Gastroesophageal reflux disease: causes, symptoms, treatment. Gastroesophageal reflux disease: how to recognize and cure? Gerb decoding medicine

Reflux disease of the stomach is a chronic pathology in which spontaneous reflux of the contents of the initial sections of the large intestine and stomach into the lower sections of the esophageal tube occurs, followed by the development of inflammation in the mucous membranes of the esophageal walls. In medicine, the pathology is abbreviated as GERD and stands for gastroesophageal reflux disease. Pathology is prone to frequent relapses, periods of exacerbation can be provoked by a violation of the regimen prescribed by the doctor, stress factors and other causes that provoke a violation of the digestive process.

Treatment of reflux disease can be both conservative and surgical. Surgery is usually required in cases where medical correction does not give the desired result, and the patient fails to achieve stable remission for a long period. Until now, not everyone understands the danger of GERD, so many ignore the treatment prescribed by a specialist and do not follow a therapeutic diet. This can lead to severe complications, such as peptic ulcer or grade 3-4 esophagitis. In order to prevent such life-threatening consequences, it is important to know the symptoms of the pathology and promptly seek help from a medical institution.

The main factor in the development of gastric reflux disease in patients of any age is insufficient tone of the muscle fibers that make up the lower esophageal sphincter that separates the organ cavity from the stomach. Against this background, the ability of the mucous membranes of the esophagus to withstand the harmful effects of acids and bile components contained in the contents of the stomach and intestines is reduced. The motility of the walls of the esophageal tube is disturbed, which also negatively affects the cleansing function and prevents the spontaneous removal of irritating agents from the esophageal cavity.

Another factor that can affect the evacuation function of the stomach and duodenum is an increase in intra-abdominal pressure - the force with which organs and fluid circulating in the peritoneal space press on the bottom of the peritoneum and its walls. The pressure can be increased during pregnancy or physical exertion, as well as in people who are overweight. An occupational factor in violation of normal intra-abdominal pressure is activity associated with work in an inclined position, therefore, gardeners, cleaners, storekeepers, loaders, etc. are at risk for the development of GERD.

Other causes that can provoke diseases include:

long-term tobacco dependence (more than 3 years);
a state of chronic stress associated with a professional or social environment;
non-compliance with the principles of healthy eating (abuse of spices, alcohol, fried foods);
taking drugs that increase the concentration of dopamine in peripheral vessels ("Pervitin", "Phenamine").

Note! The risk of gastroesophageal reflux disease increases in people over 40 years of age. At a younger age, the frequency of diagnosing pathology is about 21.9%.

Clinic of the disease and characteristic symptoms

GERD is a disease with mixed symptoms, so many patients perceive the initial manifestations of the pathology as symptoms of other diseases. Typical signs of gastric reflux almost always appear after eating: the interval between feeling worse and eating can be from 5 to 30 minutes. Symptoms are often manifested by sour belching with an unpleasant odor, as well as heartburn.

A characteristic sign of damage to the esophagus is a dull or burning pain in the solar plexus or behind the sternum. Its nature may vary depending on the amount of refluxant and the presence of various impurities and particles in it. Possible irradiation of painful sensations in the neck, interscapular space, lower jaw arch. Some patients describe the occurrence of pain in the left half of the sternum, but this irradiation is considered the least typical.

Other signs included in the GERD symptom complex are listed in the table.

Organs or organ system	What are the symptoms of reflux disease?
Respiratory system	Dry cough of moderate intensity that occurs when lying down. During coughing, the patient may experience increased discomfort and burning in the central part of the chest. Breathing in the supine position becomes superficial, shortness of breath often occurs
Gastrointestinal tract	The main manifestation of gastric reflux from the stomach and intestines is rapid satiety after taking a small amount of food, loss of appetite, weight instability. In such patients, increased flatulence is often observed, accompanied by the syndrome of flatulence - involuntary discharge of gases with a pungent odor. Many periodically experience nausea, vomiting is possible for no reason.
ENT organs	In the majority of patients with GERD, a white coating appears on the surface of the tongue, the timbre of the voice changes, a slight hoarseness appears, which can be perceived by patients as a sign of laryngitis. The mucous membranes of the oral cavity are dry, the patient constantly feels thirsty.

Note! In patients with various forms of gastric reflux disease, frequent recurrences of sinusitis (inflammation of the paranasal sinuses) and acute inflammation of the lymphoid tissue of the pharyngeal ring are noted. If these pathologies occur more often 1-2 times a year, it is necessary to undergo a comprehensive examination and exclude possible pathologies of the stomach and esophagus.

Diagnosis of reflux disease: what examinations need to be done?

The main methods for diagnosing GERD are endoscopic and x-ray examination of the esophagus. Endoscopy allows you to detect ulcers and erosive defects, evaluate the appearance and condition of the mucosa, its color, thickness, structure. During endoscopy, signs of an inflammatory and dystrophic process are clearly visible. X-rays are needed to reveal hernial protrusions in the part of the esophageal tube where it passes into the diaphragm, as well as pathological narrowing of the esophagus, leading to a significant decrease in the esophageal lumen (this condition is called esophageal stricture in medicine).

If radiography and endoscopy do not allow a complete clinical picture of the disease, the patient may be prescribed additional examinations, for example, esophagomanometry, which allows to assess the peristalsis of the walls of the esophagus, or a daily study of various refluxes of the esophagus, which include gas, acid, alkaline reflux. At the same time, daily monitoring of indicators of the acid-base environment and their relationship with various factors is carried out: taking specific medications, eating food and drinks, and physical activity.

If complex diagnostics revealed signs of GERD, the patient will have to follow a special diet and regimen. To correct the condition, drug treatment is also used, if it is ineffective, the patient will be prescribed surgical treatment.

Video: Gastroesophageal reflux disease (GERD) from the standpoint of Sergei Botkin

How to eat with gastroesophageal reflux disease?

Correction of nutrition in GERD is necessary to reduce the load on the walls of the esophagus, eliminate the negative consequences of the aggressive effects of gastric contents and stop the inflammatory process. The diet of a patient diagnosed with GERD must comply with the rules and norms of healthy and dietary nutrition, while certain foods are completely excluded from the human diet. It is important that a person receives a sufficient amount of vitamins, minerals and nutrients, so it is better to follow a personal diet compiled by the attending physician.

The main principles of nutrition for reflux disease of the stomach, recommended for all categories of patients, include the following recommendations:

you need to cook food without the use of oil, spices and seasonings;
permitted methods of heat treatment of products are boiling, steaming and baking and stewing;
it is recommended to eat 5-6 times a day (in some cases, the doctor may recommend very frequent meals in small portions - up to 10 times a day with an interval of 1-2 hours).

Compliance with the temperature regime is also of great importance: all dishes should have a comfortable temperature for consumption, not be too hot or cold. During the period of exacerbation, it is recommended to cook food that has a mushy or puree-like consistency.

What foods can't be eaten?

Patients with gastric reflux disease should not eat foods that can affect the level of acidity of the gastric environment, cause increased gas formation, or adversely affect the condition of the mucous membranes of the stomach and esophagus. Any carbonated drinks are prohibited, including beer and kvass, alcoholic drinks, marinades with the addition of apple and table vinegar. Canned food is allowed in small quantities, but only if they do not contain acetic or citric acid. When choosing meat, it is better to give preference to low-fat varieties: veal, beef tenderloin, turkey, rabbit meat. Very useful in diseases of the stomach lamb, as well as lamb. For chronic digestive problems, it is better to choose meat that is easily digested, such as quail.

From the diet of the patient should also be completely excluded:

sausage products;
oranges, lemons and other types of citrus;
products based on cocoa butter or cocoa beans (chocolate);
pepper;
fresh onions (allowed only in stewed or boiled form);
garlic;
sorrel;
coffee and strong tea.

Important! One of the main principles of GERD therapy is to maintain optimal weight, so obese people need to follow an individual nutrition plan, compiled in conjunction with an endocrinologist or nutritionist.

Video: Diet for GERD

How to treat reflux disease: drugs

Treatment of GERD is aimed at maintaining the motor function of the intestines and stomach, as well as normalizing the secretory activity of the gastrointestinal tract. The main group of drugs used for the conservative treatment of gastroesophageal disease are proton pump inhibitors. These are drugs that are used to treat acid-related diseases of the stomach and esophagus by reducing the synthesis of hydrochloric acid. The drugs of this group, as well as their dosage for the treatment of GERD, are presented in the table below.

Name of the drug	Image	Scheme of use in adults	Price
		20 mg once a day for 2-8 weeks	33 rubles
		20 mg once a day. The duration of treatment is from 4 to 8 weeks. If necessary, the daily dosage can be increased to 40 mg with the possibility of dividing into 2 doses.	115 rubles
		Up to 40 mg per day for 2 months	172 rubles
		20-40 mg 1 time per day. The minimum duration of therapy is 4 weeks	96 rubles
		20 to 40 mg per day for 6 to 8 weeks	53 rubles

Preparations from the group of proton pump inhibitors must be taken strictly in accordance with doctor's prescriptions or official instructions. With prolonged use, severe side effects may occur on the part of the respiratory system (bronchospasm), organs of vision and the musculoskeletal system. Elderly patients may require adjustment of the dosing regimen due to the high risk of systemic complications.

Heartburn medications

To combat the main symptom of GERD - heartburn - drugs from the antacid group are used: Rennie», « Gaviscon», « Maalox". Has a good therapeutic effect Almagel”: it not only eliminates heartburn, but also envelops the walls of the stomach and esophagus, protecting them from the corrosive effect of hydrochloric acid and accelerating the healing of erosive defects.

The composition of complex therapy may also include drugs that stimulate the peristalsis of the gastrointestinal tract. Tablets are the drug of choice in most cases. domperidone"from the group of blockers of central dopamine receptors. They effectively cope with vomiting and nausea, as well as functional dyspeptic symptoms that may be part of the symptom complex of gastric reflux disease.

The dosage for adult patients is 30 mg per day (3 tablets), which must be divided into 2-3 doses. Metabolites of the active substance are excreted from the body by the kidneys, so patients with various forms of renal failure require dose adjustment - no more than 10-20 mg per day.

As auxiliary components, the patient may be prescribed vitamin preparations (vitamins of group B). They have a positive effect on the state and structure of smooth muscle fibers that make up the walls of the digestive tract, and have a stimulating effect on their peristalsis. Vitamins of this group also contribute to the rapid healing and restoration of damaged mucous membranes.

Lifestyle of patients with GERD

Since one of the provoking factors in the development of gastric reflux disease is bad habits, it is important that the patient be able to limit the use or inhalation of toxic substances and vapors as much as possible. This applies primarily to smokers and patients with various forms of alcohol dependence. If the patient ignores the warnings of specialists and continues to lead an unhealthy lifestyle, the chances of a favorable prognosis for recovery and later life will be minimal. Such people should know that it is alcohol and tobacco smoke that in 19% of cases lead to a sudden exacerbation of the disease and the development of grade 3-4 esophagitis, when the only treatment is surgery.

Athletes who are diagnosed with GERD will need to adjust their exercise levels, as increased intra-abdominal pressure can cause a relapse of the disease. The same applies to those whose work involves systemic physical activity (especially forward bends). In order to reduce the load on the organs of the peritoneum, as well as its walls, it is not recommended to wear tight clothing, tight belts and belts.

During nighttime sleep, patients with impaired gastroesophageal reflux are advised to take a semi-recumbent position with several pillows under their heads. This is necessary to reduce the load on the organs of the peritoneal space and ensure normal motility of the esophagus and stomach.

Video: Treatment of GERD

If treatment doesn't help

In this case, the patient is shown surgical intervention. One of the most popular and effective methods of surgical treatment of GERD is the use of magnetic rings, which are fixed in the lower part of the esophageal tube and do not allow the contents of the stomach to enter the esophageal cavity. This method is not as traumatic as the fundoplication operation, but it cannot guarantee a complete recovery, so some patients have to take drugs from the proton pump blocker group for life.

Reflux disease of the stomach is a severe chronic pathology that in no case can be treated independently. Before taking any medications, it is necessary to conduct a comprehensive diagnosis and exclude the possibility of malignant tumors of the stomach and esophagus, which often have symptoms similar to those of diseases of the digestive system. you will find the answer in the link.

Gastroesophageal reflux disease (GERD) is a pathological condition caused by impaired motility of the upper gastrointestinal tract. It is formed as a result of reflux - regular reflux of the contents of the stomach or duodenum into the esophagus - causing the mucous surfaces of the esophagus.

What is GERD

What is this disease? GERD (gastroesophageal reflux disease, reflux) is the reflux of gastric or intestinal contents into the lumen of the esophagus. If reflux occurs immediately after a meal (infrequently) and is not accompanied by the development of a condition that is uncomfortable for the patient, then this is an acceptable physiological norm. But in the case of frequent occurrence of such a condition, accompanied by inflammation of the mucous surfaces of the esophagus, we can talk about the presence of gastroesophageal reflux.

Causes of the disease and provoking factors

Gastroesophageal reflux is the reverse movement of gastric contents into the lumen of the esophagus, due to impaired functionality of the closing sphincter. Reasons for the formation of GERD:

Fast food intake in large volumes. Simultaneously with eating, a person swallows a large amount of air, which causes an increase in intra-abdominal pressure and the development of reflux.
Lowering the tone of the lower esophageal sphincter, slow emptying of the stomach. This condition can be formed under the influence of the following factors: the toxic effects of nicotine, treatment with antispasmodics, analgesics, calcium antagonists, alcohol intake, the period of bearing a child.
Diaphragmatic hernia.
Ulcerative pathology of the 12 duodenal ulcer.
The presence in the diet of a large number of foods that increase intra-abdominal pressure - soda, fatty / fried / spicy foods.

The following factors can provoke gastroesophageal reflux disease:

professional activity of a person - a long stay of a person in a half-bent position;
frequent stressful situations;
abuse of nicotine and alcohol;
bearing a child;
the presence of extra pounds;
excessive consumption of coffee, fatty foods, chocolate, juices;
treatment with drugs that increase the concentration of dopamine.

Symptoms

Symptoms of gastroesophageal reflux are usually divided into two large groups - esophageal (esophageal) and extraesophageal. Esophagial manifestations are similar to signs of gastrointestinal motility (GIT). It:

heartburn - aggravated by bending over, lying down, after physical exertion, with overeating;
belching with a sour or bitter taste;
bouts of nausea ending in vomiting;
hiccups
regurgitation;
heaviness in the epigastric region that occurs after eating;
problems with swallowing;
pain behind the sternum, not caused by cardiac pathologies;
heavy breath odor;
increased production of saliva.

Esophageal manifestations of GERD also include damage to the structure of the esophagus. These are Barrett's esophagus, narrowing of the esophagus, reflux esophagitis, adenocarcinoma of the esophagus. Extraesophageal manifestations of GERD are caused by the ingestion of gastric contents into the respiratory tract.

Symptoms may be as follows: the development of pharyngitis, laryngitis, otitis media, runny nose, apnea (short respiratory arrest), cough, shortness of breath that occurs in a person in the supine position, coronary pain, resembling an angina attack, accompanied by arrhythmia.

GERD with esophagitis develops against the background of existing damage to the mucous surfaces of the esophagus. This is the formation of ulcers, inflammatory processes, pathological narrowing of the lower esophagus, a change in the state of the mucosa. Typical signs in this case: severe heartburn, belching with a sour taste, pain in the stomach, bouts of nausea.

GERD can develop not only in adults, but also in childhood, in particular, in infants. In the latter case, the pathogenesis (origin) of the disease is due to the immaturity of the closing sphincter.

Potential causes of gastroesophageal disease in children can be surgical interventions on the esophagus, gastric resection, cerebral palsy, difficult childbirth and high levels of intracranial pressure, and others.

General symptoms of GERD in children:

regurgitation (in infants) and belching;
poor appetite;
pain in the epigastric region;
capriciousness during feeding;
frequent vomiting;
hiccups
labored breathing;
nocturnal cough.

You can get more information about the course of GERD in childhood.

Classification

The classification of GERD is based on the presence/absence of symptoms of inflammatory processes in the esophagus. It is customary to distinguish the following subspecies. Nonerosive reflux disease. Approximately 70% are diagnosed. There are no symptoms of esophagitis. Ulcerative erosive form. Gastroesophageal reflux disease in this case is accompanied by narrowing of the esophagus and the formation of ulcers.

Barrett's esophagus. Against the background of esophagitis, metaplasia of stratified squamous epithelium develops - a precancerous condition characterized by the replacement of squamous epithelium cells with cylindrical ones. Additional types of GERD classification can be found.

Diagnosis of GERD

Diagnosis of gastroesophageal reflux is based on instrumental methods. The doctor may prescribe the following types of studies:

endoscopy - helps to determine the presence of inflammation, eroded areas, formed ulcers;
daily monitoring of acidity indicators in the lower esophagus;
radiography - allows you to identify a hernia of the diaphragm, ulcers, erosion;
manometric study of the esophageal sphincter;
scintigraphy with a radioactive substance;
biopsy - a study is prescribed if Barrett's esophagus is suspected;
daily Holter monitoring;
Ultrasound examination of the abdominal organs.

Additionally, the patient may be assigned consultations of such specialists as a cardiologist, otolaryngologist, pulmonologist, surgeon. But most often, the diagnosis is made on the basis of the results of FGDS.

How to cure?

There is no specific treatment for GERD. The therapeutic measures taken are aimed at eliminating pathological symptoms, preventing relapses and developing complications. In the initial stages of GERD, therapeutic exercises give good results. Initially, the disease is treated with medication, removing severe symptoms. But at the same time, weakness of the esophageal sphincter persists.

Exercise therapy exercises are aimed specifically at strengthening the muscles of the esophagus and diaphragm, which prevents pathological castings and improves the well-being of a person as a whole. In accordance with generally accepted practice in gastroenterology, the patient is prescribed antisecretory agents: proton pump inhibitors and H2-histamine receptor blockers. Additionally, the patient may be prescribed prokinetics - recommended for the development of bile reflux, antacids, reparants - drugs that promote the healing of damaged mucous membranes of the esophagus.

Blockers of H 2 -histamine receptors

Medicines of this group help to reduce the amount of hydrochloric acid produced. To exclude the recurrence of the pathology, they are prescribed by a course. The patient may be prescribed:

Famotidine. Reduces the activity of pepsin, reduces the amount of hydrochloric acid produced.
Cimetidine. Dosage and regimen are selected individually. The drug can cause nausea, the formation of dyspeptic symptoms.
Nizatidine. Reduces the amount of hydrochloric acid produced.

proton pump inhibitors

Against the background of taking drugs, there is a decrease in the level of produced hydrochloric acid. Esomeprazole, Omeprazole, Pantoprazole, Rabeprozol, Lansoprozol are prescribed for admission. The choice of remedy depends on the recommendations of the attending physician. For example, pregnant women are prohibited from taking omeprazole. It is replaced by Panto-or Lansoprozol.

Prokinetics

The drugs help to increase the tone and reduce the lower esophageal sphincter, which reduces the number of pathological reflux of gastric contents. Gastroesophageal reflux disease is treated with the following prokinetics:

Domperidone is an antiemetic. Against the background of the reception, the development of gastrointestinal disorders is not excluded.
Metoclopramide. Improves the motor activity of the esophagus. Has many side effects.
Cisapride. It has a stimulating effect on the motility and tone of the gastrointestinal tract, has a laxative effect.

Antacids

This group of drugs reduces the acidity of gastric juice. The following may be appointed for admission:

Phosphalugel. It has absorbent, enveloping and antacid properties.
Gaviscon. Forms a protective film on the surface of the mucous membrane of the esophagus and stomach.
Rennie. Neutralizes the acidity of gastric juice.

When bile is thrown, drugs from the group of prokinetics are used, most often it is Domperidone or Ursofalk. The drug is included in the category of hepatoprotectors. It promotes the dissolution of gallstones and lowers blood cholesterol levels.

Surgery

The main indication for surgical treatment is the ineffectiveness of previously selected drug therapy. During the procedure, the sphincter tone is restored, which eliminates the development of pathological refluxes. Indications for surgical intervention are Barrett's esophagus, esophageal ulcer, grade 3-4 esophagitis, pathological narrowing of the esophagus.

Diet

Effective treatment of gastroesophageal reflux is impossible without following the principles of dietary nutrition. The recommendations are pretty simple. It is necessary to give up overeating, after eating take a short walk. Dinner should take place 4 hours before bedtime.

Under the ban are:

fruit juices;
dishes with a spicy taste;
chocolate;
citrus;
radish;
coffee;
alcoholic drinks;
fried foods;
bakery products.

The menu of a patient with GERD should include low-fat kefir, milk, cream, low-fat fish cooked in a steam way, soups cooked on vegetable broths, fruits with a sweet taste. Mineral alkaline waters, tea with the addition of milk, homemade crackers, yesterday's bread, butter, cereals - buckwheat, semolina and rice, watermelon will be useful. Dieting reduces the risk of reflux. You can read more about dietary nutrition for GERD.

Can GERD be completely cured? No, but it is quite possible to achieve a long period of remission and practically forget about the disease.

Treatment with folk methods

As additional methods of therapy, it is allowed to use traditional medicine recipes. Combinations of drug support and home methods help to speed up recovery, eliminate pathological symptoms and improve the general well-being of the patient.

GERD can be treated in the following ways:

A decoction of flax seeds. Brew 2 tbsp. l. product with boiling water (500 ml). Insist 8 hours. Filter and take 100 ml before meals. The duration of the course is 6 weeks.
Rosehip or sea buckthorn oil. Drink 1 tsp. three times a day. It acts as an anti-inflammatory, wound healing, strengthening and antibacterial agent.
Decoction of Althea roots. So, pour 6 grams of the root with boiling water (200 ml) and simmer in a water bath for half an hour. Drink the filtered agent 100 ml three times a day.
Celery root juice. Take freshly squeezed juice 1 tbsp. l. three times a day. He copes well with the pathological symptoms of the disease.

The treatment of GERD according to Bolotov is becoming increasingly popular. But the proposed method contributes to an increase in the level of acidity of gastric juice, which can cause the development of a relapse of the disease.

Possible complications

The most common complication - occurs in about 45% of all diagnosed cases - the formation of reflux esophagitis. Accompanying the disease, ulcerative-erosive lesions of the mucosa after healing can leave rough scars. As a result, the patient has a narrowing of the lumen of the esophagus. A deterioration in patency is indicated by frequent belching and heartburn.

Long-term inflammation causes the formation of ulcers. Damage to the wall can descend to the submucosal layers and be accompanied by frequent bleeding. In the absence of adequate treatment, the replacement of the epithelium of the esophagus with cells typical of the stomach or intestines is not excluded. The resulting degeneration is called Barrett's esophagus and refers to precancerous conditions. In about 5% of patients, it progresses to adenocarcinoma.

Prevention

To prevent the development of the disease will help to follow simple recommendations. You need to carefully monitor your weight. The presence of extra pounds is one of the factors provoking pathology. To do this, you must completely refuse or significantly limit the consumption of fatty / fried foods, sweets and pastries. After eating, you should not lie down, because in this case the probability of reflux of gastric contents into the lumen of the esophagus increases several times.

The appearance of pain, regular heartburn and belching is a serious reason to see a doctor. Gastroesophageal reflux disease is a severe and difficult to diagnose disease. That is why, when characteristic symptoms appear, it is necessary to get advice from a specialized specialist and, if necessary, undergo a full course of treatment.

The internal environment of the esophagus differs in pH from the stomach. The ingress of acidic contents from the stomach into the esophagus leads to an inflammatory reaction, gastroesophageal reflux disease develops.

Etiology

Decreased tone of the lower esophageal sphincter. The reason for this may be:

eating fatty foods;
drinks with a lot of caffeine (green tea, coffee, cola);
smoking, drinking alcohol;
pregnancy (hormonal effect on sphincter tone);
medicinal effects (antispasmodics, calcium antagonists).

Ascites, obesity, pregnancy, flatulence are accompanied by an increase in intra-abdominal pressure.
A hernia of the diaphragmatic opening of the esophagus creates conditions for the development of gastroesophageal reflux disease - incomplete closure of the cardia, protrusion of the gastric mucosa into the esophagus, low pressure between the esophagus and stomach.
Swallowing air during hasty meals and on the go increases intragastric pressure.
Duodenal ulcer.
Eating a large amount of fatty, heavy foods, fried, spicy foods, carbonated drinks keeps the food lump in the stomach for more than the allotted time, increases pressure in it.
Among the reasons are a violation of the innervation of the esophagus, a decrease in saliva production, gastroparesis.

In pregnant women, the symptoms of the disease increase with an increase in the duration of pregnancy and the size of the abdomen. After delivery, most of the symptoms go away.

Symptoms of the disease

Gastroesophageal reflux disease develops gradually. The first symptom is heartburn. Initially, it appears after eating in the daytime. The progression of the disease is manifested by an increase in heartburn, it begins to bother between meals, with a change in body position, bending, at night.

Belching with air occurs after eating, may be accompanied by regurgitation of food. There is a sour or bitter taste in the mouth. Occasional nausea or vomiting. Dysphagia develops due to impaired motility or the development of esophageal strictures. Gastroesophageal reflux is accompanied by chest pain that occurs or worsens after eating, increased salivation, heaviness in the abdomen after eating, hiccups.

Extraesophageal manifestations of GERD may develop. These include the following symptoms:

pulmonary - cough with GERD, shortness of breath when lying down;
laryngitis, otitis, rhinitis;
dental manifestations - caries, periodontal disease;
anemia appears with ulceration and erosion on the mucosa of the esophagus;
cardiac manifestations - pain in the heart, arrhythmia.

GERD classification

The disease is classified according to the presence of symptoms of complications of GERD:

Non-erosive form - reflux of stomach contents without inflammation of the esophagus.
Ulcerative-erosive - deterioration, the occurrence of ulcerations and strictures.
Barrett's esophagus is a precancerous disease.

According to the severity of the acidity of gastric contents:

hyperacidity if the pH is below 4.0;
slightly acidic at pH 4.0-6.0;
alkaline at pH above 7.0.

Diagnostics

After the onset of symptoms of gastroesophageal reflux, you should seek help from your general practitioner or gastroenterologist. They will be assigned diagnostics to confirm or refute the diagnosis of GERD. Diagnosis begins with the collection of anamnesis. The patient's complaints are clarified, the time of their appearance, with which the patient himself associates gastroesophageal reflux. It also looks at whether the patient has used any medications to treat GERD on their own.

Next, the attending physician prescribes laboratory blood tests. The general analysis reflects the presence of inflammation, anemia, which will indicate presumptive chronic blood loss. Also for this purpose, a fecal occult blood test is prescribed. Fibrogastroscopy is the main method for diagnosing gastroesophageal reflux disease. The research method consists in introducing a flexible hose with a video camera into the esophagus. This allows you to examine the entire inner shell, identify suspicious areas, the presence of reflux, gaping of the cardiac opening of the stomach. Such a study allows you to take a piece of tissue for a histological examination in order to identify the degree of the inflammatory process and the presence of atypical cells.

Gastroesophageal reflux disease is diagnosed by fluoroscopy with the use of contrast. The pictures clearly show defects in the filling of the esophagus, areas of narrowing, diverticula, protrusions. Conduct intraesophageal pH monitoring during the day. Diagnosis is carried out in order to establish how often and for how long gastroesophageal reflux continues, as well as to record daily fluctuations in pH. Values below 4.0 are especially important. This method is the main one for confirming gastroesophageal reflux disease.

Chromoendoscopy of the esophagus is used as a diagnosis for a long-term chronic course of the disease. This is an endoscopy using a special dye that stains pathological areas. There is an opportunity for targeted biopsy. Often gastroesophageal reflux disease is accompanied by Helicobacter pylori infection. It can be detected during a biopsy, or during a special test. It is based on the detection of a microbial waste product in the exhaled air. With a positive test, the treatment regimen for gastroesophageal reflux disease is supplemented by eradication therapy.

It is possible to conduct an ultrasound scan, which will show the presence of concomitant pathology of the gastrointestinal tract, diseases of the liver and gallbladder. ECG allows you to identify abnormalities of the heart and differentiate them from the symptoms of atypical GERD. Additional diagnostics of sphincter tone and motor activity of the esophagus is called esophagomanometry.

Treatment

It is very difficult to completely cure the disease, but if you follow the recommendations, then gastroesophageal reflux will proceed with minimal exacerbations. Treatment of gastroesophageal reflux disease should be comprehensive, combining medication, adherence to a certain diet and lifestyle.

Diet

What can you eat with GERD, tell your doctor. Food should be fractional 4-5 times a day in small portions. Avoid eating too hot and cold foods. After eating, you can not lie down, bend over, raise your arms, do any physical exercises, these actions provoke gastroesophageal reflux.

Foods that stimulate the increased formation of gastric juice and gases are excluded from the diet. These are fried foods, fatty, black bread, rich pastries, a large amount of sweets, legumes, chocolate, vegetables with coarse fiber, sour fruits. Alcohol is strictly prohibited. The basis of the diet is cereals, vegetable oils, lean meat, boiled and stewed vegetables. If there is no intolerance, then dairy products are included.

It is recommended to get rid of cravings for smoking and correct excess weight. Lifestyle recommendations include raising the head of the bed 10-15 cm, avoiding wearing tight belts and tight clothing.

Medical treatment

For drug treatment of GERD, the following groups of drugs are used:

Proton pump inhibitors, or antisecretory drugs, are aimed at reducing the acidity of gastric juice and thus reducing its irritating effect on the esophagus. The dosage and duration of administration is selected individually, depending on what degree of GERD the diagnosis showed. In grades A and B, treatment with gastroesophageal reflux inhibitors is carried out for 4 weeks, grades C and D - 8 weeks. The drugs Omeprazole, Lansoprazole are used.
Prokinetics are substances that improve the passage of the food bolus through the stomach and intestines, reduce the likelihood of manifestations of gastroesophageal reflux disease (GERD). Metoclopramide, Domperidone belong to this group of drugs.
Antacids relieve symptoms and treat hyperacidity in the stomach. These are Almagel, Maalox, Phosphalugel.

Long-term adherence to all recommendations will help to make sure that GERD can be cured with conservative methods. With frequent exacerbations of GERD, a poor effect of the use of drugs and the occurrence of complications, they resort to surgical treatment of GERD.

Surgical treatment

Surgery will help if complications develop:

strictures;
Barrett's esophagus;
reflux 3-4 degrees;
presence of mucosal ulcers.

Various methods of surgical intervention are used - endoscopic resection, coagulation with argon plasma, multipolar coagulation. These methods without damage to the anterior abdominal wall are carried out using an endoscope. The essence of all methods is not how to cure GERD, but how to restore the natural barrier between the esophagus and stomach. For example, during radiofrequency ablation of the esophagus, the muscle layer of the cardia is specifically damaged for subsequent scarring and narrowing of the hole, which will reduce reflux.

It is also possible to perform a laparoscopic operation - a Nissen fundoplication with gastropexy. This is a way to eliminate reflux by restoring an acute angle between the esophagus and stomach. For this, the stomach is sutured to the diaphragm around the esophageal opening. Use traditional medicine methods with great care and after consultation with your doctor!

Self-medication in this case will not bring relief. Only a doctor will tell you how to treat correctly and effectively. Untimely seeking medical help can lead to the development of complications that are treated much more complicated than the underlying disease. Prevention includes following the norms of a healthy lifestyle, proper nutrition, respecting the time intervals between meals, and not snacking on the run. With age, the need for calories decreases, so you need to gradually reduce their amount in food so that you do not have to deal with excess weight later.

Gastroesophageal reflux is the reflux of gastric (gastrointestinal) contents into the lumen of the esophagus. Reflux is called physiological if it appears immediately after eating and does not cause obvious discomfort to a person. If reflux occurs often enough, at night, accompanied by unpleasant sensations - we are talking about a pathological condition. Pathological reflux is considered within the framework of gastroesophageal reflux disease.

Hydrochloric acid has an irritating effect on the mucous membrane of the esophagus and provokes its inflammation. Prevention of damage to the esophageal mucosa is carried out by the following mechanisms:

The presence of a gastroesophageal sphincter, the contraction of which leads to a narrowing of the lumen of the esophagus and obstruction of the passage of food in the opposite direction;
Resistance of the mucous wall of the esophagus to gastric acid;
The ability of the esophagus to cleanse itself of abandoned food.

When any of these mechanisms is disturbed, there is an increase in the frequency as well as the duration of refluxes. This leads to irritation of the mucous membrane with hydrochloric acid, followed by the development of inflammation. In this case, we should talk about pathological gastroesophageal reflux.

How to distinguish physiological gastroesophageal reflux from pathological?

Physiological gastroesophageal reflux is characterized by the following symptoms:

Occurrence after eating;
No associated clinical symptoms;
Low frequency of reflux per day;
Rare episodes of reflux at night.

Pathological gastroesophageal reflux is characterized by the following symptoms:

The occurrence of reflux and outside the meal;
Frequent and prolonged refluxes;
The appearance of reflux at night;
Accompanied by clinical symptoms;
Inflammation develops in the mucosa of the esophagus.

Reflux classification

Normally, the acidity of the esophagus is 6.0-7.0. When gastric contents, including hydrochloric acid, are thrown into the esophagus, the acidity of the esophagus falls below 4.0. Such refluxes are called acidic.

With an acidity of the esophagus from 4.0 to 7.0, they speak of weakly acid reflux. And finally, there is such a thing as superreflux. This is acid reflux, which occurs against the background of an already reduced acidity level of less than 4.0 in the esophagus.

If gastrointestinal contents, including bile pigments and lysolecithin, are thrown into the esophagus, the acidity of the esophagus rises above 7.0. Such refluxes are called alkaline.

Causes of GERD

Gastroesophageal reflux disease (GERD) is a chronic disease caused by spontaneous and systematically repeated throwing of gastric (gastrointestinal) contents into the esophagus, leading to damage to the esophageal mucosa.

The development of the disease is influenced by eating habits and the nature of nutrition. The rapid absorption of a large amount of food with the swallowing of air leads to an increase in pressure in the stomach, relaxation of the lower esophageal sphincter and reflux of food. Excessive consumption of fatty meat, lard, flour products, spicy and fried foods leads to a delay in the food bolus in the stomach and even an increase in intra-abdominal pressure.

The symptoms that appear in GERD can be divided into two subgroups: esophageal and extra-esophageal symptoms.

Esophageal symptoms of gastroenterologists include:

heartburn;
belching;
regurgitation;
Sour;
Swallowing disorder;
Pain in the esophagus and epigastrium;
hiccups;
Sensation of a lump in the chest.

Extra-esophageal lesions occur due to the ingress of the refluctant into the respiratory tract, the irritating effect of the refluctant, activation of the esophagobronchial, esophagocardial reflexes.

Extraesophageal symptoms include:

Pulmonary syndrome (cough, shortness of breath mainly occurring in a horizontal position of the body);
Otorhinolaryngopharyngeal syndrome (development, rhinitis, reflex apnea);
Dental syndrome (, rarely aphthous stomatitis);
Anemia syndrome - as the disease progresses, erosions form on the mucous membrane of the esophagus, accompanied by chronic blood loss in a small amount.
Cardiac syndrome (,).

Complications of GERD

Of the most common complications, it is worth highlighting the formation of esophageal stricture, ulcerative erosive lesions of the esophagus, bleeding from ulcers and erosions, and the formation of Barrett's esophagus.

The most formidable complication is the formation of Barrett's esophagus. The disease is characterized by the replacement of normal squamous epithelium with a cylindrical gastric epithelium.

The danger is that such metaplasia significantly increases the risk of esophageal cancer.

In the first few months of life, gastroesophageal reflux is normal. Infants have certain anatomical and physiological features that predispose to the formation of reflux. This is an underdevelopment of the esophagus, and low acidity of gastric juice, and a small volume of the stomach. The main manifestation of reflux is regurgitation after feeding. In most cases, this symptom resolves itself by the end of the first year of life.

When hydrochloric acid reflux damages the lining of the esophagus, GERD develops. In infants, this ailment manifests itself in the form of anxiety, tearfulness, excessive regurgitation, turning into profuse vomiting, hematemesis, coughing can be observed. The child refuses food, gains weight poorly.

GERD in older children is manifested by heartburn, pain in the upper chest, discomfort when swallowing, a feeling of food stuck, and a sour taste in the mouth.

Diagnostics

Different methods are used to diagnose gastroesophageal reflux disease. First of all, if GERD is suspected, an endoscopic examination of the esophagus should be performed. This method allows you to identify inflammatory changes, as well as erosive and ulcerative lesions on the mucous membrane of the esophagus, strictures, areas of metaplasia.

Also, patients undergo esophagomanometry. The results of the study will allow you to get an idea about the motor activity of the esophagus, changes in the tone of the sphincters.

In addition, patients should undergo daily monitoring of esophageal ph. Using this method, it is possible to determine the number and duration of episodes with abnormal esophageal acidity, their relationship with the onset of symptoms of the disease, food intake, changes in body position, and medication.

Treatment

In the treatment of GERD, medical, surgical methods are used, as well as lifestyle correction is carried out.

Medical treatment

Drug therapy is aimed at normalizing acidity, as well as improving motor skills. The following groups of drugs are used:

Prokinetics (domperidone, metoclopramide)- to increase the tone and reduce the lower esophageal sphincter, improve the transport of food from the stomach to the intestines, reduce the number of refluxes.
Antisecretory agents(proton pump inhibitors, H2-histamine receptor blockers) - reduce the damaging effect of hydrochloric acid on the esophageal mucosa.
Antacids(phosphalugel, almagel, maalox) - inactivate hydrochloric acid, pepsin, adsorb bile acids, lysolecithin, improve esophageal cleansing.
Reparants(sea buckthorn oil, dalargin, misoprostol) - accelerate the regeneration of erosive and ulcerative lesions.

Surgery

Surgical intervention is resorted to with the development of complications of the disease (strictures, Barrett's esophagus, reflux esophagitis III-IV degree, ulcers of the mucous membrane).

Surgery is also considered as an alternative if GERD symptoms fail to improve with lifestyle changes and medication.

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

To consolidate the positive result of the treatment, as well as to prevent the occurrence of recurrence of the disease, the following recommendations should be followed:

The fight against excess weight;
Stop smoking, alcohol, caffeinated drinks;
Limiting the use of products that increase intra-abdominal pressure (carbonated drinks, beer, legumes);
Restriction of the use of products with acid-stimulating action: flour products, chocolate, citrus fruits, spices, fatty and fried foods, radish, radish;
You should eat in small portions, chewing slowly, do not talk while eating;
Limitation of heavy lifting (no more than 8-10 kg);
Raising the head of the bed ten to fifteen centimeters;
Limiting the intake of medications that relax the esophageal sphincter;
Avoiding lying down after eating for two to three hours.

Grigorova Valeria, medical commentator

The proper functioning of the digestive system provides the body with a complete set of nutrients and energy. But unfortunately, a lot of harmful factors that negatively affect health lead to disruption of the functioning of this system.

Gastroesophageal reflux disease (GERD) is associated with damage to the muscular ring (sphincter) that separates the esophagus and stomach. Due to this pathology, the contents of the stomach are thrown into the esophagus, thereby leading to its irritation and subsequent inflammation.

Causes of Reflux Disease

Unbalanced and irrational nutrition. Both forced snacks at work (sandwiches and dry lunches) and a completely natural desire to look slim and fit (an inadequate diet leading to a deficiency of vital nutrients) should be blamed for all the troubles. Also, gastroesophageal reflux can develop due to the predominance of fatty, spicy and overly salty foods in the diet.

2. Frequent and profuse vomiting (it happens with poisoning, including alcohol).

3. Bad habits that contribute to the destruction of the mucous membranes of the stomach and duodenum 12 (smoking, alcohol abuse, drug addiction).

4. A side effect of taking certain drugs that reduce the tone of the sphincter (another confirmation that reading the accompanying instructions for medications is not a whim, but an urgent need).

5. Hereditary predisposition (it almost always explains cases of reflux in newborns).

6. Obesity.

7. Complication of certain diseases (or, which is also possible, a consequence of their treatment):

hiatal hernia;

systemic scleroderma (a rare connective tissue pathology);

anorexia nervosa (it is often diagnosed in models who, despite the symptoms of extreme exhaustion, continue to torture themselves with a diet);

some disorders of the central nervous system;

incorrect placement of the nasogastric tube.

Classification and stages of reflux disease

There are two main forms of gastroesophageal reflux disease:

non-erosive (endoscopically negative) reflux disease (NERD) - occurs in 70% of cases;

The condition of the esophageal mucosa is assessed by stages according to the Savary-Miller classification or by degrees of the Los Angeles classification.

There are the following degrees of GERD:

zero - symptoms of reflux esophagitis are not diagnosed;

the first - non-merging areas of erosion appear, hyperemia of the mucous membrane is noted;

the total area of erosive areas is less than 10% of the total area of the distal part of the esophagus;

the second - the area of erosion is from 10 to 50% of the total surface of the mucosa;

the third - there are multiple erosive and ulcerative lesions that are located over the entire surface of the esophagus;

fourth - deep ulcers occur, Barrett's esophagus is diagnosed.

The Los Angeles classification applies only to erosive varieties of the disease:

grade A - there are no more than several mucosal defects up to 5 mm long, each of which extends to no more than two of its folds;

degree B - the length of the defects exceeds 5 mm, none of them extends to more than two folds of the mucosa;

degree C - defects are spread over more than two folds, their total area is less than 75% of the circumference of the esophageal opening;

degree D - the area of defects exceeds 75% of the circumference of the esophagus.

Reflux disease symptoms

Heartburn. Heartburn is the main symptom of GERD. It is a burning sensation that extends upward from the abdomen to the chest and throat. Heartburn is most likely due to the following activities:

- when eating heavy food;

- at slopes;
- when climbing;
- lying down, especially on the back.

All GERD patients tend to feel more pain at night than at other times of the day.
The severity of heartburn does not necessarily indicate actual damage to the esophagus. For example, Barrett's esophagus, which causes precancerous changes in the esophagus, may show only a few symptoms, especially in the elderly. On the other hand, people can have severe heartburn without damage to the esophagus.

- Dyspepsia. About half of GERD patients have dyspepsia, a syndrome that consists of the following:

- pain and discomfort in the upper abdomen;
- feeling of fullness in the stomach;
- nausea after eating;
- regurgitation. Regurgitation is the sensation of acid and its accumulation in the throat. Sometimes the acid is regurgitated into the mouth and can be perceived as a "wet burp". It can come out like vomit. People without GERD may also have dyspepsia.

- Feelings of pain in the chest. Patients may have a feeling that food is "trapped" behind the breastbone. Chest pain is a common symptom of GERD. It is very important to distinguish it from chest pain caused by heart problems (angina pectoris, heart attack, etc.).

- Throat symptoms. Less commonly, GERD can cause symptoms in the throat:

- Acid laryngitis. A condition that is accompanied by hoarseness, a dry cough, a feeling of a lump in the throat and a frequent need to clear your throat;
problems with swallowing (dysphagia). In severe cases, patients may be in shock and food may become lodged in their esophagus, causing severe chest pain. This may indicate a temporary spasm that narrows the tube, or serious damage or abnormalities in the esophagus;
- chronic sore throat;
- persistent hiccups;
- cough and respiratory (breathing) symptoms - cough, wheezing, etc.;
- Chronic nausea and vomiting. Nausea persists for several weeks or even months, and does not go back to the cause of frequent stomach upsets, incl. heartburn symptoms. In rare cases, vomiting may occur more than once a day. All other causes of chronic nausea and vomiting should be ruled out, including ulcers, stomach cancer, obstruction, pancreatic or gallbladder disease.

Diagnosis of reflux disease

In the diagnosis of gastroesophageal reflux disease, a careful collection of complaints and anamnesis plays an important role. Since the clinical picture of GERD is quite specific, the correct diagnosis can already be made at this stage with a high degree of probability.

To confirm the diagnosis, as well as to establish the severity of the disease, endoscopic examination of the esophagus and stomach (EGD) and daily pH monitoring of the esophagus are performed.

With the help of FGDS, damage to the esophageal mucosa is determined, if necessary, a biopsy of the most suspicious areas is performed. Daily pH monitoring allows you to measure fluctuations in acidity in the esophagus, to determine what these fluctuations are associated with.

Additional research methods:

X-ray of the esophagus and stomach;
Esophageal manometry (examination of the tone of the esophagus and its sphincters);
Impedancemetry (study of peristalsis of the esophagus).

For the purpose of differential diagnosis, we perform ECG and ultrasound of the heart. If there are indications (search for the causes of GERD, treatment planning), we perform computed tomography or MRI.

Treatment of reflux disease

1. Lifestyle change

Includes sleeping with a raised headboard, eating at least an hour and a half before bedtime, avoiding food that provokes heartburn (fatty, starchy foods, citrus fruits, coffee, chocolate, carbonated drinks)

2. Inhibitors (blockers) of the proton pump (abbreviated as PPI, BPP)

These drugs reduce the production of hydrochloric acid by the stomach glands. PPIs are not suitable for immediate relief, as their effect develops several days after the start of use.

Currently, PPPs are considered the drug of choice in most patients with GERD. This group should be used in patients with reflux disease in a course of 6-8 weeks. All proton pump inhibitors should be taken half an hour before meals 1-2 times a day.

The IPPs include:

Omeprazole (Omez) 20 mg 1-2 r / day;
Lansoprazole (Lanzap, Acrylanz) 30 mg 1-2 r / day;
Pantoprazole (Nolpaza) 40 mg once a day;
Rabeprazole (Pariet) 20 mg once a day. If necessary, you can take a constant dose of half.
Esomeprazole (Nexium) 20-40 mg once a day. Swallow without chewing, drink water.

3. Antacids

Preparations of this group quickly neutralize hydrochloric acid, so they can be used to eliminate heartburn at the time of its occurrence. Antacids can be prescribed for GERD as the only drug in cases where there are no erosions and ulcers, or antacids are used at first in conjunction with proton pump blockers, since the latter do not begin to act immediately.

Of the medicines in this group, dispensed without a doctor's prescription, the most well-proven:

Aluminum and magnesium hydroxide in the form of gels:

Maalox - 1-2 tablets 3-4 times a day and at bedtime, take 1-2 hours after meals, chewing or sucking thoroughly;

Almagel 1-3 dosing spoons 3-4 times a day. Take half an hour before meals;

Phosphalugel 1-2 sachets (can be diluted with 100 ml of water) 2-3 times a day immediately after meals and at night.

Sucking tablets: simaldrate (Gelusil, Gelusil varnish) 1 tablet (500 mg) 3-6 times a day an hour after a meal or situationally in case of heartburn, 1 tablet.

4. Alginic acid preparations

have a quick effect (heartburn stops after 3-4 minutes), and therefore can be used for "ambulance" with the first symptoms of reflux disease. This result is achieved due to the ability of alginates to interact with hydrochloric acid, turning its foam with a pH close to neutral. This foam covers the outside of the food bolus, so during reflux it is she who ends up in the esophagus, where it also neutralizes hydrochloric acid.

If a patient with GERD does not have erosions and ulcers in the esophagus according to endoscopy, alginates can be used as the only treatment for reflux disease. In this case, the course of treatment should not exceed 6 weeks.

Alginates include:

Gaviscon 2-4 tab. after meals and at bedtime, chewing thoroughly;

Gaviscon forte - 5-10 ml after each meal and at bedtime (maximum daily dose of 40 ml).

5. Blockers of H2-histamine receptors III generation

This group of drugs also reduces the production of hydrochloric acid, but its effectiveness is lower than that of proton pump inhibitors. For this reason, H2 blockers are a "reserve group" in the treatment of GERD. The course of treatment is 6-8 (up to 12) weeks.

Currently used for the treatment of GERD:

Famotidine 20-40 mg 2 times a day.

6. Prokinetics

Since GERD results from impaired motility of the gastrointestinal tract, in cases where the evacuation of food from the stomach is slow, drugs are used that accelerate the passage of food from the stomach into the duodenum. Means of this group are also effective in those patients who have reflux of duodenal contents into the stomach, and then into the esophagus.

The drugs in this group include:

Metoclopramide (Cerukal, Raglan) 5-10 mg 3 times a day 30 minutes before meals;

Domperidone (Motilium, Motilak) 10 mg 3-4 times a day 15-30 minutes before meals.

At the end of the 6-8-week course of treatment, those patients who have not had erosion and ulcers of the esophageal mucosa are switched to the situational intake of proton pump blockers (better), or antacids or alginates. In patients with erosive and ulcerative forms of GERD, proton pump inhibitors are prescribed for continuous use, while the minimum effective doses are selected.

Traditional methods of treating reflux disease

To eliminate the described disease, you can use folk remedies. The following effective recipes are distinguished:

A decoction of flaxseed. Such therapy with folk remedies is aimed at increasing the stability of the esophageal mucosa. It is necessary to pour 2 large spoons of ½ liter of boiling water. Infuse the drink for 8 hours, and take 0.5 cups of nitrogen 3 times a day before meals. The duration of such therapy with folk remedies is 5-6 weeks;

Milk shake. Drinking a glass of cold milk is considered an effective folk remedy for eliminating all manifestations of gastroesophageal reflux disease. Therapy with such folk remedies is aimed at getting rid of the acid in the mouth. Milk has a soothing effect on the throat and stomach;

A decoction of the root of marshmallow. Therapy with folk remedies, including this drink, will help not only get rid of unpleasant manifestations, but also have a calming effect. To prepare the medicine, you need to put 6 g of crushed roots and add a glass of warm water. Infuse the drink in a water bath for about half an hour. Treatment with folk remedies, including the use of marshmallow root, includes taking a chilled decoction of ½ cup 3 times a day;

In the treatment of folk remedies, celery root juice helps effectively. It should be taken 3 times a day, 3 large spoons. Alternative medicine involves a large number of recipes, the choice of a specific one depends on the individual characteristics of the human body.

But treatment with folk remedies cannot act as a separate therapy, it is included in the general complex of therapeutic measures.

Prevention of reflux disease

the last meal - at least 1-1.5 hours before bedtime;

selection of loose clothing that does not restrict movement. We don’t urge you to get grandma’s dresses and grandpa’s shirts out of the closet, but it’s definitely worth thinking about the safety of most designer models;

do not overeat;

if the doctor has prescribed certain medicines for you, drink them with a sufficient amount of ordinary boiled water;

the head of the bed should be raised (a Japanese-style bed - strictly parallel to the floor - is contraindicated for you);

consult a gastroenterologist at least 2 times a year (even when the symptoms of GERD have not bothered you for a long time). And if the doctor offers to take a course of outpatient treatment, do not refuse;

remember the benefits of a healthy diet. Let us especially note that “diet” and a reasonable restriction of spicy, salty and excessively cold dishes are not the same thing at all. But it is still better to refuse soda and strong coffee;