Gastroesophageal reflux (GERD) is a pathological condition in which the contents of the intestines and stomach enter the esophagus. Reflux is physiological, if observed immediately after a meal, does not lead to severe discomfort. If the symptoms of GERD are often disturbed, the manifestations of the disturbances are characteristic of night time, accompanied by unpleasant sensations, they speak of pathology.
Physiology and Pathology
With reflux, hydrochloric acid can affect the esophagus. This compound has an irritating effect, initiates inflammatory processes. Normally, the human body is equipped with several mechanisms, thanks to which the effect of acid on the mucous membranes is not allowed. The first and main one is the sphincter, the reduction of which provides a decrease in the gaps of the passageways for food, which means that the products cannot go in the wrong direction relative to the anatomical norm. To minimize unpleasant sensations, nature provides for special components of the mucosa, due to which it becomes resistant to acids. Also, the esophagus can independently cleanse itself of food products that have erroneously come here from the stomach.
In violation of these mechanisms, symptoms of GERD are possible. Refluxes become prolonged, too frequent, the mucous membrane is irritated and inflamed. The condition becomes pathological.
What are the differences?
Physiological reflux appears after a meal, it does not have symptoms of GERD. On the day of reflux, there is little, very rarely this is observed at night.
A pathological condition is considered if refluxes are prolonged, painful, come often, appear both during a meal, and at other moments of the day or night. The mucous membranes of the esophagus become inflamed; a full-fledged clinical picture of GERD is observed.
Types and Types
Symptoms of GERD differ from case to case - it all depends on the specific features of a particular situation. The acidity of the esophagus in a healthy person varies from 6 to 7 units. If the contents of the stomach get here, the parameter becomes less than 4. This allows you to diagnose acid reflux.
If the acidity of the esophagus varies between 4-7 units, the reflux is slightly acidic. It is especially acidic - it is diagnosed if the esophagus itself has an acidity of less than 4 units, but food is thrown.
An alternative is the appearance in the esophagus of the contents of the stomach and intestines, which include lysolecithin, bile components. In this case, the acidity becomes higher than normal. Diagnosed with alkaline reflux.
Where did the trouble come from?
Possible symptoms of GERD of the stomach in chronic form. The disease is due to systematic uncontrolled ingestion of the contents of the stomach, intestines into the esophagus. Processes are repeated, occur spontaneously, damage the integrity of the mucosa.
Often, symptoms of GERD with esophagitis in adults and children are observed against the background of weakened functionality of the esophageal sphincter. This is possible, for example, if a hernia develops in the diaphragm, leading to the destruction of the organ. Sometimes GERD is observed if the esophageal clearance is below normal. This is possible if there is a violation of the chemical composition of saliva and a decrease in its quality as a neutralizer. A possible cause is a change in the concentration of bicarbonates in the mucus generated by the glands of the digestive system.
Sometimes the symptoms of GERD in children and adults are explained by the harm that the contents of the stomach and intestines cause - in abandoned volumes there are pepsin, bile, hydrochloric acid, which harms organic tissues. In some cases, the cause of the pathological condition is a violation of the gastric emptying processes, an abnormally high level of pressure in the abdominal cavity. GERD is often observed in pregnant women, in people suffering from bad habits and overweight. Sometimes the reason is drug therapy.
Important Nuances
With and without symptoms, GERD is more often observed in individuals who have negative habits associated with the regimen, the nature of the diet. If a person eats quickly, in plentiful portions, swallowing air, the likelihood of an increase in pressure in the stomach above the norm is very high. The lower gastric sphincter relaxes, products are thrown into the esophagus.
Certain risks are associated with excessive consumption of meat, fatty foods, flour, greasy, fried, spicy. All this stimulates the prolonged preservation of a lump of food in the stomach, sometimes leading to an increase in local indicators of pressure.
How to notice?
All symptoms are usually divided into esophageal and non-esophageal. Symptoms of GERD with esophagitis include heartburn and belching. Often, patients spit up food, they feel an acidic taste in their mouths. There may be a violation of swallowing function, pain in the esophagus and the surrounding area. GERD often manifests itself as a hiccup, as if a lump formed in the sternum. The patient is vomiting.
Other symptoms of GERD disease are explained by the penetration of the contents of the stomach, intestinal tract into the respiratory system. Masses have an irritating effect, activate bronchial reflux, heart reflux.
One of the characteristic manifestations is cough with GERD. Symptoms associated with breathing include breathlessness. Amplification is observed when a person lies. Possible runny nose and inflammation in the throat, ear, nose. There is a chance of reflex apnea. With GERD, the risk of caries and stomatitis, inflammatory gum disease is higher.
Progress is possible over time if there is no adequate treatment for the disease. Symptoms of GERD will include erosion on the esophageal mucosa, which is accompanied by bleeding - small but constant.
The patient suffers from discomfort in the heart. Possible pain, impaired speed and frequency of contractions of the heart muscle.
Further worse
If treatment of the disease is not started on time, the symptoms of GERD become worse. Esophageal stricture, erosion, and ulcerative processes localized in this area are observed. Possible bleeding from the affected areas. Over time, Baretta's condition develops. It is it - the most complex and severe complication of GERD. Squamous epithelium, which forms organic tissue, is replaced by a cylindrical, characteristic of the stomach. Metaplasia increases the likelihood of cancer, localized in the digestive tract.
Special occasion
GERD symptoms in infants are possible. In the first few months after birth, this is due to the insufficient formation of the digestive system. This condition is the norm. Breast babies have a number of specific anatomical, physiological features, because of which the likelihood of reflux is quite high. In addition to the underdevelopment of the digestive tract, a lower acidity of the gastric juice and a small volume of this organ play a role.
The described condition does not require treatment. The symptom of GERD in infants is to regurgitate food shortly after feeding. As a rule, the situation is corrected independently by the age of one. If the condition is stable, no improvement is observed, you should consult a doctor. You may have to go through a series of examinations.
Indicate the need for diagnosis and treatment of GERD in young children, tearfulness and concern. This is possible if reflux is accompanied by damage to the esophageal mucosa with hydrochloric acid. Vomiting passes into vomiting, the process is long, difficult, the departments are plentiful, blood inclusions in the vomit are possible. With a severe GERD, the child coughs. Weight gain is slow, weak.
As you grow older, the condition is manifested by soreness in the chest, heartburn, unpleasant sensations when swallowing food. Some children describe it as if food is stuck. A sour taste disturbs the mouth.
Status Update
To clarify whether treatment of adults and children with symptoms of GERD is necessary, you should go to the doctor. The doctor will evaluate the condition and conduct a full diagnosis. Based on the information received, a symptom management program will be selected. There are several approaches to the formulation of the diagnosis. First, an endoscopic examination is prescribed to identify the features of the esophagus. The doctor will quickly detect areas of inflammation, erosion and ulceration, lesions localized on the esophagus. If there is metaplasia, stricture, with the help of an endoscope, the doctor will get an accurate idea of the ongoing processes.
Then do esophagomanometry. Based on the results of such an event, it is possible to evaluate how food moves after getting into the esophagus. The doctor evaluates the activity of the sphincters.
During the day, it is recommended to undergo a procedure for monitoring acidity. Using this technique, one can understand how frequent episodes of reflux are, how long they are, what are the parameters of the environment at this moment, how all this is associated with manifestations that concern the patient. They will reveal whether there is a connection between manifestations and meals, the use of medicines, and changes in posture. With symptoms of exacerbation of GERD, they will determine what exactly has the most powerful effect on the patient's condition in a particular case.
What to do?
With symptoms of GERD, treatment is diet, drug therapy, sometimes radical surgery. Additionally, it will be necessary to review various aspects of everyday life and adjust the lifestyle.
Medicines prescribed for GERD are aimed at normalizing acidity and stimulating gastric motility. Prokinetics, which increase the tone of the sphincter and strengthen its contractile ability, have proven themselves well. Using such drugs, it is possible to optimize the process of moving food into the intestinal tract, and reduce the likelihood of reflux. Popular drugs are made in compounds with domperidone, metoclopramide. To mitigate the negative effects of hydrochloric acid, it is necessary to use antisecretory drugs. These are drugs that inhibit the proton pump and stop the activity of histamine-H2 receptor compounds.
To stimulate regenerative cellular processes, apply reparants. Good representatives of this group of products are sea buckthorn oil, Misoprostol, Dalargin. Antacids can be used to reduce the effects of hydrochloric acid and pepsin. Preparations of this group stimulate the cleansing of the digestive tract, absorb lysolecithin, some other chemically active substances present in the stomach. At the pharmacy you can buy Almagel and Maalox. Well established "Fosfalugel".
Operation shown
This option is recommended if the disease is accompanied by complications, Baretta changes, the third or fourth degree of esophagitis, as well as ulcerative processes on the mucous membranes are observed. If drug treatment, lifestyle correction do not allow to alleviate the symptoms of GERD, you can also consider a cardinal intervention.
Several surgical approaches are known. The main task of the doctor is to return the barrier separating the esophagus and stomach.
What's next?
To prevent relapses, it is necessary to introduce a number of useful habits into everyday life. This will save for a long time the positive results of the therapeutic course. The first thing you should start with is giving up bad habits. Completely exclude alcohol from the diet, stop smoking. It is also necessary to exclude drinks containing caffeine. If you have extra pounds, you need to start eating right, getting rid of extra weight.
Certain products are known that can increase local internal pressure in the abdominal cavity. They should be excluded from the menu. Such foods include legumes, soda, foam drinks. It would also be prudent to limit the use of foods that stimulate the production of acids. It is flour and fried, citrus and spicy, spicy. It is recommended to refuse or significantly reduce the consumption of chocolate, radish, radish.
The doctor, explaining how to maintain health with GERD, will certainly focus on proper nutrition, not only in terms of products, but also in the process itself: you need to eat food only in small portions, chew thoroughly. No conversation is allowed during the meal.
GERD sufferers should avoid lifting heavy objects, abandon medications that adversely affect the esophageal sphincter. After the meal, the next few hours, you must avoid the horizontal pose.
Leakage features
The main manifestation of GERD is heartburn, but this condition manifests itself in many, so often people do not attach importance to it. It is necessary to consult a doctor if heartburn becomes stronger when a person lies on his right side - this is a sign of GERD. When you change the position, the state becomes better. The severity of the syndrome is not proportional to the degree of damage to organic tissues.
If scars appear in the esophagus, burping will contain pieces of food. Until the condition has developed to such a level, the acid is separated.
If heartburn is frequent and severe, GERD is accompanied by vomiting. At night, this condition provokes a strong cough and disrupts sleep. In the daytime, many patients do not care at all.
Proper nutrition
With symptoms of GERD, treatment with folk remedies involves, first of all, a review of the diet. However, traditional medicine also recommends this approach. Diet with GERD is a complete rejection of salty, sour, spicy. It is necessary to choose only sparing food, which provokes chemical reactions to a minimum. Do not eat too cold, hot. To ensure minimal mechanical irritation, only shredded foods that do not have solid elements should be ingested.
Diet should include soups and dairy products, cereals and bread. Recommended mineral waters with high alkalinity. From drinks coffee and tea are allowed, but only weak. Under the absolute ban falls alcohol.
After the meal, physical effort must be avoided. GERD imposes a ban on wearing tight clothes, especially those that squeeze the stomach. Belts, belts should be loose, and blouses and shirts should be larger than required.
Surgery: Technology
In some cases, the patient with GERD is advised to undergo surgery using Nissen technology. During the intervention, a sleeve is formed to protect the lower esophageal compartment, the gastric fundus. The main objective of this formation is to strengthen the layer of the muscles of the esophagus and compensate for the weakness of the sphincter. Such an operation is recommended for esophagitis 3-4 stages, in the absence of the effectiveness of a conservative approach.
If internal bleeding is detected, it is necessary to block them. For this, it is allowed to perform Nissen surgery or endoscopic intervention. With the use of an endoscope, bleeding is stopped using technology close to FSH. The device is inserted into the esophagus, bandaged vessels or treated with drugs to activate hemostasis.
If stenosis, a malignant neoplasm is detected, an element of the esophagus is removed from the body, intestinal tract tissue is transplanted instead. After surgery, the patient can eat on their own, but you will have to adhere to a strict diet and constantly use medications. Of the possible negative consequences of the operation - inflammation, damage to sutures, relapse of the neoplasm, recurrence of stenosis.
Rules and Opportunities
It is strictly forbidden to engage in self-medication with GERD. It is important to carefully select drugs for therapy. If the doctor prescribes any funds, it is necessary to notify him by reporting reflux. A number of medicines with such a pathology is strictly prohibited, and their use can be a cause of a lot of harm.
One of the simple folk remedies for eliminating heartburn is the use of baking soda. With GERD, this approach is strictly prohibited. Soda reacts with acids in the juice of the stomach, producing carbon dioxide. Air leads to gastric distension, provokes pain, worsens the condition of the patient with gastritis and an ulcer. Perforation of a gastric ulcer is possible.
With GERD, you can occasionally resort to drugs that lower acidity, but only in an emergency. Their constant intake will lead to the same outcome as the use of soda.
The use of pain medication for GERD, if your stomach hurts, can be dangerous. Remedies stop pain, but can provoke the appearance of an ulcer. , . , , .
How to help yourself at home?
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You can try to treat herbs at home. A good result is the use of a mixture of St. John's wort, calendula, plantain, licorice, calamus, mint and tansy. The products are thoroughly mixed, a glass of water is boiled on a teaspoon and dried grass is poured into it. After 30 minutes, the water is drained - the medicine is ready. You need to use it 3 times daily before meals. A single dosage is a third of a glass. The liquid is consumed warm.