Gastroesophageal reflux disease ( GERD ) - Causes, Symptoms and Treatment .MF .
GERD - one of the most common chronic diseases of the digestive system.There is due to reflux - regularly recurring cast contents into the esophagus stomach or duodenum, resulting in damage to the esophageal mucosa, and there may be damage to overlying organs (larynx, pharynx, trachea, bronchi).
causes of reflux:
1. lowering the tone of the lower esophageal sphincter.This is due to:
- consumption of beverages containing caffeine (coffee, strong tea, cola);
- medication (calcium antagonists - verapamil, antispasmodics - papaverine, nitrates, analgesics, theophylline, etc.);
- smoking (nicotine toxic effect on muscle tone);
- alcohol consumption (and thus there is damage to the esophageal mucosa);
- pregnancy (lower esophageal sphincter hypotension due to the influence of hormonal factors).
2. Increased intra-abdominal pressure.It occurs in obesity, ascites, flatulence (flatulence), pregnancy.
3. Diaphragmatic Hernia.This creates the conditions for reflux - occurs reduction of pressure on the lower
4. hasty and excessive consumption of food, in which a large amount of swallowed air, which leads to increased intragastric pressure, and threw the contents of the stomach into the esophagus.
5. Duodenal ulcer.
6. Excessive consumption of foods rich in fat animals, products containing peppermint, fried food, spicy seasonings, carbonated mineral water.All these products lead to a long delay in mass of food in the stomach, increase of intragastric pressure.
Symptoms of GERD
Getting into the esophagus, the stomach contents (food, hydrochloric acid, digestive enzymes) irritate the esophagus, leading to the development of inflammation.Manifested typical esophageal (esophageal) symptoms: heartburn, acid regurgitation.
Heartburn - a burning sensation behind the breastbone, rising from the pit of the stomach up, may be given in the neck, shoulders, usually appears after 1-1.5 hours after a meal or at night.It increases after consumption of carbonated drinks during exercise.Heartburn is often associated with belching.
eructation caused by intake of gastric contents through the lower esophageal sphincter into the esophagus and into the oral cavity.It manifests a sense of sour taste in the mouth.Like heartburn, belching and worries more in the supine position, with the torso forward.Quite often there is belching eaten food.
Odynophagia - pain when swallowing, and during the passage of food through the esophagus.Dysphagia - the feeling of difficulty or obstacles to the passage of food.They arise in the development of complications of GERD - strictures (narrowing), tumors of the esophagus.Less commonly observed esophageal hiccups and vomiting.Hiccups caused by irritation of the phrenic nerve and frequent contraction of the diaphragm.Vomiting occurs when a combination of GERD with duodenal ulcer.
There vnepischevodnye symptoms.These include chest pain, by its nature resembling koronarogennye (angina, myocardial infarction), heart attacks, arrhythmia.Stomach contents can flow into the throat at night, the result is a dry frequent cough, sore throat, hoarseness.And with a throw of gastric contents into the trachea and bronchi occur respiratory failure - developing chronic obstructive bronchitis, aspiration pneumonia, bronchial asthma.
symptoms appear worse after eating, physical activity, in a horizontal position;decrease upright after taking alkaline mineral water.
Gastroesophageal reflux can occur in healthy people, mainly in the afternoon after a meal, but it is not long lasting, up to 3 minutes, and does not cause pathological changes in the body.But if the symptoms bother with a frequency of 2 or more times a week for 4-8 weeks, and more often, you need to see a doctor - physician, gastroenterologist, to undergo examination and the diagnosis.
diagnosis of GERD.
1.Test with proton pump inhibitors.
preliminary diagnosis of GERD can be made on the basis of typical symptoms (heartburn, acid regurgitation), and then prescribe proton pump inhibitors (omeprazole, pantoprazole, rabeprazole, esomeprazole) in standard dosages.The effectiveness of 14-day course confirms the diagnosis of GERD.
2. intraesophageal 24 hours pH monitoring.Specifies the number and duration of reflux per day and the length of time during which the pH is below 4. This is the main method of confirmation of GERD, gives the right to bring the relationship of symptoms with typical and atypical GERD.
3. FEGDS (fibroezofagogastroduodenoskopiya).Held to detect esophagitis diagnosis of cancer and pre-cancerous diseases of the esophagus.Indications for its implementation:
- inefficiency of empirical treatment (proton pump inhibitors);
- in the presence of anxiety symptoms (weight loss, pain on swallowing, bleeding);
- patients older than 40 years;
- with long-term course of the disease (5 years or more);
- in case of controversial and diagnosis, or in the presence vnepischevodnyh symptoms.
4. Chromoendoscopy esophagus.It is shown that patients with long-term course of the disease, with frequent relapses, to identify areas of intestinal metaplasia (a precancerous condition), with a further biopsy of these areas.
5. ECG and Holter monitoring - to identify arrhythmia, diseases of the cardiovascular system
6. ultrasound of the abdomen and heart - to detect diseases of the digestive system, elimination of diseases of the cardiovascular system.
7. X-ray examination of the esophagus, stomach, chest organs.Conducted to identify pathological changes of the esophagus (narrowing, ulcers), hiatal hernia, respiratory disease (pneumonia, bronchitis).
8. Carry out laboratory tests (complete blood count, blood sugar, fecal occult blood, determine the baked sample).
9. The test for Helicobacter pylori.In his revealing prescribe eradication therapy.
Consulting professionals when indicated:
- a cardiologist;
- surgeon (with the ineffectiveness of ongoing drug therapy, a large diaphragmatic hernia, with the development of complications).
1. Quitting smoking and drinking alcoholic beverages
2. When overweight - its normalization, with the help of diet selection, according to the characteristics of the body, lifestyle, age.
3.Isklyuchenie horizontal position during sleep.I need to sleep with a raised head end.This reduces the number of casting stomach contents into the esophagus by gravity.
4. If possible, limit the wearing of tires, tight belts, increase intra-abdominal pressure.
5. Eating should be 4-6 times a day, in small portions, in the form of heat, for 2-3 hours before bedtime.After a meal you need to avoid the horizontal position of the body, torso exercise, within 2 to 3 hours.
6. It is necessary to avoid foods and drinks that promote kislotoobrazovatelnoy function of the stomach and lower the tone of the lower esophageal sphincter:
- coffee, tea, cola, chocolate, carbonated beverages, spicy sauces, citrus fruits, tomatoes;
- oily, sour, spicy food, spices;
- alcohol, beer, sour fruit juices;
- cabbage, peas, beans, brown bread (contribute to flatulence and increase intra-abdominal pressure).
7. Include in the diet must be low-fat meats, cereals, vegetables, vegetable oil (containing vitamins A and E, which help to improve the update of esophageal mucosa), eggs.
8. Acceptance of certain medications prescribed by other specialists regarding comorbidities, may lead to lower esophageal sphincter tone (nitrates, calcium antagonists, beta - blockers, theophylline, oral contraceptives) or cause damage to the lining of the esophagus and the stomach (non-steroidal anti-inflammatory drugs).
9. It is necessary to avoid exercise, and work related to the slopes body and lifting weights more than 10 kg.When you visit the gym to exclude exercises that increase muscle tension and intra-abdominal pressure.
basic principles of treatment is the rapid relief of symptoms, prevention of relapses and complications.A common strategy of treatment - this treatment antisecretory drugs.These include proton pump inhibitors (omeprazole, pantoprazole, rabeprazole, esomeprazole), blockers H2-histamine receptors (famotidine).When bile reflux (bile casting) administered ursodeoxycholic acid (Ursofalk), prokinetics (domperidone).The choice of drug, the dose, duration of treatment will appoint a doctor in accordance with the individual characteristics of the disease, comorbidity.
For short-term relief of the symptoms (heartburn, regurgitation), but not for long-term treatment may be used antacids.Gaviscone forte (1-2 teaspoons of 30-40 minutes after meals and before bedtime), Aluminium phosphate gel (1-2 pack 2-3 times after meals and at bedtime).
include folk remedies, to improve the stability of the esophageal mucosa recommended a decoction of flaxseed.Brew 2 tablespoons to 0.5 boiled water for 8 hours, take ½ cup 3-4 times daily before meals and at bedtime.Within 5-6 weeks.
To prevent complications and recurrence of the disease, monitor the effectiveness of treatment, you should regularly visit the doctor, physician or gastroenterologist, at least 1 time in 6 months, especially in the fall and the spring, take a survey.
complications of GERD.
long for GERD in the absence of appropriate treatment can lead to complications in the form of erosions, ulcers of the esophagus, bleeding from esophageal ulcers, the formation of scar tissue - strictures that narrow the lumen of the esophagus, break the food passage and lead to the development of precancerous lesions (Barrett's esophagus) andesophageal cancer.Vnepischevodnye complications: development of asthma, chronic bronchitis, aspiration pneumonia.
Timely diagnosis and systematic treatment can prevent progression of the disease and the development of life-threatening complications.
Vostrenkova Irina Nikolaevna, doctor of the highest category therapist.