Gastroesophageal reflux disease (GERD), often referred to as reflux esophagitis shows regularly recurring episodes showering (reflux) of acidic stomach contents (sometimes and / or duodenal ulcers 12) into the esophagus causing damage to the lower esophagus under the influence of hydrochloric acid and cleaves proteins enzyme pepsin.
The causes of reflux is damage or functional failure of the special mechanisms of the obturator, located on the border of the esophagus and the stomach. Factors contributing to the development of the disease are stress, work-related permanent trunk bent down, obesity, pregnancy, and the use of certain drugs, fatty and spicy foods, coffee, alcohol and smoking. GERD often occurs in people with hiatal hernia.
The main symptom of GERD is heartburn, the second most common manifestation is chest pain that radiates (sends) in the interscapular region, neck, jaw, left side of the chest and can mimic angina. Unlike angina, the pain of GERD associated with food intake, body position and stopped by the reception of alkaline mineral water, soda or antacids. Pain may also occur in the back, in such cases, they are often considered a symptom of diseases of the spine.
Regular reflux of stomach contents into the esophagus may cause peptic ulcers and erosions of its mucous membrane, the latter may lead to perforation of the wall of the esophagus and bleeding (in half of the cases — severe). Another serious complication of GERD is a stricture — narrowing of the esophagus due to the formation of scar patterns of disruptions swallowing hard, and in severe cases even liquid food, a significant deterioration of health, loss of body weight. Very dangerous complication of GERD is a degeneration of stratified squamous epithelium in the cylinder, which is referred to as Barrett's esophagus is a precancerous sostoyaniem.Chastota adenocarcinoma in patients with Barrett's esophagus are 30-40 times higher than the average adult.
Furthermore, GERD can cause chronic inflammation of the nose and throat, cause chronic pharyngitis or laryngitis, ulcers, granulomas, and vocal cord polyps, stenosis of the larynx below the glottis, otitis media, rhinitis. Complications of the disease can be chronic recurrent bronchitis, aspiration pneumonia, lung abscess, hemoptysis, pulmonary atelectasis, or a fraction, the attacks of paroxysmal nocturnal cough and reflux-induced asthma. When GERD is also damage to the teeth (enamel erosion, caries, periodontitis), often marked halitosis (bad breath), and hiccups.
To detect reflux of gastric contents into esophagus perform a number of diagnostic tests. Foremost among these is the endoscope, it allows not only confirm the presence of reflux, but also to assess the degree of damage to the esophageal mucosa and monitor their healing during treatment. Also used daily (24-hour) pH-metry of the esophagus, making it possible to determine the frequency, duration and severity of reflux, the impact on his body position, meals and medicines. This method allows the diagnosis before damage occurs esophagus. Less often perform scintigraphy pischevodas radioactive isotope technetium and ezofagomanometriyu (for diagnosis of esophageal motility and tone). If you suspect that Barrett's esophagus perform a biopsy of the esophagus, followed by histological examination, as the regeneration of the epithelium can be diagnosed only by this method.
Treatment and prevention
Treatment of GERD performed conservatively (with lifestyle changes and medicines) or surgically. For medical treatment of GERD antacids (reduce the acidity of gastric contents), drugs that inhibit the secretory function of the stomach (H blockers2-histamine receptors and proton pump inhibitors), prokinetics, normalize motor function of the gastrointestinal tract. If an abandonment not only of gastric contents, but the 12-duodenal ulcers (usually in patients with cholelithiasis), good effect is achieved by taking drugs ursodezoksifolievoy acid. Patients are instructed to stop taking drugs that provoke reflux (anticholinergics, sedatives and tranquilizers, calcium channel blockers, β-blockers, theophylline, prostaglandins, nitrates), avoid eating after tilts forward and horizontal position of the body, to sleep with the head of the bed elevated, not wear tight clothes and tight girdles, corsets, braces, leading to an increase in intra-abdominal pressure, stop smoking and alcohol consumption; reduce body weight in obesity. It is also important not to overeat, eat small portions at intervals of 15-20 minutes between courses, is not later than 3-4 hours before bedtime. Should be excluded from your diet fatty, fried, spicy foods, coffee, strong tea, coca-cola, chocolate, beer, any carbonated drinks, champagne, citrus, tomatoes, onions, and garlic.
Surgical treatment is carried out in the presence of severe narrowing of the lumen of the esophagus (stricture) or severe bleeding due to perforation of the wall.