We would like to preface the discussion of therapeutic options for gastroesophageal reflux disease (GERD) with brief information on the mechanisms of development and diagnosis of this pathology. The possibilities of surgical treatment of GERD will not be discussed in this article.

Definition

So, A.S. Trukhmanov defines GERD as the occurrence of characteristic symptoms and (or) inflammatory damage to the distal parts of the esophagus due to repeated reflux of gastric contents into the esophagus .

As defined by the International Working Group, the term "gastroesophageal reflux disease" should be applied to all individuals at risk of physical complications of gastroesophageal reflux, or experiencing a significant deterioration in health-related well-being (quality of life), as a result of reflux symptoms, after adequate assurance of benign nature of symptoms .

The term "endoscopically negative reflux disease" should be used in individuals who meet the definition of gastroesophageal reflux disease, but who do not have either Barrett's esophagus or visible mucosal defects (erosions or ulcers) on endoscopic examination. .

Development mechanisms

Without dwelling in detail on the pathogenetic mechanisms of development of this disease, we will only say that it is based on the effect of acid and pepsin on the esophageal mucosa due to the combination (in varying proportions) of pathological reflux of gastric contents into the esophagus with a violation of its clearance. Pathological reflux of contents, in turn, is caused by dysfunction of the lower esophageal sphincter (either as a result of a decrease in its tone or an increase in the frequency of spontaneous relaxation, or due to its anatomical defect, for example, with a hernia of the esophagus). Impaired esophageal clearance may be caused by decreased saliva production or impaired esophageal motility. As a result of all of the above, there is an imbalance between aggressive factors and protective factors, which leads, but not necessarily, to the occurrence of reflux esophagitis.

Epidemiology

According to S.I. Pimanova, symptoms of GERD are occasionally observed in half of the adult population, and the endoscopic picture of esophagitis is observed in 2-10% of examined people . It must be remembered that GERD is not always accompanied by esophagitis. Up to 50 - 70% of patients with heartburn at the time of seeking medical help have endoscopically negative GERD . The attitude of a number of practitioners towards endoscopically negative GERD as the mildest degree of this disease that does not require intensive drug therapy is fundamentally incorrect. A number of studies have demonstrated that the quality of life in patients with endoscopically positive and negative GERD is impaired to almost the same extent . Studies have shown that endoscopically negative GERD very rarely turns into reflux esophagitis, which in turn rarely progresses to more severe forms over time .

Diagnostics

Since the diagnosis of GERD is widely described in many manuals, we will dwell only on some of its points. The main symptom of GERD, observed in at least 75% of patients, is heartburn. . There may also be pain or a burning sensation in the sternum, belching, etc. Most often, GERD symptoms occur after eating.

Diagnosis of erosive esophagitis is based on endoscopic examination. X-ray with barium has a fairly high sensitivity for severe (98.7%) and moderate (81.6%) esophagitis, but is insensitive (24.6%) for mild esophagitis . Endoscopy with biopsy is the only reliable method for diagnosing Barrett's esophagus. The severity of erosive reflux esophagitis on the endoscopic picture is divided into 4 degrees A, B, C and D (according to the Los Angeles classification).

pH monitoring is a sensitive and specific diagnostic test and is especially important for identifying endoscopically negative GERD. More than 50 episodes of pH below 4 are considered diagnostic criteria for GERD . In a number of patients, a less significant decrease in the pH of the esophagus occurs, but when most episodes of such a decrease coincide with the onset of symptoms, it allows us to speak of a “hypersensitive esophagus.”

Among provocative tests, the Bernstein test plays a certain role (the appearance of typical symptoms after the introduction of a weak solution of hydrochloric acid into the esophagus and their disappearance after the introduction of saline). Determining the pressure of the lower esophageal sphincter is useful when deciding on surgical treatment.

Treatment

Before moving on to consideration of individual aspects of the treatment of GERD, it is necessary to emphasize the fact that its main goal is to quickly relieve patients from the symptoms that bother them. The disappearance of symptoms usually correlates well with the healing of mucosal defects in erosive esophagitis .

Changing your lifestyle.

Although, according to the GERD working group, lifestyle factors do not play a determining role in the development of GERD , recommendations aimed at eliminating factors contributing to reflux or worsening esophageal clearance should be given.

Diet. It is necessary to stop taking reflux-inducing foods (fatty foods, chocolate and excessive amounts of alcohol, onions and garlic, coffee, carbonated drinks, especially various types of colas) and drugs with low pH (orange and pineapple juices, red wine). However, an attempt to sharply limit a patient’s diet (especially a young one) is rarely possible in practice; your recommendations simply will not be followed. It makes more sense to identify which products cause the appearance or exacerbation of symptoms in a given patient and try to at least give them up. The patient should be informed that overeating should be avoided. After eating, it is advisable not to take a horizontal position or work in an inclined position. The last meal should be 3 hours before bedtime.

Weight control. Losing weight does not always resolve symptoms, but losing weight may reduce the risk of developing a hiatal hernia. However, giving advice to lose weight is much easier than implementing it. Overweight people sometimes try to hide their lack of waist by over-tightening the waist belt, which leads to increased intra-abdominal pressure and the development of reflux (as does wearing clothes that are too tight).

Smoking is a contributing factor to GERD as a result of both sphincter relaxation and decreased salivation and should accordingly be stopped . Although, according to some researchers, smoking cessation has minimal positive effect on GERD .

Raising the head of the bed is important for patients with nocturnal or LA symptoms (which constitute a small proportion of patients with GERD), but its necessity in other cases is questionable.

A number of medications such as antispasmodics, beta blockers, hypnotics and sedatives, nitrates and calcium antagonists can contribute to the development of reflux.

Antacids.

Discussing the use of antacids, of which there are a great many in our time (almagel, phosphalugel, maalox, rutacid, etc.), I would like to emphasize that, in our opinion, antacids do not play an independent role in the treatment of GERD and can only be used as a short-term remedy symptom control. The low effectiveness of antacids is based on the short duration of pH control achieved by their use. Data from many authors confirm the minimal effect of antacids (even in combination with lifestyle changes) for reflux esophagitis, although it is superior to the placebo effect . We suggest that patients (being treated for GERD) use antacids as a method of quickly controlling symptoms that occur, usually after a violation of diet or exercise, and in those with rare (no more than 4 per month) episodes of heartburn without endoscopic signs of esophagitis.

Antisecretory drugs.

The most effective way to treat GERD is to reduce acid production in the stomach using H2 blockers or proton pump inhibitors. The goal of this therapy is to increase the pH of gastric juice to 4 and during the period of greatest likelihood of reflux occurring, i.e. not the prevention of reflux as such, but the elimination of the pathological effects of gastric juice components on the esophagus. H2 blockers. Before the advent of proton pump inhibitors, H2 blockers were the drug of choice in the treatment of GERD. There are currently 4 H2 histamine receptor blockers used in practice (cimetidine, ranitidine, famotidine and nizatidine). The mechanism of action of the drugs is to block gastric secretion stimulated by histamine. However, two other stimulation pathways, acetylcholine and gastrin, remain open. It is this fact that is associated with a lower degree of suppression of secretion than with proton pump inhibitors (PPI) and a gradual decrease in the degree of inhibition of gastric secretion with long-term use of H2 blockers, when stimulation of acid production begins to increasingly occur through other mediators (mainly gastrin).

Cimetidine (first generation H2 blocker). Use 200 mg 3-4 times a day and 400 mg at night. The maximum daily dose is 12 grams.

Ranitidine (second generation) is used at a dosage of 150 mg 2 times a day, which can, if necessary, reach 300 mg 2 times a day (maximum dose 9 grams per day). For nighttime symptoms - 150-300 mg at night. Maintenance therapy - 150 mg at night.

Famotidine (third generation) is used at a dose of 20 mg twice daily, with a maximum daily dose of 480 mg. For nocturnal symptoms, 20-40 mg at night, maintenance therapy 20 mg at night.

Nizatidit (fourth generation) is taken 150 mg twice a day or 300 mg at bedtime.

Due to a very wide range of side effects (from androgenic effects to blockade of respiratory enzymes) and inconvenient dosage, cimetidine is not currently used in practice. Of all the other H2 blockers, we prefer famotidine (as the drug with the least common side effects). It must be remembered that all H2 blockers are discontinued gradually in order to prevent the “recoil” syndrome - a sharp increase in acidity after stopping treatment.

Based on 33 randomized trials (involving 3000 people), the following data were obtained: the use of placebo led to relief of GERD symptoms in 27% of patients, H2 blockers in 60% and PPI in 83% . Esophagitis was relieved in 24%, 50% and 78% of cases, respectively. These figures allow us to conclude that H2 blockers are effective in the treatment of GERD, which, however, is significantly inferior to that of PPI. H2 blockers retain a certain role in the treatment of GERD. They are effective as a treatment for reflux that occurs at night. , even if you continue to take PPI and as on-demand therapy.

Proton pump blockers.

Their action is based on blocking the ATPase of the influx pump (due to the formation of an irreversible bond with the cystine residue of the enzyme). It must be remembered that PPI only blocks the currently active proton pump. Drugs of this group are absorbed in the form of inactive compounds, turning into the active substance directly in the tubular systems of secretory cells. All PPIs, except esomeprazole, have a short half-life (30 - 120 minutes). PPI destruction occurs in the liver, and there are two ways of their destruction - fast and slow. The destruction process is stereodependent. The dextrorotatory isomer decays along the fast path, and the left-handed isomer decays along the slow path. All PPIs, again except esomeprazole (only the levorotatory isomer), are represented by right and left-handed isomers. This fact explains the longer retention of the minimum therapeutic concentration by esomeprazole compared to other PPIs.

PPIs are prescribed before meals (usually 30 minutes before breakfast, with a single dose), so that the effect occurs when the maximum number of active proton pumps is present - 70 - 80% of their total number. The next dose of PPI again blocks 70-80% of the receptors (remaining and regenerated), so the peak of the antisecretory effect occurs on days 2-3 (slightly faster when using esomeprazole). PPIs are practically ineffective as an on-demand therapy (the onset of symptoms - heartburn, indicates an acid surge that has already occurred, followed, as a rule, by a decrease in the number of active pumps and, therefore, the absence of a target for PPI action).

When analyzing the comparative effectiveness of various PPIs, it can be concluded that there are no significant advantages between omeprazole, rabeprazole, lansoprazole and pantoprazole. The effectiveness of esomeprazole (Nexium) is slightly higher. When comparing the duration of maintaining intragastric pH > 4 using different PPIs, data were obtained about better control of gastric secretion when using Nexium (Fig. 1).

Although it should be noted that when using 40 mg of omeprazole, the difference is not so noticeable. The benefits of Nexium are more pronounced in severe forms of esophagitis (grade D) . Omeprazole is used in a dose of 20 - 40 mg per day (either once a day in the morning or twice a day). In severe cases, the dose can reach 60 mg per day. Lansoprazole is used at 30 mg/day, pantoprazole at 40 mg/day, rabeprazole at 20 mg/day and Nexium at 40 mg/day. Discontinuation of the drug should also be gradual.

Prokinetic drugs.

Prokinetic drugs (domperidone, metoclopramide, and cisapride) may increase lower esophageal sphincter pressure, improve esophageal clearance, and accelerate gastric emptying. Cisapride is only available for limited use in the US due to concerns about cardiac arrhythmias (see below). Metoclopamide causes weakness, anxiety, tremor, parkinsonism or tardive dyskinesia in 20-50% of cases. Use 10 mg 3-4 times a day. The maximum single dose is 20 mg, daily dose is 60 mg.

Cisapride. Although cisapride was generally considered virtually safe, its recent widespread use in the United States has been associated with the occurrence of cardiac arrhythmias. Most often they developed when taking cisapride in combination with drugs that inhibit cytochrome P-450 and increase the level of cisapride. As a result, the manufacturer has partially restricted the use of this drug in the United States. Studies have compared the effectiveness of cisapride 910 mg four times a day) with H2 receptor antagonists (ranitidine 150 mg twice a day) and cimetidine (400 mg four times a day) have demonstrated their superiority over placebo and similar effectiveness in relieving the symptoms of GERD and curing esophagitis . The combination of H2 blockers with cisapride gives a better effect than each of the drugs individually, but is inferior to omeprazole .

Domperidone (Motilium) has a mechanism of action similar to metoclopramide, but does not penetrate the blood-brain barrier and therefore does not cause central side effects, but increases the level of prolactin in the blood. Use 10 mg 3-4 times a day. None of the drugs gave a good therapeutic effect in severe degrees of esophagitis.

The role of HP infection.

Currently, the role of HP infection in GERD remains controversial. Although, according to the Maastrik Agreements, GERD is an indication for eradication therapy, not all authors agree with this. A number of studies have shown that Hp eradication does not cure reflux esophagitis, nor does it have a preventive role in terms of its relapse . The fact that Hp infection can cause either an increase or decrease in gastric secretory function makes its role in the development of GERD even more controversial. Data from some authors even indicate a protective role of HP infection in GERD , due to the alkalizing effect, and in the further development of mucosal atrophy.

Almost the only factor justifying eradication therapy for GERD is that chronic use of PPI, against the background of existing HP infection, contributes to the development of atrophic gastritis and metaplasia . According to Kuipers EJ comparing the likelihood of developing atrophic gastritis in groups of patients with GERD and HP infection who received omeprazole or underwent fundoplication, it developed in 31% and 5% of patients, respectively. Although another study did not find such a pattern . In turn, eradication therapy does not cause exacerbation or worsening of GERD .

In our practice, we test for the presence of HP and perform eradication in patients with GERD only if they have a concomitant disease of the upper gastrointestinal tract whose connection with HP infection has been established (for example, peptic ulcer) or when planning chronic (more than a year) constant use of proton pump inhibitors.

New directions of pharmacotherapy.

According to Ciccaglione et al, the drug, which reduces the number of spontaneous relaxations of the lower esophageal sphincter, baclofen at a dosage of 10 mg 3 times a day for a month showed significant superiority over placebo, improvement in esophageal pH monitoring data and a decrease in the severity of GERD symptoms . It was also noted to be well tolerated. The drug inhibits 34-60% of spontaneous relaxation of the lower esophageal sphincter and increases its basal pressure . However, there is still insufficient data to justify the widespread use of baclofen in the treatment of GERD.

Treatment regimens.

Currently, there are two main tactical approaches to the treatment of GERD, the so-called step-up and step-down. The first is the use of the weakest measures (lifestyle modification, antacids) as the first stage of treatment with the gradual use of increasingly powerful drugs if ineffective (H2 blockers, then their combination with prokinetics and only then PPI). The second treatment option involves prescribing the most effective treatment (PPI), which allows you to quickly relieve symptoms, and then reduce the dose of medications and possibly switch to weaker drugs.

In our practice, we adhere only to step-down therapy because... We believe that the patient comes to us for the fastest relief of the symptoms that bother him, which should be achieved by prescribing a group of drugs from which the best effect can be expected. You should not forget about the advice on lifestyle changes, but in combination with the administration of a standard dose of PPI. As for starting treatment with H2 blockers, followed by switching, if necessary, to PPI - you won’t be judged for this, but does it make sense? H2 blockers have no fewer potential side effects, and their price is not significantly lower. We'll leave them for on-demand therapy and nocturnal reflux episodes. It is true that there is a very small group of patients with reflux esophagitis refractory to proton pump inhibitor therapy in whom sufficient pH control can be achieved using high doses of H2 blockers .

What to do with endoscopically negative GERD? Yes, exactly the same. As mentioned above, the degree of morphological changes in the esophagus does not correlate well with the severity of symptoms . Moreover, in this group of patients there is often a less pronounced effect of antisecretory therapy with longer persistence of symptoms . It must also be remembered that the effectiveness of H2 blockers for endoscopically negative GERD does not exceed that for erosive reflux esophagitis .

In severe reflux esophagitis (C, D), therapy with the most powerful PPI (Nexium) or the maximum dose of other proton pump inhibitors is rational.

For nocturnal episodes of heartburn, despite the use of PPI, it is rational to add a single evening dose of an H2 blocker. Antacids can be used as patient-controlled, on-demand therapy.

So, we follow a knowledgeable management strategy when a new patient with GERD appears.

• Proton pump inhibitors in a standard dose (for 2-4 weeks for endoscopically negative reflux esophagitis and erosive esophagitis grades A, B and for 8 weeks for its more severe forms).
• In case of ineffectiveness (determined by the persistence of symptoms after 7-10 days of treatment or the preservation of the endoscopic picture of esophagitis), increase the dose of PPI to the maximum or switch to a potentially more effective PPI - Nexium.
• If ineffective, pH monitoring is required during treatment. Trying to switch to high doses of H2 blockers in combination with prokinetics? Antireflux surgery?
• If effective, gradually reduce the dosage until the drug is discontinued. If symptoms recur, take the minimum effective dose of the drug (every other day therapy or weekend therapy is possible), discuss the possibility of antireflux surgery.

Maintenance therapy.

Based on the chronic nature of GERD, there is a need for maintenance therapy. Reducing the dose of medication or attempting maintenance therapy with a drug less potent than the drug used for treatment often leads to a high relapse rate. Only in approximately 20% of patients after a course of treatment, lifestyle changes and periodic use of antacids are sufficient to maintain remission. H2 blockers and prokinetics are ineffective in maintaining remission in patients who achieved it using PPI . Low dose PPI therapy is most effective. The effectiveness of weekend therapy and every other day is controversial.

Conclusion.

Drug therapy remains the mainstay of treatment for GERD. PPIs are the drugs of choice for treatment and long-term maintenance therapy. The role of HP infection in the development and natural course of GERD, as well as its effect on the outcome of treatment, are not completely clear. The development of new drugs and comparison of the effectiveness of various schemes for their use is a promising direction for further improving the quality of treatment of this pathology.

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Gastroesophageal reflux disease is a pathological process that results from deterioration of the motor function of the upper gastrointestinal tract. It occurs as a result of reflux - a regularly repeated reflux of stomach or duodenal contents into the esophagus, resulting in damage to the mucous membrane of the esophagus, and damage to overlying organs (larynx, pharynx, trachea, bronchi) can also occur. What kind of disease is this, what are the causes and symptoms, as well as the treatment of GERD - we will look at this in this article.

GERD - what is it?

GERD (gastroesophageal reflux disease) is the reflux of gastric (gastrointestinal) contents into the lumen of the esophagus. Reflux is called physiological if it appears immediately after eating and does not cause obvious discomfort to a person. This is a normal physiological phenomenon if it occurs occasionally after eating and is not accompanied by unpleasant subjective sensations.

But if there are many such reflux and they are accompanied by inflammation or damage to the mucous membrane of the esophagus, and extra-esophageal symptoms, then this is already a disease.

GERD occurs in all age groups, in both sexes, including children; the incidence increases with age.

Classification

There are two main forms of gastroesophageal reflux disease:

• non-erosive (endoscopically negative) reflux disease (NERD) - occurs in 70% of cases;
• (RE) - the incidence rate is about 30% of the total number of GERD diagnoses.

Experts distinguish four degrees of reflux damage to the esophagus:

1. Linear defeat– individual areas of inflammation of the mucous membrane and foci of erosion on its surface are observed.
2. Drain lesion– the negative process spreads over a large surface due to the merging of several foci into continuous inflamed areas, but not the entire area of ​​the mucous membrane is yet covered by the lesion.
3. Circular lesion– zones of inflammation and foci of erosion cover the entire inner surface of the esophagus.
4. Stenosing lesion– against the background of complete damage to the inner surface of the esophagus, complications are already occurring.

Reasons

The main pathogenetic substrate for the development of gastroesophageal reflux disease is gastroesophageal reflux itself, that is, retrograde reflux of stomach contents into the esophagus. Reflux most often develops due to incompetence of the sphincter located at the border of the esophagus and stomach.

The following factors contribute to the development of the disease:

• Decreased functional ability of the lower esophageal sphincter (for example, due to destructuring of the esophagus due to hiatal hernia);
• Damaging properties of gastrointestinal contents (due to the content of hydrochloric acid, as well as pepsin, bile acids);
• Gastric emptying disorders;
• Increased intra-abdominal pressure;
• Pregnancy;
• Smoking;
• Overweight;
• Decreased clearance of the esophagus (for example, due to a decrease in the neutralizing effect of saliva, as well as bicarbonates of esophageal mucus);
• Taking medications that reduce smooth muscle tone (calcium channel blockers, beta-agonists, antispasmodics, nitrates, M-anticholinergics, bile-containing enzyme preparations).

Factors contributing to the development of GERD are:

• disorders of motor functions of the upper digestive tract,
• hyperacidotic conditions,
• reduced protective function of the esophageal mucosa.

Symptoms of gastroesophageal reflux disease

Once in the esophagus, the contents of the stomach (food, hydrochloric acid, digestive enzymes) irritate the mucous membrane, leading to the development of inflammation.

The main symptoms of gastroesophageal reflux are as follows:

• heartburn;
• belching acid and gas;
• acute sore throat;
• discomfort in the pit of the stomach;
• pressure that occurs after eating, which increases after eating food that promotes the production of bile and acid.

In addition, acid from the stomach, entering the esophagus, has a negative effect on local tissue immunity, affecting not only the esophagus, but also the nasopharynx. A person suffering from GERD often complains of chronic pharyngitis.

GERD often occurs with atypical clinical manifestations:

• chest pain (usually after eating, worse when bending over),
• heaviness in the stomach after eating,
• hypersalivation (increased salivation) during sleep,
• bad breath,
• hoarseness.

Symptoms appear and intensify after eating, physical activity, in a horizontal position, and decrease in a vertical position, after drinking alkaline mineral waters.

Signs of GERD with esophagitis

Reflux disease in the esophagus can cause the following reactions:

• inflammatory process,
• damage to the walls in the form of ulcers,
• modification of the lining layer in contact with the refluxate into a form unusual for a healthy organ;
• narrowing of the lower esophagus.

If the above symptoms occur more than 2 times a week for 2 months, you should consult a doctor for examination.

GERD in children

The main reason for the development of reflux disease in children is the immaturity of the lower sphincter, which prevents the evacuation of food from the stomach back into the esophagus.

Other causes that contribute to the development of GERD in childhood include:

• functional insufficiency of the esophagus;
• narrowing of the gastric outflow tract;
• recovery period after surgery on the esophagus;
• operations for gastric resection;
• consequences of serious injuries;
• oncological processes;
• difficult childbirth;
• high intracranial pressure.

Common symptoms of GERD in a child are as follows:

• frequent burping or burping;
• poor appetite;
• pain in the stomach;
• the child is excessively capricious during feeding;
• frequent vomiting or retching;
• hiccups;
• difficulty breathing;
• frequent cough, especially at night.

Treatment for gastroesophageal reflux disease in children will depend on symptoms, age, and overall health. In order to prevent the development of this disease in a child, parents should closely monitor his diet.

Complications

Gastroesophageal reflux disease can cause the following complications in the body:

• esophageal stricture;
• ulcerative lesions of the esophageal mucosa;
• bleeding;
• the formation of Barrett's syndrome - complete replacement (metaplasia) of the stratified squamous epithelium of the esophagus with columnar gastric epithelium (the risk of esophageal cancer with epithelial metaplasia increases 30-40 times);
• malignant degeneration of esophagitis.

Diagnostics

In addition to the diagnostic methods described, it is important to visit the following specialists:

• cardiologist;
• pulmonologist;
• otorhinolaryngologist;
• surgeon, his consultation is necessary in case of ineffectiveness of the ongoing drug treatment, the presence of large diaphragmatic hernias, or in the event of complications.

To diagnose gastroesophageal reflux, the following methods are used:

• endoscopic examination of the esophagus, which allows to identify inflammatory changes, erosions, ulcers and other pathologies;
• daily monitoring of acidity (pH) in the lower part of the esophagus. Normal level pH should be between 4 and 7, changes in evidence may indicate the cause of the disease;
• radiography - allows you to detect ulcers, erosions, etc.;
• manometric examination of the esophageal sphincters - performed to assess their tone;
• scintigraphy using radioactive substances - performed to assess esophageal clearance;
• biopsy - performed if Barrett's esophagus is suspected;
• ECG and daily ECG monitoring; Ultrasound examination of the abdominal organs.

Of course, not all methods are used for accurate diagnosis. Most often, the doctor only needs the data obtained during the examination and interview of the patient, as well as the conclusion of the FEGDS.

Treatment of reflux disease

Treatment of gastroesophageal reflux disease can be medication or surgery. Regardless of the stage and severity of GERD, during therapy it is necessary to constantly adhere to certain rules:

1. Do not lie down or lean forward after eating.
2. Do not wear tight clothes, corsets, tight belts, bandages - this leads to an increase in intra-abdominal pressure.
3. Sleep on a bed in which the part where the head is located is raised.
4. Do not eat at night, avoid large meals, do not eat too hot food.
5. Quit alcohol and smoking.
6. Limit consumption of fats, chocolate, coffee and citrus fruits, as they are irritating and reduce LES pressure.
7. Lose weight if you are obese.
8. Stop taking medications that cause reflux. These include antispasmodics, β-blockers, prostaglandins, anticholinergic drugs, tranquilizers, nitrates, sedatives, calcium channel inhibitors.

Medications for GERD

Drug treatment of gastroesophageal reflux disease is carried out by a gastroenterologist. Therapy takes from 5 to 8 weeks (sometimes the course of treatment lasts up to 26 weeks) and is carried out using the following groups of drugs:

1. Antisecretory agents (antacids) have the function of reducing the negative effect of hydrochloric acid on the surface of the esophagus. The most common are: Maalox, Gaviscon, Almagel.
2. As a prokinetic Motilium is used. The course of treatment for catarrhal or endoscopically negative esophagitis lasts about 4 weeks, for erosive esophagitis 6-8 weeks, if there is no effect, treatment can be continued up to 12 weeks or more.
3. Taking vitamin preparations, including vitamin B5 and U in order to restore the mucous membrane of the esophagus and generally strengthen the body.

GERD can also be caused by an unbalanced diet. Therefore, drug treatment must be supported by proper nutrition.

With timely identification and compliance with lifestyle recommendations (non-drug treatment measures for GERD), the prognosis is favorable. In the case of a long, often relapsing course with regular refluxes, the development of complications, and the formation of Barrett's esophagus, the prognosis noticeably worsens.

The criterion for recovery is the disappearance of clinical symptoms and endoscopic findings. To prevent complications and relapses of the disease, and monitor the effectiveness of treatment, it is necessary to regularly visit a doctor, therapist or gastroenterologist, at least once every 6 months, especially in the fall and spring, and undergo examinations.

Surgical treatment (operation)

There are various methods of surgical treatment of the disease, but in general their essence comes down to restoring the natural barrier between the esophagus and the stomach.

Indications for surgical treatment are as follows:

• complications of GERD (repeated bleeding, strictures);
• ineffectiveness of conservative therapy; frequent aspiration pneumonia;
• diagnosing Barrett's syndrome with high-grade dysplasia;
• the need of young patients with GERD for long-term antireflux therapy.

Diet for GERD

Diet for gastroesophageal reflux disease is one of the main areas of effective treatment. Patients suffering from esophagitis should adhere to the following dietary recommendations:

1. Eliminate fatty foods from your diet.
2. To stay healthy, avoid fried and spicy foods.
3. If you are ill, it is not recommended to drink coffee or strong tea on an empty stomach.
4. People prone to esophageal diseases are not recommended to consume chocolate, tomatoes, onions, garlic, mint: these products reduce the tone of the lower sphincter.

Thus, the approximate daily diet of a patient with GERD is as follows (see daily menu):

Some doctors believe that for patients diagnosed with gastroesophageal reflux disease, these dietary rules and a healthy lifestyle are more important than the foods from which the menu is composed. You should also remember that you need to approach your diet taking into account your own feelings.

Folk remedies

Alternative medicine involves a large number of recipes; the choice of a specific one depends on the individual characteristics of the human body. But folk remedies cannot act as a separate therapy; they are included in the general complex of therapeutic measures.

1. Sea buckthorn or rosehip oil: take one teaspoon up to three times a day;
2. The home medicine cabinet of a patient with reflux disease should contain the following dried herbs: birch bark, lemon balm, flax seeds, oregano, St. John's wort. You can prepare a decoction by pouring a couple of tablespoons of the herb with boiling water in a thermos and letting it sit for at least an hour, or by adding a handful of the medicinal plant to boiling water, remove the pan from the stove, cover with a lid and let it brew.
3. Crushed plantain leaves(2 tbsp.), St. John's wort (1 tbsp.) Place in an enamel container, pour boiling water (500 ml). After half an hour, the tea is ready to drink. You can take the drink for a long time, half a glass in the morning.
4. Treatment of GERD with folk remedies involves not only herbal medicine, but also the use of mineral waters. They should be used at the final stage of the fight against the disease or during remissions in order to consolidate the results.

Prevention

In order to never encounter an unpleasant disease, it is important to always pay attention to your diet: do not overeat, limit the consumption of unhealthy foods, and monitor your body weight.

If these requirements are met, the risk of GERD will be minimized. Timely diagnosis and systematic treatment can prevent the progression of the disease and the development of life-threatening complications.

Gastroesophageal reflux disease (GERD) questions and answers

The International Foundation for Functional Gastrointestinal Diseases (IFFGD), USA, has prepared a range of materials on functional gastrointestinal disorders for patients and their families. This material is devoted to gastroesophageal reflux disease.

Originally written by Joel Richter, Philip O. Katz, and J. Patrick Waring, edited by William F. Norton. In 2010, an updated version was prepared by Ronnie Fass.

Even a little knowledge can make a big difference

Introduction

Gastroesophageal reflux disease, abbreviated as GERD, is a very common disease, affecting at least 20% of adult US men and women. It is also common in children. GERD often goes unrecognized because its symptoms can be misinterpreted and this is unfortunate, since GERD is usually treatable, and if left untreated, serious complications can occur.

The purpose of this publication is to gain a deeper understanding of issues such as the nature of GERD, its definition and its treatment. Heartburn is the most common, but not the only symptom of GERD. (The disease can even be asymptomatic). Heartburn is not a specific symptom for GERD and may result from other diseases of the esophagus or other organs. GERD is often treated independently, without consultation with specialists, or treated incorrectly.

GERD is a chronic disease. Her treatment must be on a long-term basis, even after her symptoms are under control. Proper attention must be paid to changes in daily life habits and long-term medication use. This can be done through follow-up and patient education.

GERD is often characterized by painful symptoms that can significantly impair a person's quality of life. Various methods are used to effectively treat GERD, ranging from lifestyle changes to medications and surgery. For patients suffering from chronic and recurrent symptoms of GERD, it is important to obtain an accurate diagnosis and receive the most effective treatment available.

What is GERD?

Gastroesophageal reflux disease or GERD is a very common condition. Gastroesophageal means that it relates to both the stomach and the esophagus. Reflux- that there is a reverse flow of acidic or non-acidic stomach contents into the esophagus. GERD is characterized by its symptoms and can develop with or without damage to the tissues of the esophagus, resulting from repeated or prolonged exposure of the esophageal mucosa to acidic or non-acidic stomach contents. If tissue damage is present, the patient is said to have esophagitis or erosive GERD. The presence of symptoms without visible tissue damage is called non-erosive GERD.

GERD is often accompanied by symptoms such as heartburn and sour belching. But sometimes GERD occurs without visible symptoms and is detected only after complications become obvious.

What causes reflux?

After swallowing, food passes down the esophagus. Once in the stomach, it stimulates cells that produce acid and pepsin (an enzyme), which are necessary for the digestion process. A bundle of muscles at the bottom of the esophagus, called the lower esophageal sphincter (LES), acts as a barrier to prevent stomach contents from flowing back (reflux) into the esophagus. To allow the swallowed portion of food to pass into the stomach, the LES relaxes. When this barrier relaxes at the wrong time, when it is weak, or when it is otherwise not effective enough, reflux can occur. Factors such as bloating, delayed stomach emptying, a significant hiatal hernia, or too much stomach acid can also trigger acid reflux.

What Causes GERD?

It is not known whether there is a single cause of GERD. Failure of the esophageal defenses to resist aggressive gastric contents entering the esophagus during reflux can lead to damage to esophageal tissue. GERD can also occur without damage to the esophagus (approximately 50-70% of patients have this form of the disease).

Surgery . Surgical treatment may be indicated in the following cases:

• the patient is not interested in long-term drug therapy;
• symptoms cannot be controlled by methods other than surgery;
• symptoms return despite treatment;
• serious complications develop.

When choosing surgical treatment, a thorough analysis of all circumstances with the participation of a gastroenterologist and surgeon is recommended.

How long do you need to take medication to keep GERD from getting out of control?

GERD is a chronic disease, and most patients require long-term therapy to keep its symptoms effectively controlled. Similar to how patients with high blood pressure or chronic headaches also require regular treatment. Even after symptoms are controlled, the underlying disease remains. It is possible that you will need to take medications for the rest of your life to control GERD. Unless new drugs and treatments are developed during this time.

Is taking long-term medications to treat GERD harmful?

Long-term use of any medication should only be done under the guidance of a physician. This applies to both prescription and over-the-counter medications. Side effects are rare, however, any drug can potentially have unwanted side effects.

H2 blockers have been used to treat reflux disease since the mid-1970s. Since 1995, they have been available over the counter in reduced doses to treat rare heartburn. They have proven to be safe, although they sometimes cause side effects such as headache and diarrhea.

The proton pump inhibitors omeprazole and lansoprazole have been regularly used by patients with GERD for many years (omeprazole was approved in the US in 1989 and worldwide a few years after that). Side effects from these drugs are rare and mainly include occasional diarrhea, headache, or stomach upset. These side effects are generally no more common than with placebo and usually occur when starting to use the drug. If none of these side effects have appeared after months or years of taking proton pump inhibitors, they are unlikely to appear later.

Patients with heart disease who are taking clopidogrel (Plavix) should avoid taking proton pump inhibitors such as omeprazole and esomeprazole. In addition, recent studies have shown that long-term use of PPIs, especially more than once daily, can cause osteoporosis, bone fractures, pneumonia, gastroenteritis, and hospital-acquired colitis. Patients should discuss this with their healthcare provider.

When is surgery an alternative to therapeutic treatment for GERD?

Drug therapy helps control symptoms as long as the medication is taken correctly. Surgery is an alternative usually when long-term treatment is either ineffective or undesirable, or when there are serious complications of GERD.


The most common surgical procedure to treat GERD is a Nissen fundoplication. It can be performed laparoscopically by an experienced surgeon. The purpose of the operation is to increase pressure in the lower esophageal sphincter to prevent reflux. When performed by an experienced surgeon (who has performed at least 30-50 laparoscopic operations), its success approaches that of well-planned and carefully executed therapeutic treatment with proton pump inhibitors.

Side effects or complications associated with surgery occur in 5-20% of cases. The most common is dysphagia, or difficulty swallowing. It is usually temporary and goes away after 3-6 months. Another problem that occurs in some patients is their inability to burp or vomit. This is because the operation creates a physical barrier to any type of backflow of any stomach contents. A consequence of the inability to belch effectively is “gas-bloat” syndrome - bloating and discomfort in the abdomen.

The surgically created anti-reflux barrier can “break” in much the same way as a hernia penetrates other parts of the body. The recurrence rate has not been determined, but may be in the range of 10-30% within 20 years after surgery. Factors that may contribute to this “breakdown” include: weightlifting, strenuous exercise, sudden changes in weight, severe vomiting. Any of these factors can increase blood pressure, which can lead to weakening or disruption of the anti-reflux barrier created as a result of surgery.

In some patients, even after surgery, symptoms of GERD may persist and medication will need to be continued.

Living with GERD

It is important to recognize that GERD is a disease that should not be ignored or self-medicated. Heartburn, the most common symptom, is so common that its importance is often underestimated. It may be overlooked and not associated with GERD.

It is important to understand that GERD can have serious consequences. The complications that can arise, as well as the discomfort or pain from acid reflux, can affect all aspects of a person's daily life - emotional, social and professional.

Studies that measure the emotional state of those with untreated GERD often report worse scores than those with other chronic diseases, such as diabetes, high blood pressure, peptic ulcers, or angina. However, almost half of those suffering from acid reflux do not recognize it as a disease.

GERD is a disease. It is not a consequence of an incorrect lifestyle. It is usually accompanied by obvious symptoms, but can occur in the absence of them. Ignoring them or improperly treating them can lead to more serious complications.

Most people with GERD have a mild form of the disease, which can be controlled with lifestyle changes and medications. If you suspect you have GERD, the first step is to see your doctor for an accurate diagnosis. Once recognized, GERD is usually treatable. By partnering with your doctor, you can develop the best treatment strategy available to you.

_______________________________________________________________________________

The views of the authors do not necessarily reflect those of the International Foundation for Functional Gastrointestinal Diseases (IFFGD). IFFGD does not warrant or endorse any product in this publication or any claims made by the author and does not accept any liability regarding such matters.

This brochure is in no way intended to replace medical advice. We recommend visiting a doctor if your health problem requires an expert opinion.

One of the most common chronic diseases of the gastrointestinal tract is gastroesophageal reflux disease. This pathology is diagnosed in approximately a quarter of the world's population, and the number of cases is growing every year. This is primarily due to the lifestyle of a modern person, associated with stress and bad habits, as well as poor ecology.

The essence of the disease

Essentially, when talking about gastroesophageal reflux disease (GERD), they mean reflux esophagitis. We are talking about practically synonymous concepts. GERD is simply a newer and more comprehensive term that covers some additional forms of the disease. So, if reflux esophagitis requires the presence of erosive lesions on the esophageal mucosa, then one of the types of pathology discussed in this article is gastroesophageal reflux without esophagitis, which is not characterized by similar formations on the walls of the tubular organ.

When the abbreviation GERD is mentioned in medical documents, they mean a whole range of symptoms that arise as a result of reflux - that is, the reflux of stomach contents into the lower parts of the esophagus.

Under the influence of acid, and in some cases bile, the mucous membrane of this organ is injured, which leads to the formation of varying degrees of damage on it.

Classification of the disease

According to the modern classification, gastroesophageal reflux disease is divided into three types.

• Non-erosive form. It occurs most often and is the mildest. Does not suggest the presence of erosive lesions on the walls of the esophageal mucosa. Like other forms of GERD, it is a chronic disease, but it is more treatable (but worse diagnosed). The chances of getting long-term remission are quite high. Non-erosive GERD predominantly affects men over 40 years of age. In fact, we are talking about stage 1 of the pathology, the lack of treatment of which inevitably leads to a worsening of the situation and more serious damage to the walls of the tubular organ.
• Gastroesophageal reflux with esophagitis is the 2nd form of the disease, involving pathological formations on the esophageal mucosa of the erosive type. Sometimes at this stage the situation is aggravated by the presence of ulcers.
• Barrett's esophagus is the third stage of the disease. It is considered a precancerous form. It is characterized by metaplasia of the squamous epithelium of the esophagus, resulting from esophagitis. Patients who ignore treatment for GERD at stage 1, and especially at stage 2, have a high chance of developing this serious complication.

From the point of view of the severity of damage to the esophageal mucosa as a result of reflux, a classification has been compiled according to the degrees of the disease:

• zero degree – no erosions (GERD without esophagitis);
• 1st degree – there are few erosions, they are in different places and do not merge with each other;
• 2nd degree - erosions merge in some places, but the area covered by them is still not significant;
• 3rd degree - the esophagus is seriously affected by erosions, they occupy the mucous membrane of the entire distal section;
• Grade 4 – Barrett's esophagus.

Causes of the disease

The causes of GERD, no matter what the degree according to the above classification, may be:

• increased intra-abdominal pressure, often occurring in overweight individuals, ascites, flatulence, or in pregnant women;
• hiatal hernia, which occurs in many older people;
• weakening of the tone of the sphincter connecting the esophagus to the stomach;
• unhealthy diet (excess fatty, spicy, fried and other heavy foods);
• abuse of alcohol, coffee, strong tea, carbonated drinks;
• gastritis;
• stomach or duodenal ulcer;
• sluggish functioning of the salivary glands;
• smoking.

Symptomatic picture

It is believed that GERD without symptoms is common. Experts confirm this fact, but only if we mean the early stage of the disease. And even then, certain signs still often occur. Further, the symptomatic picture becomes more and more distinct, and the person’s life becomes less quality. The patient is tormented:

• heartburn;
• sour taste in the mouth;
• belching with acid or tasteless;
• acute sore throat;
• difficulty swallowing (even pain);
• a feeling of squeezing behind the sternum after eating “heavy” food or alcohol;
• sore throat;
• dry cough that bothers you at night;
• urge to vomit;
• nausea;
• pain behind the sternum, radiating to other parts of the body (neck, shoulder, arm).

Symptoms usually worsen after eating (especially large and unhealthy meals) or physical activity, as well as in a horizontal position of the body, when it is easiest for gastric juice to enter the esophagus.

It should be noted that some of the above symptoms may appear from time to time in healthy people. They are provoked by poor nutrition or, for example, alcohol. If this happens less than twice a week, there is generally no need to worry. Although it wouldn’t hurt to get checked just in case - perhaps there is still stage 1 (according to the generally accepted classification) of GERD.

Diagnostics

Gastroesophageal reflux disease is the responsibility of a gastroenterologist. It is with him that you should make an appointment if you have any suspicions and need diagnostics. The doctor will have a conversation with the patient, during which he will ask about disturbing symptoms and other existing diseases. Next, he will order an examination. The usual diagnostic methods in this case are:

• proton pump inhibitor test;
• intrafood pH monitoring;
• X-ray of the esophagus;
• blood, urine, stool tests;
• test for Helicobacter pylori, which often causes gastritis and ulcers.

If it is known that the patient has been suffering from GERD with esophagitis for a long time and extremely alarming symptoms have appeared (weight loss, severe pain, coughing up blood), he may be prescribed a fibroesophagogastroduodenoscopy, which will help identify cancer or a precancerous condition, if any. Such patients often undergo chromoendoscopy of the esophagus.

As additional measures, people diagnosed with GERD are often prescribed an ECG, ultrasound of the heart and gastrointestinal tract; and also consultations with specialists such as a surgeon, pulmonologist, cardiologist, ENT specialist. The need for this arises if there is reason to believe that reflux esophagitis provoked the development of other diseases.

Treatment and prospects

All patients, without exception, are interested in whether GERD can be cured completely. This is a complex question that does not have a clear answer. On the one hand, the disease is chronic, which makes the diagnosis lifelong. But on the other hand, there is still hope.

If it is possible to detect the disease in its infancy and only grade 1 GERD occurs, then with an adequate treatment regimen the chances of achieving eternal remission are quite high. And then the disease will be considered chronic only formally. If GERD with esophagitis is diagnosed, then everything is much more complicated. But the probability of the longest possible remission remains in this case. The main thing is to follow all the recommendations of your doctor and lead a healthy lifestyle. Many diligent patients forget about unpleasant symptoms, if not forever, then for decades.

According to experts, it is best to fight the disease during the period of exacerbation of GERD. A “dormant” disease responds less well to therapy.

Medications for GERD are usually prescribed antisecretory drugs, H2-histamine receptor blockers, prokinetics (if bile enters the esophagus in addition to gastric juice), as well as antacids that relieve symptoms.

It is possible to treat gastroesophageal reflux disease with traditional methods. But it should be auxiliary, not primary. The doctor may advise the patient to take decoctions of flaxseed or marshmallow root, potato juice or celery root, rosehip or sea buckthorn oil, as well as milkshakes.

Once GERD is diagnosed, surgical treatment is rare. Surgery may be prescribed if conservative therapy does not produce results for a long time, serious complications arise, or the pathology is extremely advanced. For example, surgery is usually indicated for Barrett's esophagus, since it is no longer possible to cure the disease at this stage with the usual medication.

Treatment with folk remedies

In the treatment of GERD, medicinal plants are also used that normalize the level of acidity of gastric juice and also relieve inflammation of the esophagus. Several effective recipes:

• Centaury tincture is an anti-inflammatory agent that helps restore damaged walls of the esophagus. You need to pour a tablespoon of dry raw material into 0.5 liters of boiling water, then seal it tightly and wrap it well in a towel. The infusion should be infused for half an hour. Drink a quarter glass twice a day.
• Green drink is a vegetable drink that normalizes digestion and also restores strength. To prepare it, you need to chop carrots, cucumbers, radish leaves and tomatoes. Place everything in a blender, add pepper and salt (to taste). Drink a glass once a day.
• Plantain decoction - you will need 6 tbsp of dry plantain leaves, which are mixed with 4 tbsp of St. John's wort and tbsp of chamomile flowers. All this is brewed in a liter of boiling water and simmered over low heat for 15 minutes. Next, the broth is removed from the stove, infused for 30 minutes, and filtered through cheesecloth. Use tbsp 3 times a day.

Diet and lifestyle

Patients diagnosed with GERD must adhere to a special diet and a healthy lifestyle during treatment. They will have to say “no” to alcohol, smoking, coffee, soda, fatty, spicy, smoked, salty, sour, spicy and other “heavy” foods. In the diet, pureed porridges and soups, lean meat, fish, and dairy products are desirable. Dishes should be steamed, baked or boiled.

It is highly not recommended to lie down after a meal, consume a large amount of food in one sitting (ideally, eat a little 6 times a day), wear tight clothes, sleep in a horizontal position, and do physical exercises that involve bending over. If you have extra pounds, it is advisable to get rid of them.

Much of the above is a prevention of GERD and should be taken up by healthy people. As you know, a disease is easier to prevent than to cure, so you need to make every effort to prevent the development of pathology. Proper nutrition and giving up bad habits significantly reduce the risk of developing an illness. It should be remembered that complications of GERD can be very serious. These are obstructive bronchitis, and bronchial asthma, and even oncological lesions of the esophagus. You should not risk your health for dubious pleasures. After all, there is only one life, and GERD can become truly dangerous for it.

Gastroesophageal reflux disease (GERD), which can be treated by various methods, is a pathology of the digestive system when the acidic contents of the stomach are thrown into the esophagus, causing its walls to become inflamed. The main symptoms of GERD are heartburn and sour belching. A gastroenterologist deals with the diagnosis and treatment of the disease. If a person is diagnosed with GERD, treatment will consist of taking medications that reduce the acidity of gastric juice and protect the esophageal mucosa from the effects of acid. Following a certain diet gives good results. Features of the course of GERD, symptoms, treatment will be discussed in this article.

Causes of the disease

Often, reflux disease occurs due to a decrease in the tone of the lower esophageal sphincter, and this, in turn, occurs when drinking caffeine and alcohol, smoking, or in the case of pregnancy under the influence of hormonal factors. What other reasons could there be for the development of GERD? Treatment of any ailments with antispasmodics, analgesics, or calcium antagonists can lead to gastroesophageal reflux disease. Also, its occurrence is possible against the background of increased intra-abdominal pressure caused by ascites, obesity, and flatulence. Conditions for reflux are created by a diaphragmatic hernia, when pressure on the lower region of the esophagus in the chest decreases.

An increase in intragastric pressure and reflux of stomach contents into the esophagus can occur with heavy and hasty consumption of food, since then a lot of air is swallowed along with it. The same consequences are caused by the presence in the diet of excess amounts of foods containing peppermint, rich in animal fats, hot seasonings, fried foods, and carbonated water. A duodenal ulcer can also cause the development of GERD.

Symptoms

It is advisable to begin treatment of reflux disease as early as possible, otherwise its manifestations can cause many problems. When the contents of the stomach (which includes food, digestive enzymes, and hydrochloric acid) enter the esophagus, its mucous membrane is irritated, inflammation begins, and GERD occurs. Symptoms and treatment in this case are typical for many esophageal disorders. So, the signs of the disease are usually the following:

In addition to esophageal symptoms, GERD also manifests itself extraesophageal. These are digestive disorders (flatulence, abdominal pain, nausea); pathologies of the pharynx and oral cavity (caries, sore throat, destruction of tooth enamel); damage to the ENT organs (polyps of the vocal cords, rhinitis, laryngitis, otitis media); damage to the respiratory system (pneumonia, bronchial asthma, bronchitis, emphysema, bronchiectasis); ailments of the cardiovascular system (angina pectoris, arrhythmia, arterial hypertension).

Diagnostics

Until GERD is diagnosed by a gastroenterologist, there is no point in starting treatment, because treatment methods should be selected based on the characteristics of the pathological process. To identify reflux disease and determine the mechanism of its development, the following methods are used:

• X-ray of the esophagus. With such a study, erosions, strictures, ulcers, and hernias can be detected.
• Endoscopy of the esophagus. This procedure also reveals inflammatory changes.
• Scintigraphy with radioactive technetium. The study involves taking ten milliliters of egg white with Tc11: the patient takes sips of this drug every twenty seconds, and at this time a picture is taken on the halo-chamber every second for four minutes. This method makes it possible to assess esophageal clearance.
• Manometric examination of the esophageal sphincters. This procedure allows you to detect changes in sphincter tone.
• Monitor pH in the lower esophagus. Such a study is necessary in order to select individual therapy and monitor the effectiveness of medications.

GERD: treatment

The goal of therapeutic measures for this disease is to eliminate its symptoms, combat reflux and esophagitis, improve the quality of life, and prevent complications. Conservative therapy is most often used; surgical treatment of GERD is indicated only in extreme cases. Let's take a closer look at ways to combat the disease. The set of activities includes:

• adherence to a diet and a certain lifestyle;
• taking antacids, antisecretory drugs and prokinetics.

Regardless of the stage and severity of GERD, treatment involves constant adherence to certain rules:

• Do not lie down or lean forward after eating.
• Do not wear tight clothes, corsets, tight belts, bandages - this leads to an increase in intra-abdominal pressure.
• Sleep on a bed in which the part where the head is located is raised.
• Do not eat at night, avoid large meals, do not eat too hot food.
• Quit alcohol and smoking.
• Limit consumption of fats, chocolate, coffee and citrus fruits, as they are irritating and reduce LES pressure.
• Lose weight if you are obese.
• Stop taking medications that cause reflux. These include antispasmodics, β-blockers, prostaglandins, anticholinergic drugs, tranquilizers, nitrates, sedatives, calcium channel inhibitors.

Medicines for reflux disease. Antacids and alginates

Such drugs for the treatment of GERD are used when manifestations of the disease are moderate and infrequent. Antacids should be taken after each meal (after one and a half to two hours) and at night. The main drug from this group is Almagel.

Alginates create a thick foam on the surface of the stomach contents and, due to this, return to the esophagus with each episode of reflux, thereby providing a therapeutic effect. Due to the content of antacids, alginates produce an acid-neutralizing effect, at the same time they form a protective film in the esophagus, which creates a pH gradient between its lumen and the mucosa and thus protects the mucosa from the negative effects of gastric juice.

Prokinetics

These drugs restore the normal physiological state of the esophagus by increasing the tone of the lower sphincter, improving clearance and enhancing peristalsis. The main means of pathogenetic therapy for GERD is the prokinetic drug Motilium. It normalizes the motor activity of the upper digestive tract, restores active gastric motility and improves antroduodenal coordination. "Motilium" is well tolerated when long-term therapy is necessary, and reduces the percentage of disease relapses.

Proton pump inhibitors

If GERD with esophagitis is diagnosed, treatment with prokinetics is carried out in combination with proton pump inhibitors. As a rule, the new generation drug “Pariet” is used. Due to its use, acid secretion decreases, and positive dynamics in the clinical manifestations of the disease are noted. Patients report a decrease in the intensity or even complete disappearance of heartburn and a decrease in pain.

For GERD, the treatment regimen with prokinetics and proton pump inhibitors is as follows: 20 milligrams of Pariet and 40 milligrams of Motilium are prescribed per day.

Therapy for young children

In babies, reflux causes frequent burping. Treatment consists of several stages:

Therapy in older children

Correcting the child’s lifestyle is of great importance in the treatment of reflux disease.

• The end of the bed, where the head is located, should be raised by at least fifteen centimeters. This simple measure can reduce the duration of acidification of the esophagus.
• It is necessary to introduce dietary restrictions for the child: reduce the fat content in the diet and increase the protein content, reduce the amount of food consumed, exclude irritating foods (citrus juices, chocolate, tomatoes).
• It is necessary to develop the habit of not eating at night and not lying down after eating.
• It is necessary to ensure that the child does not wear tight clothes or sit bent over for a long time.

As a drug treatment, as in adults, antacid drugs are used, usually in the form of a suspension or gel (Almagel, Phosphalugel, Maalox, Gaviscon), prokinetic agents (Motilak, Motilium) , "Cerucal"). The choice of a specific medication and determination of the dosage is carried out by the attending physician.

Surgical intervention

Sometimes, to restore normal function of the cardia, it is necessary to resort to surgery aimed at eliminating reflux. Indications for surgical treatment are as follows:

• complications of GERD (repeated bleeding, strictures);
• ineffectiveness of conservative therapy;
• frequent aspiration pneumonia;
• diagnosing Barrett's syndrome with high-grade dysplasia;
• the need of young patients with GERD for long-term antireflux therapy.

Reflux is often treated by fundoplication. However, this method is not without drawbacks. Thus, the result of the operation entirely depends on the experience of the surgeon; sometimes after surgery there remains a need for drug treatment, and there is a risk of death.

Currently, various endoscopic techniques have been used to influence foci of metaplasia: electrocoagulation, laser destruction, photodynamic destruction, argon plasma coagulation, endoscopic local resection of the esophageal mucosa.

Therapy with folk remedies

In the initial stages of GERD, alternative treatment can be very helpful. In general, at these stages you can cope with the disease simply by following an antireflux regimen and changing your lifestyle. If the disease is mild, instead of antacids to relieve heartburn, you can use various traditional medicines that strengthen and protect the esophageal mucosa, improve sphincter tone and reduce the acidity of gastric juice. In severe cases of the pathological process, it will not be possible to do without drug therapy, and in the presence of complications, surgical intervention is generally required. Therefore, treatment of GERD with folk remedies is rather an auxiliary and preventive method. It can be used as an adjunct to highly effective drug therapy regimens.

Herbal medicine is very popular among people. Here are several traditional medicine recipes for the treatment of reflux disease.

Treatment of GERD with folk remedies involves not only herbal medicine, but also the use of mineral waters. They should be used at the final stage of the fight against the disease or during remissions in order to consolidate the results. For reflux disease, alkaline low-mineralized waters, such as Borjomi, Smirnovskaya, Slavyanovskaya, are effective. You need to drink them slightly warmed up, since gas escapes during the heating process. However, the temperature should not exceed 40 degrees, otherwise the salts will precipitate. Warm degassed mineral water should be consumed forty minutes before meals, one glass at a time for one month. After drinking water, it is recommended to lie down for twenty minutes.