Description of gastroesophageal reflux disease
Gastroesophageal reflux disease is a penetration of stomach contents – of digested food and digestive juices – into the esophagus.
Gastric juice contains hydrochloric acid, which can adversely affect the mucosa of the esophagus. The cells are so there arises exfoliation and inflammation, which further damages the mucosa.Although mucosal cells renew, but if the new cells grow slower than the loss of existing cells and their function to protect the esophagus is insufficient, there is reflux esophagitis – theinflammation of the esophagus due to irritation of the acidic gastric juice.
Reflux oesophagitis is currently understood as complications or advanced stage esophageal reflux disease. That is, if well treated, it does not need Back to inflammatory changes.
At the same time, not everyone reflux must be immediately considered a disease. Episodic and short term occurs quite often in healthy individuals. May be due to a certain diet – for example, spicy foods, sugary foods and alcohol.
So if symptoms come infrequently not justify a visit to the doctor, just adjust the diet.
Risk factors and prevention of gastroesophageal reflux disease
The esophagus is protected from several natural reflex mechanism – by peristaltic waves, by neutralizing acids saliva which are alkaline, and finally the anatomy and the esophagus and stomach.
The esophagus has in its wall, the upper and lower esophageal sphincter, while just the bottom probably plays the most important role of all protirefluxních factors. Its proper function positively affects diet rich in protein, alkalinization of gastric contents (that provides both saliva and secondly, something which the pancreas) and called. Prokinetic drugs – drugs used to treat reflux.
Conversely, sphincter released and thus recorded a reversal of gastric contents, fatty and spicy foods, peppermint, chocolate, caffeine, nicotine and alcohol.
For pregnant women experiencing reflux more likely due to hormonal changes. (The action of progesterone). In this case it is not dangerous reflux, after the labor condition usually adjusts itself.
It is also known for a number of drugs that cause reflux – eg. Theophylllin (Afonilum, Euphyllin, Spophyllin, Theoplus) used to treat asthma, further nitrates to treat acute heart failure, certain antiarrhythmics (Verapamil, Isoptin, Lekoptin, Blocalcin, Diacordin) and NSAIDs, e.g., ibuprofen (Brufen) and Aspirin. Excessive use of those drugs can therefore be problems associated with reflex and it is good to consult on other, more appropriate treatment with your doctor.
As prevention of recurrent reflux suggest eating during the day more often, but in smaller doses, make a meal time and peace of mind and mental stress can have a negative impact not only on reflux, but also other diseases of the digestive tract (eg. Gastric ulcers ).
It is advisable to avoid sharp spicy foods, frequent use of alcohol (especially spirits and white wine) and drink coffee and juice concentrate.
Signs and symptoms of gastroesophageal reflux disease
Leading symptom is heartburn, which is technically called heartburn. It is a painful burning sensation behind the breastbone (may be similar to angina), which extends from the stomach to the throat and can be attached to hořkokyselým mouthfeel. Sometimes because acidic contents back up into the mouth. It was in medical terminology is called regurgitation (return).
Heartburn occurs initially only after some meals (sweet, baked foods, fried foods, alcohol, black coffee), in advanced cases suffer from pyrosis sick after every meal, sometimes even fasting and night. This contributes decubitus position when leaving the influence of gravity. It may then have worse consequences since e.g. regurgitation resulting night threatens patient inhalation recovered food.
This results in inflammation of the larynx and bronchi accompanied by chronic spastic hoarseness and nocturnal cough to asthma attack, then the patient is suffering frequent otitis media and has an increased tooth decay. Finally, the patient life-threatening suffocation.
Altogether, therefore, nighttime symptoms more severe, but their presence is not so common especially in patients with mild disease who have difficulty especially in the daytime.
A small proportion of patients complain of stagnation mouthful to swallow sometimes associated with painful swallowing (ie. Dysphagia – dys = bad, FAGI = swallowing). It is caused by a narrowing of the esophagus inflammation and congestion of the ingested food before narrowing place.
Examination of gastroesophageal reflux disease
Mostly telling her initial difficulties the district doctors. It is not a mistake, when you prescribe the right medicine (Helicid) and invite you back a few months to control. After that time will tell whether your medicine is working.
Other times you doctor immediately sent for examination to a gastroenterologist, who can doendoscopic examination of the esophagus, which is annoying (the introduction of the tube into the esophagus or stomach), but half of patients confirms the diagnosis.
If the doctor does not find any changes, through endoscopy of your esophagus, esophageal disease can not yet be ruled out. The decisive factor is then a biopsy, sampling is done frequently while endoscopy, so you no longer have to physically attend the next performance.
Quite reliable and painless examination is scintigraphy, which will undergo a nuclear medicine workplace. Sometimes it makes X-ray, but it is not so reliable.
Treatment of gastroesophageal reflux disease
The basis of treatment are mild reflux regimen and dietary measures. That regime lie in weight reduction, avoidance of increase in intra-abdominal pressure (work bent over, carrying heavy things) and sleep on a bed tilted (recommends to substantiate bed in the head section of 20 cm). These are all factors which, while not cause reflux as such, but already resulting helping reflux.
Regarding the dieting is a suitable non-irritating diet excluding alcohol and food, which lead to problems (as mentioned in the section on preventive measures). Especially avoid leavened bread, fatty foods and chocolate. Also, do not eat two to three hours before bedtime.
From the drug is most effective omeprazole (Helicid, Losec, Lomac, Loseprazol, Omepirex, Omeprazole, Omeprol, Ortanol, Ultop). It serves mostly empty stomach. Treatment can take several weeks, then you can be apart again.
Additional treatments are prokinetic agents (metoclopramide – eg. Cerucal, Degan, Domperidone – Motilium, itopride – Ganaton) that are served three times a day. Previously, it was registered with us prokinetikum cisapride (Prepulsid), which was very effective, but after what proved some adverse effects on the heart, was withdrawn from registration. Yet it can not be a lot of gastroenterologists still happen.
When treating only occasional problems, you take antacids (soda, milk, Rennie) at any time during heartburn. It works immediately, but unfortunately the relief is only temporary.
In severe reflux and their complications are sometimes inevitable surgery. This is essentially a reflux which in the night, and thus endanger the patient by inhalation of gastric contents, as reflux, which does not occupy pharmacological treatment, and the operation is also intended for young patients, which is the most appropriate and lasting solution. The procedure is performedlaparoscopically, so it is distressing to the patient. It has very good results with minimal complication rate.
Complications of gastroesophageal reflux disease
Complications arise only when inflammation develops – the reflux oesophagitis. This inflammation can cause scarring narrowing of the esophagus. Before the constriction is then accumulates food and are having trouble swallowing.
Required long-term treatment with omeprazole (Helicid) and prokinetics. When you encounter problems with swallowing, it must undergo a small endoscopic operation, the doctor (gastroenterologist) stretches the esophagus in a restricted location (esophageal dilatation) to avoid a complete blockage of the esophagus food.
Inflammation can cause the emergence of esophageal ulcer. This translates to stagnation and pain when swallowing morsels.
Serious complication is changing the lining of the esophageal mucosa (ie. Metaplasia – replacement of squamous mucosa lining of the esophagus lining of the cylinder, which is in the intestines). This is called Barrett’s esophagus. On the basis formed in 10-15% tumor of the esophagus (adenocarcinoma). Therefore, it must adhere to treatment again omeprazole and prokinetics and also endoscopic inspection once every 1-2 years to assess possible changes in the mucosa.
If changes have occurred high degree (initial tumor), the patient is then sent to either the surgicaloperation, or nowadays emerging endoscopic, or less burdensome.
Other names: gastroesophageal reflux disease, reflux, esophageal reflux, GER