Gastroesophageal reflux (GERD) is a pathological condition in which the contents of the intestine, 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 disturbing, the manifestations of disorders are characteristic of the night, 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, due 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 ensures a decrease in the gaps of the passages for food, which means that the products cannot go in the wrong direction relative to the anatomical norm. To minimize discomfort, nature provides special mucosal components, thanks to whichit becomes resistant to acids. Also, the esophagus can independently be cleansed of food products mistakenly received here from the stomach.
If these mechanisms are violated, symptoms of GERD are possible. Refluxes become prolonged, too frequent, the mucous membrane becomes irritated and inflamed. The condition becomes pathological.
What's the difference?
Physiological reflux appears after a meal, it does not have GERD symptoms. There is little reflux during the day, it is extremely rare at night.
A pathological condition is considered if refluxes are long, painful, come often, appear both during a meal and at other moments of the day and night. The mucous membranes of the esophagus become inflamed, a complete clinical picture of GERD is observed.
Types and species
GERD symptoms differ from case to case - it all depends on the specifics of a particular situation. The acidity of the esophagus in a he althy person varies from 6 to 7 units. If the contents of the stomach enter here, the parameter becomes less than 4. This allows the diagnosis of acid reflux.
If the acidity of the esophagus varies between 4-7 units, the reflux is slightly acidic. It can be especially acidic - it is diagnosed if the acidity in the esophagus itself is less than 4 units, but food is thrown back.
An alternative option is the appearance in the esophagus of the contents of the stomach and intestines, which contains lysolecithin, bile components. In this case, the acidity becomes higher than normalvalues. Alkaline reflux diagnosed.
Where did the trouble come from?
Possible symptoms of gastric GERD in a chronic form. The disease is explained by the systematic uncontrolled entry of the contents of the stomach, intestines into the esophagus. The processes are repeated, occur spontaneously, harm the integrity of the mucosa.
Often, the symptoms of GERD with esophagitis in adults and children are observed against the background of a weakened functionality of the esophageal sphincter. This is possible, for example, if a hernia has developed in the diaphragm, which has led to destructuring of the organ. Sometimes GERD occurs when esophageal clearance is below normal. This is possible in case of violation of the chemical composition of saliva and a decrease in its quality as a neutralizer. A possible reason 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 caused by the contents of the stomach, intestines - pepsin, bile, hydrochloric acids are present in abandoned volumes, which harms organic tissues. In some cases, the cause of the pathological condition is a violation of the processes of gastric emptying, an abnormally high level of pressure in the abdominal cavity. Often GERD is observed in pregnant women, in people suffering from bad habits and overweight. Sometimes medication is the cause.
Important nuances
With and without symptoms, GERD is more common in individuals who have negative dietary habits. If a person eats quickly, plentifulin portions, swallowing air, the likelihood of an increase in pressure in the stomach above the norm is very high. The lower gastric sphincter relaxes and food is pushed up the esophagus.
Certain risks are associated with excessive consumption of meat, fatty foods, flour, greasy, fried, spicy. All this stimulates the long-term preservation of a lump of food in the stomach, sometimes leading to an increase in local pressure indicators.
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 a sour taste in the mouth. There may be a violation of the swallowing function, pain in the esophagus and the surrounding area. Often, GERD manifests itself as hiccups, a feeling that a lump has formed in the sternum. The patient vomits.
Other symptoms of GERD disease are explained by the penetration of the contents of the stomach, intestinal tract into the respiratory system. The masses have an irritating effect, activate the reflux of the bronchi, the heart.
One of the characteristic manifestations is a cough with GERD. Respiratory symptoms include shortness of breath. Strengthening is observed when a person lies down. Possible runny nose and inflammation in the throat, ear, nose. There is a possibility of reflex apnea. With GERD, there is a higher risk of caries and stomatitis, inflammatory gum disease.
Progress is possible over time if there is no adequate treatment of the disease. Symptoms of GERD will include erosions on the esophageal mucosa, which is accompanied by bleeding -small but constant.
The patient suffers from discomfort in the region of the heart. Possible soreness, violation of the speed and frequency of contractions of the heart muscle.
Further - worse
If you do not start the treatment of the disease in time, the symptoms of GERD worsen. There is esophageal stricture, erosion and ulcerative processes localized in this area. There may be bleeding from the affected areas. Over time, Barrett's condition develops. It is the most complex and severe complication of GERD. The squamous epithelium, which formed organic tissues, is replaced by a cylindrical, characteristic of the stomach. Metaplasia increases the likelihood of oncological disease localized in the gastrointestinal tract.
Special Occasion
Possible symptoms of GERD in infants. In the first few months after birth, this is due to the insufficient formation of the digestive system. This state is the norm. Breastfed babies have a number of specific anatomical, physiological features, due to which the likelihood of reflux is quite high. In addition to the underdevelopment of the digestive tract, low acidity of the gastric juice and a small volume of this organ play a role.
The described condition does not require treatment. A symptom of GERD in infants is regurgitation of food shortly after feeding. As a rule, the situation corrects itself by the age of one. If the condition is stable, no improvement is observed, you should consult a doctor. Probably have to go through a seriessurveys.
Indicate the need for diagnosis and treatment of GERD in young children tearfulness and anxiety. This is possible if reflux is accompanied by damage to the esophageal mucosa by hydrochloric acid. Regurgitation turns into vomiting, the process is long, heavy, the departments are plentiful, blood inclusions in the vomit are possible. With severe GERD, the child coughs. Weight gain is slow, weak.
As you grow older, the condition manifests itself as chest pain, heartburn, discomfort when swallowing food. Some children describe it as if food gets stuck. The sour taste bothers me in my mouth.
Status update
To clarify whether GERD symptoms require treatment for adults, children, you should visit a doctor. The doctor will assess the condition and conduct a full diagnosis. Based on the information received, a symptom management program will be selected. There are several approaches to formulating a diagnosis. First, an endoscopic examination is prescribed to identify the features of the condition of the esophagus. The doctor will quickly find areas of inflammation, erosion and ulceration, lesions localized on the esophageal membrane. 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, one can evaluate how food moves after it enters the esophagus. The doctor evaluates the activity of the sphincters.
Recommended during the dayundergo an acidity test. Through this technique, one can understand how frequent episodes of reflux are, how long they last, what are the parameters of the environment at this moment, how all this is connected with the manifestations that disturb the patient. It will be revealed whether there is a connection between manifestations and meals, the use of medicines, changes in posture. With symptoms of exacerbation of GERD, it will be determined what exactly has the strongest effect on the patient's condition in a particular case.
What to do?
For symptoms of GERD, treatment is diet, drug therapy, and sometimes radical surgery. Additionally, you will have to reconsider various aspects of everyday life and adjust your lifestyle.
Medications prescribed for GERD are aimed at normalizing acidity indicators, stimulating gastric motility. Prokinetics have proven themselves well, increasing the tone of the sphincter and enhancing its contractile abilities. Using such drugs, you can optimize the process of moving food into the intestinal tract, reduce the likelihood of reflux. Popular drugs are produced in compounds with domperidone, metoclopramide. To weaken the negative effect of hydrochloric acid, it is necessary to use antisecretory drugs. These are drugs that depress the proton pump and compounds that stop the activity of histamine-H2 receptors.
Reparants are used to stimulate regenerative cellular processes. Good representatives of this group of funds are sea buckthorn oil, Misoprostol, Dalargin. To reduce the effect of hydrochloric acid andpepsin, you can use antacids. The drugs of this group stimulate the cleansing of the gastrointestinal tract, absorb lysolecithin, some other chemically active substances present in the stomach. In the pharmacy you can buy "Almagel" and "Maalox". Phosphalugel has proven itself well.
Operation shown
This option is recommended if the disease is accompanied by complications, there are Barrett's changes, the third or fourth degree of esophagitis, as well as ulcerative processes on the mucous membranes. If medical treatment, lifestyle changes do not help to relieve the symptoms of GERD, cardinal intervention can also be considered.
Several surgical approaches are known. The main task of the doctor is to restore the barrier separating the esophagus from the stomach.
What's next?
To prevent relapses, it is necessary to introduce a number of good habits into everyday life. This will keep the positive results of the therapeutic course for a long time. The first thing to start with is the rejection of bad habits. Completely exclude alcohol from the diet, stop smoking. You should also avoid drinks containing caffeine. If you have extra pounds, you need to start eating right, getting rid of extra weight.
There are certain foods that can increase local internal pressure in the abdominal cavity. They should be excluded from the menu. Such foods include legumes, soda, and foamy drinks. It would also be wise to limit the intake of foods that stimulate the production ofacids. This is flour and fried, citruses and spicy, spicy. It is recommended to refuse or significantly reduce the consumption of chocolate, radish, radish.
The doctor, explaining how to maintain he alth with GERD, will definitely focus on proper nutrition, not only in terms of products, but also the process itself: you need to eat only small portions, chew thoroughly. During the meal, conversation is prohibited.
Suffering from GERD should avoid lifting heavy objects, abandon medications that adversely affect the esophageal sphincter. After a meal, you should avoid lying down for the next few hours.
Features of flow
The main manifestation of GERD is heartburn, but this condition occurs in many, so often people do not attach importance to it. It is necessary to see a doctor if heartburn gets worse when a person lies on their right side - this is a sign of GERD. When the position changes, the condition becomes better. The severity of the syndrome is not proportional to the degree of damage to organic tissues.
If there is scarring in the esophagus, the burp will contain pieces of food. Until the condition has developed to this level, the discharge is sour.
If heartburn is frequent and severe, GERD is accompanied by vomiting. At night, this condition provokes a strong cough and disturbs sleep. In the daytime, many patients do not bother at all.
Proper nutrition
With symptoms of GERD, treatment with folk remedies involves, first of all, a revision of the diet. However,traditional medicine also recommends this approach. The diet for GERD is a complete rejection of s alty, sour, spicy foods. It is necessary to choose only sparing food, which provokes chemical reactions to a minimum. You can not use too cold, hot. To ensure minimal mechanical irritation, only crushed foods that do not contain solid elements should be eaten.
The diet should include soups and dairy products, cereals and bread. Mineral waters with high alkalinity are recommended. From drinks, coffee and tea are allowed, but only weak ones. Alcohol is strictly prohibited.
After a meal, physical effort should be avoided. GERD imposes a ban on wearing tight clothes, especially those that squeeze the stomach. Waistbands, belts should be loose, and blouses and shirts should be larger than required.
Surgery: technology
In some cases, a patient with GERD is advised to undergo surgery using Nissen technology. During the intervention, a sleeve is formed that protects the lower esophageal compartment, the gastric fundus. The main task of this formation is to strengthen the muscle layer of the esophagus and compensate for the weakness of the sphincter. Such an operation is recommended for stage 3-4 esophagitis, in the absence of the effectiveness of a conservative approach.
If internal bleeding is detected, it is necessary to block them. To do this, it is allowed to do the Nissen operation or endoscopic intervention. With the use of an endoscope, bleeding is stopped using technologyclose to FSH. The device is inserted into the esophagus, vessels are tied or treated with drugs to activate hemostasis.
If a stenosis, a malignant neoplasm, an element of the esophagus is removed from the body, tissues of the intestinal tract are transplanted instead. After surgery, the patient can eat on his own, but you will have to adhere to a strict diet and constantly use medicines. Among the possible negative consequences of the operation are inflammation, damage to the sutures, recurrence of the neoplasm, recurrence of stenosis.
Rules and Opportunities
It is strictly forbidden to self-medicate with GERD. It is important to choose drugs for therapy very carefully. If the doctor prescribes any drugs, it is necessary to inform him of the reflux. A number of medicines for such a pathology are strictly prohibited, and taking them can cause a lot of harm.
One simple home remedy for heartburn is baking soda. With GERD, this approach is strictly prohibited. Baking soda reacts with the acids in the stomach juice, producing carbon dioxide. Air leads to gastric distension, provokes pain, worsens the patient's condition with gastritis and ulcers. Possible gastric ulcer perforation.
For GERD, you can occasionally resort to acid-reducing drugs, but only in an emergency. Constant use of them will lead to the same outcome as the use of soda.
Using pain medication for GERD if your stomach hurts can be dangerous. Remedies relieve pain, but maycause an ulcer. At the same time, indicators of the acidity of the medium in the stomach increase, the patient's condition worsens. For a similar reason, non-steroidal anti-inflammatory drugs should not be used, although occasionally a doctor prescribes such drugs if there are additional strict indications for this.
How to help yourself at home?
One of the options for a medicine to improve the condition of a patient with GERD involves the use of natural bee honey. Three times more aloe juice is taken for a certain volume of the product and mixed thoroughly. The medicine is intended to be consumed three times daily 10 minutes before a meal. Single dosage - 1/2 teaspoon.
You can try to be treated with 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 dry grass is poured over 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.
