Reflux esophagitis is a chronic disease in which gastric juice refluxes into the esophagus. This process occurs due to the muscle tone of the lower esophageal sphincter. Under normal conditions, the sphincter is almost always closed, but with reflux disease it is either completely or partially open.
According to statistics, half of the country's population suffers from this disease, and many people try not to notice the occurrence of reflux esophagitis and seek medical help only after the consequences occur.
There are several reasons why stomach contents chronically enter the esophagus:
- frequent stress and nervous tension;
- exposure to harmful foods or various chemicals on the body;
- It can also be caused by increased abdominal pressure;
- Most rarely, reflux disease occurs due to a hiatal hernia.
Risk factors
It should be remembered that there are several risk factors that gradually predispose the human body to the occurrence of reflux esophagitis:
- frequent positioning of the body with the body tilted forward or downward;
- being overweight;
- bad habits such as alcoholism and smoking;
- frequent consumption of junk food;
- You should also not eat a lot of sweets and often drink drinks containing caffeine;
- pregnancy;
- the presence of peptic ulcer of the stomach or duodenum.
Every person should carefully monitor their lifestyle and health. A single attack can occur even with a sharp bend after eating.
Symptoms
There are several symptoms that accompany the course of the disease:
Reflux esophagitis responds well to treatment in the early stages of the disease, but if you return to your previous lifestyle, there is a risk of relapse.
Diagnosis of the disease
To make a correct diagnosis, you must consult a specialist, because only a physician will be able to analyze all the symptoms and distinguish reflux esophagitis from other diseases. Most often, when trying to make a diagnosis on your own, you can mistake a disorder of the lower esophageal sphincter for an accompanying disease (rhinitis, pharyngitis, etc.). Such treatment will not bring any results because the root of the problem will not be eliminated.
Diagnosis of the disease is carried out using the following methods:
The girl shares her experience of treating the disease, watch the video:
Traditional treatment
Immediately after identifying reflux esophagitis, the patient is prescribed a special diet and medications. If this disease is not treated, the following consequences may occur:
- esophageal ulcer;
- narrowing of the lumen of the esophagus;
- the risk of developing a malignant tumor increases.
Diet
Also, if you have reflux esophagitis, you need to follow a special diet and avoid consuming the following foods:
Lifestyle
One of the most important components in the treatment of reflux disease is maintaining a healthy lifestyle.
- It is necessary to avoid nervous overstrain;
- Healthy sleep is the key to a speedy recovery, so a person should rest for at least 7 hours. In this case, it is advisable to sleep on a thin pillow;
- Food should be taken at least 5 times a day in small portions. You can eat your last meal no later than 3 hours before bedtime;
- You need to eat slowly in order to feel full in time;
- Immediately after eating, it is recommended to walk a little;
- To reduce intra-abdominal pressure, you should exclude tight, belly-tight items from your wardrobe;
- Do not lift heavy objects;
- It is necessary to avoid taking medications that reduce the tone of the lower alimentary sphincter, for example, sleeping pills or sedatives;
- It is also necessary to quit smoking;
- To reduce the likelihood of relapse, it is recommended to lose excess weight.
Drug treatment
In severe cases of the disease, medications are prescribed in addition to diet.
Prokinetics
Such drugs are prescribed to increase the tone of the lower esophageal sphincter. Examples of such medications are Motilium, Motilak and Genaton.
Antacids
These medications neutralize the acidic environment, thereby reducing the risk of consequences from the involuntary release of gastric juice. Also, such drugs relieve pain and relieve heartburn. The most common antacids are Almagel and Phosphalugel.
Antisecretory drugs
The effect of such medications is similar to the effect of antacids. The only difference is that antacids neutralize the acidic environment, and antisecretory drugs suppress its formation.
Most often, doctors prescribe Omeprazole and Famotidine.
The duration of treatment and specific drugs for use are prescribed by the doctor, taking into account the stage of the disease.
Typically, treatment lasts 5-7 weeks, during which 2 groups of drugs are taken (prokinetics are prescribed together with antacids or antisecretory drugs).
Folk remedies
It is worth remembering that no traditional method can completely get rid of the disease, so such remedies can only be used in conjunction with other treatments.
Herbal remedies for reflux disease
- In a deep bowl, mix equal amounts of snakeweed roots, dried anise fruits, angustifolia fireweed, white marigold, oregano, lemon balm and calendula, after which 20-30 grams of the mixture is poured into a glass of hot water and left for 3 hours. Once ready, the infusion must be filtered and taken 1/4 cup every 2 hours;
- 1 teaspoon of chamomile tea is mixed with 2 teaspoons of wormwood and mint. The mixture is poured with a liter of boiling water and left for 3-4 hours. The tincture is taken half an hour before each meal.
Folk remedies prepared with vegetables and fruits
Other folk methods for the treatment of reflux esophagitis
Many people do not pay due attention to the symptoms of reflux esophagitis, which often leads to complications of the disease. Therefore, it is very important, at the first detection of systematic manifestations of symptoms of the disease, to consult a doctor who can competently select the necessary medications, prescribe a diet and provide advice on maintaining a correct lifestyle.
Reflux esophagitis is an inflammation of the mucous membrane of the esophagus, which causes acid reflux (pathological reflux of contents from the stomach into the esophagus), ICD-10 code: K21.0.: gastroesophageal reflux disease with esophagitis, GERD. There are two types of GERD: erosive and non-erosive. The form with esophagitis belongs to the first type.
When a person swallows food, the lower esophageal sphincter, which separates the stomach and esophagus, opens, allowing food and liquid to enter the stomach. Then it closes again. If this process is disrupted, gastric juice flows back into the esophagus. The constant reflux of acid into the esophagus and throat caused by reflux damages the mucous membrane, causing inflammation, which leads to heartburn and nausea.
Gastroesophagitis is often accompanied by a disease such as duodenogastric reflux (reflux of duodenal contents and bile into the stomach), which aggravates the course of GERD. The following reasons lead to this:
- Increased intragastric pressure, which increases the likelihood of reflux esophagitis.
- An increase in the aggressiveness of gastric juice and acidity, which causes.
Clinical manifestations of the disease are divided into two groups: esophageal and extraesophageal. In adults, typical symptoms of the first group include heartburn, indigestion, sour taste, regurgitation and chest pain that worsens when the person has eaten, lies stomach down or bends forward. Extrophageal (atypical) symptoms include cough, lump in the throat, mucus in the mouth, reflux pharyngitis and hoarseness; in the acute course of the disease, the temperature rises. Children and infants may experience the following symptoms: repeated nausea, vomiting and cough.
The pain that occurs with esophagitis is often confused with heart pain, which is due to the close location of the corresponding nerve endings. This phenomenon is called cardiac syndrome. Against the background of the underlying disease, non-obstructive bronchitis often develops.
Diagnostics
Daily pH monitoring. A special probe with a device that measures acidity for 24 hours or more is inserted into the gastrointestinal tract through the nose. At this time, the patient leads a normal lifestyle. pH-metry accurately detects the presence of reflux, the duration and frequency of episodes, and helps determine the effect of certain actions (eating, smoking, exercise, sleep) on changes in acidity levels. The results help to individually select a treatment method.
Radiography
A radiological research method that makes it possible to visualize the structure of the esophagus, stomach and duodenum. Before passing, the subject takes a contrast agent (Barium Sulfate BaSO4) orally. The person is then exposed to x-rays and pictures are taken. This is a proven and safe procedure that does not require internal intervention.
Gastroscopy
A type of endoscopy. The doctor inserts an endoscope into the mouth, pushing it into the stomach. Then he carefully examines the condition of the mucous membranes of the organs being studied. If necessary, a biopsy (removal of a tissue sample for detailed laboratory analysis) is performed.
Gastroscopy is the most detailed type of diagnosis, providing accuracy that other types of research cannot provide. Its characteristics allow you to quickly establish an accurate diagnosis.
Gastroesophagomanometry
Manometry is the measurement of intraesophageal pressure during swallowing. A thin catheter with special sensors is inserted into the esophagus through the nose. The results of the study are used to determine the pressure in the area of the esophageal sphincters and the work of peristalsis. Problems associated with gastrointestinal motility and impaired functioning of the lower esophageal sphincter play a key role in the development of reflux, which makes manometry an extremely important method.
Treatment
The patient needs to change his habits and follow a diet. Various drugs are used to relieve symptoms and normalize the functioning of the gastric system. Various folk recipes are also used that can replace many types of medications in the early stages of the disease. For serious complications, surgical treatment is used.
Diet and nutrition
The following dietary rules should be followed:
- It is necessary to switch to fractional meals, the diet is divided into 5-6 servings per day. The break between meals should not exceed 4 hours.
- Avoid horizontal position for 3 hours after eating.
- Minimize the intake of fatty foods, caffeinated drinks, mint, spicy foods, citrus fruits, tomatoes and tomato paste, and alcohol. These products weaken the tone of the cardiac sphincter and increase the secretion of hydrochloric acid.
- Increase your consumption of low-fat protein foods (white meat, low-fat cottage cheese, soy). Protein increases the body's regenerative abilities and has a beneficial effect on digestion.
Taking medications
Antacids
This includes medications whose main task is to reduce acidity levels by neutralizing hydrochloric acid and protecting the mucous membrane. Sold in the form of tablets and gels. Modern suspension antacids have an antireflux effect. The effect occurs within 10-15 minutes after administration, therefore they are often prescribed for prompt relief of exacerbations in the initial stages of treatment. Many types of drugs are not contraindicated during pregnancy. A well-known household antacid is baking soda.
A significant drawback is the drug-associated acid rebound syndrome (the stomach's response to a rapid decrease in acidity, as a result of which the secretion of gastric juice increases). This group of drugs is popular due to its availability.
Antisecretory agents
The mechanism of these drugs is to reduce the secretion of hydrochloric acid and digestive enzymes. Unlike antacids, this type of medication is designed for long-term therapy and can increase the protective capabilities of the stomach, but they have a wider range of side effects.
Alternative medicine
Using medicinal herbs and folk remedies, you can completely get rid of reflux, heartburn and other manifestations of the disease without resorting to the help of specialized pharmacological agents. It is worth remembering that this will not be enough to cure the advanced form of the disease.
Flax seed decoction
These seeds help reduce acidity and restore the mucous membrane. They can be taken in their pure form, but in this case they are more difficult to absorb by the body. To prepare the decoction, grind a tablespoon of seeds, place in a thermos, then pour boiling water over it. After this, the broth should sit for 10-12 hours.
Sea buckthorn oil
This remedy reduces the secretion of gastric juice and has an enveloping effect. Contains vitamins A, K and E. Accelerates the restoration processes of epithelial tissue, compensating for the harmful effects of esophagitis.
Herbal teas
There are many plants and herbs that are useful for diseases of the digestive system. One of the most effective recipes is tea made from plant leaves taken in equal proportions: chamomile, lemon balm and St. John's wort. To enhance the healing properties, you should add propolis to this tea, making sure there is no allergy.
Complications
Lack of adequate treatment and non-compliance with recommendations during an exacerbation period lead to various complications associated with reflux, which can be very life-threatening.
Barrett's esophagus
A precancerous condition of the esophagus, the main cause of which is chronic. Constant exposure to acidic contents causes changes in the structure of the lower part of the esophagus - metaplasia. Increases the risk of developing cancer tenfold. Diagnosis is complicated by the fact that this disease periodically passes without heartburn, which is due to the coarsening of the walls of the esophagus.
In the early stages, this disease is treated by eliminating the manifestations of reflux and other indirect causes. For complications, laser therapy and surgical treatment are used. In the most severe cases, the following operation is used -.
Acute erosive esophagitis
Also known as hemorrhagic esophagitis. Causes esophageal bleeding, which is caused by thinning of the mucous membrane and the occurrence of erosions and hemorrhages. Manifests itself in the form of bloody vomiting.
Erythematous form of gastritis
Typically, erythematous esophagitis precedes erosive esophagitis. It appears as red oval rashes on the mucous membrane.
Inflammation of the small intestine
An inflammatory process that is accompanied by functional disorders of the small intestine. Known medically as enteritis. Manifested by rumbling and bloating, stool disorders.
Dysmetabolic nephropathy
An improperly functioning gastrointestinal tract can cause metabolic disorders. The load on the urinary system increases. This is fraught with the development of a disease such as dismetabolic nephropathy - kidney damage caused by metabolic disorders.
Prevention
Extra pounds contribute to an increase in intra-abdominal pressure (for the same reason it is necessary to abandon too-tight clothing and tight belts), increasing the reflux of hydrochloric acid into the esophagus. Therefore, in case of obesity, body weight should be normalized. It is not advisable to lose more than 0.5-1 kg. per week, as this is too high a load for the body.
You should also quit smoking, as nicotine irritates the mucous membrane and increases the level of acidity, which is unacceptable for reflux esophagitis. Many medications also aggravate the disease - their use must be agreed with the doctor.
Illness and sport are compatible; only gentle exercises are indicated. Breathing exercises are recommended as they help reduce intra-abdominal pressure. You should avoid strenuous exercise after meals and stop weight training.
Lifestyle changes and a correct diet help reduce the frequency of reflux, prevent new exacerbations and forget about this disease forever.
Almost any of the symptoms described in the article can be provoked by banal overeating in a healthy person, but if any of them does not go away for a long time, then this is a good reason to consult a doctor. Timely treatment will help avoid complications with reflux esophagitis. This means that you cannot treat the disease and avoid diagnosis solely at home.
Reflux esophagitis is an inflammatory disease of the tunicae mucosae (mucous membrane) of the distal esophagus, which is caused by exposure to gastric or duodenal peptic reflux. The distal section is the part of the esophagus that is adjacent to the stomach. Cm. .
Manifestations in adults include esophageal (heartburn, belching, dysphagia, retrosternal pain and burning), and extraesophageal (dry cough, hoarseness, pain in the tongue, bitterness in the mouth) symptoms.
Reasons
In pathogenesis, there are 3 main causes of reflux esophagitis:
- Insufficiency of the lower esophageal sphincter (LES), which is divided into relative (the result of excessive gastric motility with a normally functioning LES) and absolute - the result of impaired functioning of the LES. This can be facilitated by:
- axial hernia;
- gastroduodenitis, duodenitis; bulbits;
- hypertrophic, hyperacid gastritis;
- gastric and duodenal ulcerogenic lesions, especially with;
- conditions after gastrectomy;
- JVP – biliary dyskinesia with biliary reflux, a condition with low acidity of gastric juice;
- abuse of drugs that relax smooth muscles (nitrates, beta blockers, tranquilizers).
- alcohol and smoking abuse,
- stressful situations;
- starvation.
- Impaired rate of emptying and cleansing of the esophagus (esophageal clearance).
- Violation of the mechanisms that protect the mucosa from damage.
Based on the causes of the disease, it is clear that for effective drug treatment it is necessary not only to act on the symptoms caused by esophageal disease, but also to cure the diseases that caused this condition.
Classification
RE has two main forms – acute and chronic.
The causes of acute reflux esophagitis can be:
- allergic diseases;
- exacerbation of chronic stomach diseases (condition after gastrectomy, hiatal hernia, subatrophic gastritis, gastric ulcer);
- infection (, septic esophagitis).
Acute reflux esophagitis is manifested by the following symptoms:
- general malaise;
- increased temperature;
- dysphagia;
- heartburn;
- belching;
- pain along the esophagus while eating.
Chronic reflux esophagitis can develop as an outcome of a poorly treated acute form, or as a primary chronic disease. This form of the disease is often accompanied by gastrointestinal diseases; it is characterized by both esophageal and extraesophageal symptoms of EC.
- Depending on the prevalence of the pathological process, there are:
- focal reflux esophagitis - the pathological process occupies one or more lesions on the posterior or lateral wall of the organ in the distal (adjacent to the stomach) section;
- diffuse RE - the pathological process occupies all or most of the organ.
Depending on the depth of the damage to the walls, they are distinguished: non-erosive reflux esophagitis (superficial) and.
Non-erosive forms of pathology
Non-erosive forms are divided into catarrhal and edematous. Distal nonerosive reflux esophagitis is a mild superficial form of the disease. Symptoms are usually mild, patients complain of slight pain in the retrosternal area, at times heartburn and belching occur (usually after overeating or sudden bending of the body). Sometimes the pathological condition occurs without heartburn at all.
Treatment mainly includes:
- diet;
- herbal medicine (various herbal decoctions and tinctures);
- physiotherapy.
Enveloping, astringent, and anesthetic agents are prescribed. Non-erosive reflux esophagitis ends with complete recovery.
Erosive forms
In this form, the inflammatory reaction is manifested by epithelial destruction; the deeper layers of the esophageal wall are not involved in the process.
Signs of erosive reflux esophagitis are:
- heartburn;
- belching;
- chest pain.
The uncomplicated form is treated conservatively: diet therapy, drug therapy, traditional medicine methods. If complications occur, surgical treatment is possible.
Rarely, the disease occurs with moderate symptoms or is completely asymptomatic. More often, the symptoms of reflux esophagitis in adults are pronounced. Symptoms from the esophagus and symptoms from neighboring organs are distinguished.
Symptoms from the esophagus:
- heartburn;
- belching
- pain in the retrosternal region (“tightens behind the sternum”), often radiating to the neck and back, relieved with antacids;
- dysphagia, of varying severity, of a transient nature;
- with a severe illness, vomiting with blood is possible.
Symptoms from other systems and organs:
- from the cardiac system: extrasystoles, conduction disturbances, cardialgia;
- from the pulmonary system: dry cough (sputum appears when a secondary infection is attached), shortness of breath, difficulty breathing, sleep apnea;
- from the otorhinolaryngological organs: symptoms of pharyngitis (pain and mucus in the throat, possible redness of the throat), the appearance of symptoms of acute laryngitis due to reflux disease (hoarseness, severe pain when swallowing, sore throat);
- from the dental organs: phenomena of glossitis (feeling that the tongue is burning, pain in the tongue), damage to tooth enamel, stomatitis;
- from the blood: symptoms of anemia.
Cough
The cough with reflux esophagitis is dry, often painful. Drip infections that occur against this background are severe and can be complicated by the development of bronchial asthma.
There are two mechanisms for the development of cough syndrome:
- Reflux particles, with severe damage to the esophagus, enter the pharynx, and from there into the nasopharynx and trachea, where they irritate the cough receptors of the mucous membrane.
- If the reflux rate is low, and the process is localized only in the distal esophagus, irritation of the vagal centers located in the lower part of the esophagus, which activate the cough center of the brain, is possible.
In order to properly treat cough with reflux esophagitis, it is necessary, first of all, to increase the pH of gastric juice in order to remove the cause that causes it (antacids, IGRs, PPIs). Frequent aspiration pneumonia requires surgical treatment. To make it easier to endure attacks, you can take cough remedies recommended by alternative medicine (honey, aloe, propolis). Breathing exercises are often used.
Extrasystoles
Extrasystole (extraordinary contractions of the heart muscle) is a common complaint in diseases of the stomach and gastrointestinal tract in general. Extrasystoles arise as a result of viscerocardial reflexes and are functional in nature. Special antiarrhythmic treatment is not required, especially with moderately severe extrasystole.
Another reason for the occurrence of extrasystole is the long-term effect of reflux on the vagal centers located in the lower part of the esophagus. The consequence is the development of vegetative-vascular dystonia with psychosomatic manifestations.
Treatment should be aimed at eliminating the pathology that caused the extrasystole.
When patients do not tolerate extrasystole well, especially if it is accompanied by increased excitability (fear, insomnia), of course, correction of the condition is required. But before treating extrasystole, consultation with a neuropsychiatrist is necessary, since substances usually prescribed for neuroses (antidepressants, tranquilizers, antipsychotics) can worsen the condition of the lower esophageal sphincter.
Symptoms of chronic forms of reflux esophagitis
Clinical manifestations of RE depending on the morphological form of the process.
Table 1. Symptoms of chronic reflux esophagitis
| Types of reflux esophagitis | Symptoms |
| Catarrhal and edematous | The mildest forms of the disease, accompanied by inflammation of the mucous membrane. The clinical picture is moderate or weak. Patients complain of slight discomfort in the retrosternal region and epigastrium, occasional heartburn, and belching. All symptoms worsen with overeating and physical activity. The course is usually benign and, with proper treatment, ends in complete recovery. |
| The general condition is not disturbed. In patients over 60 years of age, endoscopic examination often reveals whitish spots in the thoracic esophagus - this is intracellular glycogen deposition (acanthosis of the esophagus). Complaints of retrosternal burning pain that occurs both during and outside of meals, heartburn, provoked by constant intake of soda, belching, hypersalivation. The disease is often accompanied by extraesophageal symptoms. In severe cases, complications are possible. |
|
| Fibrinous | Complaints of difficulty swallowing, heartburn, belching, sharp chest pain radiating to the back and pericardial region, the appearance of gray films in the mouth. |
| Erythematous | The general condition is disturbed. Patients complain of dysphagia, vomiting, regurgitation of mucus, heartburn, a burning sensation in the chest, and retrosternal pain. The clinic is dominated by regurgitation of bloody mucus, vomiting mixed with blood, severe dysphagia, odynophagia - a feeling of pain during the passage of food through the esophagus, pain in the chest, melena - stool mixed with blood. |
| Necrotic | Develops against the background of severe diseases (uremia, agranulocytosis, sepsis); the disease is manifested by dysphagia, odynophagia, repeated vomiting, sharp retrosternal pain, aggravated by swallowing. |
Degrees of reflux esophagitis
During the pathology, 4 degrees of severity are distinguished.
Table 2. Reflux esophagitis and severity
| Reflux esophagitis | Symptoms | Treatment |
| 1st degree | Heartburn that occurs when the diet is violated and when overeating, discomfort in the retrosternal area, belching. | Drug treatment is usually not required. |
| 2nd degree | Heartburn dominates the clinic. The burning sensation intensifies during physical activity, especially when bending over. Patients complain of: belching, retrosternal pain, bad breath, white coating on the tongue, feeling of a lump in the throat. |
Strict adherence to the diet. Taking medications that reduce the concentration of H+ ions in refluxate (antacids, IGRs, PPIs), prokinetics. |
| 3rd degree | Heartburn, belching, retrosternal pain bother me almost constantly. Extraesophageal signs of the disease appear: dry, hysterical cough, palpitations, arrhythmias, pain in the mouth, hoarseness. |
This degree requires massive therapy lasting at least 8 weeks. PPIs, antacids, prokinetics, and reparants are used. |
| 4th degree | This is the stage of complications:
|
Drug treatment, as in grade 3 + treatment of complications. Possible surgery. |
Diagnostic methods
ER is diagnosed using endoscopy (with biopsy), x-ray examination of the esophagus and stomach, intra-esophageal pH-metry and manometry.
- Esophagoscopy allows you to carefully examine the esophageal mucosa, determine the degree of damage to the organ according to the Los Angeles classification (a, b, c, d), and take a biopsy specimen for histological examination.
- allows you to identify the lesion, the degree of narrowing of the organ lumen.
- Long-term measurement of esophageal acidity allows us to determine the presence of gastroesophageal reflux.
- Manometry of the esophagus - allows you to evaluate the motility of the organ and determine the clearance of the esophagus.
After the examination, a diagnosis is made and drug treatment is prescribed.
Reflux esophagitis and drug treatment with drugs
For rational treatment of the disease it is necessary:
- change your lifestyle to eliminate the negative influences that led to the disease;
- take all medications prescribed by your doctor;
- if necessary, supplement drug therapy with traditional medicine.
Drug therapy is prescribed in accordance with the severity of the inflammatory process and the severity of the pathological process. The doctor determines how long and in what dosage to take the tablets.
Pathogenetic drugs are:
- antacids and alginates - drugs increase the pH of gastric juice, thereby reducing acid aggression on the esophageal mucosa, in addition, they envelop the mucosa, providing cytoprotection (cell protection).
- antisecretory agents (IGR, PPI) - reduce the concentration of H+ ions in gastric juice;
- Prokinetics are drugs that accelerate the movement of food from the stomach into the intestines, thereby eliminating congestion in the stomach and increasing the tone of the lower sphincter.
Table 3. The most effective drugs for the treatment of reflux esophagitis in adults
| Preparation | How to take |
|
Antacids |
|
| Phosphalugel | The dose of the drug is prescribed individually. The drug is prescribed immediately after meals and at night |
| Almagel | 5-10 ml (1-2 scoops) 3-4 times a day after meals |
| Maalox | 1-2 packets an hour after meals or if heartburn occurs |
|
Prokinetics |
|
| Trimedat | The daily dose for oral administration is 300 mg, rectally 100-200 mg, parenterally 50 mg. The duration of use depends on the clinical situation. |
| Domperidone (Motilium) |
1 tablet (10 mg) three times a day. Max dose 30 mg |
| Ganaton | Take 50 mg 3 times a day |
| Itomed | 1 tablet (50 mg) three times a day |
| Iberogast | 20 drops 3 times a day before meals with a little water |
| Cerucal | 5-10 mg three times a day |
|
H2 histaminolytics |
|
| Ranitidine | 150 mg twice daily |
|
Proton pump inhibitors |
|
| Lansoprazole | 1 capsule per day |
|
Omeprazole |
20 mg twice daily |
|
Rabeprazole |
20 mg per day (1 tablet) |
|
Pantoprazole (Nolpaza) |
1 tab. (40 mg) per day |
| Antiulcer agents with bactericidal activity against Helicobacter pylori | |
| 1 tab. 2-3 times a day half an hour before meals | |
|
Reparants |
|
| Ursosan | 1 capsule 1 time at night |
| Venter | 1 gr. in the morning and before bed |
|
Hepatoprotectors |
|
| Ursofalk | The dose is prescribed individually |
|
Choleretic agents |
|
| Hofitol | 2 tablets each. three times a day before meals |
| Allohol | 2 tablets each. three times a day |
| Odeston | 1-2 tab. (200-400 mg) three times a day |
|
Antispasmodics |
|
| Duspatalin | 135 mg 3 times a day |
|
Enzymatic preparations |
|
| Creon | 1-2 capsules with meals |
|
Antipsychotics |
|
| Eglonil | 50-150 mg per day |
Attention! Patients should know what medications to take at night for severe nocturnal heartburn - the so-called “nighttime acid reflux.” These are Phosphalugel (antacid), Omez Insta (a special form of PPI), chamomile tea (1 glass).
But even the most effective drugs will not help if the patient does not change his lifestyle, eliminate the causes of the disease, and do not follow a diet.
What to do if the disease does not go away? First of all, you should know that treatment of reflux esophagitis is a long process. How long treatment will require depends on the severity of the disease, in any case at least 6-8 months. You need to tune in emotionally. If the disease is really difficult to treat, a re-examination is prescribed, especially if there are complaints (yellow coating on the tongue, constant bitterness in the mouth) to exclude biliary reflux esophagitis, pancreatic pathology. If the examination reveals nothing, the question of surgery arises.
Lifestyle with reflux esophagitis
Before starting treatment for reflux esophagitis, it is necessary to get rid of those addictions and habits that led to cardia insufficiency. This means that you need to listen to simple recommendations and strictly follow all medical advice:
- Diet therapy is one of the main components in the treatment of gastrointestinal patients. Patients must strictly adhere to the recommended diet, excluding all prohibited foods from the menu. Food should be warm, boiled (or steamed), soft. You need to eat regularly, often, in small portions.
- A patient with EC must avoid physical and mental stress and stressful situations in every possible way. However, you cannot completely give up physical activity (you can visit the pool, go for walks).
- It is necessary to ensure a full 8 hours of sleep at night. It is better to sleep on a special wedge-shaped pillow for GERD, one end of which is raised twenty centimeters above the level of the bed, which prevents the backflow of gastric contents and allows you to sleep correctly.
- Quit alcohol and smoking.
All these tips must be followed even after the clinical manifestations have subsided, so they are a prevention of repeated exacerbations.
Surgical treatment
Surgery for reflux esophagitis is a last resort. It is resorted to only if the consequences of refusing the operation are much more severe than the operation itself and the risks of its complications.
Indications for surgical treatment:
- complex drug therapy prescribed in maximum doses, carried out for more than six months, did not produce results;
- the patient has frequent aspiration pneumonia, threatening severe pulmonary pathology;
- severe complications of chronic reflux esophagitis have developed (scarring, severe ulcerative pathology, Barrett's esophagus, bleeding);
- The patient has a hiatal hernia.
Is reflux esophagitis dangerous?
Symptoms of an uncomplicated course of the disease can be very unpleasant. But what is dangerous about reflux esophagitis is its complications. The most dangerous consequences include:
- Esophageal stenosis, which occurs with long-term chronic inflammation. The normal mucosa is replaced by scar tissue, narrowing the lumen of the organ.
- . If inflammation exists for a long time, then not only the superficial, but also the deep layers of the esophageal wall are affected. Ulcers are often complicated by bleeding, requiring emergency surgical treatment.
- . This . With this pathology, the likelihood of development is very high.
Effective traditional medicine for the treatment of reflux esophagitis
Table 3. Traditional medicine
| Means | Action | Recipe (and how to take it) |
| Sea buckthorn oil | Normalizes the production of digestive juices. Antitumor effect Strengthens regenerative processes |
Buy at the pharmacy A dessert spoon after meals 3 times a day (2 weeks) |
| Potato juice | Has an enveloping effect, reduces symptoms - heartburn and retrosternal pain | Squeeze the juice from 1 potato tuber. Freshly squeezed juice is drunk before meals 3 times a day (for 2 weeks) |
| Honey | Anti-inflammatory effect | 25 grams 2 times a day 1 hour after meals |
| Linseed oil | Accelerates the regeneration of damaged mucosa, which is important for the treatment of reflux esophagitis | Drink a teaspoon 2 times a day an hour before meals (10 days) |
| Flax seeds | Has an enveloping property, reduces the concentration of H+ ions | Pour boiling water over the flax seed overnight in a ratio of 1:5, take it in the morning before meals. Drink in weekly courses with a 10-day break |
| Herbs | Decrease in the concentration of H+ ions in the refluxate. Acceleration of mucosal regeneration. Strengthening gastric motility and LES tone. Reduced fermentation processes in the intestines, reduced flatulence |
Collection: chamomile flowers, flax seeds, licorice rhizomes, lemon balm leaves, taken in a ratio of 2:2:1:1. The ingredients are crushed and 1000 ml of boiling water is poured. The mixture of herbs is boiled in a water bath. Leave for 2 hours, strain the broth. You should drink the drink four times a day in an amount of 50 ml. |
| Chamomile | Anti-inflammatory | 1 sachet of chamomile is brewed with boiling water. Drink as tea 2 times a day after meals |
| Aloe | The juice has regenerative and anti-inflammatory properties, helps reduce the concentration of H+ ions | Freshly squeezed aloe vera juice is diluted with water (0.060–0.030), drink aloe before meals |
| Oatmeal jelly | Used as a component of dietary nutrition for reflux esophagitis and gastritis | Hercules flakes are poured with cold water in a ratio of 1:3. Leave it overnight. In the morning, strain and simmer until the liquid thickens. Eat as breakfast |
| Mint | Menthol oil has an antispasmodic, prokinetic effect. Reduces the activity of Helicobacter pylori. An incorrectly prepared mint solution can cause an aggravation of |
Pour 3 fresh mint leaves into 0.25 liters of boiling water. Drink once a day 0.5 hours before meals |
| Rose hip | Has an anti-inflammatory effect. Accelerates regeneration. Normalizes the functioning of the gastrointestinal tract, reduces the concentration of H+ ions in gastric juice |
60 grams of dry berries are poured into 1000 ml of boiling water and left for 6 hours. Drink instead of tea 3 times a day |
| Chicory | Blocks attacks of nausea, heartburn and discomfort after eating | Brew like coffee, take after meals |
| Goat milk | A symptomatic remedy that allows you to quickly relieve inflammation and unpleasant symptoms such as heartburn and belching | 1 glass per day in the morning before meals |
| plantain herb | Relieves pain, reduces the severity of symptoms, the inflammatory reaction, reduces the concentration of H+ ions | Squeeze juice from plantain leaves, dilute in 250 ml of water, drink throughout the day |
| Calendula | Has analgesic, anti-inflammatory, antiseptic and antispasmodic properties | 5 grams of dried flowers are brewed with 1 cup of boiling water. Drink like tea after meals |
| Dandelion | The drug reduces the severity of the inflammatory reaction and the severity of the main symptoms | The container is tightly filled with dandelion flowers, sprinkled with sugar. A teaspoon of the resulting syrup is dissolved in a glass of water. Drink before every meal |
Mineral waters for reflux esophagitis
Alkaline mineral waters are used for reflux esophagitis and gastritis during remission. Low-mineralized medicinal table waters are used. They normalize the motor and secretory functions of the stomach. They have a beneficial effect on the function of the esophageal sphincters.
"Borjomi"
A course of treatment of RE with Borjomi mineral water along with diet therapy significantly reduces the number of complaints, significantly reduces the acidity of gastric juice, improves its enzymatic properties, and cleanses the walls of the esophagus. The course of treatment is 21 days (drink 150 ml without gas three times a day 40 minutes before meals).
Borjomi resort "Essentuki No. 4"
Mineral water “Essentuki No. 4” reduces the secretion of H+ ions in the stomach and improves the functioning of the LES. For hyperacid gastritis and reflux esophagitis, water is taken an hour before meals in a heated state, quickly, in large sips. Start taking Essentuki No. 4 with 100 ml, gradually increasing the dose.
Is it possible to cure reflux esophagitis forever?
It all depends on the severity of the disease. With grade 1 reflux esophagitis, for complete remission it is often enough to eliminate the causes of the disease, follow a diet, and use alternative medicine that has an anti-inflammatory, enveloping effect.
If the course is severe, then complex drug treatment is necessary to prevent complications.
If complications do arise, it is likely that surgical treatment will be required.
The mucous membrane of the esophagus has no protection from these aggressive substances, so contact with them causes damage to the epithelium, inflammation and causes pain. One of the main causes of reflux esophagitis is a hiatal hernia. With this disease, part of the stomach is displaced into the chest cavity through the enlarged esophageal opening of the diaphragm.
Causes of reflux esophagitis
The diaphragm is the muscular partition between the thoracic and abdominal cavities. For the passage of various organs from one cavity to another, there are special openings in the diaphragm (including the esophageal opening).
In case of thinning or underdevelopment of muscle tissue in combination with increased intra-abdominal pressure, a displacement of the abdominal organs into the thoracic cavity may occur. This is how the esophageal opening of the diaphragm develops.
A slight displacement of the inlet and the top of the stomach is called a sliding hernia. The incidence of such hernias increases with age in people over 50 years of age; it reaches 60%. As a rule, the only manifestation of a sliding hiatal hernia is gastroesophageal reflux, ultimately leading to reflux esophagitis.
Symptoms of reflux esophagitis
The main symptom of reflux esophagitis is. It can be observed both during the day and at night, it can intensify immediately after eating and taking a horizontal position of the body in space, and be accompanied by belching and hiccups.
Some patients experience pain reminiscent of heart pain. At the same time, reflux esophagitis can occur without heartburn and chest pain, but manifest itself as a swallowing disorder. As a rule, swallowing disorders are associated with the transition of the disease to a more severe stage with the development of cicatricial narrowing of the esophagus.
Diagnosis of reflux esophagitis
If a hiatal hernia is suspected, the following tests are performed:
- X-ray examination of the esophagus with a barium suspension (the study is carried out on an empty stomach, a series of X-ray images are taken immediately after the patient swallows the contrast mixture; spontaneous reflux from the stomach into the esophagus indicates severe reflux);
- esophagoscopy (endoscopic examination of the esophagus);
- biopsy (taking a small section of the esophageal mucosa for histological examination; performed during esophagoscopy);
- esophageal pH-metry (measurement of acidity in the lumen of the esophagus and stomach; the contents of the esophagus will be acidic due to the reflux of acidic contents from the stomach).
In some cases, the doctor may prescribe additional research methods and special tests. If a patient complains of chest pain, the patient is referred for examination to a cardiologist to rule out ischemic pain.
Complications
The most dangerous complications of reflux esophagitis are esophageal ulcers and cicatricial narrowing of the esophagus (stricture). A long course of esophagitis can contribute to the malignant degeneration of mucosal cells and the development of cancer. The most dangerous complication of a hiatal hernia is strangulation. Infringement should be suspected when sharp pain in the chest appears in combination with difficulty swallowing.
What can you do
To reduce gastroesophageal reflux, you should lose weight, sleep on a bed with the head end raised 10-15 cm, and try to maintain a time interval between eating and sleeping. You should give up smoking, eating fatty foods and chocolate, coffee, alcoholic drinks, orange juice, and the habit of drinking plenty of liquid with your meals.
Compliance with the above rules in combination with drug therapy in most cases reduces the frequency of gastroesophageal reflux and protects the esophageal mucosa from harmful effects.
How can a doctor help?
Treatment usually begins with drug therapy. Its main directions are reducing the acidity of gastric juice, protecting the esophageal mucosa from harmful influences, increasing the contractile activity of the lower esophageal sphincter and increasing the rate of esophageal emptying. Histamine H2 receptor blockers (famotidine), proton pump inhibitors (omeprazole, lansoprazole), prokinetics (domperidone), antacids, etc. are used.
Surgical intervention may be required in complicated forms and failure of drug therapy.
Reflux esophagitis- This is a disease that is chronic in nature and characterized by pathological penetration of acidic contents from the stomach into the esophagus.
According to statistics, the percentage of people suffering from this disease in developed countries is about 50–60%. Moreover, over the past 10–15 years, there has been a significant annual increase in the number of cases.
A little physiology
To complete the picture of the disease, as well as to understand its essence, it is necessary to imagine the work of the esophagus and stomach.
Esophagus- is a hollow tube of muscle tissue having a length from 23 to 30 cm, depending on gender and age. The main purpose of this organ is to transport food to the stomach. The organ has 3 components: mucous membrane, muscular membrane and outer membrane. The movement of food occurs through muscle contraction and folds in the mucosa.
The muscles that make up the esophagus have 2 valves, they are called sphincters. Their purpose is to keep food and drink out of the mouth and prevent them from returning back from the stomach. It is the disruption of the sphincter between the stomach and esophagus that leads to the appearance of reflux esophagitis.
In order to process the food received, gastric juice is needed. It consists of a group of enzymes and an acid. Reflux is not normally a disease, you need to understand that this condition (the release of acid into the esophagus) is natural (up to 30 times a day) and does not cause any symptoms, since the esophagus develops protection against the effects of food juices. Unpleasant symptoms begin to appear if, for some reason, the protection does not function or fails.
Reasons for appearance
The main cause of reflux esophagitis is a dysfunction of the sphincter located between the esophagus and the stomach. As a result of a strong decrease in tone, the valve is not able to close completely, because of this, the contents of the stomach return to the esophagus. The reasons for this phenomenon may be:
- increased pressure inside the stomach or the entire cavity;
- stress and severe nervous or physical overload;
- eating certain foods;
Another, less common cause is a hernia in the esophagus. When pressure in the stomach or abdominal cavity increases, for example during pregnancy or lifting a heavy object, part of the stomach or acid enters the esophagus.
It is customary to identify several factors that provoke the appearance of the disease:
- unnatural posture for a long time;
- pregnancy;
- taking medications with nitroglycerin or metoprolol;
- excess weight;
- bad habits;
- frequent use of caffeine or spices;
- ulcers in the gastrointestinal tract;
This is not a complete list of factors that provoke the disease. In this list, for example, by analogy with pregnancy, you can include some hormonal diseases. This is due to the fact that impaired hormone production leads to a decrease in muscle tone throughout the body.
Reflux esophagitis can occur for no apparent reason. In some cases, a simple tilt is enough to cause discomfort.
Symptoms and complications
Most often found with this disease. A characteristic feature is that such an uncomfortable burning sensation appears in the upper part of the body. The symptom occurs mainly after a meal that irritates the stomach, for example, after drinking alcohol, caffeine, fatty or hot foods.
Symptoms of the disease are:
- Dysphagia (problems with swallowing and passing food through the esophagus). Eating food is accompanied by severe pain. Occurs due to inflammatory processes of the mucous membrane of the esophagus;
- . Possible, both air and acid containing;
- Bronchoobstruction (blockage of the bronchi). In common parlance – “pulmonary mask”. The symptom is chronic and causes coughing attacks. Appears due to the presence of particles in the bronchi from the esophagus or stomach;
- Chest pain. The symptom is similar to angina, but differs in the time it appears, only after eating. It is called the “cardinal mask”;
- Inflammatory process in the nasal cavity. It is possible to develop other similar diseases. Appears due to frequent contact of gastric juice and larynx;
- Destruction of tooth enamel (“dental mask”). Caused by constant contact of gastric juice and teeth (when the first one comes out). A complication of this symptom is the rapid development of caries or tooth loss;
The symptoms of the disease are very similar to others, so it is extremely common that both an inexperienced doctor and a patient, self-medicating, prescribe or use drugs that do not eliminate the disease or have nothing to do with it at all. Such treatment will not give results. If you have symptoms, you should contact a gastroenterologist.
Complications
Complications of the disease reflux esophagitis are directly related to disruption of the normal functioning of the digestive system; special attention is paid to the fact that the development of the disease and the degree of damage may depend on many factors, ranging from genetic predisposition and ending with the consequences of self-medication.
However, reflux esophagitis, in this case, can be considered a “trigger” that allows complications to develop and not be detected. In order to prevent the development of complications, it is important to undergo a timely examination and receive the correct course of treatment.
The most common complications of reflux are:
- Stenosis. This is a change in the size of the lumen in the esophagus, which occurs due to a constant inflammatory process. The muscle walls become thicker and pain appears when swallowing, or so-called “Treatment is only possible through surgery;
- esophagus. Appears due to constant contact of the esophagus with acid. An ulcer is dangerous due to possible bleeding. When they appear, an operation called endoscopy (cauterization of a vessel in the esophagus) is performed;
- Barrett's disease. It is characterized by the fact that the cells of the esophagus are replaced by cells of the stomach. With this disease, there is a high probability of esophageal cancer (malignant tumor);
How is diagnosis carried out?
The initial examination is carried out by a doctor. He also examines the mouth and tongue for the presence of white plaque, characteristic of reflux esophagitis, as well as palpation (manual examination) of the abdominal cavity. What follows is a series of tests and laboratory tests to make an accurate diagnosis:
- Fibroesophagogastroduodenoscopy, abbreviated FEGDS. It is the main method for analyzing reflux esophagitis. The procedure involves inserting an umbrella with a camera into the esophagus through the mouth. The accuracy of the method is high, although it causes a lot of inconvenience to the patient. The study evaluates the esophagus and part of the stomach. When the disease occurs, the mucous membrane is red. If necessary, a biopsy is performed (removal of a tissue sample from the esophagus for analysis);
- X-ray. The procedure is carried out with the mandatory use of contrast (the patient is asked to drink barium fluid, which tastes like chalk). The pictures are taken in a horizontal position, and on the picture itself, due to the dye, the process of fluid entering the esophagus from the stomach will be visible;
- pH study (daily). It determines the dynamics of changes in the level of acid-base balance in the esophagus. The norm is considered to be an acidity above 4 (predominantly alkaline environment), however, with the disease in question, due to regular contact of acid and the mucous membrane of the esophagus, the studied parameter changes (decreases). This analysis allows you to assess the severity of reflux esophagitis and the time when it occurs most often;
- Esophagomanometry. The study aims to evaluate the ability of the sphincter to close. It is performed using a special instrument - a catheter, which is inserted through the nose or mouth. The main task of the analysis is to measure pressure. If there is no pathology, then it does not exceed 25 mm Hg. Art., if the pressure is lower, this means that the sphincter is not working correctly and there is pathological reflux.
In addition to these studies, the patient undergoes other tests. This is necessary in order to exclude other diseases that have similar symptoms. These studies are contraindicated if there are “mask” symptoms:
- ECG. Necessary to exclude angina pectoris;
- Chest X-ray. Necessary to exclude lung disease, for example;
How is it treated?
The first and most important answer to the question “how to treat reflux » is a change in lifestyle and abandonment of the factor causing the disease. This could be giving up smoking, unhealthy foods, or excess weight. Without this point, treatment will be ineffective, and the disease will quickly worsen again. Points to be observed:
- Eating should be slow. Eating foods quickly does not contribute to satiation, since the brain simply does not have time to react (the feeling of fullness comes only 20 minutes after eating), because of this, overeating occurs, which worsens the patient’s condition;
- Serving size. To improve the condition, it is recommended to eat frequently (at least 5 times a day) and in small portions (for adults, the portion size is no larger than the palm of your hand), the last meal no later than 3 hours before bedtime;
- Mode. With reflux esophagitis, it is important to avoid overload and heavy lifting, as this provokes new releases of acid. Another important point is sleep, it should be at least 7 hours at night. You should give preference to a pillow that is not high (the head should be 30° higher than the body), this will help avoid attacks at night;
- A person with reflux is contraindicated from wearing tight clothing, taking medications that affect muscle tone, as well as excessive stress on the abdominal muscles;
Diet also plays a significant role; you will have to adhere to it not only during drug treatment, but also in the future, in order to avoid relapses. The menu should exclude:
- Alcohol. It is recommended to reduce the dose to a minimum or remove it altogether. Alcohol has a relaxing effect on muscles (including the sphincter), and also increases acidity;
- Carbonated drinks, sour or spicy foods. They are strong irritants of the gastric mucosa;
- Legumes, cabbage, brown bread. Cause increased gas formation and increased pressure in the stomach;
- Fresh fruits and vegetables. Excluded only during exacerbation of the disease;
- Products that cause heartburn can be absolutely any product, this group is individual for each case;
Diet and changing habits can only help if reflux esophagitis is treated with mild severity; in other cases, a medicinal course of treatment is mandatory, these can be tablets, suspensions or gels. The following drugs are prescribed:
- Prokinetic group. The main task is to increase the tone of the lower sphincter. The main active ingredient is dompiridone or itopride (for example, Motilium or Genaton).
- Antacid group. Drugs for reduction (for example, Almagel or Reni).
- Group of anti-sector drugs. Used to reduce acidity (Famotidine or Omeprazole).
The duration of treatment and what medications to use depend on the severity of the disease and can only be determined by a doctor.
Are there preventative measures against reflux esophagitis? Specifically against this disease - no. All preventive measures are general, these are:
- maintaining an optimal daily routine;
- and healthy sleep.
The disease is chronic. Therefore, it is much easier to keep its course under control if the degree of damage is small and complications have not yet occurred. And this can be done with careful treatment of the body and periodic regular examinations.
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