Digestive system >>>> Gastroesophageal reflux disease

Gastroesophageal reflux disease.

This is a chronic disease with periodic relapses, which is considered as a violation of the motor and evacuation function of the esophagus. It is characterized by spontaneous throwing of stomach contents and duodenal contents into the esophagus. In this case, the mucous membrane is injured and damage to the distal esophagus of a different nature develops.

Gastroesophageal reflux disease (GERD) is considered a very common disease and therefore occupies one of the priority areas in modern gastroenterology research. An increase in the number of patients is observed all over the world. 10% of the population is, according to statistical studies, the part of the European population that experiences GERD symptoms at least once a year.

Etiology and pathogenesis.

The etiology of GERD is considered as the etiology of a functional disease and is not fully understood.

It is believed that the causes of gastroesophageal reflux disease can be:

central nervous system disorders
disorders of the innervation of the esophagus itself
dyskinesia of the esophagus (including impaired activity of the lower esophageal sphincter associated with its prolonged relaxation (relaxation), which is spontaneous)
systemic scleroderma
duodenostasis of any etiology
concomitant diseases of the digestive system (peptic esophagitis, hiatal hernia, neoplasms of the esophagus and stomach, peptic ulcer, liver disease, atherosclerosis, parkinsonism, bronchial asthma, diabetes mellitus, etc.)
excessive consumption of meat with a high content of fat, foods containing trans fats, flour products (pasta, pastry), fried foods. All this food causes prolonged digestion and contributes to a prolonged retention of the food mass in the stomach, which increases intragastric pressure).

Classification and diagnostics.

The most common classification of GERD distinguishes three forms of the disease:

non-erosive reflux disease - endoscopically negative option (the presence of a clinic in the absence of obvious violations of the integrity of the mucous layer of the esophagus
erosive reflux disease, or reflux-esophagitis (the presence of erosions and ulcers on the esophageal mucosa)
Barrett's esophagus

Signs of gastroesophageal reflux disease are divided into esophageal and extraesophageal symptoms.

Esophageal:

heartburn (the main symptom), usually occurs when eating certain foods, overeating, bending the body, exercising, lying down (especially with a low headboard), drinking alcohol, smoking
belching (bothers more often when lying down or when bending over)
dysphagia
feeling of a coma behind the breastbone
odinophagy (painful movement of food through the esophagus, the need for differential diagnosis with malignant diseases of the esophagus)
pain in the esophagus and stomach (the need for differential diagnosis with ischemic heart disease in the elderly)
hiccups
nausea, urge to vomit

Extraesophageal:

bronchopulmonary (cough, fading attacks)

otolaryngological (hoarseness, dry mouth, laryngitis, pharyngitis, laryngeal stenosis, sinusitis, chronic rhinitis, otitis media)

dental (aphthous stomatitis, caries)

Diagnosis requires differentiating GERD from other diseases by symptoms from the list of extraesophageal diseases.

Treatment of gastroesophageal reflux disease.

Treatment of the disease should be aimed at the disappearance of clinical symptoms, restoration of the mucous membrane to normal, and prevention of complications. Treatment is subdivided into medication, non-medicinal measures of a general nature, and surgical.

Drug therapy includes the use of antacids, prokinetics, antisecretory drugs (including histamine H2-receptor blockers, proton pump inhibitors), cytoprotectors. Non-drug interventions complement drug therapy while changing the patient's lifestyle and dietary habits.

Recommended:

avoiding excessive food intake
after eating, horizontal position of the body and physical activity are excluded
last meal no later than a few hours before bedtime
sleep on a bed with a raised headboard
to narrow the range of consumption of foods that cause damage, hyperemia and edema of the mucous layer of the esophagus: foods rich in fat (high-fat milk, cream, cakes, pastries); fatty poultry meat (goose, duck), fatty meats (pork, lamb, beef); alcohol-containing liquids; caffeinated drinks (coffee, strong tea, chocolate, cola); Luke; garlic (rich in essential oils); acid-containing fruits and vegetables (tomatoes, citrus fruits, sour apples, pomegranates); fried foods; refuse gaseous water; exclude the use of peppermint and pepper, as they reduce the tone of the lower esophageal sphincter
if necessary, reduce body weight
exclude loads that increase intra-abdominal pressure: do not wear tight clothing, tight belts and bodices, bandages; do not lift weights more than 7 kg in two hands; avoiding sports exercises associated with overexertion of the abdominal press
refrain, if possible, from taking drugs that lead to the development of reflux (tranquilizers, calcium channel inhibitors, alpha and beta blockers, nitrates, theophylline, prostaglandins, anticholinergics, tricyclic antidepressants, drugs containing L-dopamine, drugs, progesterone)
eliminate excessive food intake and snacks at night
switch the diet to 3 - 4 meals a day
increase the protein content in the diet (since protein food increases the tone of the lower esophageal sphincter)

Surgery

Before deciding on surgical treatment, you should carefully consider other methods of treatment and only in cases of ineffectiveness of drug therapy or complications of GERD (esophageal strictures, repeated bleeding), or in the presence of Barrett's esophagus with high-grade epithelial dysplasia (danger of malignancy), carry out fundoplication (including endoscopic).