Gastroesophageal reflux disease( GERD) - Causes, symptoms and treatment. MF.

GERD is one of the most common chronic diseases of the digestive system. It occurs as a result of reflux - a regular recurrence of the contents of the stomach or duodenum into the esophagus, resulting in damage to the mucosa of the esophagus, as well as damage to the overlying organs( larynx, pharynx, trachea, bronchi).

Causes of reflux:

1. Decreased tone of the lower sphincter of the esophagus. This is due to:
- consumption of drinks containing caffeine( coffee, strong tea, coca-cola);
- taking medicines,( calcium antagonists - verapamil, antispasmodics - papaverine, nitrates, analgesics, theophylline, etc.);
- smoking( toxic effect of nicotine on muscle tone);
- the use of alcohol( this also causes damage to the mucosa of the esophagus);
- pregnancy( hypotension of the lower esophageal sphincter is caused by the influence of hormonal factors).

2. Increased intra-abdominal pressure. It occurs with obesity, ascites, bloating( flatulence), pregnancy.

3. Diaphragmatic hernia. This creates conditions for reflux - there is a decrease in pressure on the lower part of the esophagus in the chest. Hernia of the esophageal aperture of the diaphragm is observed in approximately 1/2 people over 50 years of age.

4. Hasty and plentiful eating, during which a large amount of air is swallowed, which leads to an increase in intragastric pressure, and casting the contents of the stomach into the esophagus.

5. Peptic ulcer of the duodenum.

6. Excessive consumption of foods rich in animal fats, products containing peppermint, fried foods, spicy seasonings, aerated mineral waters. All these products lead to a prolonged delay of food masses in the stomach, an increase in intragastric pressure.

Symptoms of GERD

Getting into the esophagus, the contents of the stomach( food, hydrochloric acid, digestive enzymes) irritates the mucosa of the esophagus, leading to the development of inflammation. It manifests as typical esophageal( esophageal) symptoms: heartburn, acidic eructation.

Heartburn is a burning sensation behind the sternum, rising from the epigastric region upwards, it can give to the neck, shoulders, usually appears 1-1.5 hours after a meal or at night. It increases after drinking carbonated drinks, when performing physical exertion. Heartburn often combines with eructations.

The eructation is caused by the intake of gastric contents through the lower esophageal sphincter into the esophagus and further into the oral cavity. It is manifested by a sensation of sour taste in the mouth. Like heartburn, burp also worries more when lying down, with the torso tilted forward. Often there is a belching of food eaten.

Odinophagia - pain when swallowing and while passing food through the esophagus. Dysphagia is a feeling of difficulty or an obstacle in the passage of food. They arise in the development of complications of GERD - strictures( constrictions), tumors of the esophagus. Less frequent is esophageal hiccough and vomiting. Hiccups are caused by irritation of the diaphragmatic nerve and frequent contraction of the diaphragm. Vomiting is observed when the combination of GERD with peptic ulcer of the duodenum.

There are non-esophageal symptoms. These include the pain behind the breastbone, in character resembling coronary( angina pectoris, myocardial infarction), palpitations, arrhythmias. The contents of the stomach can flow into the larynx at night, resulting in dry, frequent cough, swallowing in the throat, hoarse voice. And with the casting of gastric contents into the trachea and bronchi, the respiratory organs are affected - chronic obstructive bronchitis, aspiration pneumonia, bronchial asthma develops.

Symptoms appear and intensify after eating, exercise, in a horizontal position;decrease in vertical position, after reception of alkaline mineral waters.

Gastroesophageal reflux can also occur in healthy people, mainly during the day after eating, but it is not prolonged, up to 3 minutes, and does not cause pathological changes in the body. But if the symptoms are disturbed at a frequency of 2 or more times a week for 4-8 weeks and more often, you need to see a doctor - therapist, gastroenterologist, for the examination and diagnosis.

Diagnosis of GERD.

1. Test with a proton pump inhibitor.
A preliminary diagnosis of GERD can be made on the basis of typical symptoms( heartburn, sour eructation), and then prescribe a proton pump inhibitor( omeprazole, pantoprazole, rabeprazole, esomeprazole) in standard dosages. The effectiveness of a 14-day course confirms the diagnosis of GERD.

2. 24 hour intrasophageal pH monitoring. Determines the number and duration of reflux per day and the length of time during which the pH drops below 4. This is the main method for confirming GERD, it gives the right to bring the symptoms of typical and atypical symptoms to gastroesophageal reflux.

3. PHAGS( fibroesophagogastroduodenoscopy).It is carried out with the purpose of revealing esophagitis, diagnosing cancer and precancerous diseases of the esophagus. Indications for it:
- inefficiency of empirical treatment( proton pump inhibitors);
- in the presence of anxiety symptoms( weight loss, pain when swallowing, bleeding);
- patients older than 40 years;
- with a long course of the disease( 5 years or more);
- in the case of a controversial diagnosis and, or in the presence of extra-oesophageal symptoms.

4. Chromoscopy of the esophagus. It is indicated for patients with a long course of the disease, with frequent relapses, for the detection of areas of intestinal metaplasia( precancerous state), with further biopsy of these sites.

5. ECG and Holter monitoring - for the detection of arrhythmia, cardiovascular diseases
6. Ultrasound of the abdominal and heart organs - to identify the pathology of the digestive system, exclude diseases of the cardiovascular system.

7. X-ray examination of the esophagus, stomach, chest organs. Carried out to identify pathological changes in the esophagus( narrowing, ulcers), hernia of the esophagus aperture, pathology of the respiratory system( pneumonia, bronchitis).

8. Conduct laboratory tests( general blood test, blood sugar, fecal occult blood test, determine baked samples).

9. Helicobacter pylori test. When it is identified, eradication therapy is prescribed.
Consultation of specialists, if indicated:
- cardiologist;
- lung specialist;
- otorhinolaryngologist;
is a surgeon( with ineffective drug therapy, large diaphragmatic hernia, with complications).

Treatment of GERD:

Lifestyle change:

1. Refusal to smoke and drink alcoholic beverages
2. With excessive body weight, it is normalized, by dieting, according to the characteristics of the body, lifestyle, age.
3. Exclude the horizontal position during sleep. To sleep it is necessary with the raised head end. This reduces the number of pellets of the contents of the stomach into the esophagus due to gravity.
4. If possible, limit the wearing of bandages, tight belts that increase intra-abdominal pressure.
5. Take food 4-6 times a day, in small portions, in a warm form, 2-3 hours before bedtime. After eating, you must avoid the horizontal position of the body, the torso of the trunk, physical exertion, for 2-3 hours.
6. It is necessary to avoid the use of foods and beverages that promote the increase of the acid-forming function of the stomach and reduce the tone of the lower esophageal sphincter:
- coffee, tea, coca-cola, chocolate, carbonated drinks, spicy sauces, citrus fruits, tomatoes;
- fatty, sour, spicy food, spices;
- alcohol, beer, acidic fruit juices;
- cabbage, peas, legumes, black bread( promote increased gas production and increase intra-abdominal pressure).
7. Include in the diet of low-fat meat, porridge, vegetables, vegetable oils( contain vitamins A and E, which contribute to improving the mucosa of the esophagus), eggs.
8. Taking certain medications prescribed by other specialists for concomitant diseases can lead to a decrease in the tone of the esophageal sphincter( nitrates, calcium antagonists, beta blockers, theophylline, oral contraceptives) or cause mucosal damage to the esophagus and stomach( non-steroidal anti-inflammatory drugs).
9. It is necessary to avoid physical exercises and work related to the slopes of the hull and lifting the weight of more than 10 kg. When you visit the gym, you should exclude exercises that increase the tension of the abdominal muscles and intra-abdominal pressure.

The main principles of treatment are rapid relief of the symptoms of the disease, preventing the development of relapses and complications. A generally accepted treatment strategy is the treatment with antisecretory drugs. These include proton pump inhibitors( omeprazole, pantoprazole, rabeprazole, esomeprazole), H2-histamine receptor blockers( famotidine).With bile reflux( throwing bile), ursodeoxycholic acid( ursofalk), prokinetics( domperidone) is prescribed. The choice of the drug, its dose, duration of treatment will be prescribed only by the doctor according to the individual features of the course of the disease, concomitant pathology.

For short-term relief of symptoms( heartburn, eructation), but not for long-term treatment, antacids can be used. Gaviscon forte( 1-2 teaspoons 30-40 minutes after eating and before going to bed), phosphalogel( 1-2 packs 2-3 times after meals and overnight).

Among folk remedies, to improve the stability of the mucosa of the esophagus, decoction of flaxseed is recommended. Brew 2 tablespoons for 0.5 boiling water, insist for 8 hours, take ½ cup 3-4 times a day before meals and at night. Within 5-6 weeks.

To prevent complications and relapses of the disease, to control the effectiveness of treatment, it is necessary to visit the doctor, therapist or gastroenterologist regularly, at least once every 6 months, especially in autumn and spring, to undergo examinations.

Complications of GERD.

Prolonged course of GERD in the absence of adequate treatment can lead to complications in the form of erosions, ulcers of the esophagus, bleeding from the ulcers of the esophagus, the formation of cicatricial changes - strictures that narrow the passage of the esophagus, disrupt the passage of food and lead to the development of precancerous diseases( Barrett's esophagus) and canceresophagus. Extra-oesophageal complications: development of bronchial asthma, chronic bronchitis, aspiration pneumonia.

Timely diagnosis and systematic treatment can prevent the progression of the disease and the development of life-threatening complications.

Irina Vostrykova, Physician of the highest category.