What to eat when you have esophagitis: Diet for Erosive Esophagitis | Livestrong.com
Diet for Erosive Esophagitis | Livestrong.com
Boiled rice should help with symptoms of erosive esophagitis.
Image Credit: KOMKRIT MUANGCHAN/iStock/Getty Images
Erosive esophagitis results from reflux of stomach acid up into the esophagus. The lining of the esophagus becomes inflamed and irritated. You may feel abdominal pain and burning that extends up into the mid-chest area. Following a bland diet can help minimize symptoms. During acute episodes you may need medication along with diet and lifestyle modifications. Erosive esophagitis is often painful and leads to complications such as Barrett’s esophagus, a precancerous condition.
What to Drink
Avoid caffeinated beverages.
Image Credit: kzenon/iStock/Getty Images
Caffeine decreases the pressure around the lower esophageal sphincter, which allows food and acid to backflow from the stomach to the esophagus. The result is inflamed tissue. Avoid all caffeinated drinks. Drink herbal teas, decaffeinated coffee or tea and water. Fruit juice and vegetable broth make good alternative beverages as long as they do not contain acidic fruit or vegetables, like orange or tomato. The authors of “Medical-Surgical Nursing” advise against drinking carbonated beverages as these also reduce LES pressure.
The BRAT Diet
Following a bland diet can help.
Image Credit: Ildiko Papp/iStock/Getty Images
MedlinePlus recommends following a bland diet during acute episodes of esophagitis. Although the American Gastroenterological Association reported in an October 2008 article published in the “Journal of Gastroenterology” that no specific diet works for every person suffering from erosive esophagitis, you can implement a bland diet permanently if it relieves your symptoms. A strict bland diet is the BRAT diet. Consisting of bananas, rice, applesauce and toast, the diet encourages easily digested foods. Breads should be made from refined flour to ease digestion. In addition to white rice, you can eat processed oats and cream of wheat cereals.
Fruits and Vegetables
Avoid fruits and vegetables that are hard to digest.
Image Credit: Don Stevenson/iStock/Getty Images
Fruit and vegetables are important for providing vitamins, minerals and fiber in your diet. However, with erosive esophagitis, you need to avoid fruits and vegetables that are hard to digest and cause gas. Carrots, peas, potatoes, summer squash and many types of squash are usually well tolerated as long as you cook them. You can also include canned, frozen, or cooked fruit like applesauce, canned peaches and pears and frozen blueberries. Bananas, peeled apples and pears make good fresh fruit choices.
Lean Meat and Dairy
Consume more lean meats like poultry, fish or buffalo.
Image Credit: Jacek Chabraszewski/iStock/Getty Images
Fat is another culprit that decreases LES pressure. You can eat lean poultry, fish and pork. Buffalo is a leaner choice for red meat than beef. Bake, broil or boil meat. When you cook meats, season with spices that do not irritate the stomach or esophagus. Small amounts of salt and pepper, rosemary, thyme and basil are unlikely to cause pain. For dairy products, select skim milk, low-fat yogurt and cheese.
You may need to make some lifestyle changes if you have erosive esophagitis.
Image Credit: Sergey Lukyanov/iStock/Getty Images
In addition to modifying your diet, you may need to make some lifestyle changes. If you have erosive esophagitis, you should not drink alcohol or smoke cigarettes. Eat small meals frequently throughout the day to aid in digestion. Do not drink while you are eating; instead, drink between meals. Keep a food diary to see which foods and drinks aggravate your symptoms so you can eliminate them from your diet.
Esophagitis | Michigan Medicine
What is esophagitis?
Esophagitis is irritation or inflammation of the esophagus. The esophagus is the tube that carries food from your throat to your stomach. Esophagitis can be painful and can make it hard to swallow.
What causes esophagitis?
Gastroesophageal reflux disease
, or GERD, is the most common cause of esophagitis. When you have GERD, stomach acid and juices flow backward into your esophagus. This can irritate the esophagus.
Other causes include:
- A hiatal hernia.
- Medicines that irritate the esophagus, such as:
- Vitamin and mineral supplements, such as vitamin C, iron, and potassium pills.
- Infection. People who have a weak immune system are more likely to get esophagitis. This includes people with HIV, diabetes, or kidney problems, as well as older adults and people who take steroid medicine.
- Radiation therapy.
- Certain diseases that make it hard to swallow, such as scleroderma.
- Allergies, often food allergies, especially to seafood, milk, nuts, soy, or eggs.
What are the symptoms?
Common symptoms of esophagitis include:
- Pain when you swallow.
- Trouble swallowing food or liquids.
- Chest pain (may be similar to the pain of a heart attack).
- A cough.
Sometimes it also causes:
- Nausea or vomiting.
- Belly pain.
How is esophagitis diagnosed?
Your doctor will ask about your symptoms and past health. He or she may do tests such as:
- An endoscopy. During this test, the doctor puts a thin, flexible tube down your throat to look at your esophagus. This test also lets the doctor get a sample of the cells to test for infection. Sometimes a small piece of tissue is removed for a biopsy. A biopsy is a test that checks for inflammation or cancer cells.
- A barium swallow. This is an X-ray of the throat and esophagus. Before the X-ray, you will drink a chalky liquid called barium. Barium coats the inside of your esophagus so that it shows up better on an X-ray.
How is it treated?
The treatment you need depends on what is causing the esophagitis. If you have esophagitis caused by acid reflux or GERD, your doctor will likely recommend that you change your diet, lose weight if needed, and make other lifestyle changes. Here are some things to try:
- Change your eating habits.
- It’s best to eat several small meals instead of two or three large meals.
- After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren’t a good idea.
- Chocolate, mint, and alcohol can make GERD worse. They relax the valve between the esophagus and the stomach.
- Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make GERD symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
- Do not smoke or use smokeless tobacco.
- If you have GERD symptoms at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
- Do not wear tight clothing around your middle.
- Lose weight if you are overweight or obese. Losing just 5 to 10 pounds can help.
If lifestyle changes alone aren’t enough to help your esophagitis, your doctor may suggest you try medicines that reduce stomach acid. Reducing the reflux gives the esophagus a chance to heal. Over-the-counter medicines include:
- Antacids, such as Maalox, Mylanta, or Tums. Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful.
- Stronger acid reducers, such as famotidine (for example, Pepcid) and omeprazole (for example, Prilosec).
If esophagitis is caused by an infection, you may need to take antibiotics or other medicines to treat the infection.
If you or your child has esophagitis caused by a food allergy, your doctor may prescribe corticosteroids.
You might need surgery if you have a tear in your esophagus or if something is blocking your esophagus, such as a tumor.
Other Works Consulted
- Falk G, et al. (2016). Diseases of the esophagus. In L Goldman, A Shafer, eds., Goldman-Cecil Medicine, 24th ed., vol. 1, pp. 896–908. Philadelphia: Saunders.
Current as of:
April 15, 2020
Author: Healthwise Staff
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Peter J. Kahrilas MD – Gastroenterology
Current as of: April 15, 2020
Medical Review:E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Peter J. Kahrilas MD – Gastroenterology
Symptoms, Causes, Diagnosis & Treatment
What is esophagitis?
Esophagitis is an inflammation (swelling) of the lining of the esophagus, the tube that connects the throat to the stomach. If it is not treated, esophagitis can become very uncomfortable, causing difficulty in swallowing, and ulcers or scarring of the esophagus. Barrett’s esophagus, a complication of acid reflux, is a risk factor for cancer of the esophagus.
Symptoms and Causes
What causes esophagitis?
Esophagitis is an irritation of the esophagus caused by any of the following:
- A backflow of acid fluid from the stomach to the esophagus (GERD)
- Medications such as aspirin and anti-inflammatories
- Viruses, fungi, bacteria, or diseases that weaken the immune system
What are the symptoms of esophagitis?
Symptoms of esophagitis include:
- Difficult and/or painful swallowing
- Acid regurgitation (bringing food back up to the mouth from the stomach)
If you have any of these symptoms, you should contact your healthcare provider.
Diagnosis and Tests
How is esophagitis diagnosed?
Once your doctor has performed a thorough physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These include:
- Endoscopy: A long, flexible lighted tube called an endoscope is used to look at the esophagus.
- Biopsy: A small sample of the esophageal tissue is removed and sent to a laboratory to be examined under a microscope.
- Barium X-ray: X-rays are taken of the esophagus after the patient drinks a barium solution. Barium coats the lining of the esophagus and is visible on X-ray. This enables doctors to view abnormalities of the esophagus.
Management and Treatment
How is esophagitis treated?
Treatment for esophagitis depends on its cause. While medications that block acid production may be recommended, other medications may be prescribed for cases of esophagitis that are caused by infection.
While you are being treated for esophagitis, you can take the following steps to help limit discomfort:
- Avoid spicy foods such as those with pepper, chili powder, curry and nutmeg.
- Avoid acidic foods and beverages such as tomatoes, oranges, grapefruits and their juices. Instead, try nectars and imitation fruit drinks with vitamin C.
- Include more soft foods such as applesauce, cooked cereals, mashed potatoes, custards, puddings and high-protein shakes in your diet.
- Take small bites and chew your food thoroughly.
- Avoid alcohol and tobacco.
Outlook / Prognosis
What is the prognosis (outlook) for people who have esophagitis?
The causes of esophagitis usually respond to treatment; however, some causes, such as acid reflux, may require long-term treatment.
Esophagitis | Johns Hopkins Medicine
Causes of esophagitis
These are some possible causes of irritation and inflammation:
Stomach acid in the food pipe. If you have gastroesophageal reflux disease (GERD), stomach acid leaks backward into your esophagus. If this happens on a regular basis, it may cause esophagitis.
Medicines, such as aspirin or other anti-inflammatory medicines
Medical procedures, such as radiation therapy
Infections that weaken your immune system
Allergies, often to foods
Esophagitis can have serious consequences that affect your quality of life. If left untreated, esophagitis may develop into a condition called Barrett’s esophagus. This may increase your risk for esophageal cancer.
You may experience these symptoms with esophagitis:
You may be at risk for esophagitis unrelated to an infection if you:
Are an elderly adult
Consume a lot of alcohol, coffee, chocolate, fatty foods, or spicy foods
Use certain medicines, including NSAID pain relievers, nitrates, and beta blockers
Have a spinal cord injury
Have had radiation therapy for chest tumors
Swallow medicine with too little water or get a pill stuck in your throat
Have scleroderma, an autoimmune disease
Have many allergies, especially to certain foods
To make a diagnosis, your healthcare provider may do these things:
Take a medical history and do a physical exam.
Order an upper GI series. This test consists of X-ray images of your esophagus and stomach as you swallow a barium fluid that shows any problem areas.
Order an endoscopy. This is an outpatient procedure in which the gastroenterologist uses a tiny camera on a thin, flexible tube to look inside your esophagus for signs of esophagitis.
Do an esophageal pH test for stomach acid. The gastroenterologist will insert sensors or thin wires during an endoscopy to gather information over 1 to 3 days. This may help your healthcare provider find out about stomach acid that may be appearing in the esophagus.
Treatment for esophagitis depends on the cause. These are possible treatments:
Therapy. This is to find the cause of your esophagitis.
Additional medicines. Your healthcare provider may prescribe medicines to strengthen the lower esophageal sphincter. This keeps stomach acid in your stomach.
Avoidance of certain foods. This is necessary if you have an allergic cause to your esophagitis.
Dilation. Stretching of the esophagus is done during an endoscopy.
Lifestyle changes. If your esophagitis is caused by GERD, your healthcare provider might offer these recommendations:
Raise the head of your bed so that you sleep with your head slightly above your feet.
Change your eating habits to limit acid or irritation of the esophagus. This might mean switching to a bland diet for a while and avoiding spicy foods, citrus foods, chocolate, fatty foods, and caffeine.
Avoid or limit alcohol.
Maintain a healthy weight.
Become more active.
Surgery. Your healthcare provider may recommend surgery if you have bleeding or narrowing of the esophagus. It also might be recommended if it is needed to control the spread of precancerous cells.
Problems that can happen with esophagitis include:
Living with esophagitis
Esophagitis can return if you do not make some changes in the way you live. Living with this condition means following your healthcare provider’s recommendations on lifestyle changes and medicine use.
When to call the healthcare provider
Contact your healthcare provider if your symptoms return.
6-Food Elimination for Eosinophilic Esophagitis (EOE)
Research shows a strong connection between food allergies and eosinophilic esophagitis (EOE). These six foods are most commonly associated with this allergic response: dairy, wheat, soy, eggs, nuts, and seafood/shellfish.
Unfortunately, there is no accurate test to identify food allergies connected with EOE. Elimination diets help to identify food allergies and improve your condition. Start by eliminating two of the most common food allergies; dairy and wheat.
How to do an elimination diet:
Step 1. Plan
Work with your healthcare team to identify which foods might be causing symptoms. Plan a time to start the diet when you know you can be successful. Prepare yourself by having the foods you will need on hand and prep as much as possible in advance.
Step 2. Eliminate
Remove all 6 foods from your diet for 4 weeks without any exceptions. It is important to read food labels and use caution when dining out, since you have less control over the ingredients in restaurants. .
Step 3. Challenge
If your symptoms have not improved after 4 weeks, follow up with your health care provider.
If your symptoms have improved, start the challenge phase with ONE of the foods you stopped eating at a time. As you do this, write down your symptoms.
Symptoms of a failed food challenge may range from mild reflux, or pains, to severe cramps, vomiting, or difficulty swallowing – even food impaction. Any of these changes after reintroducing a food should be written down and considered a reaction. It is common for EOE food reactions to be delayed for hours or even days from exposure.
- Introduce ONE new food per week. (Dairy, wheat, soy, eggs, nuts, or seafood/shellfish)
- Add 1 serving of the food in the morning. (Example: glass of milk or 1 slice of bread)
- If you don’t notice any symptoms, eat 2 larger portions in the afternoon and evening.
- Over the next 3 days, continue to eat at least 1 serving of the food per day.
- If the food does not cause symptoms, it is considered safe.
- Wait to add the safe food back into your diet until the other food challenges are complete.
|Food to avoid||What to eat||Brand Examples|
Ingredients that contain dairy:
|Food to avoid||What to eat||Brand Examples|
Ingredients may contain wheat:
|Food to avoid||What to eat||Brand Examples|
Ingredients may contain egg:
|Food to avoid||What to eat||Brand Examples|
Peanuts and Tree Nut Elimination
|Food to avoid||What to eat||Brand Examples|
Peanut butter alternatives:
Fish and Shellfish Elimination
|Food to avoid||What to eat||Brand Examples|
Peanut butter alternatives:
Reading a Food Label
Dairy Example: There are three ways milk may be indicated on a label. See examples below:
1. Within ingredient list in parenthesis ( )
- INGREDIENTS: CASEIN (MILK), DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR
2. Within ingredient list in BOLD.
- INGREDIENTS: MILK CASEIN, DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR
3. As a separate statement after the ingredient list. See example below:
- INGREDIENTS: CASEIN, DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR CONTAINS: MILK
Sample Menu: Wheat and Dairy Free
|Day 1||Day 2||Day 3||Day 4|
|Breakfast sausage or ham, 1 banana or apple, 2 Tbsp sunflower seed butter||Smoothie: unsweetened milk alternative, banana, berries, greens, protein powder||
GF Oatmeal (prepared with milk alternative) blueberries, hemp seeds
Coffee (w/coconut creamer)
Allergen free waffle with 100% pure maple syrup, berries
|Lunch||Green salad with chicken, black beans, salsa, and avocado||Tuna salad lettuce wraps, side of walnuts or olives and grapes||
Rice with beans, grilled vegetables, GF corn chips, lettuce, salsa, cheese substitute
GF wrap with chicken, vegan mayonnaise, avocado slices
|Dinner||Pot roast with potatoes, carrots, and green beans, olive oil||BBQ chicken, sweet potato, and slaw||
Grilled pork chop, GF pasta with vegetables
Baked apple with cinnamon
Beef tenderloin, rice, olive oil, steamed broccoli
|Snack||Fruit or rice crackers with nut butter||Veggie sticks with hummus||
Allergen free pretzels and hummus
Coconut milk ice cream
Seed mixture with allergen free chocolate
Mini rice cakes with sunflower seed butter
American Academy of Allergy Asthma & Immunology
American Partnership for Eosinophilic Disorders
American College of Gastroenterology
GERD and Esophagitis: Causes, Symptoms & Diagnosis
Heartburn, gastroesophageal reflux disease (GERD), and esophagitis can have a complicated, intertwined relationship.
“Esophagitis simply means inflammation of the esophagus,” says Stella Y. Chow, MD, the director of gastroenterology at the Lahey Clinic North Shore in Burlington, Massachusetts.
Your esophagus is the tube that connects your throat to your stomach. When your esophagus becomes irritated or swollen, it causes esophagitis symptoms. Heartburn, a common symptom of esophagitis, affects almost 40 percent of Americans at least twice a month, but having occasional heartburn does not necessarily mean you have esophagitis.
GERD, which affects approximately 20 percent of people in the United States, is a more serious form of regular and frequent heartburn that is more likely to lead to esophagitis. GERD occurs when stomach acid spills out of your stomach and moves upward into your esophagus, a condition called reflux. Since the lining of your esophagus is not designed to tolerate stomach acid, the acid causes irritation and swelling inside your esophagus.
Common Causes of Esophagitis
It’s not always clear why some people have a lot of acid reflux, but it may be due to a weakness of the muscles that keep acid inside the stomach, called a hiatal hernia.
“Esophagitis from acid reflux may be mild or it may be quite serious. Over time, acid reflux may cause swelling or scarring of the esophagus that interferes with swallowing,” says Dr. Chow.
“GERD is the most common cause of esophagitis, but other conditions can also cause esophagitis,” Chow explains. These include:
- Pill esophagitis “This condition may occur from swallowing pills that irritate your esophagus. Common examples include the antibiotic doxycycline and potassium pills,” says Chow. Pill esophagitis may also occur when you swallow pills without drinking enough water.
- Esophageal infection Yeast infections, fungal infections, bacterial infections, and some viral infections can all cause esophagitis.
- Eosinophilic esophagitis. An estimated 56.7 out of 100,000 people are diagnosed with eosinophilic esophagitis in the United States, according to a study published in April 2014 in Clinical Gastroenterology and Hepatology. “This is a rare type of allergic reaction that causes inflammation of the esophagus,” says Chow. Foods such as milk, eggs, wheat, soy, peanuts, beans, rye, and beef may trigger this form of esophagitis, according to the Mayo Clinic.
- Other causes These include irritation from excessive vomiting due to illness or bulimia, alcohol, caffeine, cigarette smoking, or heartburn-causing medications like aspirin or anti-inflammatories.
Heartburn and Other Esophagitis Symptoms
Heartburn or acid indigestion may be the most common symptom of esophagitis. Heartburn may occur after meals, especially when when you’re lying down, and may cause burning in your chest or throat and a bitter taste in your mouth.
Other esophagitis symptoms may include:
- Difficult or painful swallowing
- Chest pain
- Food impaction
- Acid regurgitation
- Chronic hoarseness
- Sore throat
All these symptoms can also be caused by other conditions, so you should see your doctor to determine their cause. Do not assume they are all due to esophagitis. In children and infants, feeding difficulties and failure to thrive may be signs of esophagitis, according to the Mayo Clinic.
How Esophagitis Is Diagnosed
Diagnosis of esophagitis starts with a history and physical exam, Chow explains. “If your doctor thinks you might have esophagitis, you will probably need a special type of imaging study. You may also need a special examination to look inside your esophagus, called an endoscopy.”
Diagnostic tests include:
- Esophageal manometry A thin, pressure-sensitive tube is passed through your nose, into the esophagus to measure the pressures and the pattern of muscle contractions in your esophagus.
- Barium swallow This imaging study takes an X-ray picture of your esophagus after you drink a barium solution. Barium coats the inside of the esophagus to reveal any narrowing from esophagitis.
- Endoscopy During this procedure, a doctor investigates your esophagus through a flexible lighted tube. The tube is inserted through your mouth and requires light anesthesia.
- Biopsy During an endoscopic procedure, doctors frequently remove a piece of esophageal tissue to be looked at under a microscope for signs of inflammation.
Tips to Avoid Esophagitis
“Some things you can do to prevent esophagitis symptoms caused by GERD include taking over-the-counter antacids, avoiding meals close to bedtime, losing weight, not wearing tight-fitting clothing, not smoking, and cutting back on alcohol, spicy foods, and caffeine,” suggests Chow.
Untreated esophagitis can lead to serious complications, including changes to the structure of the esophagus and tearing of the esophagus lining tissue, and can even increase your risk of developing esophageal cancer, according to the Mayo Clinic. You can lower your risks of these complications by staying away from identified triggers. Healthy people usually recover within three to five days, but those with a weakened immune system may take longer to heal from an episode of GERD with esophagitis.
If you have esophagitis symptoms that occur more than twice a week, they don’t seem to be responding to over-the-counter antacid medications, the symptoms are so severe that it is difficult to eat, or if the symptoms are accompanied by headache, fever, and muscle aches, you should visit your doctor. Esophagitis symptoms such as food getting stuck in your throat, pain when swallowing, and weight loss should be further investigated.
Additional reporting by Erica Tricarico.
Esophagitis is generally categorized by the conditions that cause it. In some cases, more than one factor may be causing esophagitis.
A valve-like structure called the lower esophageal sphincter usually keeps the acidic contents of the stomach out of the esophagus. If this valve opens when it shouldn’t or doesn’t close properly, the contents of the stomach may back up into the esophagus (gastroesophageal reflux). Gastroesophageal reflux disease (GERD) is a condition in which this backflow of acid is a frequent or ongoing problem. A complication of GERD is chronic inflammation and tissue damage in the esophagus.
Eosinophils (e-o-SIN-o-fils) are white blood cells that play a key role in allergic reactions. Eosinophilic esophagitis occurs with a high concentration of these white blood cells in the esophagus, most likely in response to an allergy-causing agent (allergen) or acid reflux or both.
In many cases, this type of esophagitis may be triggered by foods such as milk, eggs, wheat, soy, peanuts, beans, rye and beef. However, conventional allergy testing does not reliably identify these culprit foods.
People with eosinophilic esophagitis may have other nonfood allergies. For example, sometimes inhaled allergens, such as pollen, may be the cause.
Lymphocytic esophagitis (LE) is an uncommon esophageal condition in which there are an increased number of lymphocytes in the lining of the esophagus. LE may be related to eosinophilic esophagitis or to GERD.
Several oral medications may cause tissue damage if they remain in contact with the lining of the esophagus for too long. For example, if you swallow a pill with little or no water, the pill itself or residue from the pill may remain in the esophagus. Drugs that have been linked to esophagitis include:
- Pain-relieving medications, such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, others)
- Antibiotics, such as tetracycline and doxycycline
- Potassium chloride, which is used to treat potassium deficiency
- Bisphosphonates, including alendronate (Fosamax), a treatment for weak and brittle bones (osteoporosis)
- Quinidine, which is used to treat heart problems
A bacterial, viral or fungal infection in tissues of the esophagus may cause esophagitis. Infectious esophagitis is relatively rare and occurs most often in people with poor immune system function, such as people with HIV/AIDS or cancer.
A fungus normally present in the mouth called Candida albicans is a common cause of infectious esophagitis. Such infections are often associated with poor immune system function, diabetes, cancer, or the use of steroid or antibiotic medications.
90,000 treatment in Moscow, diagnosis and symptoms
Gastroesophageal reflux is a condition in which gastric contents enter the esophagus when the cardiac opening is abnormally dilated.
Today, about ¼ of the world’s population have gastroesophageal reflux. According to WHO European statistics, about 30-35% of the total number seek medical help from specialists. 3-4% receive full treatment.
The ratio of men and women among the population suffering from GERD is 2: 1.
- Disorders of muscle tone of the lower esophageal sphincter
- Congenital and acquired destructive pathologies of the esophagus
- Hernia of the diaphragm
- Connective tissue failure
Conditions in which the anti-reflux barrier is violated:
- Excessive activity of the sympathetic nervous system
- When eating foods with a high fat content, spices
- For abuse of beverages – alcohol and caffeine
- The use of high dosages of medications such as barbiturates, morphine, NSAIDs, hormonal drugs
- Increased intra-abdominal pressure
Symptoms of gastroesophageal reflux
Symptoms of GERD are divided into esophageal (typical) and extraesophageal.
- Heartburn, especially at night and in the morning
- Profuse drooling
- Belching air, sour or bitter taste
- Nausea and vomiting
- Sore throat when swallowing
- Aching pain in the epigastric region
- Pain in the throat, neck
- Heart rhythm disturbances (interruptions in the work of the heart)
- Inflammatory diseases of the oral cavity (stomatitis, gingivitis)
- Damage to tooth enamel (caries)
- Dry, unproductive cough
- General clinical analysis of blood, urine
- Analysis of feces for coprogram
- Biochemical blood test (liver function tests, cholesterol, alkaline phosphatase)
- X-ray of the chest organs in 2 projections
- X-ray of the esophagus, stomach with barium mixture
- Ultrasound of the hepatobiliary system
- Daily monitoring of pH in the lower part of the esophagus and stomach
- Non-invasive tests for the determination of Helicobacter pylori (respiratory)
Treatment of gastroesophageal reflux
The main treatment for uncomplicated course of GERD consists of a healthy lifestyle and proper balanced nutrition.
In case of inflammatory processes in the esophagus in the form of reflux esophagitis, Barrett’s esophagus, it is necessary to use medication, and in other cases, surgical treatment.
Components of a healthy lifestyle and healthy diet:
- Refusal to consume alcoholic, strongly carbonated drinks
- Weight loss with obesity
- Smoking cessation
- Avoid eating in large quantities and in late hours
- Adequate drinking regime
- Exclusion of excessive physical exertion, especially with frequent bending of the body
- Exclusion of the horizontal position after a direct meal
If such non-drug treatments do not bring relief, drugs are used.
Therapy is aimed not only at eliminating symptoms, but also at complications of GERD.
It is recommended to start treatment at the first signs of inflammation of the esophagus and stomach.
The following preparations are used:
- Prokenetics (promote the acceleration of the movement of the food lump from the esophagus into the stomach, then into the duodenum, increase the tone of the lower esophageal sphincter) – Domperidone (Motilak, Motilium), Itoprid (Ganaton)
- Antisecretory drugs (help suppress the secretion of hydrochloric acid) – proton pump inhibitors (Omeprazole, Pantoprazole, Esomeprazole, Rabeprazole)
- Antacids (Phospholugel, Almagel, Gaviscon)
The treatment regimen is selected individually in accordance with the patient’s condition and concomitant diseases.
Diet for esophagitis: menus and recipes
What is the diet for esophagitis?
What is the diet for esophagitis and how long should it be followed? The gastroenterologist recommends dietary table No. 1 to almost all patients. Such a diet is recommended for diseases of the gastrointestinal tract, that is, for peptic ulcer disease, gastritis and, of course, esophagitis. The diet should be gentle, preventing damage to the mucous membrane.
The diet should be kept for about 3-5 months.Such a long period helps to heal ulcers and restore damaged mucous membranes, that is, recover from the disease. During the period of proper nutrition, many will transform, lose weight, the skin will become clear from rashes, and the hair will be silky. The therapeutic diet must be followed after recovery, since the ailment may return, since the true causes of the ailment do not lend themselves to therapy.
Diet for reflux esophagitis
Diet for reflux esophagitis is one of the main methods of treatment; without it, drug therapy and other procedures are ineffective.When upset, gastric juice is thrown into the esophagus and irritates the walls of the mucous membrane. Belching appears, and a burning sensation in the chest after eating.
As a rule, treatment is based on finding out the cause of the disease and eliminating it. But with reflux esophagitis, this method may not work. After all, it occurs due to the underdevelopment of certain nerve endings or as a concomitant disease with gastritis or ulcers. Therefore, most doctors consider diet to be the most effective means of correcting the patient’s condition during long-term treatment.
It is necessary to eat often, but in small portions. It is forbidden to eat foods that increase acidity. It is not recommended to take a horizontal position after eating. Since this position of the body with a weak valve between the stomach and the esophagus passes gastric juice and irritates the esophagus.
, , , 
Diet for esophagitis and gastritis
A diet for esophagitis and gastritis is a way to restore the normal functioning of the gastrointestinal tract.The main symptoms of the disease are belching and soreness in the abdomen after eating. Eating involves avoiding fried, fatty, salty, spicy foods and foods that cause gas production.
Particular attention should be paid to drinking. It is better to give up carbonated drinks and sugary water with dyes. Preference should be given to natural freshly squeezed juices and herbal decoctions. The diet should contain fresh fruits and vegetables, herbs, dairy and whole grains.It is better to eat often, but in small portions. One meal every 3-4 hours is enough. You can not starve and overeat, as this aggravates the course of the disease and causes painful sensations.
, , , 
Diet for erosive esophagitis
Diet with erosive esophagitis allows you to get rid of discomfort after eating, belching and frequent painful hiccups. Without the necessary treatment, pain will appear when swallowing, causing nausea, discomfort behind the breastbone (most often occurs in the supine position), night cough, pressing feeling at the top of the stomach.In the absence of therapy, serious complications are possible: bleeding and shortening of the esophagus, narrowing of the lumen, peritonitis, malignant tumors and even death.
In addition to dietary nutrition, the recommendations for drug therapy prescribed by the doctor should be adhered to. You need to eat often, but little by little, avoid fasting and give up late snacks. The last meal should be at least 3-4 hours before bedtime. It is forbidden to eat hot food, as it irritates the esophagus.If there are such bad habits as smoking or alcoholism, then they also aggravate the pathological disorder and its symptoms.
, , , 
Diet for GERD with esophagitis
Diet for GERD with Esophagitis provides nutritional guidelines to help manage the symptoms of gastroesophageal reflux disease. Patients are prescribed dietary table No. 1, used for gastric lesions. Basic nutritional rules:
- You need to eat often, but in small portions, 4-6 meals a day are enough.
- The break between meals should not be longer than 3-4 hours.
- Drink a glass of purified water 30 minutes before meals.
- Eat only warm meals, preferably boiled, steamed or baked.
- Do not overuse salt and various spices. Do not add mayonnaise, mustard, hot sauces or ketchup to your meals.
Compliance with these simple rules will restore the normal functioning of the body and the gastrointestinal tract.
, , , 
Diet for catarrhal esophagitis
The diet for catarrhal esophagitis is a diet that eliminates the painful symptoms of the disorder. This pathology can lead to edema and hyperemia of the esophagus and the junction with the stomach. Most often, the disease is found in lovers of spicy and smoked food and people who abuse pickles and pickled foods. Symptoms cause dull, aching pain in the sternum and stomach, discomfort when swallowing.In addition, nausea, hiccups and regurgitation with air or a sour taste are possible.
Treatment begins with a course of medicines and drugs for heartburn. Medicines to envelop and protect the gastric mucosa are mandatory. Patients are prescribed vitamin preparations. Food should be rich in plant and protein foods. When drawing up a diet, it is recommended to adhere to the rules described in the dietary table No. 1 according to Pevzner.
Diet for candidal esophagitis
The diet for candidal esophagitis is a nutritional complex for eliminating the disorder caused by a fungal infection.If there is a suspicion of an ailment, then patients are prescribed esophagoscopy. During the procedure, you can see a white film on the mucous membrane of the stomach and esophagus or curdled plaque. Feelings with candidiasis, such as when food gets stuck in the larynx and esophagus. Vomiting and heartburn are common.
Treatment begins in a hospital under the supervision of doctors. Food is prescribed after a short hunger strike (1-2 days) and is introduced gradually; in case of complications, it can be fed through a tube. To achieve a therapeutic effect, diet number 1 is recommended.It is rarely possible to cure candidal esophagitis to the end, since fungi live with us in a symbiont. With a weakening of the immune system, stress, ailments and a general decline in strength, the disease can return. Try to eat a healthy diet and get rid of bad habits.
, , , 
Diet menu for esophagitis
The diet menu for esophagitis provides for the rejection of many products. But do not be upset, because even with a limited food set, you can make up a complete diet.
- A glass of green tea, kefir or liquid yogurt.
- Buckwheat or oatmeal with fruit.
- Soup with vegetable broth.
- Baked fish or chicken breast with vegetables.
- Fresh vegetable salad.
- Baked apple.
- Fresh cottage cheese with a spoonful of sour cream.
- Cauliflower puree soup with cream.
- Steamed beef or chicken cutlet.
- Baked vegetables.
- Banana with curd.
- Bran bread.
- A glass of kefir or warm milk.
Diet recipes for esophagitis
Diet recipes for esophagitis help to diversify the diet not only with healthy, but also delicious dishes. Let’s look at a few simple recipes that can be used for medicinal purposes:
- Milk – 1 liter
- Pumpkin – 500 g
- Sugar – 150 g
- Butter – 20 g
- Raisins and dried apricots – 50 g
Peel the pumpkin, cut, draw out the seeds and cut into small pieces.Boil it in milk until soft, add dried fruits. Grind the contents of the pan with a blender, add a little sugar and butter. Add more milk if needed. Such porridge is very useful for the stomach, it does not irritate the mucous membranes. Pumpkin is a natural antioxidant, rich in vitamins and minerals.
- Fresh zucchini – 2-3 pcs.
- Hard cheese (low% fat) – 100 g.
- Carrots – 1-2 pcs.
- Cauliflower – 200-300 g
- Corn – 50 g
- Eggs – 2 pcs.
- Sour cream – 100 g
Wash the courgettes, cut into two parts. Gently take out the middle and chop it. Cut the carrots and cheese into small cubes. Disassemble the cauliflower into inflorescences. Mix all products, add eggs and a little sour cream. Spread the mixture over the zucchini boats. All this should be baked in the oven at 180-200 degrees for 30-40 minutes. The boats will turn out to be very tasty and healthy for the stomach.
- Pink grapefruit – 1-2 pcs.
- Honey – 50 g
- Vanilla sugar
Wash the fruit and cut it in half. Mix honey with cinnamon and vanilla sugar. Using a knife, make small cuts in the pulp, put the filling in them. We send the future dessert to the oven for 20-30 minutes at a temperature of 180-200 degrees. The dish can also be cooked in the microwave at maximum temperature for 7-10 minutes.
Diet for esophagitis helps to cure inflammation of the esophagus and gastrointestinal tract.Therapeutic nutrition strengthens and heals, restores the normal functioning of all organs and systems.
Diet for esophagitis of the esophagus and reflux – recipes
Since the inception of dietetics, the approach to proper and nutritious nutrition for any disease has changed depending on the manifestations of the disease. Nowadays, the word diet no longer scares people who care about their health. Everyone knows that diet food can be delicious and will not affect your overall well-being.
This rule works especially well in the case when not the general principles of medical nutrition are followed, but the recommendations in accordance with the specific disease.For example, if a person knows the peculiarities of the diet for reflux esophagitis, this is the key to a full recovery and long-term remission.
Nutrition rules for reflux esophagitis
Due to the lack of the proper amount of time for each patient, at the appointment, doctors do not focus on the specifics of the diet. Rare general phrases about the principles of adherence to a diet with esophagitis reach a person suffering from an inflammatory process of the esophagus. Attempts to comply with such recommendations do not always lead to the desired result, so many people forget about them.
What is important to remember and what rules cannot be ignored when treating esophagitis?
- Food for reflux esophagitis should be fractional and in small portions, it is better to use small plates so that you do not feel that you have eaten too little.
- After eating, do not go to bed, jump, run or engage in active sports. Moderate walking is permitted. The last meal should be at least 2.5 hours before bedtime.
- You will have to forget about alcohol, coffee and carbonated drinks for the entire treatment period or longer.
- Fatty, spicy, smoked, sweet and very salty foods will need to be excluded from the diet.
At first glance, it seems that such a painful treatment with the restriction of everything loved and tasty will only worsen the state of health, but this is not so. These recommendations were developed primarily to get rid of the frequent symptoms of reflux esophagitis and to alleviate the condition. They play an important role in treatment.
As for specific foods for keeping a diet, one thing must be remembered here – their choice depends on the individual characteristics of the organism, the tolerance of substances, – different people react to the same dish in their own way. What you can eat with reflux esophagitis is often determined by everyone by trial and error. The presence or absence of heartburn is often an indicator of how the stomach reacts to food.
What can and cannot be eaten with reflux esophagitis
Why are all the above foods excluded? They weaken the work of the round lower esophageal muscle (sphincter), which should fully close after food enters the stomach. Plus, your favorite treats irritate and contribute to inflammation of the mucous membrane of the esophagus and stomach, impairing their work during the period of illness.In order not to harm yourself, it is better to prepare properly. Therefore, we will find out in a little more detail how to eat, observing a therapeutic diet in the proposed conditions.
Sour vegetable and rich first courses should be avoided. Red borsch, cabbage soup, pea, bean and mushroom soups are contraindicated – they are heavy food for the esophagus and stomach.
In the menu for reflux esophagitis, you can add puree soups, noodles soup, dairy and fruit first courses, vegetarian with vegetables.You can eat fish and chicken soups, but you cannot fry the ingredients.
Meat rolls, jellied meat, lard, beef, pork, duck and smoked sausages are temporarily prohibited. Do not eat fatty fish: catfish, sturgeon. Let’s forget cream, fatty dairy products and spicy cheese for a while.
What can you eat?
- It is allowed to eat veal, rabbit, chicken in the form of steamed cutlets, meatballs, dumplings, soufflés, casseroles.
- Beef sausages, diet and doctor sausages – in small quantities.
- Fresh fat-free cottage cheese (not the lowest percentage), kefir, yogurt and milk can be included in the diet for exacerbation of reflux esophagitis. Sour cream is allowed only for dressing dishes.
- You can fish stewed and boiled: herring, pollock, cod, carp, perch, pike perch.
- Eggs are recommended to be used mainly for cooking or in the form of steam omelets no more than twice a week.
Side dish for meat
Here we will talk about cereals, potatoes and pasta.
Any products fried, and at the time of aggravation and baked are excluded.
What is possible? Potatoes are included in the diet for esophagitis of the esophagus and reflux. Recipes from it are allowed in boiled or pureed form without adding oil and raw eggs, you can boiled dumplings. Gradually, it is allowed to introduce casseroles with potatoes into the diet.
Porridge on the water: buckwheat, oatmeal, rice, semolina. If the body accepts milk well, not very sweet milk cereals are also allowed, but not often.It is allowed to add dried fruits to them.
Boiled vermicelli and pasta, seasoning with animal fats is not recommended, you can add a spoonful of vegetable oil.
Fruits, vegetables and greens
Raw fruits and vegetables in the acute period of the development of esophagitis is better not to eat them – they can irritate the esophagus. But baked and boiled is almost unlimited. When the symptoms of the disease have subsided, gradually add raw fruits and vegetables of local origin to the menu so as not to harm the body.You can not eat sour unripe fruits, nuts are temporarily prohibited.
Greens – not limited.
As for vegetables, the situation is different. The following vegetables are prohibited while dieting:
- raw onions and garlic;
- legumes, other than green peas;
- any tomatoes are prohibited.
Cake, pastries, chocolate, marshmallow, honey, jam, candy and ice cream are not allowed. But in rare cases, as an exception, after a full meal, you can eat a small piece of cake or candy.On an empty stomach, such foods are strictly prohibited.
Desserts in the form of jellies, soufflés and creams are allowed. Baked fruits with berries can be added to the diet, as well as boiled mashed ones. You can make cookies from uncooked dough, marmalade and marshmallow no more than two pieces a day.
Sample menu for reflux esophagitis
With reflux esophagitis, you can develop a sample menu for a week with a nutritionist. For a day, it should look something like this.
- Breakfast: milk oatmeal porridge with raisins, dried apricots and prunes.A glass of herbal tea with one spoonful of sugar and a piece of marshmallow.
- Second breakfast – cottage cheese with sour cream and compote.
- Lunch: vegetable puree soup with chicken and herbs, boiled noodles with omelet, rosehip broth with cookies.
- For an afternoon snack, it is recommended to eat a baked apple with berries and sugar with tea or compote.
- Dinner can consist of a piece of fish baked (or boiled) in sour cream sauce with potatoes or vegetable salad. Drink – tea or compote with a slice of white bread.
- For the second dinner, it is recommended to drink a glass of milk or kefir with cookies.
In any case, each dish can be varied with herbs, natural spices and sauces.
Reflux esophagitis is not a terrible disease in which you have to drive yourself into a rigid framework and eat only bread, cereals and water. With a careful approach to diet, the menu is supplemented with healthy and tasty products that will not worsen your well-being and help you recover.
Gastroesophageal reflux with esophagitis treatment in St. Petersburg, price
Esophagitis is one of the most common diseases of the esophagus.Multiple retrograde intake of the contents of the lower gastrointestinal tract into the esophagus may cause the development of chronic inflammation of the esophageal mucosa.
The term “reflux esophagitis” was first used by Allison in 1951. Today, the term reflux esophagitis is most commonly used by both surgeons and therapists, although definitions such as “peptic esophagitis” or “reflux disease” are also used.
Clinical presentation of gastroesophageal reflux with esophagitis
Initially, all clinical manifestations of this disease were associated with the presence of hiatal hernia in patients. However, not all patients with hiatal hernia have signs of esophagitis.
I. The first and most important violation is the loss of an adequate barrier function of the cardia, which under normal conditions is provided by a complex of anatomical and physiological factors.
- 1. The diaphragmatic component is formed by the legs of the diaphragm, which have a rather variable structure, which determines the size of the esophageal opening of the diaphragm and the transmission of contractions of the diaphragm to the wall of the esophagus at this level.
- 2. The valve component t (Gubarev’s valve) is formed due to the acute angle of His formed by the esophagus and the fundus of the stomach, the gas bubble of the fundus of the stomach and positive intra-abdominal pressure, forcing the abdominal segment of the esophagus to collapse.Any disturbance in the normal anatomical relationships in this area leads to a decrease in the ability of the cardia to prevent pathological gastroesophageal reflux. In particular, such disorders inevitably occur during the formation of sliding hiatal hernias.
- 3. The muscle component of the obturator mechanism of the cardia is provided by a relatively small segment of the distal esophagus located below the diaphragm. This segment of the esophagus is called the lower esophageal sphincter.Violation of its function can occur due to various reasons. Sometimes it can be a traumatic injury to the esophagus. In some cases, the triggering factor causing damage is mental stress. These mechanisms are still poorly understood today.
II. The second most important factor influencing the development of gastroesophageal reflux with esophagitis in the presence of pathological gastroesophageal reflux is the duration of contact of substances entering the esophagus with its mucosa.
The mechanism of self-cleaning of the esophagus under normal conditions is provided by peristaltic waves. In the mechanism of impaired neuro-reflex regulation of esophageal peristalsis, progressive neuromuscular dystrophy of various origins can play a role, and the consequences of stress exposure, and in some cases, organic damage to the esophageal wall.
III. The next damaging factor is the aggressive properties of substances that enter the esophagus retrogradely.
1. Acid Reflux . Numerous studies have proven that the incidence of reflux esophagitis is directly proportional to the level of acid production in the stomach. With increased production of hydrochloric acid in the stomach, reflux esophagitis is detected in 54% of those examined.
2. Alkaline reflux . With pronounced disorders of the motility of the gastrointestinal tract, duodenostasis, duodenogastroesophageal reflux may occur, in which the contents of the duodenum can be thrown into the esophagus, practically without mixing with the contents of the stomach.
Thus, reflux esophagitis can develop as an independent disease. However, its combination with other pathological changes is revealed much more often. The most common combination of reflux esophagitis with hiatal hernia . According to the literature, it is found in 80% of patients with sliding hiatal hernias. The reason for this frequent combination is a violation of the anatomical relationships in the area of the esophageal-gastric junction, which almost always occurs even with small hernias.
In 63% of cases, reflux esophagitis complicates the course of peptic ulcer disease duodenal ulcer. It is duodenal ulcers that are accompanied by increased acid production in the stomach, an increase in the total volume of gastric secretion, frequent development of motor-evacuation disorders caused by stenosis of the pyloroduodenal zone or chronic violation of duodenal patency.
The combination of reflux esophagitis, duodenal ulcer and hiatal hernia has received the name of the Carver triad in the literature after the author who first described it in detail.
Symptoms of gastroesophageal reflux with esophagitis
Typical symptoms that indicate the presence of inflammation in the lining of the esophagus are heartburn and chest pain. The subjective sensation of heartburn occurs when there are inflammatory changes in the mucous membrane. In some cases, patients have excessive salivation, which is explained by a reflex reaction to irritation of the esophagus. Symptoms such as regurgitation, belching indicate a failure of the cardia closure mechanism.Dysphagia (swallowing disorder) usually occurs in the later stages of the disease, when esophageal stricture begins to form.
The course of reflux esophagitis can become complicated. The most serious complications can be of three types.
- The development of chronic pneumonia, bronchitis is associated with regular aspiration of the contents of the gastrointestinal tract due to a failure of the cardia closure mechanism.
The subjective feelings of patients do not always correspond to the actual changes in the esophagus. Therefore, it is impossible to draw conclusions about the severity of the disease, based only on complaints.
In order to fully establish the degree and causes of the development of the disease, it is necessary to answer a number of questions:
- 1. Is there pathological gastroesophageal reflux?
- 2.Is it the cause of the patient’s complaints?
- 3. Are there any changes in the esophageal mucosa?
- 4. Are there any disorders of esophageal motility?
Changes in the esophageal mucosa and their degree can be easily established using endoscopic examination. In addition, FGDS allows you to identify a hiatal hernia, determine the acidity of gastric contents and perform a targeted biopsy.
Evaluation of esophageal motility, confirmation of hiatal hernia, cardia tone, condition of the fornix of the stomach and His angle, length of the abdominal segment of the esophagus and the degree of reflux can be determined using X-ray examination.
When examining patients with chronic esophagitis, two points are fundamental. The first is the exclusion of pathology from the heart, often accompanied by chest pain. The second exception to the disease is known as Barrett’s esophagus. Clinically, it manifests itself with symptoms characteristic of reflux esophagitis. But at the same time, the prognosis is much more serious, since Barrett’s esophagus is considered a precancerous condition.
The diagnostic departments of our clinic allow you to carry out a full examination.
Treatment of gastroesophageal reflux with esophagitis
I. Conservative treatment
According to the literature, up to 90% of patients with uncomplicated forms of reflux esophagitis can be cured by conservative methods. First of all, these are dietary restrictions. It is necessary to refrain from bad habits, since smoking and drinking alcohol not only irritates the mucous membrane, but also leads to dysfunction of the esophageal sphincter. You can get recommendations on drug therapy by signing up for a consultation.
II. Reflux Surgical Treatment
The indications for surgical treatment are:
- Ineffectiveness of intensive conservative therapy, manifested by persistence of excruciating heartburn or pain, progression of the disease or the addition of complications.
- Ulcerative reflux esophagitis in the absence of positive dynamics after a course of intensive treatment.
- Complicated reflux esophagitis (bleeding, pneumonia, bronchitis).
The goal of surgical treatment for reflux esophagitis is to eliminate pathological gastroesophageal reflux. Today, in world practice, a number of operations of varying degrees of complexity are used. In our opinion, the risk of surgery should not exceed the risk of the disease itself. When choosing the scope of the operation, we take into account the severity of reflux esophagitis, the degree of violation of the size of the esophageal opening of the diaphragm and the angle of His. We give preference to Nissen fundoplication.In this operation, a circular cuff is formed by stitching the anterior and posterior walls of the stomach around the abdominal segment of the esophagus. If necessary, in addition, posterior cruraphy is performed (reducing the size of the esophageal opening of the diaphragm by suturing the posterior legs of the diaphragm).
In our Clinic, most of these operations are performed endovideosurgically (laparoscopically). In this case, the hospital stay after the operation is reduced to 1-2 days.You can clarify the expediency of surgical treatment and choose the optimal method by passing an examination and consulting a specialist.
Gastroesophageal reflux disease – Network of MC “Doctor Bogolyubov”
Gastroesophageal reflux disease (GERD) is 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 turned for 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 unpleasant sensations. If such phenomena are repetitive and cause irritation of the esophagus, we can talk about 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.
The main manifestation of gastroesophageal reflux disease is chronic heartburn or sour belching, which usually occurs after eating, or at night, or when bending the trunk forward, or lifting a weight.
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 carry out 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 resisting 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
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
Gastroesophageal reflux disease (GERD) occurs as a result of the throwing of aggressive gastric or intestinal contents into the esophagus with the development of erosive and ulcerative changes and / or functional disorders in it.Depending on the severity and prevalence of inflammation, five degrees of reflux esophagitis (RE) are distinguished, but they are differentiated only on the basis of the results of endoscopic examination.
Primary compulsory examinations
General blood test, blood group and Rh factor, fecal occult blood test, general urine test, blood serum iron, electrocardiography, esophagogastroscopy.
Other studies are carried out according to indications: daily monitoring of the pH of the upper digestive tract, ultrasound of the abdominal organs and others.Consultations of specialists are appointed according to indications.
Symptoms, syndromes, physical status
Complaints: heartburn, burning sensation behind the breastbone and their intensification after eating, in the supine position, when the trunk is tilted, physical exertion; sour and bitter eructations, throwing sour and bitter contents into the mouth, excessive salivation during sleep, burning sensation in the throat with an unpleasant taste and excessive mucus formation in the larynx; recurrent chest pain, which sometimes resembles angina pectoris; feeling of a lump in the throat, pain in the ear and jaw, cough, hoarseness, bad breath.The listed symptoms in GERD occur with different frequency and severity, and under the influence of the regimen and adequate drug treatment, they can disappear.
Physical status: phenomena of pharyngitis, esophagitis of varying severity.
Long-term intraesophageal pH-metry. The presence of reflux is indicated by a drop in intraesophageal pH below 4, reflux is considered pathological if its duration exceeds 5 minutes
Distinguish between endoscopically positive and endoscopically negative GERD.This unit is of great importance in the choice of treatment tactics.
Non-erosive GERD or endoscopically negative (in which there are symptoms, reflux has been proven, but esophagitis is absent) occurs in about 60% of patients.
In non-erosive GERD, atypical manifestations (cardiac, larigophageal, pulmonary) are more often observed, and also significantly more often as a concomitant disease occurs irritable bowel syndrome.
Erosive GERD or endoscopically positive (symptomatic and proven reflux esophagitis) occurs in about 40% of patients.
90,000 Gastroesophageal reflux disease (GERD). Causes, symptoms, treatment in Mariupol
GERD-gastroesophageal reflux disease.
Gastroesophageal reflux disease (GERD) is one of the most common chronic diseases of the gastrointestinal tract, which occurs due to insufficiency of the lower esophageal sphincter and in 25-50% of cases requires the use of acid-lowering drugs throughout life.
The beginning of the third millennium is characterized by the rapid growth of GERD in the developed countries of the world (4-5 times), which allows us to consider it as a kind of “problem of the third millennium”. It is believed that this may be due to the high prevalence of obesity, a risk factor for GERD, as well as to a sedentary lifestyle and changes in food composition. In developed countries of the world, which include Ukraine and Mariupol, the prevalence of GERD can reach 40-50% among the entire adult population.
Definition and classification of GERD
GERD is a chronic disease caused by the discharge of gastric contents into the esophagus, which leads to symptoms that worsen the patient’s quality of life, regardless of whether they are accompanied by visible damage to the esophageal wall or not.
GERD was recognized as a separate nosological entity in the mid-1930s, and in 1946 Allison first coined the term reflux esophagitis, recognizing that irritating gastric juice is thrown into the esophagus and causes damage there.Over time, when clinicians became more familiar with this pathology, it became clear that most patients with reflux symptoms do not have endoscopic mucosal changes.
Therefore, at present, there are two main clinical forms of GERD – erosive, which can be accompanied by complications, and non-erosive, for which extraesophageal manifestations are more characteristic. Traditionally, Barrett’s esophagus is considered a complication of GERD.
For the classification of erosive GERD, the Los Angeles classification of reflux esophagitis (1998.), according to which there are 4 degrees of their severity – A, B, C and D.
Grading of reflux esophagitis by severity has a great reflux esophagitis value in determining the tactics and timing of their treatment.
1. Erosive GERD (endoscopically positive variant, GERD with esophagitis) – about 35% of all cases.
Complications of erosive GERD:
- Peptic ulcer of the esophagus
- Esophageal strictures.
2. Non-erosive GERD (NERD, endoscopically negative variant, GERD
without esophagitis, symptomatic GERD) – about 60% of cases.
3. Barrett’s esophagus (intestinal metaplasia of incomplete type in the distal esophagus).
The manifestations of GERD are classified into esophageal symptoms with or without damage to the esophagus, and extraesophageal symptoms with established or suspected association.
The causes of GERD are different:
The leading factor is the dysfunction of the lower esophageal sphincter (LES).
diaphragmatic hernia. The main anatomical cause of LPS insufficiency is a diaphragmatic hernia.Other factors are obesity, pregnancy, smoking, various dietary factors, flatulence, duodenostasis, the presence of inflammatory diseases of the digestive system (peptic ulcers, pancreatitis, cholecystitis), the use of drugs that reduce the tone of the LPS (nitrates, Ca antagonists, beta-blockers, theophylline, etc. .), scleroderma, surgery or pneumocardiodilation, etc.
The main factor in the development of symptoms of GERD and damage to the esophagus is hydrochloric acid.Traditionally, the severity of damage to the esophagus is thought to be directly related to the duration of exposure to the acid in the esophagus.
Erosive and non-erosive GERD
As mentioned above, there are two main clinical forms of GERD – erosive, which may be accompanied by complications, and non-erosive, which are more characteristic of extraesophageal manifestations.
Heartburn and sour belching (regurgitation) are characteristic of the typical symptoms of GERD.
Heartburn is a burning sensation behind the breastbone that spreads up towards the neck.It manifests itself as a result of prolonged contact of acidic gastric contents (pH <4) with the esophageal mucosa.
Acid regurgitation is described as a sensation of backflow of gastric contents with the formation of a sour taste in the mouth.
It is believed that the likelihood of GERD is high if heartburn occurs with a frequency of at least 2 times a week, but it cannot be ruled out with a lower frequency of heartburn. Thus, patients who develop symptoms at a frequency of twice a week for 4 to 8 weeks or more should be considered as having GERD.
The frequency and intensity of symptoms are not predictors of the presence or absence of esophagitis. Therefore, it is impossible to distinguish between erosive GERD and NERD on the basis of symptoms alone. However, the duration of the disease is associated with an increased risk of developing Barrett’s esophagus, a condition in which the risk of developing esophageal adenocarcinoma increases 50-100 times.
The absence of typical symptoms does not exclude the diagnosis of GERD.
Atypical symptoms of GERD:
- Chest pain of non-cardiac origin
- Non-obstructive dysphagia
- Pulmonary: reflux-induced asthma, chronic cough,
- Recurrent pneumonia, idiopathic pulmonary fibrosis
- Otorhinolaryngological: hoarseness, posterior chronic laryngitis, pharyngitis, chronic sinusitis, recurrent otitis media, otalgia
- Dental: damage to tooth enamel, halitosis (bad breath)
Extraesophageal symptoms and syndromes in GERD are associated with mechanisms such as the direct action of refluxate, esophagobronchial reflex.
Diagnostics and diagnostic criteria of GERD.
Methods for the diagnosis of GERD. which can be divided into non-invasive and invasive.
Based on modern approaches, GERD should be attributed to diseases in which the emphasis is not on instrumental or laboratory diagnostics, but primarily on the clinic (patient complaints).
Methods for the diagnosis of GERD
- Assessment of clinical manifestations
- API Test
- X-ray examination
- Esophageal scintigraphy
- Upper endoscopy (including chromoendoscopy with biopsy for suspected Barrett’s esophagus)
- 24-hour intraesophageal pH monitoring
- 4 hour impedance pH monitoring
- 8-hour esophageal monitoring with Bravo
- Esophageal manometry
- Intragastric pH-metry (to assess the risk of developing GERD and the effectiveness of its treatment)
In the absence of anxiety symptoms in young patients (up to 40 years old, in the USA – up to 50 years) with a heartburn duration of up to 5 years, EGD is not performed and the diagnosis of GERD should be preliminarily exposed to the patient based on the presence of typical symptoms – heartburn and / or regurgitation.
Anxiety symptoms requiring mandatory endoscopy in GERD
- Weight Loss
- Gastrointestinal bleeding
- Nausea and vomiting
Since GERD questioning is of great clinical importance, many countries use heartburn questionnaires for the early detection of GERD. The sensitivity of this method in comparison with instrumental methods (endoscopy of the esophagus and monitoring of intraesophageal pH) is, according to various authors, from 73% to 92%.Table 7.6 shows one such questionnaire. If the patient answers “Yes” to at least one of the questions presented, then most likely he has GERD.
- Do you often experience heartburn (a burning sensation that spreads from the stomach or from the bottom of the chest up towards the neck)?
- Does heartburn interrupt your sleep?
- Does it happen that food is swallowed with difficulty or painful?
- Does it sometimes happen that the eaten food comes back into the mouth?
- Do you often get a sour taste in your mouth?
- Do you have a habit of drinking alkaline mineral water, soda, milk or antacids after meals?
- Do you often feel a burning sensation behind the breastbone or do you have sour (or airy) eructations?
- Do you have any discomfort and / or pain in the upper abdomen and / or behind the breastbone?
- Do these symptoms get worse after lying down or leaning forward?
After GERD is suspected based on patient complaints, empiric treatment with one of the proton pump inhibitors at full dose should be initiated.
Test and proton pump inhibitor (PPI test).
Consists of an empirical 2-week appointment of a standard dose of omeprazole (20 mg) and an assessment of the results of treatment. The sensitivity of the PPI test in the diagnosis of GERD (NERD) is 70-80%. The undoubted advantages of the PPI test include non-invasiveness and harmlessness, as well as a pronounced therapeutic effect in the presence of GERD. Moreover, in many cases, the PPI test is positive (complete disappearance of symptoms) when the presence of GERD is not confirmed by any other instrumental methods.That is, in such cases, it can be considered as a diagnostic method of choice.
The sensitivity of the PPI test depends on which drug is used and at what dose. The results of the PPI test using the most powerful PPIs – rabeprazole (Parieta) and esomeprazole (Nexium) in the diagnosis of GERD with high reliability can be assessed as early as 3-4 days of PPI intake. A positive PPI test serves as an indirect confirmation of the diagnosis of GERD.
Unfortunately, routine esophagoscopy in NERD not only does not provide diagnostic help, but can be a factor that negatively affects the formation of the correct diagnosis and appropriate treatment, since such patients do not have visually detectable changes in the esophagus.Therefore, in many cases, in a typical GERD clinic, special endoscopy is not required.
According to current concepts, endoscopy for GERD is usually indicated only in certain cases.
The main goal of endoscopy is to establish the degree of reflux esophagitis, which is necessary to determine the dose of PPIs and the duration of treatment, to identify Barrett’s esophagus or esophageal adenocarcinoma, to identify non-reflux causes of heartburn (esophagitis of various origins, etc.).
Indications for endoscopy / esophageal biopsy in GERD:
- Presence of alarming symptoms
- Persons over 40 years old
- Long-term medical history (5 years or more)
- Failure of treatment with double doses of PPI
- Unclear diagnosis or atypical symptoms
- Establishment / confirmation of Barrett’s esophagus and esophageal adenocarcinoma
- Establishment of non-reflux causes of heartburn (non-reflux esophagitis, etc.)
- In the complex of preoperative preparation
If Barrett’s esophagus is suspected, especially with a long history of disease, methylene blue chromoendoscopy is indicated. The purpose of chromoendoscopy is to identify selectively stained areas of intestinal metaplasia and subsequent biopsy of these areas.
24-hour intraesophageal pH monitoring.
This method is the main method for confirming GERD, allowing you to prove the relationship of symptoms (both typical and atypical) with gastroesophageal reflux.
Today, pH monitoring is considered as the most effective method for confirming GERD and is approaching the “gold standard”.
48-hour probeless pH monitoring (Bravo capsule).
The most accurate data are obtained with a radiotelemetric probeless pH test using the Bravo capsule, which allows you to extend the monitoring period up to 48 hours and is more comfortable for the patient, since it eliminates the discomfort associated with transnasal probe insertion.
Esophageal impedance monitoring.
Reflux is determined by recording changes in the electrical resistance of the intraluminal contents of the esophagus. It allows you to record reflux episodes, regardless of the pH of the refluxate, therefore, in combination with pH monitoring, it is considered the most informative method for diagnosing GERD.
- For typical symptoms of GERD (heartburn, regurgitation) in patients with a normal endoscopic picture who do not respond adequately to anti-secretory therapy (double doses of PPIs)
- For atypical extraesophageal symptoms likely to be associated with reflux disease (for initial diagnosis or after trial treatment):
- Chest pain suspected of esophageal origin
- Pulmonary symptoms – cough, asthma, re-aspiration pneumonia
- Otolaryngological symptoms – hoarseness, laryngitis.
- To assess the effectiveness of a treatment regimen (drug therapy, surgical treatment)
- Preoperative confirmation of GERD
Allows you to measure the pressure in the area of the lower esophageal sphincter (LES). Is of great importance in the differential diagnosis of GERD, especially in refractory GERD that does not respond to double doses of PPIs. Along with endoscopy, it is shown as a method for determining the localization of LPS before installing a pH sensor for daily monitoring.Intraoperative manometric control can significantly increase the efficiency of fundoplication.
Gastric pH-metry is informative for determining the effectiveness of treatment of GERD with antisecretory drugs, primarily PPIs. The effect on gastric acidity, calculated as a percentage of the time during the day when the pH exceeds 4.0, is an excellent marker of the effectiveness of PPIs in the treatment of GERD.
It should be remembered that heartburn can be observed in other diseases when there is no GERD.In such cases, it is necessary to carry out a differential diagnosis. If esophagitis is not of a reflux nature, then conditions such as drug esophagitis, certain skin diseases, eosinophilic esophagitis, which will be discussed in more detail below, in the section “refractory GERD”, should be considered. Inflammation of the esophagus can occur with Chagas disease or idiopathic achalasia due to stasis and food fermentation. This leads to heartburn unrelated to gastroesophageal reflux.In this situation, heartburn is usually associated with dysphagia and regurgitation of undigested food. Symptoms of non-erosive GERD may overlap with those of functional dyspepsia. The data of pH monitoring are of decisive importance, pathological gastroesophageal reflux testifies in favor of GERD.
In cases where there are no structural changes in the esophagus, and the data of pH-impedance monitoring and esophageal manometry are normal, the diagnosis of functional heartburn is made.
Treatment of GERD is a rather difficult task.This is because GERD is a chronic disease prone to recurrence.
It should be said that, correctly using the modern most powerful acid-lowering drugs – PPIs, it is not difficult to achieve a quick clinical effect and healing of erosive esophagitis in the vast majority of cases. However, the problem is that if the patient does not change his lifestyle and diet, after drug withdrawal, relapses of GERD occur in most patients.In this regard, in 25-50% of cases, the use of acid-lowering drugs is required throughout life.
The main goals of GERD treatment are the fastest elimination of clinical and endoscopic manifestations of the disease, elimination of existing complications and reduction of the risk of their occurrence, prevention of recurrence of the disease, and improvement of the quality of life of patients.
For this, along with lifestyle recommendations, drug therapy is used, and sometimes surgical treatment may be required.
Drug-free treatment for GERD.
In all cases, the patient should be advised to make lifestyle modifications to combat risk factors for GERD. First of all, it is necessary to exclude smoking and normalize body weight. You should avoid eating foods and drinks that contribute to increased production of stomach acid and relieve pressure in the area of the NPS, such as coffee, tea, cola, fatty, spicy foods, spices, pickles, citrus fruits, tomatoes, green onions, peppers, garlic, chocolate.Alcoholic beverages, sour fruit juices, dry wines, and beer are also contraindicated. Foods such as peas, beans, beans, cabbage contribute to increased gas production in the intestines, which leads to an increase in intra-abdominal pressure, therefore, it is advisable to refrain from using these products for patients with GERD.
Basic treatments for GERD
- Lifestyle modification (regimen and diet)
- H-histamine blockers
- Antacids (Maalox)
- Others (baclofen, prokinetics, ursodeoxycholic acid, cytoprotectors, cholestyramine, antidepressants, antispasmodics)
Surgical antireflux operations (fundoplication)
- Radiothermal destruction of NPS (Strett procedure)
- Introduction of a special polymer (Enterix) into NPS
- Installation of a special locking device
Patients should avoid overeating and not eating 2-3 hours before bedtime.Raising an elevated position in the bed and head of the bed using stands can significantly reduce the intensity of nocturnal refluxes. In this case, one must remember about one nuance. Reaching an elevated position of the torso with the help of several pillows, on the contrary, it is possible to increase the likelihood of reflux, since in this case the body bends somewhat, and intra-abdominal pressure increases, which contributes to the reverse reflux of gastric contents into the esophagus. Therefore, in order to raise the head end of the bed by 15-25 cm, it is enough to put something under its legs.
Patients should be warned about the undesirability of taking drugs that reduce the tone of the NPS (theophylline, progesterone, nitrates, calcium antagonists), and may themselves cause damage to the mucous membrane (non-steroidal anti-inflammatory drugs, doxycycline, quinidine). It is advisable to avoid stress on the abdominal muscles. work with an incline of the torso, wearing tight belts, belts, etc. However, these measures have a certain effect only in milder forms of GERD.In most cases, you have to resort to medication.
Drug treatment for GERD.
The most effective treatment for GERD is to reduce the aggressiveness of refluxate, that is, suppress the production or binding of acid. The less acid is retrogradely thrown into the distal esophagus, the faster and more completely the main clinical symptoms of GERD are stopped and the erosive changes in the esophagus heal.
Modern treatment of GERD is based on the principle of acid suppression: “the stronger the better.”
Regardless of the severity of symptoms and endoscopic presentation, all patients are subject to treatment.
The drugs of choice in the treatment of GERD are PPIs that can maintain intragastric pH for 16-18 hours a day. H, histamine blockers and antacids are used much less frequently.
In mild cases, antacids may be used for symptomatic treatment of episodic heartburn.
With what does the patient usually not go to the doctor?
COUGH, SNOW, LARINGITIS, HEADACHE AND … HEARTBURN.IT WOULD LIKE – THE COUGH MAY BE COLD, THE SMELL IS TEMPORARY ALLERGIC, THE VOICE CAN BE RIPPED, BUT HEARTBURN AND AT ALL – WHO DOESN’T HAVE IT WITH OUR DIET? HOWEVER, THE COLLECTION OF THESE SYMPTOMS, AND YET AND SUPPLIED WITH PAIN IN THE UNDERBAR (LIKE THE HEART PROMOTES) MEANS NOT COLD AT ALL, NOT ALLERGY AND NOT STENOCARDIA. In the overwhelming majority of cases, such a clinical picture occurs in GERD – gastroesophageal reflux disease.
GERD refers to acid-related diseases, and, as a rule, occurs due to the reflux of stomach acid into the esophagus.In fact, when the pressure in the esophageal sphincter decreases, the stomach releases acid into the lower third of the esophagus, which causes heartburn and pain. In addition, changes in the chemical composition of saliva and mucus, increased intra-abdominal pressure, and impaired gastric motility can contribute to gastroesophageal reflux.
Statistics show that the most prone to reflux are obese people, food lovers, especially nocturnal “gluttons”, heavy coffee drinkers, alcohol drinkers and heavy smokers.But in fact, it turns out that one of the provocateurs of insidious reflux disease is an increase in material well-being and an improvement in the quality of life – a person becomes shady, moves less, eats more. And given the dominance of advertising on television, he also self-medicates symptoms, not really understanding the causes of their occurrence.
And the enemy is in the rear!
Meanwhile, GERD, in terms of the number of manifestations completely, at first glance, unrelated to it, is almost a champion of deceit.After all, even bronchial asthma may not be a pulmonary disease at all, but a symptom of reflux! In the West, this disease has long been regarded as serious, requiring deep study. There is more and more information about this in open sources, as a result – more willingly referring patients, more correct diagnoses.
Domestic medicine is just getting used to the fact that a sore esophagus does not give rest to the throat. Why is GERD misdiagnosed? heartburn, for example, drugs indicated for asthmatics aimed at expanding the bronchi and making breathing easier, cause resistance.Of course, constantly taking them, the patient, who actually suffers from inflammation of the esophageal mucosa, does not get rid of the problem, but the drugs help him less and less. Meanwhile, the inflamed walls of the esophagus, which no one notices behind attacks of suffocation, continue to collapse, risking complications, including oncology. A dry, persistent cough for years should also alert. Complaints of frequent heartburn, especially at night. Often the disease is accompanied by night sweats.In addition, the obvious companions of reflux are sour belching, difficulty in the stomach – bloating, constipation, vomiting, nausea, a feeling of fast satiety when eating, heaviness in the stomach.
Sudden angina pectoris or pain in the heart, as well as in the epigastric region, should not be ignored, especially if these sensations are experienced immediately after eating. Pain in the region of the heart, or “pseudo coronary” pain, occurs quite often with inflammatory changes in the wall of the esophagus.Pain with GERD can cause spasm of the coronary arteries, thereby provoking an attack of reflex angina. There is even a saying among doctors: “If your patient is less than thirty-five years old and does not have heart defects, but it hurts, look for the cause in his stomach.”
One of the signs of the disease is a problematic oral cavity – an unpleasant odor, white plaque on the tongue, destruction of tooth enamel, gum damage. Yet again. – you can endlessly treat the symptoms at the dentist, without reaching the cause, lose all your teeth and never get rid of the problem.Because it does not lie on the surface, but deeper. And you need to stop it there. Undiagnosed and untreated GERD can cause complications such as pharyngitis, pneumonia, malignant lesions of the larynx and pharynx, vocal cords and much more. Therefore, it is imperative to exclude the ill-fated reflux in the treatment of ENT diseases and bronchopulmonary diseases.
Diagnosis of gastroesophageal reflux disease is carried out using pH-metry, endoscopic examination (gastroscopy) and biopsy of the mucous membrane.X-ray examination or gastroscopy can reveal a hiatal hernia, if any.
In uncomplicated forms of GERD, there may be episodes of heartburn that occur at least 2 times a week – a direct sign of GERD, then antisecretory drugs are prescribed. To reduce acidity in modern medicine, various groups of drugs are used: antacids and antisecretory agents (H2-blockers, M-anticholinergics, proton pump inhibitors).
To date, it has been proven that of all classes of antisecretory drugs, it is the PPI group that has a number of indisputable advantages. For example, antacids, which reduce the acidity of the stomach due to chemical interaction with hydrochloric acid, have a short duration. Absorbable acid-binding antacids often cause more acid production than complicate the situation rather than resolve it. Therefore, the use of non-absorbable antacids has become more popular.But even here it is not so simple: preparations of this group are aluminum-containing, which adversely affects the process of cleansing the intestines, in other words, they provoke constipation and even, accumulating excess aluminum ions in the body, can lead to hypophosphatemia. And by enveloping the walls of the stomach, nonabsorbable antacids make it difficult for the patient to absorb other drugs if they are needed.
Another group of drugs used in the treatment of GERD is histamine H2 receptor blockers, however, in comparison with PPIs, their effectiveness is much lower.It is also worth considering a number of undesirable side effects of H2-blockers that limit their use: rapid addiction to drugs of this group (when used for more than 2 weeks, the decrease in effectiveness by 50% or more, “rebound” syndrome, the occurrence of gynecomastia. The most unfavorable effect of H2-blockers is cicatricial healing of ulcerative defects due to suppression of the secretion of not only hydrochloric acid, but also other secretions of the mucous membranes, including protective factors Formation of cicatricial defects of the mucosa leads to frequent recurrence of ulcers.