Gastroesophageal reflux disease( GERD)

Gastroesophageal reflux disease( GERD) is a pathological condition due to impaired motor activity in the upper gastrointestinal tract. Formed as a result of reflux - regular casting into the esophagus of the contents of the stomach or 12 duodenal ulcer - causing mucous surfaces of the esophagus.

What is GERD

What is this disease? GERD( gastroesophageal reflux disease, reflux) is the casting of gastric or intestinal contents into the lumen of the esophagus. If the reflux occurs immediately after a meal( infrequently) and is not accompanied by the development of a discomforting condition for the patient, then this is an acceptable physiological norm. But in the case of the frequent occurrence of such a condition, accompanied by inflammation of the mucous surfaces of the esophagus, one can speak of the presence of gastroesophageal reflux.

Causes of the disease and provoking factors

Gastroesophageal reflux is the reverse movement of gastric contents into the lumen of the esophagus due to impaired functionality of the closing sphincter. Reasons for the formation of GERD:

• Fast food intake in large volumes. Simultaneously with eating, a person swallows a large amount of air, which causes an increase in intra-abdominal pressure and the development of reflux.
• Lowering the tone of the lower sphincter of the esophagus, slow emptying of the stomach. Such a condition can be formed under the influence of the following factors: toxic effects of nicotine, treatment with antispasmodics, analgesics, calcium antagonists, alcohol intake, the period of gestation.
• Diaphragmatic hernia.
• Ulcerous pathology of the duodenum.
• The presence in the diet of a large number of products that increase intra-abdominal pressure - soda, fatty / fried / spicy dishes.

The following factors are capable of provoking gastroesophageal reflux disease:

• a person's professional activity - a person's long standing in a semi-bent position;
• frequent stressful situations;
• abuse of nicotine and alcohol;
• child bearing;
• the presence of extra pounds;
• excessive consumption of coffee, fatty foods, chocolate, juices;
• treatment with drugs that increase the concentration of dopamine.

Symptoms of

Symptoms of gastroesophageal reflux are divided into two large groups - esophageal( esophageal) and extra-vascular. Esophagic manifestations are similar to signs of a violation of the motility of the gastrointestinal tract( GIT).This:

• heartburn - is strengthened with tilts, in a prone position, after physical exertion, with overeating;
• belching with a sour or bitter taste;
• attacks of nausea, resulting in vomiting;
• hiccups;
• regurgitation;
• severity in the epigastric region that occurs after eating;
• problems with swallowing;
• pain behind the sternum, not caused by cardiac pathologies;
• heavy breath odor;
• increased saliva production.

Esophageal manifestations of GERD also include damage to the structure of the esophagus. This Barrett's esophagus, narrowing of the esophagus, reflux esophagitis, adenocarcinoma of the esophagus. Extra-oesophageal manifestations of GERD are caused by ingestion of gastric contents into the respiratory tract.

Symptoms can be as follows: the development of pharyngitis, laryngitis, otitis, colds, apnea( short breath stop), coughing, shortness of breath in a person lying down, coronary pain resembling an attack of angina accompanied by arrhythmia.

GERD with esophagitis develops against the background of existing lesions of the mucous surfaces of the esophagus. This formation of ulceration, inflammatory processes, pathological narrowing of the lower esophagus, change in the mucosa. Typical signs in this case: severe heartburn, belching with a sour taste, pain in the stomach, attacks of nausea.

Potential causes of gastroesophageal disease in children can be surgical interventions on the esophagus, gastrectomy, cerebral palsy, complicated childbirth and a high level of intracranial pressure, and others.

General symptomatology of GERD in children:

• regurgitation( in infants) and belching;
• poor appetite;
• tenderness in the epigastric region;
• capriciousness during feeding;
• frequent vomiting;
• hiccups;
• shortness of breath;
• night cough.

More information on the course of GERD in childhood, you can get here.

Classification of

The classification of GERD is based on the presence / absence of symptoms of inflammatory processes in the esophagus. It is accepted to distinguish the following subspecies. Non-erosive reflux disease. It is diagnosed approximately in 70%.There is no symptomatology of esophagitis. Ulcerative erosive form. Gastroesophageal reflux disease in this case is accompanied by a narrowing of the esophagus and the formation of ulcers.

Barrett's Esophagus. Against the background of esophagitis, metaplasia of multi-layered flat epithelium develops-a precancerous state characterized by replacement of flat epithelial cells with cylindrical epithelium. Additional types of GERD classification can be found in this article.

Diagnosis of GERD

Diagnosis of gastroesophageal reflux is based on instrumental techniques. The doctor can prescribe the following types of studies:

• endoscopy - helps to determine the presence of inflammation, erosion, ulcers;
• daily monitoring of acidity in the lower esophagus;
• radiography - allows you to identify hernia diaphragms, ulcers, erosion;
• manometric examination of the esophageal sphincter;
• scintigraphy with radioactive substance;
• biopsy - examination is given if there is a suspicion of a Barrett esophagus;
• ECG;
• daily holter monitoring;
• Ultrasound investigation of abdominal organs.

In addition, the patient can be assigned consultations of specialists such as cardiologist, otolaryngologist, pulmonologist, surgeon. But most often the diagnosis is made on the basis of the results of the FGD.

How to cure?

There is no specific treatment for GERD.The medical measures taken are aimed at eliminating pathological symptoms, preventing recurrences and developing complications. At the initial stages of GERD, good results are achieved by therapeutic gymnastics. Initially, the disease is treated medically, removing severe symptoms. However, the weakness of the esophageal sphincter remains.

Exercises of exercise therapy are aimed specifically at strengthening the muscles of the esophagus and diaphragm, which prevents pathological casts and improves the well-being of the person as a whole. In accordance with the generally accepted practice in gastroenterology, the patient is prescribed antisecretory drugs: proton pump inhibitors and H2-histamine receptor blockers. In addition, the patient can be prescribed prokinetics - recommended for the development of bile reflux, antacids, reparants - drugs that promote the healing of damaged mucous esophagus.

Blockers of H2-histamine receptors

Drugs of this group reduce the amount of hydrochloric acid produced. To exclude a relapse of pathology, they are appointed by the course. The patient may be prescribed:

• Famotidine. Reduces the activity of pepsin, reduces the amount of hydrochloric acid produced.
• Cimetidine. Dosage and the scheme of reception are selected individually. The drug can cause nausea, the formation of dyspeptic symptoms.
• Nisatidine. Reduces the amount of hydrochloric acid produced.

Inhibitors of the proton pump

Against the background of taking drugs, the level of hydrochloric acid produced decreases. Admission to appoint esomeprazole, Omeprozol, Pantoprozole, Rabeprozol, Lansoprozol. The choice of the remedy depends on the recommendations of the attending physician. For example, pregnant women are not allowed to take omeprazole. It is replaced by Panto-or Lansoprozol.

Prokinetics

Drugs contribute to an increase in tone and a reduction in the lower sphincter of the esophagus, which reduces the amount of abnormal casting of gastric contents. Treatment of gastroesophageal reflux disease is carried out using the following prokinetics:

• Domperidone - antiemetic. Against the background of the development is not excluded the development of gastrointestinal disorders.
• Metoclopramide. Improves the motor activity of the esophagus. Has many side effects.
• Cisapride. Has a stimulating effect on motility and tone of the gastrointestinal tract, has a laxative effect.

Antacids

This group of drugs reduces the acidity of gastric juice. To reception can be appointed or nominated:

• Fosfaljugel. Possesses absorbing, enveloping and antacid properties.
• Gaviscon. Forms on the surface of the mucosa of the esophagus and stomach a protective film.
• Renny. Neutralizes the acidity of gastric juice.

When casting bile used drugs from the prokinetic group, most often Domperidon or Ursofalk. The drug belongs to the category of hepatoprotectors. It promotes the dissolution of gallstones and lowers blood cholesterol levels.

Operative intervention

The main indications for surgical treatment is the ineffectiveness of the previously selected drug therapy. During the procedure, the tone of the sphincter is restored, which excludes the development of pathological refluxes. Indications for surgical intervention are Barrett's esophagus, peptic ulcer disease, 3 to 4 degrees of esophagitis, and abnormal narrowing of the esophagus.

Diet

Effective treatment of gastroesophageal reflux is impossible without following the principles of dietary nutrition. Recommendations are quite simple. It is necessary to refrain from overeating, after taking food, take a short walk. Dinner should be held 4 hours before going to bed.

Under the ban are:

• fruit juices;
• dishes with a sharp taste;
• chocolate;
• citrus fruits;
• radish;
• coffee;
• alcohol-containing beverages;
• fried foods;
• baking.

The menu of the patient GERD should include low-fat kefir, milk, cream, fish of low-fat varieties, cooked in a steam way, soups prepared on vegetable broths, fruit with a sweet taste. Useful are mineral alkaline water, tea with milk, homemade croutons, yesterday's bread, butter, cereals - buckwheat, mango and rice, watermelon. Compliance with the diet reduces the risk of developing reflux. More details about dietary nutrition with GERD you can read in this article.

Treatment with folk methods

As additional methods of therapy, it is allowed to use traditional medicine recipes. Combinations of drug support and home methods help to quicker recovery, eliminate pathological symptoms and improve the overall well-being of the patient.

GERD can be treated with the following methods:

• Decoction of flax seeds. Brew 2 tbsp.l.product with boiling water( 500 ml).Insist 8 hours. Filter and take 100 ml before meals. The duration of the course is 6 weeks.
• Rosehip oil or sea buckthorn. Drink 1 tsp.three times a day. It acts as an anti-inflammatory, wound-healing, firming and antibacterial agent.
• Decoction of althea roots. So, pour 6 grams of the root with boiling water( 200 ml) and pound on the water bath for half an hour. Drink the filtered product 100 ml three times a day.
• Celery root juice. Take freshly squeezed juice for 1 tbsp.l.three times a day. He copes well with the pathological symptoms of the disease.

Treatment of GERD for Bolotov is becoming increasingly popular. But the proposed method helps to increase the level of acidity of gastric juice, which can cause a relapse of the disease.

Probable complications of

The most common complication is found in about 45% of all diagnosed cases - the formation of reflux esophagitis. Accompanying the disease ulcerative-erosive lesions of the mucosa after healing can leave rough scars. As a result, the patient is narrowing the lumen of the esophagus. Deterioration of patency is indicated by dysphagia( a violation of swallowing), frequent eructations and heartburn.

Prolonged inflammation causes ulceration. Damage to the wall can be lowered to the submucosa and accompanied by frequent bleeding. In the absence of adequate treatment, it is possible to replace the epithelium of the esophagus with cells typical of the stomach or intestine. The resulting degeneration is called Barrett's esophagus and refers to precancerous conditions. Approximately in 5% of patients it passes into adenocarcinoma.

Prevention

To prevent the development of the disease will help to comply with simple recommendations. You need to carefully monitor the weight. The presence of extra pounds is one of the factors provoking pathology. To do this, you must completely refuse or significantly limit the consumption of fatty / fried foods, sweets and baked goods. After eating, you can not go to bed, because in this case the probability of casting gastric contents into the lumen of the esophagus increases several times.

The appearance of a pain syndrome, regular heartburn and belching is a serious reason to call a doctor. Gastroesophageal reflux disease is a difficult and difficult disease to diagnose. That's why when you have a characteristic symptomatology, you need to get a consultation from a specialized specialist and, if necessary, get a full course of treatment.