Gastroesophageal reflux: symptoms, diagnosis, and treatment features

German physician, surgeon and scientist Heinrich Quinke in 1879 described the physiological process occurring in the digestive system of people after eating, and called it gastroesophageal reflux (in the reduction of GER). A synonym for this difficult-to-pronounce term is gastroesophageal reflux. The word "reflux" in Latin means "flow back", and in medicine this term refers to moving backwards in comparison with the normal course of movement of the contents of any hollow organs. If you were diagnosed with this, you do not need to get upset, because the GER itself is not a disease and does not require treatment. But sometimes the mechanisms of this physiological process fail, the food that has returned from the stomach to the esophagus, begins to eat up its epithelial cells, and the person experiences quite unpleasant sensations at the same time. In these cases, the diagnosis indicates gastroesophageal reflux with esophagitis - a serious enough disease that can lead to esophageal cancer.

The mechanism of gastroesophageal reflux

From the lessons of anatomy, we know that the food crushed in the mouth when swallowed enters the esophagus, which is a hollow tube. Its functions are limited to the rapid delivery of a lump of food into the stomach, where it begins to be digested. The length of the esophagus in most people is 30 cm. In the lower part, the muscle fibers of its walls are so arranged that they act as a valve (sphincter). When you move the lump of food, they relax, passing it into the stomach, and then shrink, preventing the exit of food back into the esophagus. If the passage is not blocked enough, the contents of the stomach (food and gastric juice) partially move back to the esophagus, that is, gastroesophageal reflux occurs. Symptoms and treatment of this condition depend on how well the defense mechanisms work in the esophagus. In most people, this process does not cause any unpleasant or painful sensations, so it does not require treatment at all. However, in some cases the return of a portion of food back from the stomach to the esophagus is accompanied by painful or simply unpleasant sensations. In these cases, a doctor's consultation and treatment is necessary.

How Protective Mechanisms Work

Why in some cases is harmless gastro-food reflux, and in others dangerous? The fact is that the human esophagus is "programmed" by nature to contact only with the alkaline medium, which is the chewed food coming into it from the mouth. The stomach does not just take food lumps, it starts to digest them, for which it produces gastric juice - a liquid from a mixture of enzymes, mucus and the main component - hydrochloric acid. Once in the esophagus, it begins to "digest" the epithelial cells of its walls in the same way as food fragments. If a person has protective mechanisms against an aggressive acidic environment, the reflux of food is not terrible for them. Such mechanisms are:

- sufficiently high tone of esophageal sphincter, which does not allow food to go beyond the gastroesophageal zone;

- good clearance (rapid cleansing of the esophagus from the received contents of the stomach);

- Stability of esophageal epithelial cells to hydrochloric acid;

- control of acidity of gastric juice.

Signs of a GER that is not a disease

Let us consider when gastro-nutritional reflux can be considered a normal act of human physiology. Symptoms of such a harmless process in the digestive system are as follows:

- a person does not feel any discomfort (this is one of the dominant signs);

- throwing food into the esophagus from the stomach is observed only immediately after a meal;

- reflux lasts for a short time and happens only a couple of times a day;

- at night during sleep, reflux does not occur.

It should be noted that the physiological reflux of food from the stomach to the esophagus is observed in people of any age, including children.

Prevention of harmless GER

Even in cases where gastroesophageal reflux is not a problem, you can take a number of simple efforts to help your GIT. Reduce the manifestation of reflux can such simple actions:

- do not go to bed immediately after a meal;

- do not start physical work, especially related to slopes, barely finished eating;

- Do not overeat;

- reduce the consumption of products (chocolate, alcohol, certain specific sauces), relaxing sphincter of the esophagus;

- do not start eating too tightly, with a tight belt;

- reduce the volume of servings, and increase the number of meals.

Signs of GER, which is a pathology

The disease is gastroesophageal reflux with esophagitis. It happens when the protective mechanisms of the esophagus fail and can no longer protect the epithelial cells from corroding hydrochloric acid. This disease has two types of symptoms.

1. Esophageal. The patients note such unpleasant sensations:

- heartburn;

- a sour taste in the mouth;

- eructation (mostly sour);

- dysphagia (eating possible perephivaniya);

- pain behind the sternum (tend to increase with tilts and lying down, can extend to the arms and neck).

2. Non-Esophageal. Patients may have all or some of the following symptoms:

- problems with the teeth (caries, defects of the enamel);

- sinusitis;

- laryngitis;

- pharyngitis;

- Coughing;

Pain in the heart.

Because of these manifestations, GERs are often diagnosed incorrectly and treat people from diseases that do not exist.

Causes

Pathological gastroesophageal reflux may occur for the following reasons:

- obesity;

- Alcohol, smoking;

- hernia of the esophageal opening;

Unbalanced nutrition;

- drugs that reduce the tone of the sphincter;

- Abundant vomiting (happens at a poisoning);

- systemic scleroderma;

- nasogastric tube.

Gastroesophageal reflux in infants

In the first days and months of life, about 80% of babies are observed regurgitation after feeding. Most often, the gastroesophageal reflux of the baby is not a pathology and arises from the imperfection of its GIT system. Also, regurgitation protects the baby from overeating and ingress of air into his intestines. Parents can simply hold the crumb vertically for about 10 minutes after feeding, so that regurgitation does not happen. The more serious problems with the stomach and esophagus are evidenced by such signs:

- constant crying and worry of the baby;

- belching;

- vomiting (not to be confused with regurgitation) after feeding;

- refusal to eat;

- hiccough;

- causeless cough;

- The child is not sleeping well and is not gaining much weight.

According to the indications, the doctor can prescribe to the infant mixtures with thickeners and medications "Cisapride", "Domperidon", "Metoclopramide", "Cimetidine". If the reflux is caused by pathologies in the structure of the digestive tract, surgical intervention is possible.

Gastroesophageal reflux in children older than 1 year

In most children, by 12-18 months of regurgitation after feeding, they completely disappear. Toddlers grow up healthy and do not experience any discomfort after eating. But some children have other complaints that indicate problems with the stomach or esophagus:

- heartburn (the child explains this symptom as "fire" or "fire");

- belching sour;

- pain in the sternum;

- nausea;

- a feeling of raspiraniya in the stomach;

- regurgitation at night during sleep (this can be seen in the footsteps on the pillow).

Often point to the gastroesophageal reflux in children are symptoms that are completely unrelated to the digestive system:

- cough;

- hoarse voice;

- a lump and a sore throat;

- hard breath;

- Shortness of breath;

Difficulty in swallowing;

- frequent pneumonia.

Usually, these symptoms begin to cure a cold, but with GER such therapy does not give results.

Diagnostics

If the patient has unpleasant or painful symptoms of gastroesophageal reflux disease, the diagnosis should be carried out using modern laboratory and instrumental methods. At the first stage, the gastroenterologist collects an anamnesis that includes information about such illnesses in the patient's relatives, the duration and intensity of reflux symptoms. The second stage is to conduct laboratory studies, such as:

- blood test (biochemical and general);

- coprogramme;

- Analysis of urine.

The third stage of the diagnosis includes instrumental studies:

- manometry of the esophagus;

- EGDS (esophagogastroduodenoscopy);

- provocative test;

- Radiography using barium suspension;

- Ultrasound.

Treatment

If gastroesophageal reflux is diagnosed, the treatment is carried out in three directions:

1. Non-drug. It includes the following items:

- weight correction;

- Diet (not chocolate, alcohol, fatty, spicy, coffee, garlic, citrus);

- ordering of food;

- Exclusion from the wardrobe of tight clothing, narrow belts;

- raising the head of the bed by 20 cm.

2. Medication:

-inhibitors of proton pump (reduce the release in the stomach of hydrochloric acid, "Rapeprazole", "Omeprazole");

- antacids (these drugs neutralize hydrochloric acid "Fosfalugel", "Almagel");

- prokinetics (speeding up the movement of food from the stomach into the intestine "Metoclopramide").

3. Surgical. Applicable if the two previous types do not provide visible improvements.

If the disease is not treated, hydrochloric acid entering the esophagus can provoke ulceration of its walls, their perforation, bleeding, the so-called Barrett's esophagus, which increases the risk of the onset of a malignant tumor 10-fold.