The German doctor, surgeon and scientist Heinrich Quincke in 1879 described the physiological process that occurs in the digestive system of people after eating, and called it gastroesophageal reflux (in the reduction of GER). A synonym for this difficult-to-pronounce term is gastroesophageal reflux. The word "reflux" in Latin means "reverse flow", and in medicine this term refers to movement in the opposite direction compared to the normal course of movement of the contents of any hollow organs. If you have been diagnosed with this, you don’t need to be upset, since GER is not a disease in itself and does not require treatment. But sometimes the mechanisms of this physiological process fail, food that returns from the stomach to the esophagus begins to corrode its epithelial cells, and the person experiences rather unpleasant sensations. In these cases, the diagnosis indicates gastroesophageal reflux with esophagitis - a serious disease that can lead to cancer of the esophagus.
The mechanism of gastroesophageal reflux
From the lessons of anatomy, we know that the food crushed in the mouth, when swallowed, enters the esophagus, which is a hollow tube. Its functions are limited to the quick delivery of a lump of food into the stomach, where it begins to be digested. The length of the esophagus in most people is 30 cm. In the lower part, the muscle fibers of its walls are so arranged that they act as a valve (sphincter). When a lump of food moves, they relax, passing it into the stomach, and then shrink, preventing food from returning to the esophagus. If the passage does not close enough, the contents of the stomach (food and gastric juice) partially move back into the esophagus, that is, gastroesophageal reflux occurs. Symptoms and treatment of this condition depend on how well protective mechanisms work in the esophagus.
For most people, this process does not cause any unpleasant or painful sensations, therefore it does not require treatment at all. However, in some, the return of part of the food back from the stomach to the esophagus is accompanied by painful or simply unpleasant sensations. In these cases, a doctor’s consultation and treatment are necessary.
How defense mechanisms work
Why is gastrointestinal reflux harmless in some cases and dangerous in others? The fact is that the human esophagus is "programmed" by nature to contact only with an alkaline environment, which is chewed food that enters it from the mouth. The stomach does not just take food lumps, it begins to digest them, for which it produces gastric juice - a liquid from a mixture of enzymes, mucus and the main component - hydrochloric acid. Once in the esophagus, it begins to "digest" the epithelial cells of its walls in the same way as food fragments. If a person has protective mechanisms against an aggressive acidic environment, they are not afraid of food reflux. These mechanisms are:
- a sufficiently high tone of the esophagus sphincter, not allowing food to go beyond the gastroesophageal zone;
- good clearance (quick cleansing of the esophagus from the incoming contents of the stomach);
- resistance of epithelial cells of the esophagus to hydrochloric acid;
- control of acidity of gastric juice.
Signs of non-disease GER
Consider when gastrointestinal reflux can be considered a normal act of human physiology. Symptoms of such a harmless process in the digestive system are as follows:
- a person does not feel any discomfort (this is one of the dominant signs);
- throwing food into the esophagus from the stomach is observed only immediately after a meal;
- reflux does not last long and happens only a couple of times a day;
- At night during sleep, reflux does not occur.
It should be noted that physiological reflux of food from the stomach to the esophagus is observed in people of any age, including children.
Prevention of harmless GER
Even in cases when gastroesophageal reflux does not cause problems, a number of simple efforts can be made to help your digestive tract work. Such simple actions can reduce the manifestation of reflux:
- Do not go to rest immediately after a meal;
- Do not start physical work, especially related to slopes, barely finished eating;
- do not overeat;
- reduce the use of foods (chocolate, alcohol, some specific sauces), relaxing the sphincter of the esophagus;
- do not start eating in tight clothing, with a tight belt;
- reduce the amount of servings, and increase the number of meals.
Signs of GER, which is a pathology
A gastroesophageal reflux disease with esophagitis is considered a disease. It happens when the protective mechanisms of the esophagus fail and can no longer protect the epithelial cells from being corroded by hydrochloric acid. This disease has two types of symptoms.
1. Esophageal. Patients note such unpleasant sensations:
- heartburn;
- sour taste in the mouth;
- belching (mostly acidic);
- dysphagia (choking is possible with food);
- pain behind the sternum (tend to increase with bending and lying down, can spread to the arms and neck).
2. Non-esophageal. Patients may experience some or all of the following symptoms:
- problems with teeth (caries, enamel defects);
- sinusitis;
- laryngitis;
- pharyngitis;
- coughing;
- pain in the heart.
Because of these manifestations, GER is often misdiagnosed and treated for diseases that do not exist in them.
Causes
Pathological gastroesophageal reflux can occur for the following reasons:
- obesity;
- alcohol, smoking;
- hiatal hernia ;
- unbalanced nutrition;
- drugs that reduce the tone of the sphincter;
- copious vomiting (it happens with poisoning);
- systemic scleroderma;
- nasogastric tube.
Gastroesophageal Reflux in Infants
In the early days and months of life, about 80% of infants have regurgitation after feeding. Most often, gastroesophageal reflux in an infant is not a pathology and occurs due to imperfection of its gastrointestinal system. Also, regurgitation protects the baby from overeating and air into his intestines.
It is enough for parents just to hold the baby vertically for about 10 minutes after feeding, so that spitting up does not occur. The following symptoms indicate more serious problems with the stomach and esophagus:
- constant crying and anxiety of the baby;
- belching;
- vomiting (not to be confused with regurgitation) after feeding;
- refusal of food;
- hiccups;
- causeless cough;
- the child does not sleep well and gains little weight.
According to the testimony, the doctor can prescribe to the infant mixtures with thickeners and medicines “Cisapride”, “Domperidone”, “Metoclopramide”, “Cimetidine”. If the reflux is caused by pathologies in the structure of the digestive tract, surgical intervention is possible.
Gastroesophageal reflux in children older than a year
In most children, by 12-18 months of spitting up after feeding completely disappear. Kids grow up healthy and do not feel any discomfort after eating. But some children have other complaints that indicate problems with their stomach or esophagus:
- heartburn (the child explains this symptom as “fire” or “fire”);
- belching sour;
- pain in the sternum;
- nausea;
- a feeling of fullness in the abdomen;
- regurgitation at night during sleep (this can be seen in the tracks on the pillow).
Often indications of gastroesophageal reflux in children are symptoms that are completely unrelated to the digestive system:
- cough;
- hoarse voice;
- lump and sore throat;
- hard breath;
- shortness of breath;
- difficulty swallowing;
- frequent pneumonia.
Usually, with these symptoms, they begin to treat a cold, but with GER, such therapy does not give results.
Diagnostics
If the patient has unpleasant or painful symptoms of gastroesophageal reflux, the diagnosis should be carried out using modern laboratory and instrumental methods. At the first stage, a gastroenterologist collects an anamnesis, including information about similar diseases in the patient's relatives, the duration and intensity of reflux symptoms.
The second stage is to conduct laboratory tests, such as:
- blood test (biochemical and general);
- coprogram;
- Analysis of urine.
The third stage of diagnosis includes instrumental research:
- esophageal manometry;
- endoscopy (esophagogastroduodenoscopy);
- provocative test;
- X-ray using barium suspension;
- Ultrasound.
Treatment
If pathological gastroesophageal reflux is diagnosed, treatment is carried out in three directions:
1. Non-pharmacological. Includes the following items:
- weight correction;
- diet (chocolate, alcohol, fatty, spicy, coffee, garlic, citrus fruits are not allowed);
- food ordering;
- exclusion from the wardrobe of tight clothing, narrow belts;
- rise of the head of the bed by 20 cm.
2. Medication:
- proton pump inhibitors (reduce the release in the stomach of hydrochloric acid "Rapeprazole", "Omeprazole");
- antacids (these drugs neutralize hydrophobic acid "Fosfalugel", "Almagel");
- Prokinetics (accelerate the movement of food from the stomach to the intestine "Metoclopramide").
3. Surgical. It is used if the two previous types do not give visible improvements.
If the disease is not treated, hydrochloric acid entering the esophagus can provoke ulceration of its walls, their perforation, bleeding, the so-called Barrett's esophagus, which increases the risk of a malignant tumor by 10 times.