Heartburn ( reflux) symptoms
-pischevoy Gastro-oesophageal reflux (heartburn) is a burning sensation behind the breastbone and in the epigastrium, where are located the esophagus and stomach.Probably everyone at least once in a lifetime experience heartburn, but not always its appearance indicates pathology.Acid reflux is not a disease, but only one of the symptoms of diseases of the gastrointestinal tract as gastric ulcer and duodenal ulcer, gastritis, duodenitis, chronic cholecystitis and functional disorders of the biliary system, hiatal hernia.Typically, these diseases are accompanied by increased gastric secretions, excessive production of hydrochloric acid and digestive enzymes that promptly cause damage to the gastric mucosa and in the development of the inflammatory process it.However, heartburn can occur in patients with reduced gastric secretion.
most common cause of heartburn can be regarded as gastro-oesophageal reflex, ie,casting with the esophagus of gastric contents anastaltic wave, which has an acidic environment
However, individual casts may occur in healthy people, especially when used excessively hot, greasy, spicy foods, large amounts of chocolate, coffee, carbonated drinks, alcohol, while smoking, taking certain medicines (nitrates, narcotic analgesics, aminophylline, etc.)..Also heartburn occurs often, and in pregnant women.In infants, as a result of anatomical features, the reflex may be normal.
Individual reflexes do not cause inflammation of the esophagus, as the protective mechanisms are included.Frequent long reflexes may lead to gastro-oesophageal reflex disease.
Clinically heartburn is a burning sensation occurs rapidly in the chest, throat podkatyvaniya to warm the liquid.These symptoms worse when bending forward, especially if they are made after the meal, voltage abdominal muscles, in the prone position and after a meal.The vertical position of the body, the use of small amounts of fluid, as well as receiving antacids significantly reduce its intensity.Often heartburn can be accompanied by profuse salivation, or the occurrence of regurgitation, accompanied by the appearance of the mouth of acid or bitter as a result of casting of bile.The most common heartburn occurs in people with high acidity of gastric juice and is registered in 30-45 minutes after eating, much less likely to occur on an empty stomach.
course, the clinical picture will be different, depending on the disease, which led to heartburn, but almost all patients revealed abdominal pain.
First of all, to prevent the occurrence of heartburn is necessary to observe certain rules that prevent an increase in intra-abdominal pressure and, consequently, help to reduce the degree of reflux and improve the evacuation of gastric contents:
• do not wear tight belts;
• after a meal should not be taken in a horizontal position for at least 30-45 minutes;
• after eating recommended to resemble half an hour, at least, to sit for 30-40 minutes;
• feeding the baby should be in a sitting position (sitting at an angle of 15-60 °);
• the last meal should be no later than 3-4 hours before bedtime;
• not carry out the slopes after a meal;
• people with frequent cases of heartburn during exercise should be excluded exercises, accompanied by an increase in intra-abdominal pressure, such as rocking abdominal muscles, lifting rod and a few others;
• monitor the regularity of the chair in order to avoid constipation, accompanied by prolonged straining during defecation, and, consequently, an increase in intra-abdominal pressure;
• recommended to sleep on a bed with headboard raised to the head end of the bed was 20-25 cm above the foot.
important component of non-drug treatment is dieting.Meals should be frequent, at least 5-6 times a day, a fraction, the food should be thoroughly chewed, it is not recommended to overeat, eat cold food, hurry while eating, swallowing poorly chewed food.Food should be mechanically and chemically gentle.After a meal should not immediately go to bed.
from the diet should be excluded: spicy, fatty, fried foods, spices, alcohol, as well as products, relaxing the esophageal-gastric pulp (chocolate, citrus fruits, tomatoes, onions, garlic, radish, radishes, garlic, coffee, and some others)and products that lead to increased flatulence (milk, rye bread, beans, cabbage).Infants
to reflux special diet connected antireflux mixture with thickener (bean gum gluten - gum), which give at the end of each feeding.Such mixtures are Frisovom, Nutrilon-antireflyuks et al.
prevent the occurrence or reduce the intensity of heartburn may be due to the use of alkaline mineral water.It recommended the use of bicarbonate water "Essentuki", "Dilijan", "Sairme" and bicarbonate water sulfate - "Slavyanovskaya", "Smirnoff", "Jermuk", "Kislovodsk seltzer" and some others.Mineral water drink for 1 hour before a meal or 30-40 minutes after eating.On the first day the amount of mineral water to the reception should not exceed V4 cup (50-100 ml), which gradually can be increased to 1 cup on reception.
Drug treatment of heartburn includes treatment of the underlying disease, provoked her appearance, and symptomatic treatment, aimed at neutralizing gastric acid.
primarily in therapy connected antacids.They neutralize the hydrochloric acid, reduces the irritant effect of enzymes adsorbed to bile acids themselves, increase the formation of bicarbonate, have a cytoprotective effect, promote more rapid purification of the esophagus and stomach contents basified, which in turn improves the functioning of the lower esophageal sphincter.Antacids are divided into soluble and insoluble.Soluble antacids act more rapidly, but briefly.These include baking soda, calcium carbonate (chalk), and magnesium oxide.Currently soluble antacids are not practically used due to the fact that they have not only a local effect on the gastrointestinal tract, but also the common alkalizing effect on the entire body, which is accompanied by a large number of side effects.Insoluble antacids have a longer duration of action.These formulations inherently contain nonabsorbable aluminum and magnesium.Antacids are used within 1-2 hours after a meal at night.
These include the following drugs:
• Almagel - the drug is available as a suspension in bottles of 170 and 200 ml, assigned 3 times a day for 30 minutes before eating and 1 time at night.Children under the age of 10 years appoint 1 / 2-1 / 3 dosage spoons, 10-15 years - 1 dosing spoon, over 15 years - 1-2 dosing spoons.The course of treatment is 3-4 weeks;
• Maalox - medicine comes in tablet form, oral suspension in bottles of 250 ml and sachets of 15 ml, administered 1-2 hours after eating and at night, apply 1-2 sachets or tablets 3-4 timesin a day.Before use, the suspension is shaken in bottles, bags knead and tablets chewed or held in the mouth until resorption;
• Gustav - the drug has the form of tablets that are swallowed without chewing on 1 2 tablets 3-4 times a day;
• Aluminium phosphate gel - gel presented in a plastic bag, which is taken orally, undiluted, 2-3 times a day, drinking a small amount of liquid or diluted in half a glass of water;
• De-nol - the drug is available in tablets.Children under 12 years are used tablets 120 mg, and in children older than 12 years and in adults - 240 mg 2 times a day 30 minutes before meals or 2 hours after a meal.The course of treatment is 4-8 weeks.The basic substance is colloidal bismuth preparation, the effect of which is the film formation on the mucosa and which enhances slizeobrazovanie providing cytoprotective effect.
cytoprotectors - drugs that accelerate healing of erosive ulcers of the mucous membrane of the gastrointestinal tract:
• Venter (sucralfate) - is used inside for 1 / 2- 1 hour before a meal to 500 mg 4 times a day.The drug is available in tablets of 500 mg, which is swallowed without chewing, with a small amount of water.The course of treatment is 4-6 weeks or more;
• bismuth nitrate (vikalin, Vikair) - has an enveloping and astringent - used drug for 15-30 minutes before meals, 100-200 or 300 mg 3-4 times a day.The course of treatment not less than 10 days, an average of one month.
In order to reduce the harmful gastric effects on esophageal mucosa and gastric apply antesekretornye drugs:
• H2 histamine blockers - to stimulate processes of healing of erosive ulcers of the mucous improve microcirculation in the mucosa, decrease the production of pepsin, enhance the formation of bicarbonatesmembranes.They include the following tools:
a) cimetidine - comes in the form of tablets and capsules, 200, 300, 400, 600 and 800 mg, however, the drug is used only in children older than 14 years a multiplicity of 2-3 times a day.However, the treatment may cimetidine "rebound phenomenon", ieincreasing the concentration of hydrochloric acid above the initial level after cessation of treatment;
b) Ranitidine - tablets available in 150, 200 and 300 mg, and in ampoule 2 and 5 ml.Babies assigned based medicine 2-8 mg / kg 2-3 times per day, for adults 150 mg 2 times a day.The duration of treatment is 4-8 weeks;
c) famotidine - just as ranitidine and has the form of tablets of 20 mg and 40 is applied to 1 / 2- and 1 tablet (20 mg), 2 times a day for children drug is given at the rate of 5.10 mg / kgappointment;
• proton pump inhibitors:
a) omeprazole (lansoprazole, esomeprazole) - available in tablets or capsules of 10,20 and 40 mg in 2 divided doses a day, a course of treatment is 4 weeks.The drug is given 20 mg 2 times a day;
b) ezomoprazol (Nexium) - drug is given at 10-40 mg 1 time per day;
c) rabeprazole (Pariet) - the drug is used at a dose of 10-20 mg 1 time a day.The course of treatment an average of 4 weeks;
g) pantoprazole - a drug available in tablets of 20 mg and 40, assigned at 40-80 mg per day in 2 divided doses.
In order to accelerate the promotion of food from the stomach to the gastrointestinal tract, as well as to improve the tone of the lower esophageal sphincter and prevent the return throw food used drugs group prokinetic:
• domperidone (Motilium, Motilak) - the drug is prescribed at the rate of 025 mg / kg body weight, children with a body weight of 20-30 kg / 2 tablets, and children weighing more than 30 kg: 1 tablet 3 times a day for 15 to 30 minutes before a meal.The drug is available in tablets of 10 mg.The course of treatment is 2-4 weeks;
• Reglan (metoclopramide, Raglan) - is produced in tablets for oral administration through 5, and 10 mg in vials for intramuscular injection.Children older than 6 years appoint 1 / - 1 tablet 3 times a day, adults - 1-2 tablets 3 times a day.
In the complex treatment of diseases associated with heartburn, it is advisable to include the enzyme preparations:
• pancreatin - available in tablets and pills, 200, 250 and 500 mg, administered to children aged 6-7 years 1 tablet, 8-9years 1-2 tablets, 10-14 years and adults - 2 tablets 3-4 times a day during meals;
• panzinorm forte - is used 1 tablet 3 times a day during meals;
• Festal - used vehicle on / 2- 1 to 2 tablets 3 times a day during or after a meal;
• Digestal - consists of bile extract and an enzyme (pancreatin).The drug is given inside of 1-2 tablets 3 times a day during meals;
• enzistal - appointed 1-2 tablets, 3-4 times a day during meals;
• mezim forte - Take 1-2 tablets, 3 times a day before meals or during meals, not chewed and washed down with plenty of water;
• Creon - is available in capsules, administered to children under 1 year 1/4 -1/2 capsule, children older than 1 year - 1 / 2- 1 capsule, adults - 1-2 capsules with each meal.
order to reduce gas formation in the gastro-intestinal tract used sorbents.These include the following drugs: active carbon, polisorb, laktofiltrum, neosmektin, smectite, enterosorbent enterogel.
Pronounced flatulence that occurs with increased abdominal pressure, should be the appointment carminative: fennel fruit, carminative fee (peppermint leaves, fennel fruit, roots valerian), the fruits of fennel fragrant, simethicone (gakson, Espumizan, Baby Calm).