Gastroesophageal reflux is a symptom complex that characterizes the movement of stomach contents in the opposite direction (into the esophagus). In some cases this can be a normal phenomenon, in others it can provoke serious pathologies.
Gastroesophageal reflux causes
The throwing of contents from the stomach, occurring in isolated cases immediately after eating, which does not cause discomfort to the person and does not cause other disorders, is considered a variant of the norm. If this happens often, including at night, is accompanied by obvious symptoms, it is a question of a deviation leading to the development of gastroesophageal reflux disease.
Considering the causes of gastroesophageal reflux, it is necessary to understand the mechanism of casting the contents in the wrong direction. A major role in the prevention of this phenomenon is played by the lower esophageal sphincter - a muscle almost always staying in a closed state and opening in two cases - when the food coma moves to the stomach and when the swallowed air exits.
Spontaneous relaxation of the lower sphincter of the esophagus can be associated with both its functional disorders and with a decrease in muscle tone. The latter is very often provoked by such factors:
- consumption of caffeinated drinks;
- use of hot dishes and drinks;
- taking certain medications (antispasmodics, analgesics, nitrates, etc.);
- smoking;
- alcohol consumption;
- intensive physical activity;
- a change in the hormonal background.
In addition, the precondition for reverse casting is sometimes increased intra-abdominal pressure, observed with excessive body weight, ascites, constipation, flatulence. Intragastric pressure is provoked by the use of carbonated drinks, fried foods, spicy spices. Also, the conditions for reflux are available with a hernia of the esophagus of the diaphragm, peptic ulcer, bronchial asthma.
In pathological gastroesophageal reflux, it is important not only to directly cast, but also the ability of the esophagus to be freed from the incoming stimulus. Normally, if acidic gastric contents fall, the restoration of pH and return back to the stomach by increasing the peristalsis of the esophagus and salivary secretion occurs quickly (this ability is called esophageal clearance).
Gastroesophageal reflux symptoms
In a typical clinical picture, the following signs of gastroesophageal reflux are crucial:
- heartburn ;
- eructation;
- sensation of a lump in the throat;
- discomfort when swallowing food;
- bloating ;
- vomiting;
- nausea;
- retrosternal pain resembling an attack of angina.
In many cases, especially with "high" refluxes, a number of so-called extra-oesophageal symptoms are noted:
- cough;
- dyspnea;
- inflammation of the mucous larynx, nasopharynx, bronchi;
- hoarseness of voice;
- caries, inflammation of the gums .
Pathological manifestations intensify at night, after eating, during physical exertion. In the presence of characteristic symptoms gastroesophageal reflux disease can occur in one of two forms:
- with inflammatory changes in the esophageal walls, revealed by the endoscopic method (with esophagitis);
- without inflammation of the esophagus, which is established by means of an endoscope (without esophagitis).
Gastroesophageal reflux without esophagitis
In this case, gastroesophageal reflux disease is called non-erosive. In this case, the esophageal mucosa is protected from the entry into the body of the contents, which is not characteristic of it, i.e. clearance is normal. In addition, normal microcirculation in the vessels and lymphatic capillaries plays a role in ensuring the regeneration of the epithelium. Episodes of reflux with manifestations are not repeated very often, but this may be the previous stage of the erosive process.
Gastroesophageal reflux with esophagitis
If gastroesophageal reflux is associated with a high frequency of ingestion of gastric contents, the risk of pathological changes in the mucosa of the esophagus tract increases. Contributes to this and increased aggressiveness of reflux associated with other diseases (for example, with increased acidity, the presence of bile acids). The clinical picture, basically, consists of gastrointestinal manifestations. In this case, often accompanies gastroesophageal reflux cough - dry, often occurs during the day, increasing with changes in the position of the body.
Gastroesophageal reflux - degree
Pathological gastroesophageal reflux is a consequence of the weakening of the esophageal defense mechanisms and the aggressiveness of the damaging factors. Depending on the extent of damage, pathology is classified into degrees. Here is one of the classifications used:
- 0 degree - no clinical manifestations:
- I degree - the presence of individual foci of erosion against the background of hyperemic tissue, occupying no more than 10% of the distal esophagus;
- II degree - there are confluent areas of erosion, which account for up to 50% of the surface of the distal section;
- III degree - multiple ulcerative lesions, occupying the surface of the distal part completely;
- IV degree - development of complications: deep ulcers, narrowing of the esophagus, Barrett's esophagus, etc.
Gastroesophageal reflux - diagnosis
Preliminary diagnosis is often made on the basis of complaints and anamnesis. To determine the form of gastroesophageal reflux, visual diagnosis is of paramount importance. Conduction of esophagogastroduodenoscopy gives a wide picture of the lesion and accompanying abnormalities. If necessary, a biopsy is performed. In addition, the following methods may be required:
- X-ray diagnostics with barium;
- daily monitoring of the pH of the esophagus;
- esophagotho-kymography;
- bimetry;
- scintigraphy.
How is gastroesophageal reflux treated?
Diagnostic pathological gastro-esophageal reflux treatment should have a complex, with the priority role played by drug therapy. It is important to follow the diet and the following recommendations:
- decreased body weight;
- restriction of lifting of cargoes (no more than 10 kg);
- Avoiding the slope and tension of the press;
- refusal to restrain clothing;
- sleep on a high pillow;
- rejection of bad habits.
Gastroesophageal reflux - treatment, drugs
To avoid complications gastroesophageal reflux with esophagitis treatment must necessarily have a medical treatment. Depending on the severity of the pathology, drugs are assigned to these groups:
- antacids - (Fosfalugel, Maaloks);
- alginates (Gaviscon);
- prokinetics (Motilium);
- proton pump inhibitors (Omez, Lansoptol);
- blockers of H2-receptor histamine (Ranisan, Famotidine).
Some of these medications are taken occasionally for relief of symptoms, others require a course of treatment until persistent elimination of symptoms. With reflux without esophagitis, only the use of antacids and alginates is shown. In severe cases, surgical intervention may be required (for example, Nissen fundoplication).
Gastroesophageal reflux - treatment with folk remedies
In the stage of remission, when gastroesophageal reflux has no pronounced manifestations, it is permissible to use non-traditional methods for preventive purposes. Patients who are diagnosed with gastroesophageal reflux, folk treatment offers, mainly, the use of phytotherapeutic agents for enveloping and anti-inflammatory action. Here is one of the recipes.
Herbal infusion
Ingredients:
- Flax seed - 1 table. a spoon;
- leaf of the mother-and-stepmother - 1 table. a spoon;
- licorice root - 1 table. a spoon;
- water - 200 ml.
Preparation and use:
- Prepare the collection.
- Pour 2 teaspoons of the mixture with boiling water and pour on a water bath for a quarter of an hour.
- Cool, drain.
- Take before meals on a tablespoon 5 times a day.
Gastroesophageal reflux - diet
Gentle diet with gastroesophageal reflux with esophagitis and without - a mandatory part of the treatment. Recommended small meals 5-6 times a day, while the dishes are allowed only warm, not sharp, not firm. You can not, standing up from the table, immediately take a horizontal position and eat before going to bed. Exclude:
- chocolate;
- coffee, strong tea;
- tomatoes;
- citrus;
- fats.