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About Treatment

Gastroesophageal Reflux disease (GERD) is a chronic acid-dependent disease that occurs with poor functioning of the lower sphincter of the esophagus, which significantly impairs the quality of human life. The main reason for the lack of function of the lower esophageal sphincter is a diaphragmatic hernia (abdominal organs enter the chest through a defect in the diaphragm).

Are you experiencing constant heartburn and do not understand what is the reason? All the components of the digestive system have long quarreled among themselves? Does food seem to choose its own route through your internal organs? It's time to have consultation with a gastroenterologist. 

The progression of gastroesophageal reflux disease is aggravated by obesity, pregnancy, peptic ulcers (chronic inflammatory processes on the mucous layer of the digestive organs), pancreatitis, cholecystitis, and taking a number of drugs that are difficult for the body to absorb in individual cases.

Gastroesophageal Reflux Treatment

The main treatment for uncomplicated GERD course 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 use alcoholic, strongly carbonated drinks
 Weight loss with obesity
 To give up smoking
 Avoid eating in large quantities and in late hours
 Adequate drinking regimen
 Elimination of excessive physical exertion, especially with frequent body tilts
 Elimination of a 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 already at the first signs of inflammation of the esophagus and stomach.

The following drugs are used:

Prokenetics (help accelerate the movement of the food lump from the esophagus into the stomach, then into the duodenum, increase the tone of the lower esophageal sphincter) 
Antisecretory drugs (help suppress the secretion of hydrochloric acid) - proton pump inhibitors 
Antacids 

The treatment regimen is selected individually in accordance with the patient's condition and taking into account concomitant diseases.

Surgical Treatment of Gastroesophageal Reflux

Operation is an alternative to conservative treatment for GERD. Operation is most often prescribed for young patients (since otherwise they will need long-term treatment) with typical GERD symptoms (heartburn and belching), who are helped by drug treatment, but they are looking for an alternative to daily medication.

Patients with atypical symptoms or patients who are unresponsive to drug treatment are only prescribed surgery if there is no doubt about the diagnosis of GERD and the relationship between symptoms and reflux is confirmed by test results.

Fundoplication is used in most cases. During this operation, the upper stomach is wrapped around the lower esophageal sphincter, thereby increasing its tone. Today, instead of the traditional "open" surgery, minimally invasive (laparoscopic) technologies are usually used. One of the advantages of fundoplication is that hiatal hernia can also be treated during surgery.

Operation is not always effective, and some patients still have to take medication after it. The results of this surgery are usually positive, but complications can nevertheless occur, such as difficulty swallowing, bloating and gas, a difficult recovery from surgery, and diarrhea that results from damage to the nerve endings that are adjacent to the stomach and intestines.

Causes

 Disorders of muscle tone of the lower esophageal sphincter
 Congenital and acquired destructive pathologies of the esophagus
 Hernia of the diaphragm
 Connective tissue failure
 Excessive activity of the sympathetic nervous system
 Foods high in fat, spices
 Abuse of drinks - alcohol and caffeine
 High dosages of medications such as barbiturates, morphine, NSAIDs, hormonal drugs
 Increased intra-abdominal pressure

Symptoms

GERD symptoms are divided into esophageal (typical) and extraesophageal symptoms.

Esophageal:

 Heartburn, especially at night and in the morning
 Excessive drooling
 Belching of air, sour or bitter taste
 Nausea and vomiting
 Sore throat when swallowing
 Aching pain in the epigastric region
 

 Extraesophageal:

 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, nonproductive cough
 Hoarseness 

Diagnostics

  General clinical analysis of blood, urine
  Stool analysis for coprogram
  Biochemical blood test (liver function tests, cholesterol, alkaline phosphatase)
  ECG
  Chest x-ray in 2 projections
  X-ray of the esophagus, stomach with barium mixture
  Ultrasound of the hepatobiliary system
  Daily pH monitoring in the lower esophagus and stomach
  Non-invasive tests for the determination of Helicobacter pylori (respiratory)

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