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Reflux doctor: Acid Reflux Symptoms, Remedies, Causes, Diet, Treatment & Foods to Avoid

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When to See a GI Doctor for Gastroesophageal Reflux Disease

Almost everyone has experienced acid reflux, which is commonly known as heartburn. Acid reflux occurs when stomach acid backs up into your esophagus, resulting in symptoms like chest pain, a burning sensation in your throat and a sour taste in your mouth.

GERD vs. Heartburn

An occasional episode of heartburn is normal, but if you’re experiencing heartburn several times a week, you’ll need to see a doctor. Chronic acid reflux is known as gastroesophageal reflux disease or GERD. In GERD patients, the lower esophageal sphincter – the ring of muscle that closes off the stomach from the esophagus – does not work properly. This allows digestive acid to enter the esophagus and can cause damage over time. Heartburn is the most common symptom of GERD, but other symptoms may include coughing, wheezing, chest pain, hoarseness, difficulty swallowing and frequent throat clearing and regurgitation.  

Over-the-Counter Medications and GERD

Approximately 7 million Americans have GERD, but most people who have it have not been diagnosed. They attribute their discomfort to something they ate or drank and self-medicate with over-the-counter antacids, H-2 blockers or proton-pump inhibitors (PPI). While these medications can help provide immediate relief, they’re only intended for occasional use. PPIs, for example, should not be taken regularly for more than two weeks because of their long-term side effects. Studies have linked PPIs to bone fracture, renal failure, heart attack, dementia, Clostridium difficile (or C. diff) infections and vitamin deficiency.

How Gastroenterologists Help with GERD

The key to treating your GERD: a board-certified gastroenterologist

If you are suffering from chronic acid reflux, a specialist can help. GERD is a potentially serious condition, and it will not go away on its own. Untreated GERD can lead to inflammation of the esophagus and cause complications like ulcers, strictures and increased risk of Barrett’s esophagus, which is a precursor to esophageal cancer.

A gastroenterologist is a physician with specialized training in managing diseases of the gastrointestinal tract (esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver). Our gastroenterologists are fellowship-trained and qualified to diagnose GERD and help develop a meet your treatment plan.

When to See a Gastroenterologist

Sometimes it’s difficult to know when your symptoms are severe enough that you need to make an appointment with a gastroenterologist, and we understand that. Here are some indications that it’s time to call a gastroenterologist:

  • Symptoms that continue for more than two weeks
  • Heartburn that persists after taking over-the-counter medications
  • Heartburn episodes that change in frequency or intensity
  • Nighttime symptoms that affect your sleep quality
  • Acid reflux that interferes with your daily activities or affects your quality of life
  • Unexplained weight loss or decreased appetite
  • Pain or difficulty swallowing
  • Heartburn accompanied by nausea or vomiting
  • Unexplained weight loss
  • Chronic hoarseness or wheezing

If you experience any of the symptoms above, it’s time to see one of our gastroenterologists. After performing a complete medical exam, your gastroenterologist may recommend that you undergo an upper endoscopy to evaluate your symptoms and see if you have suffered any damage to your esophagus, or provide you with the peace of mind that everything is all right. During your visit, the doctor will examine the lining of your esophagus, stomach and duodenum (the first part of your small intestine) to determine the cause of your digestive symptoms and the appropriate treatment.

Gastroesophageal Reflux Disease – Wake Gastroenterology

Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach

 

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion.

Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

Anyone, including infants, children, and pregnant women, can have GERD.

What are the symptoms of GERD?

The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, sore throat, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

What causes GERD?

No one knows why people get GERD. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can predispose to reflux.

Other factors that may contribute to GERD include:

  • alcohol use
  • excess weight
  • pregnancy
  • smoking

Also, certain foods can be associated with reflux events, including:

  • citrus fruits
  • chocolate
  • drinks with caffeine
  • fatty and fried foods
  • garlic and onions
  • mint flavorings
  • spicy foods
  • tomato-based foods, like spaghetti sauce, chili, and pizza

Modifying your diet to reduce or eliminate these items can greatly reduce GERD symptoms.

How is GERD treated?

If you have had heartburn or any of the other symptoms for a while, you should see your doctor. You may want to visit an internist (a doctor who specializes in internal medicine) or a gastroenterologist (a doctor who treats diseases of the stomach and intestines). Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes and medications or surgery.

Lifestyle Changes

  • If you smoke, stop.
  • Do not drink alcohol.
  • Lose weight if needed.
  • Eat small meals.
  • Change your diet to eliminate those foods and beverages which aggravate GERD.
  • Wear loose-fitting clothes.
  • Avoid lying down for 3 hours after a meal.
  • Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts Ð just using extra pillows will not help.

Medications

Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production, or others which help the muscles that empty your stomach.

Antacids, such as Maalox, Mylanta, Pepto-Bismol, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts magnesium, calcium, and aluminum – with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, have side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.  They can also minimize excess belching.

h3 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter h3 blockers should not be used for more than a few weeks at a time without physician supervision. They are effective for about half of those who have GERD symptoms.  We strongly recommend that you consult with a physician before using these on a long-term basis.

  • Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are all available by prescription and many are generic. Prilosec OTC and Prevacid is now available over-the-counter. Proton pump inhibitors are more effective than h3 blockers and can relieve symptoms in almost everyone who has GERD.  Both these medications are taken 30-60 minutes before eating.  Again, since persistent heartburn symptoms can indicate a number of more serious conditions, we strongly recommend discussing this medication with your physician before choosing to take it for an extended period of time.

Another group of drugs, prokinetics, helps strengthen the sphincter and makes the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.

Because drugs work in different ways, combinations of drugs may help control symptoms.  Your doctor is the best source of information on how to use medications for GERD.

What if symptoms persist?

If your heartburn does not improve with lifestyle changes or drugs, you may need additional tests.

  • barium swallow radiograph uses x-rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus. With this test, you drink a solution and then x-rays are taken. Mild irritation will not appear on this test, although narrowing of the esophagus called stricture – ulcers, hiatal hernia, and other problems will.  This test is rarely used these days.
  • Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor’s office. The doctor will spray your throat to numb it and slide down a thin, flexible plastic tube called an endoscope. A tiny camera in the endoscope allows the doctor to see the surface of the esophagus and to search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.
    The doctor may use tiny tweezers (forceps) in the endoscope to remove a small piece of tissue for biopsy. A biopsy viewed under a microscope can reveal damage caused by acid reflux and rule out other problems if no infecting organisms or abnormal growths are found.
  • In an ambulatory pH monitoring examination, the doctor puts a tiny tube into the esophagus that will stay there for 24 hours. While you go about your normal activities, it measures when and how much acid comes up into your esophagus. This test is useful in people with GERD symptoms but no esophageal damage. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.  A wireless version of this test is also available to detect acid reflux over a 48 hour period (Bravo testing).

SurgeryGastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach

 

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn.The fluid may even be tasted in the back of the mouth, and this is called acid indigestion.

Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

Anyone, including infants, children, and pregnant women, can have GERD.

What are the symptoms of GERD?

The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, sore throat, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

What causes GERD?

No one knows why people get GERD. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can predispose to reflux.

Other factors that may contribute to GERD include:

  • alcohol use
  • excess weight
  • pregnancy
  • smoking

Also, certain foods can be associated with reflux events, including:

  • citrus fruits
  • chocolate
  • drinks with caffeine
  • fatty and fried foods
  • garlic and onions
  • mint flavorings
  • spicy foods
  • tomato-based foods, like spaghetti sauce, chili, and pizza

Modifying your diet to reduce or eliminate these items can greatly reduce GERD symptoms.

How is GERD treated?

If you have had heartburn or any of the other symptoms for a while, you should see your doctor. You may want to visit an internist (a doctor who specializes in internal medicine) or a gastroenterologist (a doctor who treats diseases of the stomach and intestines). Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes and medications or surgery.

Lifestyle Changes

  • If you smoke, stop.
  • Do not drink alcohol.
  • Lose weight if needed.
  • Eat small meals.
  • Change your diet to eliminate those foods and beverages which aggravate GERD.
  • Wear loose-fitting clothes.
  • Avoid lying down for 3 hours after a meal.
  • Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts Ð just using extra pillows will not help.

Medications

Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production, or others which help the muscles that empty your stomach.

Antacids, such as Maalox, Mylanta, Pepto-Bismol, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts magnesium, calcium, and aluminum – with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, have side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.  They can also minimize excess belching.

h3 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter h3 blockers should not be used for more than a few weeks at a time without physician supervision. They are effective for about half of those who have GERD symptoms.  We strongly recommend that you consult with a physician before using these on a long-term basis.

  • Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are all available by prescription and many are generic. Prilosec OTC and Prevacid is now available over-the-counter. Proton pump inhibitors are more effective than h3 blockers and can relieve symptoms in almost everyone who has GERD.  Both these medications are taken 30-60 minutes before eating.  Again, since persistent heartburn symptoms can indicate a number of more serious conditions, we strongly recommend discussing this medication with your physician before choosing to take it for an extended period of time.

Another group of drugs, prokinetics, helps strengthen the sphincter and makes the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.

Because drugs work in different ways, combinations of drugs may help control symptoms.  Your doctor is the best source of information on how to use medications for GERD.

What if symptoms persist?

If your heartburn does not improve with lifestyle changes or drugs, you may need additional tests.

  • barium swallow radiograph uses x-rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus. With this test, you drink a solution and then x-rays are taken. Mild irritation will not appear on this test, although narrowing of the esophagus called stricture – ulcers, hiatal hernia, and other problems will.  This test is rarely used these days.
  • Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor’s office. The doctor will spray your throat to numb it and slide down a thin, flexible plastic tube called an endoscope. A tiny camera in the endoscope allows the doctor to see the surface of the esophagus and to search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.
    The doctor may use tiny tweezers (forceps) in the endoscope to remove a small piece of tissue for biopsy. A biopsy viewed under a microscope can reveal damage caused by acid reflux and rule out other problems if no infecting organisms or abnormal growths are found.
  • In an ambulatory pH monitoring examination, the doctor puts a tiny tube into the esophagus that will stay there for 24 hours. While you go about your normal activities, it measures when and how much acid comes up into your esophagus. This test is useful in people with GERD symptoms but no esophageal damage. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.  A wireless version of this test is also available to detect acid reflux over a 48 hour period (Bravo testing).

Surgery

Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Fundoplication, usually a specific variation called Nissen fundoplication, is the standard surgical treatment for GERD. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.

This fundoplication procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. To perform the fundoplication, surgeons use small instruments that hold a tiny camera. Laparoscopic fundoplication has been used safely and effectively in people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.

Endoscopic devices, The U.S. Food and Drug Administration (FDA) has approved several endoscopic devices to treat chronic heartburn. The Bard EndoCinch system puts stitches in the LES to create little pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.  Endoscopic devices are rarely used in the management of GERD.

What are the long-term complications of GERD?

Sometimes GERD can cause serious complications. Inflammation of the esophagus from stomach acid causes bleeding or ulcers. In addition, scars from tissue damage can narrow the esophagus and make swallowing difficult. Some people develop Barrett’s esophagus, where cells in the esophageal lining take on an abnormal shape and color, and which over time can lead to cancer.

Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD.

Points to Remember

  • Heartburn / acid indigestion, is the most common symptom of GERD. Anyone experiencing heartburn twice a week or more may have GERD.
  • You can have GERD without having heartburn. Your symptoms could be excessive clearing of the throat, problems swallowing, the feeling that food is stuck in your throat, burning in the mouth, or pain in the chest.
  • If you have been using antacids for more than 2 weeks, it is time to see a doctor. Most doctors can treat GERD. Or you may want to visit an internist–a doctor who specializes in internal medicine–or a gastroenterologist–a doctor who treats diseases of the stomach and intestines.
  • Doctors usually recommend lifestyle and dietary changes to relieve heartburn. Many people with GERD also need medication. Surgery may be an option.

Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Fundoplication, usually a specific variation called Nissen fundoplication, is the standard surgical treatment for GERD. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.

This fundoplication procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. To perform the fundoplication, surgeons use small instruments that hold a tiny camera. Laparoscopic fundoplication has been used safely and effectively in people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.

Endoscopic devices, The U.S. Food and Drug Administration (FDA) has approved several endoscopic devices to treat chronic heartburn. The Bard EndoCinch system puts stitches in the LES to create little pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.  Endoscopic devices are rarely used in the management of GERD.

For More Information

To learn more about this topic, visit:

American College of Gastroenterology (ACG)
American Gastroenterological Association (AGA)

How Doctors Diagnose Acid Reflux and GERD

Most people experience acid reflux, or heartburn, from time to time. But if you experience heartburn over the course of a few weeks, it could be a more serious type of acid reflux called GERD (gastroesophageal reflux disease). Left untreated, GERD can cause problems with the esophagus and breathing. If you’re concerned you may have acid reflux or GERD, talk with your doctor for an accurate diagnosis.  

To diagnose acid reflux, your doctor will review your medical history and ask about your symptoms. Your doctor may suggest making some changes to your diet, lifestyle or medicines. If these treatments don’t help, you may need testing for GERD.

If your doctor suspects you may have GERD, he or she may recommend one or more tests to help diagnose it. In some cases, your doctor may use these tests to see whether GERD has caused any other health conditions, such as problems with your esophagus. 

Your doctor can use the results of these tests to find out whether you have GERD and decide the best type of treatment: 

Upper gastrointestinal (GI) endoscopy.  This test looks inside your digestive tract. Your doctor may recommend it if you have moderate to severe acid reflux. You can expect:

  • Before the test, you may get a sedative to help you relax and keep you comfortable during the test. You will also get an anesthetic to numb the back of your throat.

  • Your doctor places a small tube, called an endoscope, down your throat. A small camera at the end of the tube lets your doctor look for any problems caused by GERD.

  • Your doctor may also take a small piece of tissue from the lining of your esophagus, called a biopsy. This checks to see whether GERD has caused any problems in your esophagus.

Upper GI series.  This test consists of a series of X-rays of your upper digestive tract. During the X-rays, you will drink a chalky liquid called barium. The barium coats the lining of your digestive tract so your doctor can see problems related to GERD, such as a narrowing in your esophagus, ulcers, or hiatal hernias. 

Esophageal pH and impedance monitoring. This test measures how much acid is in your esophagus as you go through a normal day. For this test:

  • Your doctor places a tube through your mouth and into your esophagus. The upper part of the tube gets taped to your cheek and is left there for 24 hours.

  • A sensor at the bottom of the tube monitors how much acid comes into your esophagus. A monitor records the readings from the sensor.

  • Your doctor may also ask you to keep a diary of the types of foods you eat and your GERD symptoms to see how different foods and the time of day affect the acid.

  • Your doctor removes the tube after 24 hours.

Wireless esophageal pH monitoring. This test is another way to measure how much acid is in your esophagus:

  • During an upper GI endoscopy, your doctor places a small capsule on the wall of your esophagus. The capsule is about the size of a pencil eraser. It has a pH sensor, battery, and a transmitter. The capsule records the pH levels in your esophagus and sends the information to a small receiver you wear on a belt.

  • When you have symptoms of GERD, you press a small button on the receiver.

  • Your doctor may also ask you to record some of your daily activities, such as when you eat and drink, lie down, and get up.

  • Most people wear the monitor for about 48 hours. The capsule will detach on its own and pass through your digestive system.

Esophageal manometry. This test measures muscle movement in your esophagus. It can be done right in your doctor’s office: 

  • Your doctor sprays an anesthetic on the back of your throat to numb the area.

  • A thin tube passes through your nose and into your esophagus.

  • A computer will measure how strong the muscle contractions are in different areas of your esophagus.

This test can tell whether your GERD is due to a weak muscle connecting your esophagus to your stomach or whether you have other esophagus problems. 
If you have GERD, your doctor will likely recommend diet and lifestyle changes as the first step towards managing the condition. You may also benefit from medicines that control the amount of acid in your stomach or the movement of your upper GI tract, respectively.

When You Visit Your Doctor – Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD)

Questions to Discuss with Your Doctor:
  • Do you get a burning sensation in your chest or throat after eating?
  • Do you ever have a bitter or sour taste in your mouth?
  • Do you ever have bloating or nausea after you eat?
  • How often do you get these symptoms?
  • What do you do to relieve the symptoms?
  • Are the symptoms related to physical exertion?
  • Are the symptoms worse when you are lying down or sitting up?
  • Have you noticed any black stools?
  • Do you have a persistent cough?
  • Do you have a history of ulcer disease?
  • Are you taking any medications, especially ones that can irritate the esophagus or stomach, such as aspirin, ibuprofen, naproxen or tetracycline?
  • Do you drink alcohol or smoke?
  • How soon after you eat at night do you go to bed?
  • Have you tried any over-the-counter medications? If so, do they help?
Your Doctor Might Examine the Following Body Structures or Functions:
  • Chest and lung exam
  • Abdominal exam
Your Doctor Might Order the Following Lab Tests or Studies:
  • Upper endoscopy (internal examination of the esophagus and stomach)
  • pH probe (to assess the acid level in the esophagus and stomach)
  • Manometry (to measure the pressure of the sphincter between the esophagus and the stomach)
  • Stool testing for blood
  • Complete blood cell count

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Diagnosis of GER & GERD

How do doctors diagnose GER & GERD?

In most cases, doctors diagnose gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by reviewing your symptoms and medical history. If your symptoms suggest you have GERD, your doctor may recommend treatment with medicines and lifestyle changes, instead of doing tests.

Your doctor may recommend medical tests if

  • your symptoms suggest you might have a complication of GERD
  • your symptoms suggest that you might have another health problem that causes symptoms similar to those of GERD
  • your symptoms don’t improve after treatment with medicines and lifestyle changes

Your doctor may refer you to a gastroenterologist to diagnose and treat GERD.

What tests do doctors use to diagnose GERD?

Your doctor may order one or more of the following tests to help diagnose GERD and check for GERD complications or other health problems.

Upper gastrointestinal (GI) endoscopy

Upper GI endoscopy is a procedure in which a doctor uses an endoscope—a flexible tube with a camera—to see the lining of your upper GI tract, including your esophagus, stomach, and duodenum. During upper GI endoscopy, a doctor may obtain biopsies by passing an instrument through the endoscope to take small pieces of tissue from the lining of your esophagus. A pathologist will examine the tissue under a microscope. Doctors may order an upper GI endoscopy to check for complications of GERD or problems other than GERD that may be causing your symptoms.

Your doctor may order an upper GI endoscopy to help diagnose GERD.

Esophageal pH monitoring

Esophageal pH monitoring is the most accurate way to detect stomach acid in the esophagus. Two types of esophageal pH monitoring are

  • catheter monitoring, in which a health care professional passes one end of a catheter—a thin, flexible tube—through your nose and into your esophagus to measure acid and nonacid reflux
  • capsule monitoring, in which a health care professional uses an endoscope to place a small, wireless capsule on the lining of your esophagus to measure acid reflux

During esophageal pH monitoring, you’ll wear a monitor that receives information from the catheter or capsule and tracks information about your diet, sleep, and symptoms. Your doctor will use this information to see how your diet, sleep, and symptoms relate to acid reflux in your esophagus. Doctors may order this test to confirm the diagnosis of GERD or to find out if GERD treatments are working.

Reflux/Acid Reflux (GERD) – familydoctor.org

Reflux treatment

If your symptoms are mild, treatment may not be necessary. Ask your doctor if he or she recommends taking medicine to relieve symptoms. Over-the-counter medicine is effective for treating mild cases of reflux. These medicines include:

  • Antacids: This is a quick-acting medicine that reduces stomach acid. Unfortunately, antacids alone won’t heal the damage stomach acid causes in your esophagus. Sometimes, overusing antacids can cause diarrhea or constipation.
  • H-2 receptor blockers: These medicines reduce acid production. They don’t work as quickly as antacids. However, they provide longer relief (up to 12 hours). Stronger versions of these medications are available by sphincter. The medicine may decrease the number of times your muscle relaxes. It often is used for severe reflux. Side effects include fatigue or confusion. Another medicine your doctor may prescribe helps your stomach empty faster. This will cause the food to move along the digestive tract and not back up into your throat. Your doctor may combine more than one medicine, depending upon the severity of your reflux.

    In some cases, surgery may be required to treat reflux. This is when medicine doesn’t help, or if you want a long-term solution. Types of surgery may include:

    • Nissen fundoplication: This surgery reinforces the lower muscle in the esophagus. A surgeon will wrap the very top of the stomach around the outside of the lower esophagus. This reduces reflux by putting pressure on your esophagus. This is a laparoscopic surgery. This means the surgeon makes three or four small cuts in the abdomen (stomach region). He or she will insert instruments, including a flexible tube with a tiny camera, through the cuts.
    • Linx surgery: This surgery strengthens the muscle in the esophagus. The Linx device is a ring of tiny beads made of titanium. The surgery wraps the ring around the area between the stomach and esophagus. The magnetic attraction of the beads is strong enough to keep the opening between the two closed. This helps keep acid from backing up into your throat. However, it’s weak enough to allow food to pass. The surgery is minimally invasive.

    When To See Your Doctor About Constant Heartburn Symptoms?

    Everyday Health: When should you see your doctor about your heartburn symptoms?

    Kenneth Brown, MD: You should see your doctor immediately if you have any trouble swallowing, chest pain, hoarseness, or any other atypical symptom. Anyone with reflux-like symptoms over a period of years is at risk for esophageal cancer and should also see a physician. Finally, if the symptoms persist after trying a two-week course of over-the-counter medications, you should make an appointment with your doctor.

    Andrew Sable, MD, and Seth Rosen, MD: Heartburn symptoms that occur occasionally – fewer than two times per week – and easily respond to over-the-counter acid reducers rarely suggest a serious condition. If symptoms are more frequent or more severe, if they consistently wake you up at night, or if you develop difficulty swallowing, then you should seek medical evaluation. These symptoms could represent complications from acid reflux and GERD such as Barrett’s esophagus or a stricture (narrowing) in the esophagus. Barrett’s esophagus can increase the risk of esophageal cancer.

    Lisa Ganjhu, DO: You should see your doctor when symptoms of heartburn are not controlled with modifications in lifestyle and over-the-counter medicines are needed two or more times a week; you should also contact your doctor if your symptoms remain unresolved on the medication you are taking. When GERD or heartburn is not treated, serious complications can occur, such as severe chest pain that can mimic a heart attack, esophageal stricture (a narrowing or obstruction of the esophagus), bleeding, a pre-malignant change in the lining of the esophagus called Barrett’s esophagus, or esophageal cancer. Some symptoms suggest that serious damage may have already occurred, like dysphagia, which is the medical term for difficulty swallowing or a feeling of food trapped behind the breastbone. There can be bleeding from an esophageal ulcer. This can present as vomiting blood or having tarry, black bowel movements. You can have a sensation of acid refluxed into the windpipe that causes shortness of breath, coughing, choking, or hoarseness of the voice. Weight loss can develop, which may be a result of eating less due to the symptoms or development of esophageal cancer.

    Elisa Faybush, MD: If you have any of the following heartburn symptoms or conditions, contact your doctor:

    • Your heartburn symptoms have become more frequent or severe.
    • You have difficulty swallowing or pain when swallowing.
    • You have nausea or vomiting.
    • You have had a drastic weight loss.
    • You have been using over-the-counter antacid medicines for more than two weeks and you still have heartburn symptoms.
    • Your discomfort interferes with your lifestyle or daily activities.
    • You are experiencing black or bloody bowel movements.

    Jo Ann Hattner, MPH, RD: If you are experiencing heartburn more than two times a week, it is appropriate for you to seek medical attention. Although occasional heartburn is common, persistent heartburn or acid reflux can damage the esophagus, the tube that allows the food you ingest to travel to the stomach. The esophagus is lined with a soft tissue and can be damaged by consistent acid exposure.

    Gastroesophageal reflux disease – Network of MC “Doctor Bogolyubov”

    Gastroesophageal reflux disease (GERD) – one of the most common diseases of the gastrointestinal tract, competing in frequency with peptic ulcer and cholelithiasis.

    This ailment often affects food lovers, overweight people, and those who abuse alcohol, smoking and coffee. The danger of this disease has been underestimated for a long time, people have sought help even with a severe form and the appearance of complications. Currently, due attention is paid to early diagnosis and prevention of this disease.

    What is GERD

    Gastroesophageal reflux disease is a chronic disease of the digestive system, which is characterized by the periodic release of acidic gastric contents into the esophagus, causing irritation of the lower esophagus with the development of chronic inflammation of its mucous membrane.

    The entry (throw) of stomach contents into the lower esophagus through an unclosed muscle sphincter is called gastroesophageal reflux (GER).Normally, this rarely happens, for example, after a heavy meal, and is not accompanied by discomfort. If such phenomena are repetitive and cause irritation of the esophagus, we can talk about GERD.

    Classification of GERD

    There are two types of gastroesophageal reflux disease:

    • Endoscopic-negative reflux disease (non-erosive reflux disease, or NERD) – a disease in which there are no visible changes in the mucous membrane of the esophagus, but there are symptoms of the disease;
    • Reflux esophagitis is a disease of the esophagus, which is manifested by inflammation of its mucous membrane, caused by the throwing of acidic stomach contents into the esophagus. Esophagitis can be both superficial and accompanied by damage to the mucous wall of various depths.


    Symptoms of GERD

    The main manifestation of gastroesophageal reflux disease is chronic heartburn or sour belching, which usually occurs after a meal, or at night, or when bending the trunk forward, or lifting weights.

    Symptoms of GERD include upper abdominal discomfort, fast satiety, and coughing, especially at night and for no apparent reason.May appear: white coating on the tongue, bad breath, gum disease. Due to the reflux, gastric contents sometimes enter the upper respiratory tract, usually during sleep. As a result, shortness of breath, dry throat may occur, diseases of the ENT organs become more frequent (pharyngitis, sinunsitis appear).

    A common symptom of GERD is also chest pain, sometimes radiating to the neck, shoulder, and jaw. Such pains can resemble heart disease, and even angina pectoris. Therefore, it is important to conduct a timely correct diagnosis of the disease.

    Reasons for the development of GERD

    The main reasons for the development of gastroesophageal reflux include:

    • Decrease in the tone of the muscle ring (sphincter) between the esophagus and the stomach,
    • increased intra-abdominal pressure;
    • decreased muscle tone of the esophagus;
    • violation of gastric motility;
    • Absence of a natural “barrier” on the esophageal mucosa capable of withstanding the destructive action of the acidic contents of the stomach containing aggressive gastric juice.
    • constitutional predisposition.

    The development of a disease associated with gastroesophageal reflux is facilitated by: an unhealthy lifestyle, unbalanced diet (excess of fatty foods), consumption of large amounts of acidic fruit juices, chocolate, coffee, alcohol consumption, obesity, smoking. Also, pregnancy can cause the onset of the disease with a predisposition.

    Diagnosis of reflux esophagitis

    The main diagnostic methods include: Laboratory research, endoscopic examination, daily monitoring of intraesophageal pH, X-ray examination, examination of the motor function of the esophagus.

    This pathology is treated in our medical center

    gastroenterologist nutritionist

    Korobova Irina Vladimirovna.

    Registration is carried out by phone +7 (495) -745-65-03 +7 (495) -745-65-06 +7 (495) -745-65-07

    Gastroesophageal reflux disease – treatment, prices and appointment for a consultation with a doctor of the Department of Gastroenterology “IAKI” CAO

    Gastroesophageal reflux disease (GERD) is a chronic recurrent disease caused by reflux (reverse movement) of gastric or duodenal contents into the esophagus against the background of impaired motor-evacuation function of the gastroesophageal zone organs. The high prevalence, difficult clinic significantly worsens the patient’s quality of life.

    INSTITUTE OF ALLERGOLOGY AND CLINICAL IMMUNOLOGY has:

    When concomitant diseases are identified, consultations are held with specialists in related fields (otorhinolaryngologists, endocrinologists, neurologists, gastroenterologists, dermatovenerologists), consultations with doctors of medical sciences.

    Attention! GERD refers to diseases with mixed symptoms, many patients perceive the initial manifestations of pathology as symptoms of other diseases.Do not self-medicate, consult a gastroenterologist!

    Classification

    The following types of GERD are distinguished:

    • Non-erosive reflux disease – diagnosed in about 70% of cases.
    • ulcerative and erosive form – the appearance of erosions and ulcers on the mucous membrane of the esophagus.

    Erosive and ulcerative form leads to the development of complications:

    1. Peptic ulcers with esophageal stricture
    2. Barrett’s esophagus – replacement of squamous epithelium cells with a cylindrical one with the development of metaplasia – a precancerous condition requiring dynamic observation
    3. Bleeding, Mallory-Weiss syndrome
    4. Adenocarcinoma of the esophagus.

    The development of late stages and complications is associated with the lack of competent diagnosis in the early stages of the disease, self-medication, and late visits to the doctor!

    Factors affecting the development of GERD

    The leading role in the development of GERD is played by a functional impairment of the sphincter apparatus, in particular the lower esophageal sphincter. Constant reflux (reflux) of hydrochloric acid, bile, food – leads to inflammatory changes in the mucous membrane of the esophagus, as well as to its structural restructuring.

    The following factors contribute to this:

    • professional activity – prolonged bent position, heavy lifting;
    • 90,025 frequent stressful situations;

    • nicotine and alcohol abuse;
    • overweight;
    • pregnancy;
    • 90 025 fast intake of large amounts of food without thorough chewing;

    • Excessive consumption of coffee, fatty foods, chocolate, juices;
    • treatment with medications that increase the concentration of dopamine.

    Clinical manifestations

    The clinical picture is very diverse, there are esophageal and extraesophageal symptoms of GERD.

    Main symptoms: heartburn, belching, bitterness in the mouth, nausea, swallowing disorder.

    Esophageal symptoms

    Extraesophageal symptoms

    Heartburn (burning sensation behind the breastbone)

    Bronchopulmonary (cough, frequent bronchitis, bronchial asthma, pulmonary fibrosis)

    Regurgitation (belching sour, bitter, food)

    Otolaryngological (sore throat, hoarseness, dry cough)

    Chest pain and painful passage of food through the esophagus

    Dental (tooth damage, periodontitis, gingivitis, halitosis, stomatitis)

    Dysphagia and difficulty swallowing (feeling of a lump in the throat when swallowing)

    Cardiological (non-coronary pain behind the breastbone)

    Diagnostics

    • The gold standard for detecting GERD is esophagogastroduodenoscopy. An examination of the mucous membrane of the esophagus, cardia, stomach is carried out, the function of the lower esophageal sphincter, intraluminal contents is assessed, if necessary, a biomaterial is taken to study the histological picture of the mucous membrane.
    • Laboratory methods – clinical blood test, biochemical blood test, antibodies to H. pylori.
    • Daily and 3-hour pH-metry, electromyography of the esophagus.
    • X-ray examination of the upper digestive tract, helps to establish the presence of esophagospasm, strictures, diaphragmatic hernia.

    Treatment methods

    1. Non-pharmacological measures include:

    • normalization of body weight, adherence to the diet (in small portions every 3-4 hours, food intake no later than 3 hours before bedtime)
    • Refusal of fatty, fried, spicy foods, coffee, chocolate, citrus fruits, spices and tomatoes
    • Avoiding tight clothing that pinches the torso
    • sleeping on a bed with the headboard raised by 15 cm
    • smoking cessation and alcohol abuse
    • Lifting and Tilting
    • drugs that negatively affect esophageal motility (nitrates, calcium channel blockers, progesterone, b-blockers), as well as non-steroidal anti-inflammatory drugs acting on the esophageal mucosa are contraindicated.

    2. Drug treatment.

    The therapy is long-term, takes 5-8 weeks, is carried out with the use of the following groups of drugs:

    • H2-histamine blockers (famotidine, etc.)
    • proton pump inhibitors (rabeprazole, esomeprazole, omeprazole)
    • antacids (gaviscon, phospholugel, maalox)
    • prokinetics (motilium, ganaton, itomed)

    3. In case of ineffectiveness of conservative therapy, development of complications, large diaphragmatic hernias, surgical treatment is performed – gastrocardiopexy and laparoscopic Nissen fundoplication.

    Preventive measures

    Compliance with the recommendations of non-drug therapy, a healthy lifestyle, regular monitoring of the condition by a gastroenterologist.

    Diet for gastroesophageal reflux disease (GERD)

    This diet is advisory in nature, the selection of the diet should be made individually!

    Foods that are recommended to be excluded from the diet:

    1. Any carbonated drinks, including beer and kvass, alcoholic beverages, marinades with the addition of apple cider and table vinegar.
    2. Canned food.
    3. Products based on cocoa butter or cocoa beans (chocolate).
    4. Condiments, raw onions and garlic.
    5. Strong tea and coffee.
    6. Citrus fruits.
    7. Fermented milk products of high acidity.
    8. Fatty, salty, spicy dishes.
    9. Fatty fish and meat.

    Foods that can be included in the diet:

    • Lean meat or fish dishes.
    • Low-fat dairy products.
    • Oil (in small quantities).
    • Yesterday’s or dried bread.
    • Low fat biscuits.
    • Cooked vegetables.
    • Porridge (puree, slimy).
    • Milk, cream and non-acidic kefir, milk jelly and milk cream are allowed.
    • Medium fat cottage cheese in the form of soufflé, pudding.
    • Refined vegetable oils (sunflower, etc.)etc.).
    • Steamed omelets.
    • Fruit mousses and desserts.
    • Drinks: weak tea (including milk), pure water, rosehip broth, mineral water, juices, dried fruit compotes.

    Reflux and pharyngitis

    Many works have been devoted to the diagnosis, clinical course and treatment of chronic pharyngitis. Most of them describe new methods of examination and treatment.However, the number of patients with chronic pharyngitis at the ENT doctors’ appointments is not decreasing.

    Chronic pharyngitis is a common polyetiological disease characterized by inflammatory-dystrophic changes in the mucous membrane of the posterior pharyngeal wall [4].

    Depending on the pathomorphological changes, catarrhal, hypertrophic, subatrophic and atrophic pharyngitis are distinguished. A mixed form of chronic pharyngitis is quite common.

    Patients with chronic pharyngitis complain of a soreness of perspiration, tickling “in the throat”, increased salivation, which causes the need for frequent coughing and expectoration of the accumulating contents. At the same time, dryness in the pharynx, a feeling of incomplete swallowing of food, a “lump symptom” may be disturbing [6].

    The disease is painful for patients. Patients repeatedly seek medical help from various specialists, undergo multiple courses of treatment.However, most of them do not receive real help and are left alone with their problems.

    In many domestic and foreign works, the influence of waste products of various microorganisms and viruses on the mucous membrane of the oropharynx was studied in detail. However, this etiological factor is not the root cause of the disease, i.e. the occurrence of chronic pharyngitis depends not so much on the nature and virulence of the microorganism, but on the degree of disruption of the biochemical processes of both the mucous membrane and the body as a whole [4].

    According to A.Yu. Ovchinnikova, chronic pharyngitis in most cases is a non-infectious disease, since the qualitative and quantitative composition of the microflora sown from the pharyngeal mucosa in patients with chronic pharyngitis differs little from that in persons with a normal oropharyngeal mucosa [5].

    The true causes of the disease are far from being understood. Obviously, further work is needed and the introduction of new modern views and research methods into clinical practice.

    Chronic cough is an equally important and common problem. Chronic cough is reported by about a third of patients seeking medical help.

    Physiologically, coughing is a protective reflex aimed at removing excess secretions, dust or smoke from the airways. This is a quick strong exhalation, as a result of which the tracheobronchial tree is cleared of foreign bodies [8, 9].

    According to the classification of Richard S.Irvin 2000, an acute cough is considered a cough that lasts no more than three weeks (most often against the background of an acute viral infection), a subacute cough that lasts more than three but less than eight weeks, a chronic cough for more than eight weeks [8, 9].

    Despite the fact that cough is often associated in patients with pathology of the bronchopulmonary system, it can occur in a number of diseases that are diverse in their pathogenesis and site of lesion [4].

    Richard S. Irvin in 1990conducted a prospective study of the causes of chronic cough. As a result, several diseases were identified, which are characterized by chronic cough. Of those examined, 54% had postnasal drip syndrome, 31% had bronchial hyperreactivity, 28% had gastroesophageal reflux, 7% had chronic bronchitis, 12% had other causes of cough, and in almost 10%, the reason could not be established. At the same time, almost a quarter of the surveyed have two causes of cough, and 3% have three reasons.

    At present, the problem of gastroesophageal reflux disease (GERD) and its extraesophageal manifestations has been raised more and more often at the world gastroenterological forums. Interest in this problem is not accidental. Foreign colleagues have identified and are actively studying the relationship between the pathology of the upper respiratory tract and gastroesophageal reflux.

    The term GERD most clinicians and researchers designate a chronic recurrent disease caused by spontaneous, regularly recurring retrograde intake of gastric and / or duodenal contents into the esophagus, leading to damage to the distal esophagus and / or the appearance of characteristic symptoms (heartburn, retrosternal pain, dysphagia) [7, 3, 2], which basically allow one to suspect GERD in a patient. However, in some patients, the disease has less typical manifestations – reflux-associated cardiac, pulmonary and ENT organs. They are often underestimated, especially in the absence of specific symptoms of GERD, which can lead to underdiagnosis and incorrect patient management tactics.

    According to the 2006 Montreal International Classification of Gastroesophageal Reflux Disease, chronic pharyngitis is a suspected extraesophageal manifestation of gastroesophageal reflux disease.There is currently no substantiated evidence of this relationship.

    The aim of the work is to develop an algorithm for the examination and treatment of patients with chronic pharyngitis, to assess the effectiveness of antireflux therapy in the treatment of chronic pharyngitis.

    The patients observed by us were examined before the start of treatment, as well as in the process of carrying out medical measures. Immediate results were assessed not earlier than two months after the start of therapy directly by the patients themselves (who were offered a specially developed questionnaire), as well as using the above objective methods.

    In the course of the study for the period 2005-2006. 37 patients with chronic pharyngitis at the age from 19 to 70 years were examined who applied for a consultation at MCDC MONIKI. There were 14 men among them, 23 women. 17 patients suffered from chronic subatrophic pharyngitis, chronic catarrhal pharyngitis occurred in 11 people, hypertrophic – in 9. Patients were divided into three groups, the first group consisted of 16 patients who had GERD with high gastroesophageal reflux , the second group consists of 8 patients with GERD without high pathological reflux, the third group consists of 13 patients who have no data for GERD based on the results of daily monitoring of pH.Thus, 24 people suffer from GERD among the patients with chronic pharyngitis examined by us (Tables 1, 2).

    In our study, in seven patients we observed reflux – grade A esophagitis, in two – grade B. At the same time, one patient with reflux – grade B esophagitis had high alkaline reflux. Among our patients, there was not a single one with grade C and D reflux esophagitis.

    In our study, at the level of the upper third of the esophagus, pH fluctuations from 2.0 to 8.5 were revealed.

    After 24-hour monitoring of pH in establishing the diagnosis of GERD, antireflux therapy was included in the standard therapy of chronic pharyngitis. The therapy was carried out for at least two months. Against the background of therapy, there is a significant improvement in the course of chronic pharyngitis, as well as data of daily monitoring of pH, while numerous courses of standard treatment for chronic pharyngitis for these patients are ineffective.

    Preliminary results suggest a significant pathogenetic role of GERD in the development and course of pharyngitis.In this regard, we believe that:

    • Patients under the supervision of an otorhinolaryngologist diagnosed with chronic pharyngitis should be consulted by a gastroenterologist.
    • all patients with chronic pharyngitis need fibroesophagogastroduodenoscopy
    • when endoscopic signs characteristic of GERD are detected, daily high pH-metry is indicated
    • daily pH metering should be performed in patients who clinically do not respond to standard therapy for chronic pharyngitis, regardless of the presence of complaints characteristic of GERD and the endoscopic picture in the esophagus.

    D.M. Mustafaev, Z.M. Ashurov, V.A. Isakov, V.G. Zenger, S.V. Morozov, S.G. Tereshchenko, V.L. Shabarov, N.G. Lyubimova, A.S. Epanchintseva, L.V. Gibadullina.

    Moscow Regional Research Clinical Institute. M.F. Vladimirsky, Moscow (Director – Doctor of Sciences of the Russian Federation, Corresponding Member of the Russian Academy of Sciences and the Russian Academy of Medical Sciences, Professor G.A. Onoprienko)

    Surgical treatment of gastroesophageal reflux disease (heartburn, reflux esophagitis)

    What is gastroesophageal reflux disease?

    True (primary) gastroesophageal reflux disease (GERD) is a consequence of dysfunction of the lower esophageal sphincter and manifests itself as a gaping (opening) of the cardia (esophageal-gastric junction) during endoscopy of the esophagus or its contrast radiography, which reveal signs of reflux esophagitis of varying severity …

    The clinical manifestations of GERD include heartburn, belching, regurgitation of food, retrosternal pain in the throat, difficulty in passing food into the stomach, pain in the abdomen and chest are possible, as well as extraesophageal manifestations – night cough, hoarseness, episodes of choking, etc.

    Secondary (symptomatic) GERD occurs against the background of other diseases of the abdominal organs in the patient (diaphragmatic hernia, duodenal ulcer, chronic pancreatitis, duodenostasis, achalasia of the cardia, etc.), or systemic diseases (scleroderma and other diffuse connective tissue diseases, eosaginophilis ).Late complications of long-standing GERD are the development of peptic ulcers and strictures (cicatricial narrowing) in the lower third of the esophagus, shortening of the esophagus, which often happens in old age and requires complex surgical treatment. Another common complication of GERD is Barrett’s metaplasia – replacement of the esophageal mucosa over the cardia by the intestinal epithelium, which is often accompanied by epithelial dysplasia and increases the risk of developing esophageal adenocarcinoma.

    Why is it better to perform the operation at the Grand Medica clinic?

    The task of specialists (gastroenterologist, surgeon) of the medical clinical center is to establish the true cause of GERD and determine the optimal method of treatment (conservative therapy with an assessment of the state of the clinical situation in dynamics, or surgical treatment – the type of antireflux surgery and the prognosis of its result depending on the existing symptoms). Performing laparoscopic fundoplication in a medical clinical center guarantees the correct determination of the indications for this method of treatment, careful adherence to the intervention technique, which is the key to its effectiveness and good long-term results.

    Who needs surgery for gastroesophageal reflux disease?

    Indications for antireflux surgery in GERD can be both true GERD and secondary gastroesophageal reflux (acidic or alkaline).Surgical treatment is indicated for true GERD complicated by Barrett’s metaplasia, esophageal stricture, shortening of the esophagus, esophageal bleeding, side effects of acid-lowering drug therapy. In patients with extraesophageal manifestations, it is necessary to determine the acidity in the esophagus – probe pH-metry of the esophagus to identify the relationship of symptoms with reflux.

    Laparoscopic fundoplication in our center is performed according to the “gold standard” methods or in the form of full or partial fundoplication (short-floppy Nissen, Tupe). A properly formed fundoplication cuff around the clock, in contrast to drug treatment, protects the esophagus from acid or alkaline (bile) reflux.

    In patients with morbid obesity and severe manifestations of GERD, the Grand Medica clinic uses laparoscopic gastric bypass surgery, which, along with a stable correction of body weight, relieves the patient from gastroesophageal reflux.

    Laparoscopic fundoplication, as a rule, is easily tolerated by the patient, eliminates the existing symptoms, relieves the patient of the need for constant drug therapy, improves the quality of life, prevents the progression of changes in the esophagus and the development of complications of reflux esophagitis.The results of surgical treatment of reflux esophagitis and GERD are assessed by fluoroscopy and esophagogastroscopy no earlier than 6 months later. The frequency of recurrence (return) of symptoms many years after laparoscopic fundoplication does not exceed 13-15% of all operated patients, the need for repeated fundoplication (with the development of side effects of surgery) is no more than 3-5%.

    Diagnostics and treatment of GERD (gastroesophageal reflux disease), symptoms, complications

    Diagnostics and treatment of GERD

    The sooner you see your doctor and start treatment GERD , the more likely you are to achieve lasting remission and avoid complications.Despite the availability of standard therapy regimens and a sufficient number of drugs, this is not always achieved immediately, but you should not despair. The success of the treatment of GERD depends on the successful cooperation of the patient and the doctor, the active participation of patients in the treatment process helps to achieve good long-term results.

    Gastroenterologists GC “Expert” use the methods of treatment of GERD, based on modern European and Russian recommendations, and an individual approach to each patient.With their help, many patients were able to achieve a successful remission of this disease.

    Before the appointment of treatment, an examination of the gastrointestinal tract is carried out to identify the causes that contribute to the development of the disease. After the examination, patients are assigned a comprehensive treatment regimen using drugs that reduce the acidity of gastric juice, improve the functioning of the gastrointestinal tract and other drugs.

    The patient will receive

    as a result of treatment

    1. No symptoms and improved quality of life.
    2. Prevention of complications and prolongation of remission.
    3. Improvement of the histological picture of the esophageal mucosa, healing of erosions and ulcers.
    4. Inhibition of atrophy of the esophageal mucosa.
    5. Elimination of risk factors for the development of cancer.
    Tips and tricks

    Treatment of gastroesophageal reflux disease takes time. Even after its manifestations are “brought under control” and do not bother you, do not quit treatment halfway and continue to follow the doctor’s recommendations.
    Changes in lifestyle, diet and diet, and restriction of medication that reduce the tone of the lower esophageal sphincter, help to reduce the symptoms of GERD.

    We offer to take a survey “6 questions for heartburn”, which will help you decide whether it is time to see a doctor.

    Treatment of gastroesophageal reflux disease (heartburn, reflux esophagitis)

    Surgical treatment of gastroesophageal reflux disease (heartburn, reflux esophagitis)

    What is gastroesophageal reflux disease?

    True (primary) gastroesophageal reflux disease (GERD) is a consequence of the paralysis of the lower esophageal sphincter and is manifested by a gaping (opening) of the cardia (esophageal-gastric junction) during endoscopy of the esophagus or its contrast radiography, in which signs of reflux esophagitis of varying severity are found.

    The clinical manifestations of GERD include severe heartburn, belching, regurgitation of food, retrosternal pain in the pharynx, difficulty in passing food into the stomach, epigastric pain and extraesophageal manifestations are possible – night cough, repeated bronchospasm, etc.

    Secondary (symptomatic) GERD occurs against the background of other diseases of the abdominal organs in the patient (diaphragmatic hernia, duodenal ulcer, chronic pancreatitis, duodenostasis, achalasia of the cardia, etc.), or systemic diseases (scleroderma and other diffuse connective tissue diseases, eosaginophilis ).

    Late complications of long-standing GERD are the development of peptic ulcers and strictures (scarring) in the lower third of the esophagus, which often occurs in old age and requires complex surgical treatment. Another common complication of GERD is Barrett’s metaplasia – the replacement of the esophageal mucosa over the cardia by the intestinal epithelium, which is often accompanied by epithelial dysplasia and the threat of developing esophageal adenocarcinoma.

    Why is it better to have surgery at the Grand Medica center?

    The task of the specialists of our center is to establish the true cause of GERD and to determine the optimal method of treatment (conservative therapy with an assessment of the state of the clinical situation in dynamics, or surgical treatment – the type of antireflux surgery and the prognosis of its result depending on the existing symptoms).

    Performing laparoscopic fundoplication in our center guarantees the correct determination of indications for this method of treatment, careful adherence to the intervention technique, which is the key to its effectiveness and good long-term results.

    Who needs surgery for gastroesophageal reflux disease?

    Indications for antireflux surgery in GERD can be both true GERD and secondary gastroesophageal reflux (acidic or alkaline).Surgical treatment is indicated for true GERD complicated by Barrett’s metaplasia, esophageal stricture, shortening of the esophagus, esophageal bleeding, side effects of acid-lowering drug therapy.

    Laparoscopic fundoplication in our center is performed either as a complete fundoplication (short-floppy Nissen, Nissen modified by E.A. Gallyamov, symmetric according to A.F. Chernusov).

    In patients with morbid obesity and severe manifestations of GERD, our center uses laparoscopic gastric bypass surgery, which, along with a stable correction of body weight, relieves the patient from gastroesophageal reflux.

    Laparoscopic fundoplication, as a rule, is easily tolerated by the patient, eliminates the symptoms of GERD, relieves the patient of the need for constant drug therapy, and improves the quality of life. The results of surgical treatment of reflux esophagitis and GERD are assessed by fluoroscopy and esophagogastroscopy no earlier than 6 months later.

    The frequency of recurrence (return) of symptoms several years after laparoscopic fundoplication does not exceed 6-8% of all operated patients.

    GERD under control »Medvestnik

    New algorithms

    One of the main reports at the conference was the report of the chief gastroenterologist of the Moscow Department of Health Dmitry Bordin “Esophageal protection in the treatment of gastroesophageal reflux disease: today and tomorrow.” According to his data, the prevalence of GERD in Moscow is 23.6%. In other cities of Russia this figure is slightly lower – 13.3%. At the same time, about a third of patients who come to polyclinics with various diseases have signs of reflux disease.

    High prevalence, a tendency to an increase in morbidity on all continents, a chronic relapsing course, a negative impact on the quality of life and psychological status, the complexity of treatment distinguish GERD from other diseases of the digestive system and necessitate the development of new algorithms for managing a group of patients with this disease.

    Dmitry Bordin noted: according to some reports, GERD can transform from one form to another. So, among patients with non-erosive reflux disease who did not receive supportive therapy, with dynamic observation, erosions of the esophagus are detected in 25% of cases, and untreated erosive reflux disease (ERD) can lead to Barrett’s esophagus and then to adenocarcinoma.

    In more than 80% of patients, reflux esophagitis (ER) recurs within a year, recurrence of reflux symptoms occurs in 75% of patients with non-erosive reflux disease (NERD) on the background of discontinuation of drug therapy [1].

    According to the Russian register [11], the most common form of GERD, erosive esophagitis, is revealed at a doctor’s appointment. The greater the severity of the disease, the greater the decrease in the synthesis of mucins in the stimulated phase, and this reduces the protective properties of the mucous membrane, explained Professor Bordin.According to clinical guidelines, treatment should be aimed not only at reducing the aggressive properties of refluctate and improving esophageal clearance, but also at protecting the esophageal mucosa. The doctor’s task is to take the disease under control, remove the inflammatory process, so that the progression and formation of Barrett’s esophagus and esophageal adenocarcinoma do not occur. Adequate therapy for erosive forms of GERD is important not only in terms of eliminating symptoms, but also in terms of cancer prevention.

    Hydrochloric acid, pepsin and bile acids have the main damaging potential for the esophagus. It should be noted that hydrochloric acid itself does not damage the esophagus, explained Dmitry Bordin. Moreover, patients with reflux disease generally lack acid hypersecretion. Fundamentally important is the fact that the contents of the stomach enter the esophagus and the duration of its effect. The most effective drugs for the treatment of GERD, proton pump inhibitors (PPIs), reduce acid production and refluctate volume, but do not affect pepsin activity and bile.It has been shown that pepsin retains its activity even when the pH rises to 5.5. If PPI therapy is ineffective in clinical practice, combination therapy is used – the addition of a drug with a different mechanism of action to the standard basic antisecretory therapy.

    Space for combination

    Systematic reviews have shown control or relief of symptoms in 56–76% of cases with standard doses of PPIs [4–5]. At the same time, according to P.O. Katz et al., In patients with NERD, in contrast to patients with erosive esophagitis, symptom relief with PPI intake is less pronounced, and therapeutic efficacy is reduced by about 20%.

    Dmitry Bordin draws attention to the fact that one of the reasons for the ineffectiveness of GERD treatment is the preservation of microscopic damage to the mucous membrane caused by weakly acidic reflux, pepsin or other components of refluctate when its integrity is damaged.

    Today, medicine is actively used in medicine that have a protective effect at the level of the mucous membrane of the stomach and small intestine: enveloping drugs containing bismuth, and a group of drugs with a cytoprotective potential – a synthetic analogue of prostaglandin E2 – misoprostol and an inducer of endogenous prostaglandin synthesis – rebamipide [ 2].Their main disadvantage, doctors say, is the lack of evidence base for efficacy in GERD.

    Optimal treatment of patients with GERD should be aimed not only at suppressing acid secretion, but also at increasing the effectiveness of protective pathophysiological mechanisms that provide barrier properties and / or bind residual aggressive components of refluctate (pepsin, bile acids, lysolecithin, etc.) and stimulate recovery mucous membrane. In this regard, the possibility of combination therapy with the addition of drugs with a different mechanism of action to PPIs is being considered.New approaches in the treatment of GERD involve the use of innovative products. One of them is a medical device registered in 2018 in the Russian Federation with a proven esophagoprotective potential – Alfazox, which is a mixture of hyaluronic acid and chondroitin sulfate applied to a bioadhesive carrier Poloxamer 407.

    It aims to protect against all components of refluctate: hydrochloric acid, pepsin and bile. Chondroitin sulfate is a natural component of the protective layer of mucus, has the ability to inhibit aggressive damaging factors – pepsin, trypsin, histamine.

    The action of the medical device is aimed at enhancing the protection of the esophageal mucosa. “Alfazox” can be effective in patients with erosive disease, since its protective and restorative properties contribute to the healing of lesions of the esophageal mucosa [6].

    Potential assessment

    Dmitry Bordin spoke about the European studies of Alfazox (in Europe it is registered under the trade name Esoxx, under the same name preclinical and clinical studies were carried out).Their results showed that the application of a medical device to the mucous membrane of the esophagus gives it an additional protective potential, preventing damage from the application of hydrochloric acid and pepsin, and prevents an increase in the permeability of the mucous membrane [7].

    A large study evaluating the efficacy and safety of a combination of hyaluronic acid and chondroitin sulfate as an oral dosage form for 15 days as an adjunct to a PPI in the treatment of patients with NERD (154 patients) was conducted in Italy in 2017 in 16 hospitals [eight].In this work, the high clinical efficacy of such a therapy has been demonstrated. Compared with PPI monotherapy, their combination with Alfazox provided advantages reflected in a significant increase in quality of life indicators on the scales of general health and social functioning of the SF-36 questionnaire. In this work, it was demonstrated that, against the background of adding Alfazox to PPIs, the effectiveness of therapy doubles. The incidence of side effects while using Alfazox was comparable to the incidence of side effects when using placebo.Experts come to the conclusion that Alfazox is the only innovative product that solves the problem of protecting the esophageal mucosa not only from acidic, but also from mixed GERs, which have a more pronounced damaging potential ”[9].

    Preliminary data of the study of the effectiveness of “Alfazox” in combination with pantoprazole in erosive esophagitis, going to the Moscow Research Center named after A.S. Loginova, indicate that, in contrast to monotherapy with pantoprazole, there are advantages in stopping or alleviating regurgitation and dysphagia.

    Professor Bordin emphasized that this medical device is unlikely to be considered as an alternative to PPIs, however, in combination with PPIs, it can increase the effectiveness of therapy both for a reliable symptomatic response and for preventing PPI dose escalation, reducing the incidence of treatment failure [10].

    1. Talley NJ, Armstrong D, Junghard O et al. Predictors of treatment response in patients with non-erosive reflux disease. Aliment Pharmacol Ther 2006; 24 (2): 371-6.

    2. Ivashkin V.T., Mayev I.V., Trukhmanov A.S. and other Clinical guidelines of the Russian gastroenterological association for the diagnosis and treatment of gastroesophageal reflux disease // Ros. zhurn. gastroenterology, hepatology, coloproctology. 2017; 27 (4): 75–95.
    3. Bakulina N.V., Tikhonov S.V., Lishchuk N.B. Alfazox is an innovative medical device with proven esophagoprotective potential // Gastroenterology. Surgery. Intensive therapy. Consilium Medicum. 2019; 2: 17-23.
    4.Tack J., Fass R. Review article: approaches to endoscopicnegative reflux disease – part of the GERD spectrum or a unique acid-related disorder? // Aliment. Pharmacol. Ther. 2004. Vol. 19. Suppl. 1. P. 28–34.
    5. Katz P.O., Scheiman J.M., Barkun A.N. Review article: acid-related disease – what are the unmet clinical needs? // Aliment. Pharmacol. Ther. 2006. Vol. 23.Suppl. 2. P. 9-22.
    6. Embutnieks Yu.V., Valitova E.R., Bordin D.S. A new approach to the treatment of gastroesophageal reflux disease: protection of the esophageal mucosa // Effective Pharmacotherapy.2019.Vol. 15, p. 82.
    7. Savarino V, Pace F, Scarpignato C et al. Randomized clinical trial: mucosal protection combined with acid suppression in the treatment of non-erosive reflux disease – efficacy of Esoxx, a hyaluronic acid – chondroitin sulphate based bioadhesive formulation. Aliment Pharmacol Ther 2017; 45 (5): 631–42.
    8. Bakulina N.V., Tikhonov S.V., Lishchuk N.B. Alfazox is an innovative medical device with proven esophagoprotective potential // Gastroenterology. Surgery. Intensive therapy.Consilium Medicum. 2019; 2: 17-23.
    9. Embutnieks Yu.V., Valitova E.R., Bordin D.S. A new approach to the treatment of gastroesophageal reflux disease: protection of the esophageal mucosa // Effective Pharmacotherapy. 2019.Vol. 15, p. 82.
    10.