• Heartburn( reflux) symptoms

    Gastro-nutritional reflux( heartburn) is a burning sensation behind the sternum and in the epigastric region, where the esophagus and stomach are located. Probably, everyone at least once in a life experienced heartburn, however not always its or her occurrence testifies to a pathology. Heartburn is not a disease, but only one of the signs of such diseases of the organs of the gastrointestinal tract, like peptic ulcer of the stomach and duodenum, gastritis, duodenitis, chronic cholecystitis and functional disorders of the biliary system, hernia of the esophageal aperture of the diaphragm. As a rule, these diseases are accompanied by increased gastric secretion, excessive production of hydrochloric acid and digestive enzymes, which in the shortest time lead to damage to the gastric mucosa and the development of an inflammatory process in it. However, heartburn may also occur in patients with reduced gastric secretion.

    The most frequent cause of heartburn is the gastroesophageal reflex, i.e.throwing into the esophagus with an anti-peristaltic wave of gastric contents that has an acidic environment, contains hydrochloric acid and enzymes involved in the digestion of food, and damages the mucosa of the esophagus, causing the development of an inflammatory process in it. Normally, the ingestion of gastric contents into the esophagus does not occur due to the operation of the lower esophageal sphincter and the timely emptying of the stomach. Another fairly frequent cause of the reflex is increased intragastric and intra-abdominal pressure.

    However, single casts can also occur in healthy people, especially when consuming excessively hot, fatty, spicy foods, lots of chocolate, coffee, carbonated drinks, alcohol, smoking, taking certain medicines( nitrates, narcotic analgesics, euphyllins, etc.)).Also heartburn often occurs in pregnant women. In infants, as a result of anatomical features, the reflex can exist in the norm.

    Single reflexes do not cause inflammation of the esophagus, since protective mechanisms are included. Frequent prolonged reflexes can lead to the development of gastroesophageal reflex disease.

    Clinically, heartburn represents a sudden burning sensation behind the sternum, rolling up to the throat of a warm liquid. These manifestations increase with tilting forward, especially if they are produced after eating, straining the abdominal muscles, lying down and after eating. The vertical position of the body, the use of a small amount of liquid, as well as the use of antacid agents significantly reduce its intensity. Often, heartburn can be accompanied by excessive salivation or the eruption, accompanied by the appearance in the mouth of acidic contents or bitterness as a result of casting bile. Most often heartburn occurs in people with high acidity of gastric juice and is registered 30-45 minutes after eating, much less occurs on an empty stomach.

    Of course, the clinical picture will be different, depending on the disease that led to heartburn, but almost all patients have abdominal pain.

    First of all, to prevent the occurrence of heartburn, it is necessary to follow certain rules that prevent the increase in intra-abdominal pressure, and therefore, help to reduce the degree of reflux and improve the evacuation of stomach contents:

    • Do not wear tight belts;

    • after meals, you must not take a horizontal position for at least 30-45 minutes;

    • after meals, it is recommended to go for half an hour, at the most, to sit for 30-40 minutes;

    • the feeding of the infant should be carried out in a sitting position( sitting at an angle of 15-60 °);

    • the last meal should be at least 3-4 hours before bedtime;

    • do not slope after eating;

    • In people with frequent heartburn during exercise, exercises accompanied by increased intra-abdominal pressure, such as swinging the abdominal muscles, lifting the bar, and some others, should be ruled out;

    • follow the regularity of the stool, to avoid constipation accompanied by prolonged straining during the act of defecation, and consequently, increased intra-abdominal pressure;

    • It is recommended to sleep on a bed with an elevated headboard, so that the head end of the bed is 20-25 cm above the foot.

    An important component of non-drug treatment is diet compliance. The food should be frequent, at least 5-6 times a day, fractional, the food must be thoroughly chewed, it is not recommended to overeat, eat dry, rush during meals, swallowing badly chewed food. Food should be mechanically and chemically sparing. After meals do not immediately go to bed.

    From the diet should be excluded: acute, fatty, fried foods, spices, alcohol, as well as products that relax the esophageal-gastric pulp( chocolate, citrus, tomatoes, onions, garlic, radish, radish, garlic, coffee and some others)as well as products that lead to increased gassing in the intestine( milk, rye bread, legumes, cabbage).

    To children with reflux, special anti-flux mixtures with thickeners( carob gluten gluten-gum) are added to the diet, which are given at the end of each feeding. Such mixtures include Frisov, Nutrilon-antireflux, etc.

    It is possible to prevent the occurrence or decrease the intensity of heartburn due to the use of alkaline mineral waters. Bicarbonate waters are recommended for use: "Essentuki", "Dilijan", "Sairme", as well as hydrocarbonate sulfate waters - "Slavyanovskaya", "Smirnovskaya", "Jermuk", "Kislovodsk narzan" and some others. Mineral water is drunk 1 hour before meals or 30-40 minutes after eating. On the first day, the volume of mineral water per reception should not exceed U4 cups( 50-100 ml), which can be gradually increased to 1 cup per reception.

    Medicinal treatment of heartburn includes treatment of the underlying disease that provoked its occurrence, as well as symptomatic treatment aimed at neutralizing the acid of gastric juice.

    First of all antacids are connected to the therapy. They neutralize hydrochloric acid, reduce the irritating effect of enzymes, adsorb bile acids, increase the formation of bicarbonates, have cytoprotective action, promote a faster cleansing of the esophagus and alkaline the contents of the stomach, which in turn improves the lower esophageal sphincter. Antacids are divided into soluble and insoluble. Soluble antacids act more quickly, but for a short time. These include bicarbonate soda, calcium carbonate( chalk) and magnesium oxide. Currently, soluble antacids are practically not used due to the fact that they have not only a local effect on the gastrointestinal tract, but also a general alkalizing effect on the entire body, which is accompanied by a large number of side effects. Insoluble antacids have a longer lasting effect. These preparations basically contain nonabsorbable aluminum and magnesium. Antacids are administered 1-2 hours after meals at night.

    These include the following drugs:

    • Almagel - the drug is available as a suspension in vials of 170 and 200 ml, is prescribed 3 times a day for 30 minutes before meals and once a night. Children under 10 years of age are prescribed 1 / 2-1 / 3 dosing spoon, 10-15 years - 1 dosage spoon, over 15 years - 1-2 dosage spoons. The course of treatment is 3-4 weeks;

    • Maaloks - the drug is available in the form of tablets, suspensions for oral administration in bottles of 250 ml and sachets of 15 ml, prescribed 1-2 hours after meals and at night, apply 1-2 packets or tablets 3-4 times per dayday. Before use, the suspension in the vials is shaken, the bags are kneaded, and the tablets are chewed or kept in the mouth until completely absorbed;

    • Gastal - the preparation has the form of tablets, which are swallowed without chewing 1 to 2 tablets 3-4 times a day;

    • phosphalugel - is presented by gel in plastic bags, which are taken orally, undiluted, 2-3 times a day, with 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 of age use tablets of 120 mg, and in children over 12 years and adults - 240 mg 2 times a day for 30 minutes before meals or 2 hours after eating. The course of treatment is 4-8 weeks. The main substance of the drug is colloidal bismuth, the effect of which is to form a film on the mucosa, which increases mucus formation and exerts a cytoprotective effect.

    Cytoprotectors - drugs that accelerate the healing of erosive and ulcerative defects of the gastrointestinal mucosa:

    • Venter( sucralfate) - use inside for 1 / 2-2 hours before meals 500 mg 4 times a day. The drug is available in the form of tablets of 500 mg, which are swallowed without chewing, washed down with a small amount of water. The course of treatment is 4-6 weeks or more;

    • bismuth nitrate( vikalin, vicair) - has an enveloping and astringent effect - the drug is applied 15-30 minutes before meals, 100-200 or 300 mg 3-4 times a day. The course of treatment is not less than 10 days, an average of 1 month.

    To reduce the damaging effect of gastric contents on the mucous membrane of the esophagus and stomach, antisecretory drugs are used:

    • H2-histaminoblockers - improve microcirculation in the mucous membrane, reduce pepsin production, increase the formation of bicarbonates, stimulate the healing of erosive ulcers of the mucous membranes. These include the following:

    a) cimetidine - available in the form of tablets and capsules of 200, 300, 400, 600 and 800 mg, but the drug is used only in children older than 14 years, with a frequency of 2-3 times a day. However, in the treatment of cimetidine, a "ricochet phenomenon" may occur, i. E.increase in the concentration of hydrochloric acid above the initial level after discontinuation of treatment;

    b) ranitidine - is available in the form of tablets of 150, 200 and 300 mg, as well as in ampoules of 2 and 5 ml. Children the drug is prescribed at the rate of 2-8 mg / kg 2-3 times a day, adults 150 mg twice a day. Duration of treatment is 4-8 weeks;

    c) famotidine - in the same way as ranitidine, has the form of tablets of 20 and 40 mg, is applied on 1 / 2-1 tablet( 20 mg) 2 times a day, the drug is prescribed for children at the rate of 5-10 mg / kg per dayreception;

    • proton pump inhibitors:

    a) omeprazole( lansoprazole, esomeprazole) - available in tablets or capsules of 10,20 and 40 mg in 2 divided doses per day, the course of treatment is 4 weeks. The drug is prescribed for 20 mg 2 times a day;

    b) esomoprazole( neksium) - the drug is prescribed for 10-40 mg once a day;

    c) rabeprazole( pariet) - the drug is used in a dose of 10-20 mg once a day. The average course of treatment is 4 weeks;

    d) pantoprazole - the drug is available in tablets of 20 and 40 mg, prescribed 40-80 mg per day in 2 divided doses.

    In order to accelerate the food movement from the stomach through the gastrointestinal tract, as well as to increase the tone of the lower esophageal sphincter, and prevent the reflux of food, preparations of the prokinetic group are used:

    • domperidone( motilium, motilac) - the drug is prescribed at the rate of 0.25 mg /kg orally, children with a body weight of 20-30 kg / 2 tablets, and children weighing over 30 kg 1 tablet 3 times a day for 15-30 minutes before meals. The drug is available in tablets of 10 mg. The course of treatment is 2-4 weeks;

    • Cerucal( metoclopramide, raglan) - is produced in tablets for oral administration at 5, 10 mg and in ampoules for intramuscular injection. Children older than 6 years are prescribed 1 / - 1 tablet 3 times a day, adults - 1-2 tablets 3 times a day.

    In the complex treatment of diseases accompanied by heartburn, it is expedient to include enzyme preparations:

    • pancreatin - is produced in tablets and pellets for 200, 250 and 500 mg, is prescribed for children aged 6-7 years for 1 tablet, 8-9 years for 1-2 tablets, 10-14 years and adults - 2 tablets 3-4 times a day with meals;

    • panzinorm-forte - 1 tablet is used 3 times a day with meals;

    • Festal - apply the drug on / 2- 2 tablets 3 times a day during or after a meal;

    • digestal - consists of an extract of bile and an enzyme( pancreatin).The drug is administered orally 1-2 tablets 3 times a day with meals;

    • Enzistal - prescribed 1-2 tablets, 3-4 times a day with meals;

    • mezim-forte - taken 1-2 tablets, 3 times daily before meals or during meals, not chewed and washed down with a lot of water;

    • Creon is available in capsules, it is prescribed for children under 1 year to 1/4 -1/2 capsules, children over 1 year - 1 / 2-1 capsule, adults - 1-2 capsules with each meal.

    Sorbents are used to reduce gassing in the gastrointestinal tract. These include the following drugs: activated carbon, polysorb, lactofiltrum, neosmectin, smecta, enterosorbent, enterogel.

    In severe meteorism, which occurs with increased intra-abdominal pressure, the use of carminative agents is necessary: ​​fennel fruits, carminative collection( peppermint leaves, fennel fruits, valerian rootstocks), dill fetuses, simethicone( haxon, espumizan, baby-calm).