Gastroesophageal Reflux

The term gastroesophageal reflux refers to a pathological condition in which the hydrochloric acid and the contents of the stomach are injected into the upper parts of the digestive system,as a result of which the histology of the esophagus tissues is disturbed. The disease provokes esophagitis( inflammation of the esophagus mucosa) or Barrett's esophagus( narrowing of the esophageal tube), cancer, so it is necessary to start therapy on time.

Reflux can also occur in healthy people, for example, as a result of overeating or increased gas formation in the stomach due to the use of certain products. In the absence of pathology reflux is prevented by the lower esophageal sphincter and the ability of the organ to self-purification, so there is no specific damage to the mucous tube.

Symptoms of pathology

Typical signs of gastroesophageal reflux are:

• heartburn. Heartburn means a feeling of burning behind the sternum, which can spread to the neck, the area of ​​the scapula. A mild heartburn occurs after using antacids or milk;
• regurgitation. Gastric juice rises in the throat, which causes an unpleasant aftertaste in the mouth. Reflux of the stomach occurs after overeating, torso bending forward or in a supine position;
• dysphagia or difficulty swallowing. With long-flowing esophageal reflux, benign strictures are formed in the esophageal tube, which affect the speed of passage of food. If the lumen of the esophagus has narrowed and is less than 13 mm, then the symptom appears when swallowing solid food, if the diameter is even smaller, this can lead to difficulty in swallowing saliva;
• liquid belching. This manifestation of the disease is rare, but it can be considered a specific symptom. The patient has a foam in his mouth as a result of hypersecretion of saliva( up to 10 ml of saliva per minute), which occurs as a reaction to esophageal-salivary reflux.

Also, patients can complain about voice changes( especially when they become hoarse and raspy after sleeping, as the larynx is irritated), coughing, neck tension, hiccups, ear diseases, erosion in the tongue, belching, food regurgitation, nausea after eating.

Indirect signs of reflux disease can be increased symptomatology when wearing tight, tight clothing, thinning of tooth enamel, children can have head movements when swallowing. If the pathology is strongly pronounced, the patients complain of pain in the chest as the food lumps move.

Since hydrochloric acid can penetrate the throat, bronchospasm

can occur. Bleeding from the digestive system with GER is rare. As the endoscopic study shows, the cause of bleeding is erosive esophagitis, which is a consequence of gastroesophageal reflux.

Causes of the disease

With frequent gastroesophageal reflux, inflammation of the lower esophagus leads to the development of GERD( gastroesophageal reflux disease).The cause of stomach reflux may be:

• alcohol intake;
• smoking;
• excess weight;
• diaphragmatic hernia;
• pregnancy;
• scleroderma;
• drug therapy( anticholinergics, beta-blockers, calcium channel blockers, dopamine-active and sedative drugs, tricyclic antidepressants).
• hyperacid gastritis;
• duodenitis.

In pathologies of the gastrointestinal tract, pressure in the small intestine can change, as a result of which bile enters the stomach, and then the hepatic secret enters the esophagus along with the gastric juice. With this pathology the leading signs will be diffuse pain in the abdomen, nausea, vomiting with an admixture of bile, a yellow coating on the tongue, belching of air, bitterness in the mouth.

The transfer of the contents of the stomach into the esophagus leads to increased salivation and increased swallowing movements. Saliva neutralizes the acidic environment and causes a contraction of the muscles of the esophagus, which ensures its purification from acid and food residues. The person makes about 72 swallowing acts per hour, and during the meal this figure reaches 192.

In a dream, only 7 swallowings of saliva per hour are performed, and this figure decreases with the use of sedatives, alcohol or if a person smokes. And since saliva is secreted less and the esophagus is not cleared, patients after waking can cough, notice voice changes.

Diagnosis of the disease

Gastro-oesophageal reflux should be distinguished from esophagitis of infectious or medicinal origin, peptic ulcer, gastritis, diseases of the hepatobiliary system, deterioration of esophageal motility.

A GER attack can be induced by angina or myocardial infarction that threatens the life of the patient

The number of necessary studies depends on the severity of the symptoms. Patients who do not have severe signs of stomach reflux( aspiration or asphyxia) or dysphagia, a rational diet and the administration of H-2 blockers of histamine receptors are indicated. After drug therapy, the patient's condition is assessed. If the symptoms remain or are resumed, 2-3 months after taking the medication, then a hardware examination is performed.

An x-ray examination using barium suspension is performed to identify anatomical disorders, in particular hernia of the esophagus or detection of strictures. Spontaneous casting of contrast to the upper orifice of the chest is considered a sign of GER.This examination is useful in differential diagnosis. Esophagogastroduodenoscopy( EHDS) is used to detect macroscopic signs of esophagitis.

This study allows you to determine the stage of the disease:

• 0 degree. Macroscopic disorders are absent, there are only histological signs;
• 1 degree. One or more foci are identified, reddening of the mucosa or exudate;
• 2 degree. Erosions merge( but they are not yet circular), there are exudative lesions of the tissue;
• 3 degree. Erosions are circular;
• 4 degree. There are chronic damage to the mucosa of the esophageal tube( ulcers, strictures, Barrett's esophagus).

To determine the severity of gastroesophageal reflux, tests are carried out to assess the acidity in the esophagus, the esophageal barrier and motor organ, the time of cleansing the tube from acidic contents. These studies are conducted only for those patients who are not helped by drug therapy or a diagnosis in doubt.

Ultrasound of the abdominal cavity helps to see the contours, structure and size of the organs, reveals the presence of formation or compaction, which is important for determining the diagnosis of

. Recommendations for patients with gastroesophageal reflux

Patients with ERS are advised to adhere to certain rules that prevent the transfer of gastric contents into the esophagus:

• to give up tight clothing, corsets, do not wear belts or belts;
• to refuse from alcohol and smoking;
• to exclude from the diet products that reduce the tone of the lower esophageal sphincter( fats, chocolate, peppermint, tomatoes and products based on them, orange and pineapple juice);
• discard chewing gums and sweets for resorption;
• not stay up for 2-4 hours after ingestion;
• raise the head of the bed by 10-15 centimeters;
• if there is excess weight, then you need to lose weight.

Drug withdrawal

To eliminate food and hydrochloric acid from the stomach, the following groups of medicines are assigned to the esophagus:

• antacids( Almagel, Maalox).They neutralize hydrochloric acid in the stomach;
• proton pump inhibitors( esomeprosol, Rabeprozol).Reduce the amount of hydrochloric acid in the stomach;
• H-2 blockers( Ranitidine-Acry, Famotidine).Reduce the production of cells of hydrochloric acid;
• prokinetics( Cisapride, Motiyium, Cerucal).Affect the function of the lower esophageal sphincter.

At the first stage of the disease, it is recommended that patients change their lifestyle and adhere to dietary nutrition, and when heartburn occurs, drink antacids, prokinetics or sucralfate. Antacids are taken after meals, and also before bedtime, if necessary, you can drink 1 g of the drug 4 times a day. Side effects of therapy include diarrhea( if the medicine contains magnesium) or constipation( if the drug contains aluminum and calcium).

In the 2 stages of esophagitis, it is advised to radically reduce weight and change the diet. Drug treatment is prescribed by H-2 blockers of histamine receptors, the dosage of which is selected individually. At stage 3, the treatment of gastric reflux is carried out by blockers of the proton pump( omeprazole or lansoprazole).It is assumed that these drugs increase the risk of developing malignant tumors.

In 4 stages of the disease, surgical intervention is indicated, as long-term administration of large doses of medication is required. During the operation, a sphincter is formed from the walls of the stomach. If the pathology is started, then the manifestations of the disease are eliminated by inhibitors of the proton pump( omeprazole or lansoprazole), but in 4 patients out of 5 the disease recurs within six months after the cessation of drug therapy. Therefore, it is difficult to cure the disease.

The person can overlook symptoms of gastric reflux for years

Erosive gastroesophageal reflux refers to chronic pathologies, since the likelihood of its recurrence is high. The purpose of drug therapy in this case, to reduce the severity of symptoms and prevent the development of complications( esophageal stricture, bleeding, Barrett's esophagus).If you have symptoms of ailment, you need to change your eating habits and give up fatty, spicy, salty foods.

It is necessary to adhere to the rules of rational and fractional nutrition. If heartburn does not pass, then it is recommended to start taking antacids prescribed by a doctor. In the absence of the results of drug treatment it is necessary to undergo a survey to determine the degree of inflammation and the general condition of the gastrointestinal tract. How to treat reflux, tells the gastroenterologist, after carrying out diagnostic activities and collecting anamnesis.