-157-4 - page 12
   4. Bordin D.S. Treatment safety as a criterion for choosing a proton pump inhibitor in a patient with gastroesophageal reflux disease. Consilium Medicum. - 2010. - Volume 12. - No. 8 - http://www.gastroscan.ru/literature/authors/4375
   5. Standards for diagnosis and treatment of acid-dependent and Helicobacter pylori-associated diseases (fourth Moscow agreement). Adopted by the X Congress of the Scientific Society of Gastroenterologists of Russia on March 5, 2010 - http://www.gastroscan.ru/literature/authors/4230

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Gastroesophageal reflux is the reflux of gastric (gastrointestinal) contents into the lumen of the esophagus. Reflux is called physiological if it appears immediately after eating and does not cause obvious discomfort to a person. If reflux occurs quite often, at night, and is accompanied by unpleasant sensations, we are talking about a pathological condition. Pathological reflux is considered within the framework of gastroesophageal reflux disease.

Hydrochloric acid has an irritating effect on the mucous membrane of the esophagus and provokes its inflammation. Prevention of damage to the esophageal mucosa is carried out through the following mechanisms:

1. The presence of a gastroesophageal sphincter, the contraction of which leads to a narrowing of the lumen of the esophagus and obstruction of the passage of food in the opposite direction;
2. Resistance of the mucous wall of the esophagus to stomach acid;
3. The ability of the esophagus to cleanse itself of abandoned food.

When any of these mechanisms are disrupted, there is an increase in the frequency as well as the duration of reflux. This leads to irritation of the mucous membrane with hydrochloric acid, followed by the development of inflammation. In this case, we should talk about pathological gastroesophageal reflux.

How to distinguish physiological gastroesophageal reflux from pathological?

Physiological gastroesophageal reflux is characterized by the following symptoms:

• Occurrence after eating;
• Absence of accompanying clinical symptoms;
• Low frequency of reflux per day;
• Rare episodes of reflux at night.

The following signs are characteristic of pathological gastroesophageal reflux:

• The occurrence of reflux even outside of meals;
• Frequent and prolonged reflux;
• The appearance of reflux at night;
• Accompanied by clinical symptoms;
• Inflammation develops in the esophageal mucosa.

Classification of reflux

Normally, the acidity of the esophagus is 6.0-7.0. When gastric contents, including hydrochloric acid, are thrown into the esophagus, the acidity of the esophagus drops to less than 4.0. Such refluxes are called acidic.

When the acidity of the esophagus is from 4.0 to 7.0, we speak of weakly acidic reflux. And finally, there is such a thing as superreflux. This is acid reflux, which occurs against the background of an already reduced acidity level of less than 4.0 in the esophagus.

If gastrointestinal contents, including bile pigments and lysolecithin, are thrown into the esophagus, the acidity of the esophagus rises above 7.0. Such refluxes are called alkaline.

Causes of GERD

Gastroesophageal reflux disease (GERD) is a chronic disease caused by spontaneous and systematically repeated reflux of gastric (gastrointestinal) contents into the esophagus, leading to damage to the mucous membrane of the esophagus.

The development of the disease is influenced by eating habits and nutritional patterns. Rapid absorption of large amounts of food with the swallowing of air leads to increased pressure in the stomach, relaxation of the lower esophageal sphincter and reflux of food. Excessive consumption of fatty meat, lard, flour products, spicy and fried foods leads to retention of the food bolus in the stomach and even an increase in intra-abdominal pressure.

Symptoms that appear with GERD can be divided into two subgroups: esophageal and extraesophageal symptoms.

Gastroenterologists include esophageal symptoms:

• Heartburn;
• Belching;
• Regurgitation;
• Sourish;
• Swallowing problems;
• Pain in the esophagus and epigastrium;
• Hiccups;
• Sensation of a lump behind the sternum.

Extraesophageal lesions occur due to the entry of the refluxant into the respiratory tract, the irritating effect of the refluxant, and activation of the esophagobronchial and esophagocardial reflexes.

Extraesophageal symptoms include:

• Pulmonary syndrome (cough, shortness of breath, predominantly occurring in a horizontal position of the body);
• Otorhinolaryngopharyngeal syndrome (development of rhinitis, reflex apnea);
• Dental syndrome (rarely aphthous stomatitis);
• Anemic syndrome - as the disease progresses, erosions form on the mucous membrane of the esophagus, accompanied by chronic loss of blood in small quantities.
• Cardiac syndrome (,).

Complications of GERD

Among the most common complications, it is worth highlighting the formation of esophageal stricture, ulcerative-erosive lesions of the esophagus, bleeding from ulcers and erosions, and the formation of Barrett's esophagus.

The most serious complication is the formation of Barrett's esophagus. The disease is characterized by the replacement of normal squamous epithelium with columnar gastric epithelium.

The danger is that such metaplasia significantly increases the risk of esophageal cancer.

In the first few months of life, gastroesophageal reflux is normal. Infants have certain anatomical and physiological features that predispose them to the formation of reflux. This includes underdevelopment of the esophagus, low acidity of gastric juice, and small stomach volume. The main manifestation of reflux is regurgitation after feeding. In most cases, this symptom resolves on its own by the end of the first year of life.

When hydrochloric acid reflux damages the lining of the esophagus, GERD develops. In infants, this disease manifests itself in the form of anxiety, tearfulness, excessive regurgitation, turning into profuse vomiting, bloody vomiting, and coughing may occur. The child refuses food and does not gain weight well.

GERD in older children is manifested by heartburn, pain in the upper chest, discomfort when swallowing, a feeling of food being stuck, and a sour taste in the mouth.

Diagnostics

Various methods are used to diagnose gastroesophageal reflux disease. First of all, if GERD is suspected, it is necessary to conduct an endoscopic examination of the esophagus. This method makes it possible to identify inflammatory changes, as well as erosive and ulcerative lesions on the mucous membrane of the esophagus, strictures, and areas of metaplasia.

Patients also undergo esophagomanometry. The results of the study will provide insight into the motor activity of the esophagus and changes in sphincter tone.

In addition, patients should undergo 24-hour monitoring of esophageal pH. Using this method, it is possible to determine the number and duration of episodes with abnormal acidity levels of the esophagus, their relationship with the onset of symptoms of the disease, food intake, changes in body position, and medications.

Treatment

In the treatment of GERD, medications, surgical methods, and lifestyle correction are used.

Drug treatment

Drug therapy is aimed at normalizing acidity and improving motor skills. The following groups of drugs are used:

• Prokinetics (domperidone, metoclopramide)- to enhance the tone and contraction of the lower esophageal sphincter, improve the transport of food from the stomach to the intestines, reduce the number of refluxes.
• Antisecretory agents(proton pump inhibitors, H2-histamine receptor blockers) - reduce the damaging effects of hydrochloric acid on the esophageal mucosa.
• Antacids(phosphalugel, almagel, maalox) - inactivate hydrochloric acid, pepsin, adsorb bile acids, lysolecithin, help improve esophageal cleansing.
• Reparants(sea buckthorn oil, dalargin, misoprostol) - accelerate the regeneration of erosive and ulcerative lesions.

Surgery

Surgical intervention is resorted to when complications of the disease develop (strictures, Barrett's esophagus, grade III-IV reflux esophagitis, mucosal ulcers).

An alternative in the form of surgical treatment is also considered if it is not possible to achieve a reduction in GERD symptoms against the background of lifestyle correction and drug treatment.

There are various methods of surgical treatment of the disease, but in general their essence comes down to restoring the natural barrier between the esophagus and the stomach.

To consolidate the positive results of treatment, as well as to prevent relapses of the disease, you should adhere to the following recommendations:

• Fighting excess weight;
• Quitting smoking, alcohol, caffeine-containing drinks;
• Limiting the consumption of foods that increase intra-abdominal pressure (carbonated drinks, beer, legumes);
• Limiting the consumption of foods with an acid-stimulating effect: flour products, chocolate, citrus fruits, spices, fatty and fried foods, radishes, radishes;
• You should eat food in small portions, chewing slowly, and do not talk while eating;
• Limiting heavy lifting (no more than 8-10 kg);
• Raising the head of the bed ten to fifteen centimeters;
• Limiting the use of medications that relax the esophageal sphincter;
• Avoid taking a horizontal position after eating for two to three hours.

Grigorova Valeria, medical observer