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Acid Reflux Disease Symptoms, Causes, Tests, and Treatments
At the entrance to your stomach is a valve, which is a ring of muscle called the lower esophageal sphincter (LES). Normally, the LES closes as soon as food passes through it. If the LES doesn’t close all the way or if it opens too often, acid produced by your stomach can move up into your esophagus. This can cause symptoms such as a burning chest discomfort called heartburn. If acid reflux symptoms happen more than twice a week, you may have acid reflux disease, also known as gastroesophageal reflux disease (GERD).
What Causes Acid Reflux Disease?
One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia. This occurs when the upper part of the stomach and LES move above the diaphragm, a muscle that separates your stomach from your chest. Normally, the diaphragm helps keep acid in our stomach. But if you have a hiatal hernia, acid can move up into your esophagus and cause symptoms of acid reflux disease.
These are other common risk factors for acid reflux disease:
- Eating large meals or lying down right after a meal
- Being overweight or obese
- Eating a heavy meal and lying on your back or bending over at the waist
- Snacking close to bedtime
- Eating certain foods, such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods
- Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea
- Being pregnant
- Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications
What Are the Symptoms of Acid Reflux Disease?
Common symptoms of acid reflux are:
- Heartburn: a burning pain or discomfort that may move from your stomach to your abdomen or chest, or even up into your throat
- Regurgitation: a sour or bitter-tasting acid backing up into your throat or mouth
Other symptoms of acid reflux disease include:
- Bloody or black stools or bloody vomiting
- Dysphagia — the sensation of food being stuck in your throat
- Hiccups that don’t let up
- Weight loss for no known reason
- Wheezing, dry cough, hoarseness, or chronic sore throat
How Is Acid Reflux Disease Diagnosed?
It’s time to see your doctor if you have acid reflux symptoms two or more times a week or if medications don’t bring lasting relief. Symptoms such as heartburn are the key to the diagnosis of acid reflux disease, especially if lifestyle changes, antacids, or acid-blocking medications help reduce these symptoms.
If these steps don’t help or if you have frequent or severe symptoms, your doctor may order tests to confirm a diagnosis and check for other problems. You may need one or more tests such as these:
- Barium swallow (esophagram) can check for ulcers or a narrowing of the esophagus. You first swallow a solution to help structures show up on an X-ray.
- Esophageal manometry can check the function and movement of the esophagus and lower esophageal sphincter.
- pH monitoring can check for acid in your esophagus. The doctor inserts a device into your esophagus and leaves it in place for 1 to 2 days to measure the amount of acid in your esophagus.
- Endoscopycan check for problems in your esophagus or stomach. This test involves inserting a long, flexible, lighted tube with a camera down your throat. First, the doctor will spray the back of your throat with anesthetic and give you a sedative to make you more comfortable.
- A biopsymay be taken during endoscopy to check samples of tissue under a microscope for infection or abnormalities.
Can Acid Reflux Disease Be Treated With Diet and Lifestyle Changes?
One of the most effective ways to treat acid reflux disease is to avoid the foods and beverages that trigger symptoms. Here are other steps you can take:
- Eat smaller meals more frequently throughout the day and modify the types of foods you are eating..
- Quit smoking.
- Put blocks under the head of your bed to raise it at least 4 inches to 6 inches.
- Eat at least 2 to 3 hours before lying down.
- Try sleeping in a chair for daytime naps.
- Don’t wear tight clothes or tight belts.
- If you’re overweight or obese, take steps to lose weight with exercise and diet changes.
- Also, ask your doctor whether any medication could be triggering your heartburn or other symptoms of acid reflux disease.
Can Acid Reflux Disease Be Treated With Medications?
In many cases, lifestyle changes combined with over-the-counter medications are all you need to control the symptoms of acid reflux disease.
Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, or Riopan, can neutralize the acid from your stomach. But they may cause diarrhea or constipation, especially if you overuse them. It’s best to use antacids that contain both magnesium hydroxide and aluminum hydroxide. When combined, they may help counteract these gastrointestinal side effects.
If antacids don’t help, your doctor may try other medications. Some require a prescription. Your doctor may suggest more than one type or suggest you try a combination of medications such as these:
Don’t combine more than one type of antacid or other medications without your doctor’s guidance.
Is Acid Reflux Disease Ever Treated With Surgery?
If medications don’t completely resolve your symptoms of acid reflux disease and the symptoms are severely interfering with your life, your doctor could recommend surgery. There are two types of surgical treatment used to relieve symptoms of GERD if daily use of medication isn’t effective.
The most recently approved procedure involves surgically placing a ring known as a LINX device around the outside of the lower end of the esophagus, the tube that connects the mouth to the stomach. The ring consists of magnetic titanium beads held together by titanium wires. The device helps reflux by preventing stomach contents from backing up into the esophagus. In one study, patients were able to stop taking medicine or cut down the amount they took. You shouldn’t get the LINX device if you’re allergic to certain metals, and once you have a LINX device you shouldn’t get any type of MRI test.
Another surgical procedure called a fundoplication can help prevent further acid reflux. It creates an artificial valve using the top of your stomach. The procedure involves wrapping the upper part of the stomach around the LES to strengthen it, prevent acid reflux, and repair a hiatal hernia. Surgeons perform this procedure through either an open incision in the abdomen or chest or with a lighted tube inserted through a tiny incision in the abdomen.
These procedures are done only as a last resort for treating acid reflux disease after medical treatment has proven to be inadequate.
Heartburn, Regurgitation, Dyspepsia, and More
Lots of people are intimately familiar with acid reflux symptoms. More than 60 million Americans experience acid reflux at least once a month. Acid reflux disease, also known as gastroesophageal reflux disease (GERD), can produce a variety of symptoms.
What Are the Common Acid Reflux Symptoms?
Heartburn, regurgitation, and dyspepsia are a few of the most common acid reflux symptoms.
Heartburn. Also called acid indigestion, heartburn is a burning pain or discomfort that can move up from your stomach to the middle of your abdomen and chest. The pain can also move into your throat. Despite its name, heartburn doesn’t affect your heart.
Regurgitation. Another common symptom of acid reflux is regurgitation — or the sensation of acid backing up into your throat or mouth. Regurgitation can produce a sour or bitter taste, and you may experience “wet burps.”
Dyspepsia. Many people with acid reflux disease also have a syndrome called dyspepsia. Dyspepsia is a general term for stomach discomfort. Symptoms of dyspepsia include:
Symptoms of acid reflux may be a sign that stomach acid has inflamed your esophagus. When that happens, stomach acid can damage the lining of your esophagus and cause bleeding. Over time, it can also change the cells of esphagus and cause cancer (Barrett’s esophagus).
Although acid reflux is extremely common and rarely serious, don’t ignore your acid reflux symptoms. Making a few lifestyle changes and using over-the-counter antacids are often all you need to control acid reflux symptoms.
When Do Acid Reflux Symptoms Occur?
Acid reflux symptoms most often occur:
- After eating a heavy meal
- When bending over or lifting an object
- When lying down, especially on your back
People who have frequent acid reflux symptoms most often experience them at night. Nighttime GERD also produces the most pain. However, the level of pain does not always indicate the degree of damage to your esophagus.
More than half of all pregnant women experience heartburn during pregnancy. Increased hormones and pressure from a growing fetus can combine to produce this acid reflux symptom. In most cases, heartburn improves or completely goes away after delivery.
What Makes Acid Reflux Symptoms Worse?
Certain foods can make the symptoms of acid reflux worse for some people. To lessen your symptoms, try avoiding:
- Citrus fruits
- Caffeinated drinks or alcohol
- Spicy, fatty, or fried foods
- Garlic and onions
Are There Potential Complications With Acid Reflux Symptoms?
Usually, acid reflux symptoms cause no complications. In a few cases, continued esophageal damage can lead to scarring, which may cause the esophagus to narrow. The narrowing creates strictures and makes it difficult to swallow. You may have dysphagia, a sensation that food is stuck in your esophagus. In some cases, normal cells in the lining of the esophagus may be replaced by a different type of cell. This is called Barrett’s esophagus, which can sometimes develop into cancer.
When Should I Call the Doctor With Acid Reflux Symptoms?
Be sure to call your doctor if you don’t get lasting relief from medications. Also call the doctor right away if you have any “alarm” acid reflux symptoms, such as these:
- Unexpected weight loss
- Blood in vomit
- Black, tarry, or maroon-colored stools
- Difficulty or pain with swallowing
Other acid reflux symptoms that should prompt a call to your doctor include:
- Asthma-like symptoms, such as wheezing or dry cough
- Hoarseness, especially in the morning
- Chronic sore throat
- Hiccups that don’t let up
- Nausea that lasts for more than a day or two
Sometimes, people confuse the symptoms of heart attack with symptoms of acid reflux disease. That’s because pain in the chest can feel like heartburn. When in doubt, call your doctor.
Call 911 if you have any of these symptoms of heart attack:
- Chest pain, pressure, or fullness lasting more than a few minutes or that goes away and comes back
- Pain or discomfort in your neck, shoulder, upper back, or jaw
- Shortness of breath, with or without chest pain
- Dizziness, lightheadedness, or nausea
- Sweating along with chest pain
Reglan Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing
See also Warning section.
Drowsiness, dizziness, tiredness, trouble sleeping, agitation, headache, and diarrhea may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.
Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as anxiety, confusion, depression, thoughts of suicide), decreased sexual ability, inability to keep still/need to pace, muscle spasms/uncontrolled muscle movements (such as twisting neck, arching back), Parkinson-like symptoms (such as shaking, slowed/difficult movement, mask-like facial expression), abnormal breast-milk production, enlarged/tender breasts, swelling of the hands/feet, changes in menstruation in women.
This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness, severe confusion, sweating, fast/irregular heartbeat.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US –
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
What’s the Difference Between Acid Reflux and GERD? | Everyday Health
Got a burning feeling in your upper chest? If you’re thinking heartburn, you’re probably right. “Heartburn is the manifestation — the symptom — of acid reflux, or stomach contents coming back up in your esophagus,” says Matilda Hagan, MD, a gastroenterologist at The Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore.
You can often pinpoint a reason for the burn (that five-alarm chili, perhaps?), but if heartburn happens often — defined as a couple of times a week — it could be a symptom of a more serious condition called gastroesophageal reflux disease (GERD).
While it may seem that GERD is just a fancy name for heartburn, they are more like close cousins than identical twins.
That Burning Feeling: What Is Heartburn?
After you swallow food, it makes its way down the esophagus and into the stomach, where a ring of muscle, called the lower esophageal sphincter (LES), closes to keep the food in. But sometimes the LES is weak or doesn’t properly close, allowing stomach acid to backup, which irritates the lining of the esophagus. That’s acid reflux, or heartburn.
The American College of Gastroenterology (ACG) estimates that more than 60 million Americans experience heartburn at least once a month. Symptoms include:
- A burning sensation in the center of your chest that lasts from several minutes to an hour or two
- A feeling of chest pressure or pain that is worse if you bend over or lie down
- A sour, bitter, or acidic taste in the back of your throat
- A feeling that food is “stuck” in your throat or the middle of your chest
You can generally avoid occasional bouts of heartburn with some lifestyle modifications. Your doctor will likely suggest you try to treat heartburn by making the following lifestyle changes before medication comes into play.
- Avoid foods that trigger reflux for you. Spicy, acidic, and fried or fatty foods are more likely to trigger reflux. So can caffeine and alcohol.
- Stay upright after eating a big meal to allow for optimal digestion. “It’s best to not eat in the hours leading up to bedtime,” says Dr. Hagan.
- If you’re overweight or obese, losing some weight can help. (Obesity is a factor in the weakening of the lower esophageal sphincter.)
- If you smoke, do your best to quit.
Related: Heartburn and Foods: Dos and Don’ts
Related: 7 Low Acid Foods to Add to Your Reflux Diet
When Acid Reflux Is Chronic: What Is GERD?
According to the ACG, GERD is acid reflux that occurs more than a couple of times per week. That said, it’s not the case that a person who has occasional heartburn will necessarily progress toward having GERD, says Louis Cohen, MD, gastroenterologist and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai Hospital in New York City. But the symptoms are the same as those of acid reflux, such as the burning feeling in your chest and the sensation that your stomach contents are in your throat. You may also have a dry cough or trouble swallowing.
Diagnosing the condition can usually be done by a primary care doctor (or gastroenterologist) by simply evaluating symptom frequency and severity.
“We may also put a probe into a patient’s esophagus for a day to measure how frequently reflux happens,” says Dr. Cohen. Knowing how often reflux occurs is another way (beyond symptoms) to confirm a diagnosis.
Treatment for GERD starts with lifestyle modifications, adds Hagan, “we’ll ask patients to try these steps before we offer medication, although we understand that it can be hard to do some things, such as quitting smoking.”
The medication most often prescribed for GERD is a proton pump inhibitor (PPI), such as:
PPIs work to decrease the amount of acid your stomach produces. The ACG notes that there’s strong evidence that an eight-week course of a PPI eases symptoms and can heal the lining of the esophagus that’s been damaged by stomach acid. Other drugs called h3 blockers, such as Zantac (ranitidine) or Pepcid (famotidine) may also be tried and are effective, says Hagan. h3 blockers also lower stomach acid production, and are available over the counter.
“If we determine that GERD symptoms are caused by hypersensitivity in the esophagus or excessive relaxation of the lower esophagus, we might prescribe tricyclic antidepressants or selective serotonin uptake inhibitors,” adds Cohen.
Delaying Treatment May Lead to Complications
If GERD goes untreated, it can lead to more serious complications. One such issue is esophagitis, which is inflammation in the esophagus. Hagan says if that’s not treated, you may develop strictures, which is a narrowing of the esophagus that can lead to esophageal pain and affect proper swallowing.
Another complication of GERD is a condition called Barrett’s Esophagus (BE). “Over time, the stomach acid causes cells in the lining of the esophagus to look more like the stomach lining,” says Hagan. These changes, which happen on a cellular level, may in rare cases lead to a form of esophageal cancer called esophageal adenocarcinoma. BE is more common in:
- Caucasian males
- People older than age 50
- People who are overweight
This form of cancer appears to be on the rise, according to research published in March 2013 in the journal Cancer.
Meanwhile more recent research, published in May 2016 in the Journal of the American Medical Association, suggests that the “chemical burn” of stomach acid may not be the sole cause of changes to the esophageal lining. Instead, the study suggests that damage may be caused by an inflammatory response to proteins called cyotokines that are secreted in the intestinal lining of people with GERD.
If you have BE, says Hagan, your doctor may recommend surveillance endoscopy, which means he or she will perform an endoscopy periodically to see how well your esophagus is healing, secondary to drug therapy.
The bottom line: If you’re experiencing heartburn at an increased frequency, talk to your doctor about testing to uncover the underlying issue. If you learn to treat GERD with lifestyle changes or medication, you can avoid more serious complications.
Chronic Heartburn | Rush System
It’s just heartburn, right? Take an antacid, hope it works and worry about it tomorrow. While this approach is fine for occasional heartburn, frequent or uncontrollable heartburn may lead to far more serious problems and shouldn’t be ignored.
Heartburn is caused by acid reflux, when acid from the stomach flows up or refluxes into the esophagus, the muscular tube that connects the throat with the stomach. The result of this acid irritating or damaging the lining of the esophagus can be a sensation of tightness, pain or discomfort in the middle of the chest — what we call heartburn.
“When the lower part of the esophagus is exposed to acid from the stomach, the cells begin to adapt,” says Michael D. Brown, MD, a gastroenterologist specializing in digestive disorders at Rush University Medical Center.
In fact, over time, the cells of the esophagus that are repeatedly in contact with acid adjust to become more like cells found in the small intestines. This is referred to as Barrett’s esophagus. While this change in the cells can protect the esophagus from further damage caused by inflammation, people with Barrett’s esophagus may develop dysplasia, a condition that dramatically increases the risk of getting cancer of the esophagus.
Take a proactive approach
That’s why, if you have had heartburn or acid reflux consistently for longer than three years, you should have an endoscopy, says Brown. An endoscopy is a simple procedure where a specially designed scope is used to examine the esophagus and take tissue samples, when necessary.
“The tissue samples or biopsies are examined to look for any abnormal cell growth,” Brown explains. “The hope is that we’ll be able to catch any abnormal cells before they become cancerous.”
Patients who are diagnosed with Barrett’s typically undergo repeat endoscopies one year and three years later. If precancerous cells are seen at that point, treatment may involve surgical removal of the esophagus to prevent eventual progression to cancer.
But a technique available at Rush, the HALO Ablation System, enables doctors to use radiofrequency ablation (high-frequency electrical currents) to remove Barrett’s tissue completely, without invasive surgery and with relatively few complications.
“HALO ablation has shown to be an effective alternative to surgery in select patients,” says Brown. “However, the good news is that most patients with Barrett’s will never progress to the point that they require this level of intervention.”
Keep the lines of communication open
Brown says it’s important to talk to your primary care doctor if you’ve been experiencing recurring acid reflux or are treating yourself for heartburn with over-the-counter medications or a prescription from another doctor. You’ll also want to visit your doctor if you experience any of the following:
- Trouble swallowing
- Unexplained weight loss
- Blood in your stool or vomit, which indicates bleeding in the gastrointestinal tract
“These are important symptoms to watch out for, because you can have Barrett’s esophagus without experiencing heartburn,” says Brown.
If you have chronic heartburn, falling asleep in the wrong position enables acid to sneak into the esophagus. Keeping your head raised slightly keeps that from happening.
5 tips to keep heartburn on the backburner
To prevent occasional bouts of heartburn, try taking the following five steps:
1. Avoid eating within three hours of the time you go to bed.
2. Take any acid suppressant medication, such as a proton pump inhibitor, first thing in the morning. “Because of the way proton pump inhibitor-type medications activate, it’s not helpful to take these medications at night on an empty stomach,” says Brown.
3. Sleep on a slight incline, with your head elevated, and/or sleep on your left side. If you have chronic heartburn, falling asleep in the wrong position enables acid to sneak into the esophagus. Keeping your head raised slightly keeps that from happening. Studies have also found that while sleeping on the right side actually aggravates heartburn, flipping over to your left side is likely to calm it, although the reason why is unknown.
4. Avoid foods that may cause acid reflux, such as peppermint, coffee and chocolate. “Interestingly, spicy foods haven’t been shown to cause heartburn,” says Brown. “And there’s some evidence that spicy foods may actually protect the body from ulcers.”
5. If you smoke or use other tobacco products, quit. Not only does smoking relax the lower esophageal sphincter, allowing stomach acid to move up into the esophagus where it doesn’t belong, but it also can slow the production of saliva, which protects against acid in the esophagus.
“The most important thing is to be aware of what causes you personally to have heartburn,” says Brown. “Everyone is different, so be aware of what triggers an attack for you and what food and remedies work best for you. But always work closely with your doctor and let him or her know when you are experiencing prolonged bouts of heartburn.”
Control your acid reflux
If you have frequent acid reflux, that means you have acid reflux disease (also called gastroesophageal reflux disease, or GERD). The vast majority of patients with acid reflux disease respond well to daily acid suppressing medications, such as proton pump inhibitors.
It’s important to note, however, that while these medications effectively manage symptoms, they are not a cure. The heartburn pain will go away, but the backsplash of damaging fluid still occurs.
That’s because proton pump inhibitors can’t fix the underlying mechanical problem — the dysfunction of the valve between the esophagus and stomach. Long-term use of proton pump inhibitors can also cause significant side effects, and you must consider the lifetime cost of taking these medications.
For these reasons, surgery may be necessary to correct the valve mechanism, with the goal of eliminating the need for reflux medication. Advances in technology have improved doctors’ ability to tailor procedures to each individual patient, with greatly improved outcomes.
These techniques are performed through small or even no incisions, and serve to restore the valve mechanism between the esophagus and stomach to prevent acid reflux,” explains Justin Karush, DO, a thoracic surgeon at Rush. Common procedures for GERD include laparoscopic Nissen fundoplication, transoral incisionless fundoplication (also called TIF Esophix) and magnetic sphincter augmentation (also called LINX).
“If you believe you have acid reflux disease and are having difficulties using medications to control it, TIF and other laparoscopic antireflux procedures may be helpful,” Brown adds. “Having a discussion of these procedures with your gastroenterologist is a great starting point.”
About GERD (Gastroesophageal reflux disease)
Gastroesophageal reflux disease, also abbreviated to GERD, is unusually frequent or chronic reflux. Patients typically experience the symptoms at least two times a week, if not more. In the United States, GERD is one of the most commonly diagnosed gastrointestinal diseases, with nearly 20 percent of the adult population experiencing symptoms regularly. When left untreated, it can lead to serious complications such as changes to esophageal structure or Barrett’s esophagus. Acid reflux has a variety of causes that can lead to GERD. These include, but are not limited to diet, genetics, age and previous injuries.
GERD affects people differently and involves symptoms which vary from mild to moderate or severe. Mild sufferers may experience occasional bouts of heartburn. Patients with more severe reflux can experience heartburn daily. Other patients never experience heartburn but may have symptoms such as asthma, chronic cough, hoarseness, or chest pain due to persistent reflux.
What Is Acid Reflux?
Acid reflux, commonly experienced as heartburn or regurgitation, occurs when stomach fluids back up, or reflux, into the esophagus, exposing it to gastric acid and other contents. While occasional reflux is normal, for some it can be frequent and severe enough to impact daily life.
How GERD Can Impact Your Daily Life
Researchers estimate that pain and discomfort from acid reflux impacts up to 60 percent of the U.S. population every year. GERD can impact a patient’s life in some of the following ways:
- Persistent Typical and Atypical Symptoms: May result in heartburn, chest pain, sore throat and other symptoms despite medication.
- Sleeping Positions: Nighttime reflux can compromise sleep for people who sleep in a typical horizontal position. This can affect alertness and productivity the following day.
- Diet: Dietary restrictions including regimented timing of meals and the need to avoid consuming foods and beverages that trigger reflux.
- Additional Healthcare Costs and Work Productivity: Costs associated with GERD can reach thousands of dollars annually in medications and lost productivity from work.
How Is GERD Treated?
Treatment for GERD varies from person to person depending on the severity of symptoms: mild sufferers may experience relief by implementing simple lifestyle changes, while others can control symptoms through medication therapy. However, common medications like Proton Pump Inhibitors prescribed to control GERD symptoms carry their own risks and limitations, and may not be the best long-term solution for GERD.
People who experience more debilitating symptoms of GERD consistently may require or opt for surgery. It is important to remember that GERD is a chronic disease that usually requires lifetime management to control symptoms if left untreated.
What Happens if You Don’t Treat Gastroesophageal Reflux Disease?
Chronic, prolonged exposure to reflux may result in inflammation, irritation or swelling of the esophagus. This condition, known as esophagitis, can be accompanied by more concerning complications such as ulcers, hemorrhage or precancerous cellular changes.
While symptoms alone can significantly interfere with one’s quality of life, GERD is also associated with the development of Barrett’s esophagus, a condition that causes a cellular change in the lining of the lower esophagus. In a percentage of patients, it can progress to esophageal cancer, a potentially life-threatening illness. To avoid this and additional potential complications, it is important to take GERD symptoms seriously and seek evaluation and diagnosis from a healthcare professional as soon as possible.
Talk to Your Doctor About GERD
Having heartburn or acid reflux from time to time is normal; having it frequently interrupt your life is not. If you suffer symptoms of reflux more than twice a week, you may have GERD. Take the GERD-HRQL (Health Related Quality of Life) survey if you suspect a problem and bring the results to a qualified physician near you for a GERD evaluation.
Six Signs Your Heartburn Could Be Something More Serious
That burning, uncomfortable sensation in your chest? It’s probably heartburn. Heartburn is a very common ailment that affects many people for many reasons. It occurs when digestive acid escapes the stomach and irritates the delicate lining of the esophagus.
Usually, it’s the result of eating certain foods, or simply overeating, and can be treated with over-the-counter antacids. But sometimes, heartburn is a symptom of bigger problems, that require other solutions. Here’s when to call a doctor:
If you have frequent heartburn (more than twice a week), you may have gastroesophageal reflux disease (GERD). GERD is a digestive disorder that affects the lower esophageal sphincter (LES), a muscle that connects the esophagus and the stomach.
When working properly, the LES serves as a barrier that prevents digestive acid from the stomach from leaking into the esophagus. However, if the LES is weakened or malfunctioning, stomach acid can reach the esophagus and cause repeated bouts of heartburn. Over time, GERD may damage your esophagus, or lead to a serious complication called Barrett’s esophagus. In Barrett’s esophagus, repeated exposure to stomach acid causes changes to esophageal cells. These damaged cells can transform into esophageal adenocarcinoma, a potentially fatal cancer.
If GERD is suspected, your doctor may perform an endoscopy, a procedure in which a lighted scope is inserted into the esophagus, to examine the digestive tract.
If you are experiencing severe abdominal pain or bloating in addition to heartburn, you may be suffering from gastritis. Gastritis is inflammation of the stomach lining and may be caused by bacteria, infection, chronic vomiting, or excessive use of alcohol or non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen. An endoscopy will reveal the extent of the damage to your stomach lining.
Hiccup or cough
A persistent cough or hiccup may be a sign of a hiatal hernia, a condition in which part of the stomach slips through a hole in the diaphragm. The diaphragm is the muscle between the chest and the abdomen that plays a crucial role in breathing: when your diaphragm contracts, it inflates your lungs, allowing you to inhale. It has a small opening through which the esophagus passes. If the stomach slips through this opening, it can cause severe heartburn, in addition to chest or abdominal pain, nausea and vomiting, or shortness of breath.
If you find that it is difficult or painful to swallow in addition to suffering from heartburn, you may have esophagitis. Esophagitis is inflammation of esophageal tissue, that is often caused by GERD. If esophagitis is suspected, your doctor may order an endoscopy to assess the damage to your esophageal lining.
Nausea or vomiting
Nausea and vomiting may be signs of GERD, hiatal hernia, or esophagitis. Regurgitation of the stomach’s contents may occur as a complication of any of these conditions. This regurgitation often results in a “sour taste” that causes some patients to feel nauseated or lose their appetite. Extreme nausea or vomiting may also be a sign of a serious medical emergency – a heart attack.
Severe chest pain or pressure
If you experience severe chest pain or pressure, especially in combination with pain in the jaw, neck, or back, nausea and vomiting, or difficulty breathing, seek medical help immediately. You may be having a heart attack.
Heartburn is a common annoyance that is usually harmless, but it could be a sign of a bigger medical problem. If your symptoms persist or are interfering with your daily life, contact your doctor to discuss treatment options or request further testing.
Reflux disease treatment
What is reflux (GERD – gastroesophageal reflux disease)?
Reflux is the reverse flow of various fluids, in this case from the stomach into the esophagus. There is also gaseous reflux (regurgitation) and regurgitation – the throwing of partially solid or more often liquid stomach contents into the esophagus.
Reflux is a completely normal phenomenon that occurs in every healthy person during or shortly after a meal.Pathologic refrux is different from normal. It is more aggressive and moves up the esophagus closer to the neck. This causes some excruciating pain, damage to the esophagus, and possibly adjacent organs. The degree of reflux disease does not always correlate with symptoms. Sometimes patients present with massive symptoms without objectively detectable reflux disease and vice versa. Complaints are also varied, but not always manifested.
What are the most common causes of reflux?
The most common causes of reflux are congenital or, more commonly, acquired diaphragmatic hernias and associated lower esophageal sphincter malfunction.Like any hernia of soft tissues, a diaphragmatic hernia can occur from overexertion or overload. In practice, there are many reasons for this. In general, it is a chronic or acute increase in abdominal pressure (eg, during pregnancy, childbirth, chronic cough, allergies with frequent sneezing, or excessive exercise).
What symptoms should alert you?
Regular recurring reflux should alert, for example 1-2 times a week. In this case, it is necessary to consult a specialist and, for clarification, carry out at least a gastroscopy. With a hereditary predisposition to problems with the gastrointestinal tract, in particular to neoplastic diseases, it is recommended to take the symptoms seriously and undergo extensive diagnostics. There are also situations where neighboring organs are affected without the typical reflux symptoms. The most common examples are bronchial asthma, COPD, sore throat, etc. In such cases, it is necessary to diagnose reflux after excluding other causes.
How do you diagnose reflux?
The most important is the accurate collection of information about the course of the disease and the response to medication (= history). Gastroscopy is the first of the most important studies. It takes place under medication sleep and is completely painless for the patient. During gastroscopy, the duodenum, stomach and esophagus are examined, tissue samples are removed, and the entire study is saved in the form of photo or video documents.
Most patients with reflux have a diaphragmatic hernia (= hiatal hernia) and inflammation of the esophagus, especially where the esophagus enters the stomach.Often, the size of a diaphragmatic hernia and the extent of reflux damage to the esophagus are not directly related.
For high-quality collection of information, a 24-hour impedance measurement is performed. Thanks to this measurement, it is possible to determine not only which substances are thrown back into the esophagus (acid, bile), but also how aggressive they are. In addition, the patient can register their typical symptoms in the memory of the device during the impedance measurement.
Thus, we determine whether the symptoms are caused by reflux or not.This is especially important for atypical symptoms and damage to neighboring organs such as the lungs and ENT organs.
Video cinematography , as a functional study, answers the rest of the questions. Its main advantage is in assessing the movement of the esophagus, as well as timely relaxation of the lower esophageal sphincter.
Manometry is often performed only if there is a suspicion of complex disorders of esophageal peristalsis, or dysfunction of the sphincter, in the absence of a diaphragmatic hernia.To clarify specific issues, especially regarding the esophageal wall, planimetry is performed. Comprehensive reflux diagnosis usually takes 1-2 days.
How is reflux treated?
There are conservative symptomatic therapies, such as lifestyle changes with adherence to a special diet, and measures that maintain low pressure in the abdominal cavity, namely drugs that inhibit the production of acid in the stomach and thus partially eliminate reflux.The reflux itself remains, but its acidity becomes less aggressive, and thus it is less noticeable to the patient.
The only method that eliminates the causative factor of reflux disease, with a good long-term result, is the surgical treatment of diaphragmatic hernia, using the fundoplication method. This operation is currently performed almost exclusively by the laparoscopic method.
Fundoplication allows you to eliminate all forms of reflux and restore the natural mechanism of closure of the esophageal sphincter.Thanks to surgical treatment, it is possible to avoid the side effects that may occur with drug therapy. Other forms of therapy have not proven themselves due to poor medium to long term results.
The Linx System is a new treatment for reflux. This is a titanium ring with a magnetic core that is implanted around the lower part of the esophagus during laparoscopic surgery to support the sphincter and improve existing reflux. This form of therapy is most often used for small diaphragmatic hernia, i.e.e. with mild reflux. However, there are no really convincing data on this method.
Is it possible to finally recover from reflux?
Symptomatic therapy with proton pump inhibitors along with lifestyle changes is very effective in the early stages. Success depends not only on the severity of the disease, but also on the composition of the reflux.
Acid reflux responds much better to drug therapy than mixed or alkaline bile reflux.With this therapy, of course, it is impossible to stop the flow of fluid back into the esophagus, but aggressive acid reflux can be neutralized, thereby making it less noticeable to the patient. Over time, as a rule, an increase in the dose of drugs is necessary.
A complete cure with drug therapy is not possible, since the cause of reflux, diaphragmatic hernia, cannot be eliminated with medication. A complete cure is possible only with the reconstruction of the esophageal sphincter, i.e. closing the diaphragmatic hernia.
In this case, fundoplication is the method that gives the best long-term results and a high level of satisfaction (over 90%) among all types of therapy.
With both fundoplication techniques (360-degree cuff, 270-degree cuff), approximately equivalent reflux control can be achieved with a very low complication rate. The most common complication is dysphagia (difficulty swallowing). It manifests itself in 4% of cases and is well controlled with medication.The need for reoperation arises, according to the literature, in only 0.9% of cases.
The most important for determining the effectiveness of fundoplication is the postoperative control with measurement of impedance. Especially in Barrett’s esophagus, this measurement is predictive of any progression to esophageal cancer.
What are the consequences of this disease?
Reflux can contribute to the development of Barrett’s syndrome along with distressing symptoms that are only partially relieved by medication.And Barrett, in turn, is the strongest risk factor for esophageal cancer. The number of new cases of esophageal cancer is on the rise worldwide.
In rare cases, reflux can cause the esophagus to narrow. Disease of neighboring organs is much more common. For example, COPD and asthma are closely related to GERD. Up to 40% of coughs are caused by GERD, and reflux is found in 80% of asthma patients. Hoarseness and sore throat are often also caused by reflux disease.
What preventive measures would you recommend to readers?
For patients without diaphragmatic hernia and pathological symptoms, there are no recommendations in the medical literature.For patients with advanced reflux disease, there are a number of lifestyle adjustments that can be made to keep reflux from developing naturally. In this case, diet also plays an important role.
In case of regular or severe complaints, I recommend that you undergo diagnostics in a timely manner, so that after the therapy and follow-up examination it is possible to compare the results and evaluate the success of therapy. Regularly, it is necessary to rethink the method of treatment with an assessment of the effectiveness and side effects.The aim is to tailor the treatment to achieve good results, ideally with no or minor side effects, and thereby significantly improve the quality of life.
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90,000 Ayurvedic drugs, causes and symptoms
What is acid reflux
Acid reflux is a medical condition that causes a burning sensation (heartburn) in the lower chest. In this case, there is a reverse outflow of acid from the stomach into the esophagus. When acid reflux is diagnosed as gastroesophageal reflux disease (GERD) after two weeks.
Acid reflux from the point of view of Ayurveda
According to Ayurveda, acid reflux occurs due to exacerbation of the body’s Pitta and Vata dosha.Increased Pitta causes a burning sensation, and increased Vata causes acid to move up the esophagus.
Causes of acid reflux
Acid reflux occurs due to the drainage of stomach acid into the esophagus, causing heartburn. This condition occurs when the abdomen and upper body move above the diaphragm. The diaphragm is the muscle that separates the stomach from the chest and stores acid in the stomach. However, due to irregularities in the diaphragm, acid can move up into the esophagus, causing acid reflux symptoms.A common hiatal hernia is considered the main possible cause of acid reflux.
Risk factors for developing acid reflux
It affects people of all ages, sometimes regardless of the cause. Often lifestyle factors such as:
- Eating before bedtime
- Insufficient or low physical activity
- Certain medications such as calcium channel blockers, pain relievers, antihistamines and sedatives as well as asthma medications.
- Drinking drinks such as alcohol, coffee, tea, soda, etc.
Symptoms of acid reflux
Symptoms that commonly occur during acid reflux include:
Other symptoms include:
- Gas, bloating
- Bloody or black stools
- Bloody vomiting
- Belching and hiccups
- Dysphagia t.e. difficulty swallowing
- Sudden weight loss
- Wheezing (high-pitched whistling sound when breathing)
- Dry cough
- Hoarseness or chronic sore throat
Complications associated with acid reflux
if acid reflux persists for more than two weeks, it can be called GERD, and further complications of GERD are esophagitis, Barrett’s esophagus, esophageal cancer, and heart disease.
How to Diagnose Acid Reflux
Onset of heartburn-like symptoms is the key to diagnosing acid reflux.Doctors may recommend tests to confirm the diagnosis of acid reflux and evaluate if other problems have occurred:
- Barium swallow (esophagram)
- Esophageal manometry
- pH monitoring
- or Biopsies for abnormalities
Ayurvedic products for the treatment of acid reflux
Ayurveda offers effective herbal remedies that contain pure herbal extracts without external additives. These remedies can be used safely for acid reflux as they have no side effects.
Discontinuation or dose reduction of proton pump inhibitors versus continuous long-term use in adults
The aim of this review was, building on previous studies, to evaluate the effects of discontinuation or dose reduction of proton pump inhibitors (PPIs; acid-lowering drugs) in adults compared with normal practice (i.e.e. continuous long-term (more than four weeks) daily use of PPIs. Effects include both benefits and harms (eg, pill use, symptom control, and cost).
PPIs are used for many different conditions (eg, heartburn, acid reflux, stomach ulcer). Research done on most of these conditions only supports short-term use of these drugs (two to 12 weeks), however, these drugs usually continue to be taken for long periods of time or even indefinitely.Long-term use of PPIs contributes to drug abuse and puts patients at risk of unwanted drug interactions and side effects (eg, diarrhea, headache, bone fractures). It also leads to a high burden of health care costs. “Deprescribing” includes the gradual withdrawal and cessation of medication. The most common approach is on-demand therapy, which allows people to take their medication only when they have symptoms (ie.that is, when heartburn occurs). The overall goal of discontinuation is to minimize the number of drugs taken, thereby reducing the likelihood of drug misuse and preventing side effects.
We found six trials involving 1758 people. Five of these studies looked at on-demand withdrawal and one trial looked at abrupt withdrawal from PPIs. The participants were between the ages of 48 and 57, with the exception of one trial (mean age 73).Most of the participants had mild heartburn and acid reflux with mild esophagitis (inflammation of the esophagus that can lead to damage).
We found that withdrawal methods resulted in worse symptom control with a significant reduction in pill use. Discontinuation of PPIs can lead to side effects such as inflammation of the esophagus. Very little data were available to conclude on the long-term benefits and harms of dose reduction or discontinuation of PPIs.
Quality of evidence
Overall, the quality of the evidence for this review ranged from very low to moderate. Symptom control results in trials were reported inconsistently. There were also limitations in how the studies were conducted (for example, participants and researchers could know which drug they were receiving), which lowered the quality of the evidence. Other factors influencing quality included small sample sizes in most trials and conflicting research results.
GERD is considered a disease of modern civilization “Medvestnik
– Alexander Sergeevich, what is the prevalence of gastroesophageal reflux disease (GERD) in the world and in our country?
– The exact statistics on the prevalence of GERD is unknown – due to the fact that the clinical manifestations of the disease are diverse, and the data, as a rule, are based on taking into account only one of its symptoms – heartburn. Firstly, there are a number of other clinical manifestations that are not taken into account, and secondly, very often people do not consider heartburn as a manifestation of the disease at all, do not go to the doctor and take medications that relieve symptoms on their own.
The number of drugs sold worldwide for the treatment of GERD is very large, although not everyone has a verified diagnosis.
Even with these circumstances, according to statistics, worldwide the prevalence of the disease is between 8 and 33%, depending on the country. GERD is considered a disease of modern civilization or, as it is sometimes called, a disease of the “Western lifestyle”, which includes unhealthy diet, fast food, and overweight.In eastern countries, its prevalence is less, but even there, due to changes in lifestyle, the incidence rate has recently been growing, and quite rapidly. Twenty-eight studies investigating the epidemiology of GERD have shown that the prevalence of the disease is 18.1-27.8% in North America, 8.8-25.9% in Europe, 2.5-7.8% in East Asia. 8.7-33.1% in the Middle East, 11.6% in Australia, 23.0% in South America, 11.9% in Turkey.
In Russia, according to several studies, from 18 to 46% of the adult population suffer from GERD.The incidence has been steadily increasing and there has been an approximately 50% increase in the number of patients in the United States, Europe and East Asia since 1995. Why this is happening is difficult to say unequivocally, since it is influenced by many factors. However, if we compare the dynamics of the growth in the number of overweight and obese people with the dynamics of the growth in the number of patients with gastroesophageal reflux disease, we will see a very close correlation. Therefore, we can assume that the reason for the increase in the incidence of GERD is the increase in the number of overweight and obese people, although, I repeat, this dynamics is due not only to this.
Very often, both doctors and patients are interested in such a problem as Barrett’s esophagus – a complication of gastroesophageal reflux disease. Patients are worried about this diagnosis, since Barrett’s esophagus is in some cases a precancerous disease. Despite the fact that the number of patients with Barrett’s esophagus is increasing, globally it is not a common disease. It cannot be said that patients with GERD will necessarily have Barrett’s esophagus as a complication. Approximately 8% of patients with GERD have Barrett’s esophagus, but with a low degree of dysplasia, esophageal carcinoma may develop in less than 0.5%, and in the absence of dysplasia, in 0.1%.With a high degree of dysplasia, the risk is increased. To talk about the statistics of Barrett’s esophagus, you must first use an accurate definition of this condition. And, of course, to establish the correct diagnosis, so that, on the one hand, not to miss the formidable complications, and on the other, not to cause undue anxiety in the patient. Correct diagnosis is the basis for correct patient treatment and prevention of esophageal adenocarcinoma development.
– What are the clinical differences between “typical” and “atypical” manifestations of GERD?
– For any doctor and patient, the presence of heartburn is associated with gastroesophageal reflux, with an unpleasant burning sensation that significantly reduces the patient’s quality of life.Heartburn can occur at night, disrupt sleep and lead to decreased performance. GERD can impair quality of life to a greater extent than, for example, such a serious illness as hypertension. Hypertension is a socially significant disease, the cause of disability and mortality. GERD, fortunately, does not lead to consequences of this kind, but at the same time, the quality of life of patients with GERD decreases enormously.
The next symptom in order that doctors and patients understand is belching, either with air or with acidic contents.With the development of severe inflammation in the esophagus, patients develop pain when swallowing – single phagia, which is a reliable sign of the development of erosive esophagitis. These symptoms are typical of GERD.
There is also an atypical esophageal symptom – chest pain, and its localization is the same as for pain in the heart, but it is not associated with cardiac pathology, and this often leads to diagnostic difficulties. Therefore, it must be remembered that chest pain can also be a sign of esophageal pathology, in particular, gastroesophageal reflux disease.
There are extraesophageal manifestations that develop as a result of gastroesophageal reflux, but the pathological process is localized not only in the esophagus, but also, for example, in the bronchopulmonary system. In patients with GERD, in particular, a cough may appear associated with the possible throwing of stomach contents into the oral cavity and its aspiration. Difficulty breathing may even be observed, either due to aspiration or due to a reflex that occurs on the esophageal mucosa and is transmitted to the bronchi, which can lead to bronchial obstruction.
Otorhinolaryngological manifestations are very common in patients with GERD. Laryngitis, pharyngitis can become symptoms of this disease, some authors even mention the possibility of developing sinusitis, but to a lesser extent. Sore throat, perspiration, hoarseness are quite common with GERD. The reason lies in the damaging effect of refluctate on the mucous membrane. These symptoms require very careful analysis and interpretation. Of course, not every laryngitis and pharyngitis is the result of gastroesophageal reflux disease, but if these manifestations occur against the background of heartburn, then the connection is very likely.If symptoms appear without heartburn, additional testing is required, in particular a 24-hour impedance-pH measurement of the esophagus. It is necessary to pay attention to the extraesophageal manifestations, but at the same time do not overestimate them and correctly differentiate them.
– Alexander Sergeevich, what are the current recommendations for the management and treatment of patients with GERD?
– Gastroesophageal reflux disease is understood as a chronic recurrent disease characterized by the discharge of stomach contents into the esophagus due to disturbances in the motor-evacuation function of the gastroesophageal zone organs, which leads to damage to the esophageal mucosa and the appearance of clinical symptoms that reduce the patient’s quality of life.
There is a basic guide to treating patients – clinical guidelines of the Russian Gastroenterological Association, published in the Russian Journal of Gastroenterology, Hepatology, Coloproctology. I recommend that all specialists refer to the materials that are published in this journal, they are reviewed by leading domestic and foreign experts, and you can be sure of their extremely high quality. All clinical guidelines of the Russian Gastroenterological Association are regularly updated by the professional community.The latest guidelines for the treatment of GERD were published in 2017, and, according to the established procedure, their updated version will be presented in 2020.
– What are the features in modern methods of diagnosis and treatment of the disease?
– Progress in the diagnosis and treatment of GERD exists, although it has not kept pace with the growing number of patients with both typical and atypical manifestations of the disease. Doctors, solving the problems of diagnosis and treatment of patients, are faced with such problems as refractory gastroesophageal reflux disease, that is, persistence of symptoms against the background of treatment, complications of reflux disease.At the same time, the progress in the development of approaches to therapy is impressive: we can cure these patients much faster than before.
Several decades ago, the duration of therapy for erosive esophagitis began at three months, and the treatment was very stressful for the patients, included a lot of procedures, and the results did not differ in efficiency. Today we have in our arsenal an effective tool that allows you to reduce the secretion of hydrochloric acid in gastric juice – these are proton pump inhibitors.With their help, the duration of therapy was reduced, but we must not forget that the course of therapy must be observed in full.
A center for the study of chronic diseases of the esophagus, including gastroesophageal reflux disease, is successfully operating at the V.Kh. Vasilenko Multidisciplinary Clinic of Internal Medicine Propedeutics, Gastroenterology and Hepatology at the I.M.Sechenov First Moscow State Medical University. Based on the rich traditions of domestic medicine, we have introduced into everyday practice the latest technologies and techniques that can significantly increase the effectiveness of treatment of patients with GERD, received the latest scientific data that expand our understanding of the disease and the possibilities of therapy.
The main method for diagnosing erosive esophagitis and Barrett’s esophagus is esophagogastroduodenoscopy, which allows not only to assess the severity of esophagitis, but also to obtain biopsies of the mucous membrane to exclude eosinophilic esophagitis and adenocarcinoma of the esophagus. There are “gold standard” methods for diagnosing and monitoring the systemic nature of GERD therapy. It is a 24-hour pH meter that detects acid gastroesophageal reflux, intraluminal impedance pH meter and esophageal mucosa impedance meter.Intraluminal impedance-pH-metry can detect various types of GERD, study the physical characteristics of refluctate and calculate clearance, that is, the ability of the esophagus to clear refluctate. Esophageal mucosa impedance measurement is a completely new method that has allowed us to significantly expand our understanding of the nature of mucosal inflammation and individualize therapy.
As a high-tech method that allows diagnosing the functional state of the esophagus, that is, identifying individual characteristics that lead to the development of the disease, we use high-resolution esophageal manometry.This method studies the qualitative and quantitative indicators of pressure in the esophagus, peristaltic activity, studies the contractility reserve of the thoracic esophagus, visualizes the transient relaxation of the lower esophageal sphincter. The method is fundamental in understanding the processes that lead to the disease, since GERD is based on impaired motor function.
All described methods are used in daily practice of the Clinic of Propedeutics of Internal Diseases, Gastroenterology and Hepatology of Sechenov University.In addition, the doctors of our pulmonology and cardiology departments have extensive experience in the diagnosis and treatment of extraesophageal manifestations of reflux disease.
At the present time, we are paying great attention to the study of the microbiota of the esophagus. As part of the first study that we conducted in the Russian Federation, the features of the microbial composition of the esophagus and stomach were established in patients with GERD in comparison with healthy people. For many, this will seem unexpected: it was assumed that there are no bacteria in the esophagus, while in fact they exist there.In patients with gastroesophageal reflux disease, the composition of the esophageal microbiota changes, and after therapy with proton pump inhibitors, it normalizes. We believe that this discovery paves the way for understanding the mechanism of mucosal inflammation, and this hypothesis will continue to be actively developed. I think that in the near future we will be able to offer new recommendations for the complex drug treatment of patients with GERD.
– What is the role of the doctor in adherence to the patient’s timing in the treatment of GERD?
– As I said, there are accepted standards and guidelines for the management of patients with gastroesophageal reflux disease.The “gold standard” is the appointment of proton pump inhibitors to the patient, that is, drugs that reduce the level of secretion of hydrochloric acid in the stomach to the optimal level. It has been shown that the use of this class of antisecretory drugs can effectively eliminate clinical symptoms, lead to the healing of esophageal erosions and prevent the development of complications.
Among the principles of prescribing proton pump inhibitors, the need to comply with the timing of the main and maintenance courses of treatment of gastroesophageal reflux disease is distinguished first of all.If patients have only heartburn but no erosive esophagitis on endoscopic examination, proton pump inhibitors should be given for four weeks. If erosive esophagitis is detected, then, depending on the number of erosions (they can be single or multiple), the terms increase to 8 weeks.
If there are complications of GERD, then treatment should be carried out for at least 8 weeks, and in a double dose. In this case, supportive therapy is necessarily indicated, because if it is not carried out to a patient with erosive esophagitis, then the risk of recurrence will be extremely high.Thus, the first principle of therapy is adherence to the timing of treatment. The second principle is the revision and individualization of therapy in accordance with the response to the initial course of treatment aimed at induction of remission. If the patient does not achieve remission, no positive dynamics is observed, heartburn does not stop or erosion does not heal, then the entire clinical picture should be analyzed and additional examination should be carried out, in particular, a 24-hour impedance-pH meter in order to make sure that the diagnosis was installed correctly.
Among the reasons for the ineffectiveness of the treatment of GERD in the first place is the patient’s non-compliance with the doctor’s recommendations. Being overweight is a major risk factor, therefore, weight loss, adherence to dietary prescriptions and healthy lifestyle recommendations are the basis for improving the effectiveness of GERD treatment.
It is very important to increase patient adherence to prescribed therapy. Taking medications should be carried out in accordance with the recommendations.If the patient ignores the doctor’s instructions for taking the medication, then the impression may be that the medication itself is ineffective. It is very important not to increase your proton pump inhibitor dose without good reason. In clinical practice, we observe that this often does not lead to an improvement in results, but, on the contrary, leads to a decrease in the effectiveness of therapy, therefore it is important to refer to the recommendations of the Russian Gastroenterological Association, where all the algorithms are prescribed.
If we talk about how to “force” the patient to follow the doctor’s recommendations, it should be mentioned that, first, you should prescribe a drug that quickly and effectively relieves symptoms.For example, among patients who took esomeprazole, the proportion of those who reported satisfaction with the drug was very high. And the most common reason for such a positive assessment was the decrease or absence of symptoms. When a doctor chooses a specific drug from the entire class of proton pump inhibitors, one should first of all pay attention to the effectiveness of the drug in relieving symptoms and healing esophageal erosions. Esomeprazole has been shown to maintain symptomatic remission in more than 90% of patients.It is very important for the doctor that not only the symptoms are stopped, but also the erosions in the esophagus heal, because this is one of the manifestations of GERD. Proton pump inhibitors are the drugs of choice for the treatment of erosive esophagitis, as they lead to the healing of erosions. Against the background of a daily intake of 40 mg of esomeprazole, the healing of mucosal defects after four weeks was 82%, and after 8 weeks – 94%. This is a pretty high level.
There are a number of other circumstances that should be taken into account: patients metabolize proton pump inhibitors differently – in some they are absorbed quickly, in some more slowly, this may have a different effect from the drug.We cannot study the genotype of patients at the outpatient stage, but if the doctor has the impression that proton pump inhibitors are not effective, then before canceling them, an additional examination should be carried out – a 24-hour pH meter.
Some time ago, a very important study was carried out that determined the strategy of treating patients with GERD for many years to come. This is an international LOTUS study, in which dozens of European centers compared the results of surgical treatment of gastroesophageal reflux disease by fundoplication and long-term use of the original drug esomeprazole.These groups were very strictly randomized, and it turned out that over five years the results of treatment of patients receiving the original drug were not only no worse, but even better in a number of indicators than those of patients who underwent fundoplication. This demonstrated the advantage of taking the original drug esomeprazole in maintaining long-term remission of this disease.
In conclusion, I would like to emphasize once again the high urgency of further study of the problem of gastroesophageal reflux disease.Progress in the treatment of patients with GERD depends primarily on the ability to make the correct diagnosis, including using modern techniques, as well as the prescription of highly effective drugs.
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Heartburn is the main symptom of reflux esophagitis or gastroesophageal reflux disease (GERD) – a chronic disease that affects the lower esophagus due to the ingestion of stomach contents.
Symptoms of gastroesophageal reflux disease
The characteristic symptoms of gastroesophageal reflux disease are heartburn, pain in the sternum, sour belching, regurgitation, nausea, painful and difficult passage of food, discomfort after eating, flatulence . Errors in diet (consumption of fatty, carbonated drinks, alcohol), smoking, physical activity, wearing clothes with a tight belt can provoke an increase in symptoms.
Gastroesophageal reflux disease (GERD, reflux esophagitis) is one of the most common diseases of the esophagus, episodically its symptoms, primarily heartburn, occur in half of the country’s adult population, men and women get sick equally often, usually between the ages of 20 up to 45 years old.
GERD is an insidious disease, without proper treatment it can lead to serious complications, including esophageal cancer. The danger is aggravated by the fact that, despite the mass of unpleasant symptoms that spoil their lives, many people are in no hurry to go to the doctor, preferring to muffle the symptoms with heartburn pills.
Causes and course of GERD
Factors contributing to the development of GERD are considered hiatal hernia (hernia of the esophagus), stress, obesity, pregnancy, smoking, taking certain medications (calcium antagonists, anticholinergic drugs, beta-blockers, etc.).
The immediate cause of gastroesophageal reflux disease is prolonged contact of gastric contents with the lining of the esophagus. Impaired motility leads to the fact that the acidic gastric environment not only enters the esophagus, but also stays there for a long time.
Incorrect work (weakness) of the lower esophageal sphincter, which should prevent the reverse movement of the masses, causes the gastric contents to enter the esophagus, and insufficient esophageal peristalsis and a decrease in esophageal clearance cause slow gastric emptying and the removal of this aggressive environment.This imbalance of protective functions leads to the development of reflux esophagitis.
Prolonged exposure to acid and bile on the mucous membrane of the esophagus leads to its chronic inflammation and erosive and ulcerative changes, foci of altered mucous membrane of the lower esophagus often serve as a source of cancer growth.
At the initial stages of the disease, separate areas of erosion of the distal esophagus are noted, at the second stage, individual foci of inflammation merge into a common area, then at the third stage, the inflammatory process covers the entire surface of the mucous membrane, ulcers appear.The fourth stage is a chronic ulcer of the esophagus, stenosis, cylindrical metaplasia of the esophageal mucosa (Barrett’s esophagus).
Patients with reflux disease are at increased risk of acquiring various diseases of the paranasal sinuses, diseases of the trachea, larynx and lungs (coronary heart disease with angina pectoris and / or heart rhythm disturbances, reflux laryngitis and pharyngitis, recurrent pneumonia, bronchial asthma, dental erosion and dr ).
These are the results that “ordinary heartburn” can lead to!
If you experience these symptoms, we advise you to make an appointment with your doctor.Timely consultation will prevent negative consequences for your health. Phone for appointment +7 (495) 292-39-72
Diagnosis of gastroesophageal reflux disease (GERD)
Various methods are used to diagnose GERD. The main method is endoscopic – it allows you to confirm the presence of reflux esophagitis, to assess its severity. Histological analysis of biopsies of the esophageal mucosa provides additional information on the degree of dystrophic changes in the epithelial layer.
Contrast radiography of the esophagus allows you to identify reflux as such, that is, to fix the ingress of contrast from the stomach into the esophagus. X-ray examination of the esophagus can also indicate the presence of a hiatal hernia, esophageal stricture, diffuse esophagospasm of the diaphragm.
Manometry of the esophagus (esophagomanometry) – allows you to assess the contractile activity of the esophagus, to study the indicators of movement of its wall and the activity of the esophageal sphincters.
Treatment of gastroesophageal reflux disease (GERD)
After carrying out a comprehensive diagnosis, the gastroenterologist comprehensively assesses the patient’s health, analyzes the severity and nature of the disease and selects an individual treatment regimen.
The goal of treating gastroesophageal reflux disease is to relieve its symptoms, treat esophagitis, prevent or eliminate complications of the disease, and improve the patient’s quality of life. Treatment for GERD can be conservative or surgical.
Conservative treatment of gastroesophageal reflux disease (GERD)
Conservative treatment is indicated for mild to moderate reflux disease.
Correctly selected antireflux therapy can reduce reflux, reduce the damaging properties of refluctate (gastric contents), improve esophageal clearance and protect the esophageal mucosa.
Effective antireflux treatment is based on lifestyle changes, in particular, it is necessary to normalize body weight, seriously adjust the diet, volume and time of food intake (avoid eating fatty, sour, gas-enhancing foods, as well as chocolate, coffee, carbonated drinks). It is very important to exclude smoking and alcohol consumption, you should refrain from taking drugs that inhibit the function of the lower esophageal sphincter. Patients should avoid overeating, as well as stress on the abdominal muscles.
Antireflux drug therapy includes regular intake of antacids and alginic acid derivatives, prokinetics and antisecretory drugs that reduce gastric acidity, protect the esophageal mucosa, activate peristalsis, increase the activity of the esophageal sphincters and improve the overall motility of the esophagus and stomach.
With the complex drug therapy of moderate reflux esophagitis in most patients, there is a significant decrease in symptoms and an improvement in the quality of life.
The basic course of treatment should be at least one month, and then within 6-12 months the patient should receive supportive treatment. Without supportive treatment, the likelihood of recurrence of erosive esophagitis is high – it reaches 90% within a year.
It should be borne in mind that many antacids contain a large amount of aluminum, and, accordingly, their long, haphazard intake leads to its accumulation in the body, which increases the risk of developing Alzheimer’s disease in old age.
Surgical treatment of gastroesophageal reflux disease (GERD)
The question of surgical treatment of GERD arises when conservative therapy does not give the expected effect, despite repeated courses of drug therapy and adherence to all recommendations for normalizing the lifestyle. Conservative treatment can reduce the severity of symptoms and prevent complications from developing, but does not eliminate the cause of the disease.
If, despite the active drug treatment of GERD, heartburn, pain and other symptoms of reflux disease continue to torment you for more than a year, then it’s time to think about consulting an experienced surgeon.
The indication for surgical treatment of reflux esophagitis is also a complicated course of the disease: bleeding, ulcerative lesions, peptic strictures of the esophagus, development of Barrett’s esophagus with high-grade epithelial dysplasia. Especially often, indications for surgery arise when GERD is combined with a hiatal hernia.
Experienced surgeons work in “CM-Clinic” who successfully carry out surgical treatment of gastroesophageal reflux disease.
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Treatment of GERD in Tomsk: addresses, prices, reviews. Sign up for reflux esophagitis treatment
Larisa Fedorovna is a doctor from God! My family has been monitored and treated by her for many years. It helps even when narrow specialists cannot fully help. Always friendly, responsive and persistent in finding the cause of the ailment. He does not prescribe unnecessary things, but only what is really necessary.I can see how she worries about the patients. If something is really serious, he periodically calls and clarifies how the treatment is going – this is very reassuring. Thank you very much, Doctor, for our health !!!
Olga Zemlyakova, 08/05/2020
I can’t help but write a couple of kind words about Larisa Fedorovna. I visited her as a hematologist. A competent specialist, very attentive, competent, and, what is important, a very positive person! I left her reception with the feeling that all my problems were left behind, and those that still exist will certainly pass! After all, there are such wonderful people nearby!
Happy holiday, Larisa Fedorovna! Always be so optimistic, witty cute! Thank you patients and satisfaction from such a hard work!)
I would like to express my deep gratitude to Doctor-Hematologist Larisa Fedorovna Desyatova for her attentive and sensitive attitude towards people, her professionalism and kindness.
I visited her several times. After her words, you feel hope and confidence in the future, you feel the joy of life.
Health to you and good luck in everything Larisa Fedorovna !!! I want to say with great confidence Man is in his place.
I was very lucky that I got an appointment with Larisa Fedorovna, she was able to sort out my difficult situation, professionally and carefully.I prescribed the necessary treatment, it became much easier for me.
Elena Sergeevna, 03/10/2020
I would like to wish a Happy New Year to our family rescuer, our Doctor Desyatova Larisa Fedorovna. All the best to you, patience, optimism, health to you and your loved ones.
Thank you for your selfless work, for your kind attitude towards people, for your high professionalism! I wish you happiness and success!
Olga Ivanovna, 28.12.2019
I am very pleased with the reception at Larisa Fyodorovna’s. A thinking, understanding doctor, a professional in his field.And at the same time, she is very sensitive and with a sincere desire to help.
Thanks for your advice and help!
Olga Fedorovna, 03.12.2019
Wonderful doctor. Very attentive and competent. Analyzes all analyzes and previous examinations. It helped me a lot. Thank you so much.
Elena Vladimirovna, 15.08.2019
I went to write a review, and completely agree with the previous one. Desyatova Larisa Fedorovna is a super doctor !! Understanding, competent, answered all my questions, was amazed at the depth of the doctor’s knowledge in related specialties.Most importantly, I left Larisa Fyodorovna with the confidence that together we will overcome my illness. And so it will be!
Angelina Evgenievna, 07/09/2019
Am I satisfied? Yes, absolutely! Recommend to others? Yes of course! I came out after receiving the wonderful doctor Larisa Feodorovna Desyatova, and it was as if the wings had grown behind my back! The doctor greeted me with a benevolent smile, listened to everything calmly and attentively, looked at all the previously submitted tests and conducted an examination very carefully. A real doctor! She explained everything in detail, including the meaning of the prescribed treatment.This is how doctors should be!
Svetlana Ivanovna, 02.07.2019
I would like to leave a review about a wonderful person with a big soul and a highly qualified specialist – Desyatova Larisa Fedorovna.
Wonderful, highly qualified and competent doctor! Great practical experience, professionalism! Larisa Fedorovna explained everything, reassured, encouraged, which is very important for the patient, put everything on the shelves, observing courtesy and respect. Many thanks! Thank you very much, God grant you and your loved ones good health and happiness !!!
Larisa Fedorovna, a doctor who once saved my life (a little three-year-old girl with non-Hodginsky lymphoma). For which I will be grateful to her all my life. A specialist in his field.
Food for reflux gastritis – Vesti-Kuzbass
Nutrition for reflux gastritis forms the basis of effective treatment. Spicy, fatty, smoked are removed from the menu. The diet should be balanced, the food should be steamed, boiled or baked.
Correctly selected food for reflux gastritis relieves nausea, belching and heartburn after meals.Strict adherence to the diet prescribed by the attending physician is the key to recovery, but does not cancel the intake of medications. When drawing up the menu, you also need to take into account the individual intolerance of products and the stage of development of the disease.
Diet: how to eat with reflux gastritis?
Overeating and starvation negatively affect the state of the gastrointestinal tract, therefore the patient’s diet should be rich in micro-, macronutrients, vitamins and contain a sufficient amount of calories.
The optimal diet for esophagitis and gastritis will be helped by a nutritionist, or you can find it on the website https://etozheludok.ru/, however, if this is not possible, you must follow the following recommendations of doctors:
- Shown fractional meals 4-5 times a day in small portions. Calorie count is calculated based on physical parameters.
- You can’t eat at night.
- If the patient is diagnosed with obesity, then the amount of calories received should be less than expended.For this, it is recommended to have a special notebook.
- The diet is composed of liquid or chopped meals to reduce the stress on the gastrointestinal tract.
- Food is cooked, stewed or steamed. Fried and smoked foods are excluded.
- If even a weak feeling of hunger appears, you should immediately have a snack so as not to provoke the production of gastric juice.
- The optimum temperature is warm. Hot and cold food and drinks are bad for the stomach.
- It is recommended to drink 1 glass of water before meals to reduce the concentration of hydrochloric acid in the stomach. You can also drink potato juice.
- After a meal, it is better to walk, but never lie down.
- In the stage of exacerbation, it is worth wearing clothing that does not restrict movement. It is better to remove the belt.
The approximate amount of required elements is presented in the table: Nutrients Norm, g / day. Protein 80-90 Carbohydrates 310-350 Fats 70-80
What can you eat?
According to the recommendations of doctors, the diet for gastric reflux gastritis is based on dishes that act like alkali:
- any fully cooked cereals;
- soups: dairy, vegetable-based, with the addition of cereals;
- meat, fish soufflés;
- beef, chicken, turkey;
- pike perch, hake, carp;
- baked and boiled potatoes;
- white bread, crackers;
- egg soufflé and puffed omelet;
- low-fat cottage cheese, milk, kefir, yogurt;
- vegetables chopped in a blender;
- apples, pears;
- beets, carrots.
During cooking, you do not need to add spices, salt – in a minimum amount. You can drink jelly, weak black tea with milk, a decoction of wild rose and berries, compote. The most useful mineral water, which lowers the acidity of the stomach. Herbal tinctures based on chamomile, dandelion, plantain, motherwort have a good effect on the digestive tract. They are best taken at bedtime as they are relaxing.
What not to eat?
Diet with reflux esophagitis, especially during an exacerbation, completely excludes the use of such dishes:
- fatty broths based on meat and fish;
- fresh bakery products;
- fatty, commercial sauces;
- sour fruits: citrus fruits, kiwi, pineapple;
- salty, smoked, pickled, spicy dishes;
- vegetables that provoke gases: cabbage, radish, radish, onion, artichoke;
- fermented milk products;
- honey, jam;
- fast food;
- sparkling water;
- Caffeinated drinks.