Gerb complaints. Gastroesophageal reflux disease: diagnosis, therapy and prevention. Conservative treatment includes

Gastroesophageal reflux disease (GERD), which can be treated using different methods, is a pathology digestive system, when the acidic contents of the stomach are thrown into the esophagus, as a result of which its walls become inflamed. The main symptoms of GERD are heartburn and sour belching. A gastroenterologist deals with the diagnosis and treatment of the disease. If a person is diagnosed with GERD, treatment will consist of taking medications that reduce the acidity of gastric juice and protect the esophageal mucosa from the effects of acid. Following a certain diet gives good results. Features of the course of GERD, symptoms, treatment will be discussed in this article.

Causes of the disease

Often, reflux disease occurs due to a decrease in the tone of the lower esophageal sphincter, and this, in turn, occurs when drinking caffeine and alcohol, smoking, or in the case of pregnancy under the influence of hormonal factors. What other reasons could there be for the development of GERD? Treatment of any ailments with antispasmodics, analgesics, or calcium antagonists can lead to gastroesophageal reflux disease. Also, its occurrence is possible against the background of increased intra-abdominal pressure caused by ascites, obesity, and flatulence. Conditions for reflux are created with a diaphragmatic hernia, when the pressure on the lower region of the esophagus in the chest.

An increase in intragastric pressure and reflux of stomach contents into the esophagus can occur with heavy and hasty consumption of food, since then a lot of air is swallowed along with it. The same consequences result from the presence in the diet of excess amounts of foods containing peppermint, rich in animal fats, hot seasonings, fried foods, carbonated water. A duodenal ulcer can also cause the development of GERD.

Symptoms

It is advisable to begin treatment of reflux disease as early as possible, otherwise its manifestations can cause many problems. When the contents of the stomach (and this includes food, digestive enzymes, and hydrochloric acid) enter the esophagus, its mucous membrane is irritated, inflammation begins, and GERD occurs. Symptoms and treatment in this case are typical for many esophageal disorders. So, the signs of the disease are usually the following:

In addition to esophageal symptoms, GERD also manifests itself extraesophageal. These are digestive disorders (flatulence, abdominal pain, nausea); pathologies of the pharynx and oral cavity(caries, sore throat, destruction of tooth enamel); damage to the ENT organs (polyps of the vocal cords, rhinitis, laryngitis, otitis media); damage to the respiratory system (pneumonia, bronchial asthma, bronchitis, emphysema, bronchiectasis); ailments cardiovascular system(angina pectoris, arrhythmia, arterial hypertension).

Diagnostics

Until GERD is diagnosed by a gastroenterologist, there is no point in starting treatment, because treatment methods should be selected based on the characteristics of the pathological process. To identify reflux disease and determine the mechanism of its development, the following methods are used:

• X-ray of the esophagus. With such a study, erosions, strictures, ulcers, and hernias can be detected.
• Endoscopy of the esophagus. This procedure also reveals inflammatory changes.
• Scintigraphy with radioactive technetium. The study involves taking ten milliliters of egg white with Tc11: the patient takes sips of this drug every twenty seconds, and at this time a picture is taken on the halo-chamber every second for four minutes. This method makes it possible to assess esophageal clearance.
• Manometric examination of the esophageal sphincters. This procedure allows you to detect changes in sphincter tone.
• Monitor pH in the lower esophagus. Such a study is necessary in order to select individual therapy and monitor the effectiveness of medications.

GERD: treatment

Purpose therapeutic activities with this disease is the elimination of its symptoms, the fight against reflux and esophagitis, improving the quality of life, and preventing complications. Conservative therapy is most often used, surgical treatment GERD is indicated only in extreme cases. Let's take a closer look at ways to combat the disease. The set of activities includes:

• adherence to a diet and a certain lifestyle;
• taking antacids, antisecretory drugs and prokinetics.

Regardless of the stage and severity of GERD, treatment involves constant adherence to certain rules:

• Do not lie down or lean forward after eating.
• Do not wear tight clothes, corsets, tight belts, bandages - this leads to an increase in intra-abdominal pressure.
• Sleep on a bed in which the part where the head is located is raised.
• Do not eat at night, avoid large meals, do not eat too hot food.
• Quit alcohol and smoking.
• Limit consumption of fats, chocolate, coffee and citrus fruits, as they are irritating and reduce LES pressure.
• Lose weight if you are obese.
• Stop taking medications that cause reflux. These include antispasmodics, β-blockers, prostaglandins, anticholinergic drugs, tranquilizers, nitrates, sedatives, calcium channel inhibitors.

Medicines for reflux disease. Antacids and alginates

Such drugs for the treatment of GERD are used when manifestations of the disease are moderate and infrequent. Antacids should be taken after each meal (after one and a half to two hours) and at night. The main drug from this group is Almagel.

Alginates create a thick foam on the surface of the stomach contents and, due to this, return to the esophagus with each episode of reflux, thereby providing a therapeutic effect. Due to the content of antacids, alginates produce an acid-neutralizing effect, at the same time they form a protective film in the esophagus, which creates a pH gradient between its lumen and the mucosa and thus protects the mucosa negative influence gastric juice.

Prokinetics

These drugs restore normal physiological state esophagus by increasing the tone of the lower sphincter, improving clearance and enhancing peristalsis. The main means of pathogenetic therapy for GERD is the prokinetic drug Motilium. It normalizes motor activity of the upper sections digestive tract, restores active gastric motility and improves antroduodenal coordination. Motilium is well tolerated when long-term therapy is necessary and reduces the percentage of disease relapses.

Proton pump inhibitors

If GERD with esophagitis is diagnosed, treatment with prokinetics is carried out in combination with proton pump inhibitors. As a rule, the new generation drug “Pariet” is used. Due to its use, acid secretion decreases, positive dynamics are noted clinical manifestations illness. Patients report a decrease in intensity or even complete disappearance of heartburn and a decrease in pain.

For GERD, the treatment regimen with prokinetics and proton pump inhibitors is as follows: 20 milligrams of Pariet and 40 milligrams of Motilium are prescribed per day.

Therapy for young children

In babies, reflux causes frequent burping. Treatment consists of several stages:

Therapy in older children

Correcting the child’s lifestyle is of great importance in the treatment of reflux disease.

• The end of the bed, where the head is located, should be raised by at least fifteen centimeters. This simple measure can reduce the duration of acidification of the esophagus.
• It is necessary to introduce dietary restrictions for the child: reduce the fat content in the diet and increase the protein content, reduce the amount of food consumed, exclude irritating foods (citrus juices, chocolate, tomatoes).
• It is necessary to develop the habit of not eating at night and not lying down after eating.
• It is necessary to ensure that the child does not wear tight clothes or sit bent over for a long time.

As drug treatment, as in adults, antacid drugs are used, usually in the form of a suspension or gel (Almagel, Phosphalugel, Maalox, Gaviscon), prokinetic agents (Motilak, Motilium, Cerucal) ). The choice of a specific medication and determination of the dosage is carried out by the attending physician.

Surgical intervention

Sometimes, to restore normal function of the cardia, it is necessary to resort to surgery aimed at eliminating reflux. Indications for surgical treatment are as follows:

• complications of GERD (repeated bleeding, strictures);
• ineffectiveness of conservative therapy;
• frequent aspiration pneumonia;
• diagnosing Barrett's syndrome with high-grade dysplasia;
• the need of young patients with GERD for long-term antireflux therapy.

Reflux is often treated by fundoplication. However, this method is not without drawbacks. Thus, the result of the operation entirely depends on the experience of the surgeon; sometimes after surgery there remains a need for drug treatment, and there is a risk of death.

Currently, various endoscopic techniques have been used to influence foci of metaplasia: electrocoagulation, laser destruction, photodynamic destruction, argon plasma coagulation, endoscopic local resection of the esophageal mucosa.

Therapy with folk remedies

In the initial stages of GERD, alternative treatment can be very helpful. In general, at these stages you can cope with the disease simply by following an antireflux regimen and changing your lifestyle. If the disease is mild, various remedies can be used to relieve heartburn instead of antacids. traditional medicine, strengthening and protecting the esophageal mucosa, improving sphincter tone and reducing the acidity of gastric juice. In severe cases of the pathological process, it will not be possible to do without drug therapy, and in the presence of complications, surgical intervention is generally required. Therefore, treatment of GERD with folk remedies is rather an auxiliary and preventive method. It can be used as an adjunct to highly effective drug therapy regimens.

Herbal medicine is very popular among people. Here are several traditional medicine recipes for the treatment of reflux disease.

Treatment of GERD with folk remedies involves not only herbal medicine, but also the use mineral waters. They should be used at the final stage of the fight against the disease or during remissions in order to consolidate the results. For reflux disease, alkaline low-mineralized waters, such as Borjomi, Smirnovskaya, Slavyanovskaya, are effective. You need to drink them slightly warmed up, since gas escapes during the heating process. However, the temperature should not exceed 40 degrees, otherwise the salts will precipitate. Warm degassed mineral water should be consumed forty minutes before meals, one glass at a time for one month. After drinking water, it is recommended to lie down for twenty minutes.

The twentieth century is the century of gastric ulcers, and the 21st century is gastroesophageal reflux disease, or GERD. This medical term has a number of symptomatic signs, the main one of which is heartburn.

The concept of gastroesophageal reflux disease, symptoms, the causes and treatment of which are associated with a disease that develops as a result of the formation of reflux of any stomach contents into the esophagus, entered gastroenterology a little more than ten years ago, and today represents the most pressing clinical problem of the esophagogastric canal.

If you ate a fragrant slice of pizza, and then felt an unpleasant burning sensation in the pit of your stomach, heartburn and discomfort in the esophageal canal, then it is likely that these are symptoms of GERD (gastroesophageal reflux disease). To understand what causes heartburn and other pain symptoms, you need to trace the path of this pizza.

As soon as a person bites off and chews a slice of pizza, it immediately enters the esophagus. It is from this organ of the digestive system that the transit of food that we have consumed begins. Where the esophagus flows into the stomach, there is a special valve - the lower sphincter, which serves as a kind of restrictive door between the esophagus and the stomach, opening for the passage of food, and closing after food enters the stomach.

When food is in the stomach, its muscles begin to work intensively - contract, relax and mix. At the same time, the pressure inside the stomach increases, and if the sphincter is not tightly closed, then part of the food is automatically sent to the floor above. As a rule, this happens in those who like to eat heavily, however, the stomach is not rubber, and it is not able to accommodate a large amount of food consumed. That's why he's trying to get the extra food back.

A burning sensation in the esophagus occurs because the stomach contains hydrochloric acid, which is necessary for digesting the contents of the stomach. It is this, that is, hydrochloric acid, that burns the mucous membrane of the esophagus and injures it. For isolated cases, heartburn after overeating is not so dangerous, however, if such episodes of ejection of stomach contents are often repeated, this can lead to serious consequences, for example, develop signs of GERD - gastroesophageal reflux disease.

Epidemiology and etiology of GERD

Gastroesophageal reflux disease is a chronic relapsing form of a disease of the digestive system, caused by the development of disturbances in the motor and evacuation functions of the gastroesophageal zone, characterized by spontaneous or regular reflux of duodenal or gastric contents into the esophagus, leading to distal disruption of the esophagus and the appearance of characteristic clinical signs:

• heartburn;
• dysphagia;
• retrosternal, or chest pain.

By international classification diseases of the tenth revision (ICD 10), GERD is defined as gastroesophageal reflux with esophagitis - K21, or gastroesophageal reflux without esophagitis - K22.
The true prevalence of the clinical condition is poorly understood to date. To a greater extent, this fact is associated with the great variability of various manifestations of GERD - from occasional burning sensations in the esophagus to clear signs of complicated reflux esophagitis.

As a rule, gastroesophageal reflux disease, the symptoms and signs of which are detected in almost 50% of the adult population during a visual gastroenterological examination, are confirmed in only 10% of cases when a person undergoes a more qualitative and informative endoscopic examination.

The etiology of GERD is a multifactorial disease that has a number of predisposing cause-and-effect factors for the occurrence of the disease:

• frequent stress and nervous shock;
• forced horizontal posture, for example, due to illness;
• obesity;
• smoking, which contributes to structural changes in the mucous surface of the esophagus;
• pregnancy;
• congenital insufficiency of the lower esophageal sphincter;
• decreased resistance (resistance) of the esophageal mucosa to external stimuli;
• prolonged exposure to medications, etc.

Gastroesophageal disease: symptoms of the disease

The clinical signs of GERD are quite varied. The main symptoms of the disease are associated with impaired motor function of the upper gastrointestinal tract, that is, the esophagus and hypersensitivity stomach to external irritants. There are esophageal and extraesophageal symptoms of GERD.

Thus, the main esophageal symptoms of gastroesophageal reflux disease:

• Heartburn or burning sensation in the esophageal canal, occurring in 90% of patients. Strengthening the symptomatic sign is facilitated by physical overexertion (bending, turning), carbonated and/or alcoholic drinks, and dietary errors.
• Sour belching is another leading symptomatic sign of GERD, occurring in half of patients and worsening after a dietary mistake, such as drinking carbonated drinks, alcohol, fatty and/or spicy foods.
• Regurgitation, or frequent regurgitation, is the result of physical stress or incorrectly chosen posture.
• Dysphagia, or difficulty swallowing, occurs as the disease progresses. Moderate or persistent dysphagia is the result of a complicating factor, hypermotor dyskinesia of the esophagus or the formation of its stricture, respectively.
• With a pronounced inflammatory reaction of the mucous surface, odynophagia is noted, that is, a pain reflex that occurs when food passes through the esophageal tube. Such a symptom requires high-quality differential diagnosis with esophageal cancer.

In addition to these symptomatic esophageal signs, gastroesophageal reflux disease responds with pain in the epigastric region, localized in the projection of the xiphoid process, and aggravated after eating, physical activity, and so on.

Patient complaints of chest pain often resemble signs of angina pectoris. provoke painful condition capable physical activity person.

Extraesophageal symptomatic signs of GERD include:

• A qualitative voice disorder characterized by hoarseness, nasal sound, or hoarseness.
• Rough chronic dry cough.
• Feeling of a foreign body in the throat.
• Violation of the frequency and depth of breathing.
• Nasal congestion and discharge.
• Bronchopulmonary complication.
• Headache and so on.

Such severity of clinical manifestations, as a rule, causes discomfort to a person at night when he is sleeping.

Before treating gastroesophageal reflux disease, it is necessary to conduct a diagnosis that will determine the severity of the disease and evaluate the endoscopic classification of GERD.

Diagnosis of reflux esophagitis

Gastroesophageal reflux disease (GERD) is determined not only by visual symptomatic signs, patient complaints about pain syndrome in the digestive system, but also with the help of various laboratory and instrumental tests:

1. Therapeutic testing involves the administration of proton pump inhibitors, which is performed over 5-10 days. For example, the standard dosage of a drug Omeprazole® – medicine, which helps suppress the secretion of gastric juice, is 20 mg 2 times a day. The effectiveness of the prescribed medication for reflux disease is determined by the disappearance of the main symptomatic signs - heartburn, pain in the chest and/or epigastric region.
2. A more effective and reliable method for diagnosing gastroesophageal reflux is considered to be 24-hour pH-metry of the esophageal canal, which allows a qualitative assessment of the severity of reflux, its duration and frequency.
3. Carrying out an X-ray examination.

However, the main confirmation of the diagnosis of gastroesophageal reflux disease in children or adults is the endoscopic scanning method.

There is a special classification of reflux esophagitis, introduced in Los Angeles (USA) in 1994.

Gastroesophageal reflux disease, according to the results of endoscopic examination, can have four classification degrees of formation:

• The first degree is determined without pathological changes in the structural composition of the cells of the mucous membrane of the esophagus.
• The second degree is esophagitis with diffuse transformations of the mucous walls of the esophagus.
• The third degree is defined as erosive esophagitis.
• The fourth degree of the disease forms erosive-ulcerative esophagitis.

According to these classification features, reflux esophagitis can be peptic stricture of the esophagus, bleeding, Barrett's esophagus, or adenocarcinoma. All these clinical conditions are considered as complicating factors.

Treatment options for GERD

Carrying out therapeutic measures involves a comprehensive therapeutic or surgical approach. It all depends on the severity of the disease, the presence or absence of concomitant reflux esophagitis. In all cases of gastroesophageal reflux disease, treatment is recommended to begin with a dietary regimen and proper nutrition, which involves eating small fractional portions 5-6 times a day.

All foods that can reduce muscle tone esophageal sphincter and thereby increase gastroesophageal reflux disease. The diet includes the exclusion of fatty and spicy foods, tomato juice, chocolate, coffee, cocoa, citrus fruits, various spices, and so on. If reflux is severe, it is recommended to eat while standing, and after eating you should walk for half an hour.

Among other ways non-drug treatment, gastroenterologists recommend:

• During sleep, you should keep your head elevated.
• Drinking alcohol and smoking is strictly prohibited.
• The patient needs regular bowel movements.

In addition, a person should avoid deep bending of the body, overexerting the abdominal muscles, lifting weights and wearing tightening belts.

Drug treatment of GERD

Medical therapy for initial stage diseases include the use of pharmaceutical antacids or histamine H2 receptor blockers, e.g. Ranitidine®, Kvamatel®, Famotidine®, which are prescribed during the first 4-6 weeks. The presence of Helicobacter pylori infection requires 7-day antibacterial therapy. Usually prescribed Amoxicillin® And Furazolidone®. Among the liquid forms of pharmaceutical preparations of the antacid group are: Gaviscon®, Almagel® or Phosphalugel®.

Dopamine receptor blockers, e.g. Motilium® And Perilium®, are prescribed for severe reflux. Such pharmacological combinations belong to the group of prokinetics, which not only increase the muscle tone of the lower sphincter, but also enhance peristalsis of the antrum of the stomach and play important role in the prevention of duodenogastric reflux.

The use of these drugs in the treatment of gastroesophageal reflux disease blocks discomfort and specific symptoms of the disease - sour belching, burning, heartburn, painful discomfort behind the sternum or in the area of ​​the xiphoid process. After therapeutic treatment, it is recommended to undergo repeated endoscopy. If drug therapy is ineffective, surgical intervention is considered.

Help from traditional medicine

Along with diet and drug therapy, the attending physician may prescribe treatment of gastroesophageal reflux disease with folk remedies through the use of herbal medicine with medicinal plants that have an enveloping, antispasmodic, hyposensitizing and calming effect.

Thus, the following have an enveloping effect:

• marshmallow root;
• coltsfoot leaves;
• flax seeds.

The following will have an antispasmodic and calming effect:

• peppermint leaves;
• medicinal valerian root.

With pronounced allergic reactions use medicinal plants that have a hyposensitizing effect, for example, chamomile, string or wild strawberry. When carrying out phytotherapeutic activities, three collections of medicinal plants are usually recommended:

Features of nutrition in gastroesophageal reflux disease

People suffering from GERD need to properly organize a complete and varied diet. A comprehensive menu for gastroesophageal reflux disease is part of the treatment process that affects a speedy recovery.

The basic principle is selective diet, fractional meals and an adequately designed regimen food products. Cooking should be based on careful grinding and heat treatment of food products.

The choice of any diet is based on an individual approach, taking into account physiological characteristics person, his age and gender. Taking these features into account, a consulting specialist or nutritionist will select a rational composition of products.

It is most correct to follow the dietary recommendations compiled by the Soviet nutritionist M.I. Pevzner, who developed more than 20 types of different diets, covering all diseases of the digestive system.

Despite the apparent limitations, the list of permitted products for gastroesophageal reflux disease is quite impressive.

Prevention of GERD

Treatment and preventive measures include following simple recommendations:

• Avoid smoking and drinking carbonated and alcoholic drinks.
• Abstinence from taking medications that disrupt the functional functioning of the esophagus and affect its mucous membrane. First of all, these are non-steroidal anti-inflammatory groups, which can only be prescribed by a doctor.
• Compliance with dietary recommendations and nutritional rules, excluding the consumption of hot and too spicy foods, eating at night, etc.

The abbreviation GERD stands for gastroesophageal reflux disease - this pathology has a number of characteristic symptoms, causes and methods of treatment, both official and folk. The disease itself occurs as a result of regularly repeated release of the contents of the stomach or duodenum into the esophagus. Symptoms of the disease are especially pronounced after eating and physical activity. To prevent the development of complications, it is necessary to confirm the diagnosis of GERD in time and begin treatment.

What is GERD in gastroenterology

This term refers to a disease in which the contents of the duodenum or stomach are refluxed into the lower esophagus. This may be hydrochloric acid, bile, pepsin and components of pancreatic juice. Otherwise, the pathology is simply called reflux disease. The mass that is thrown back is called refluxate. She may have varying degrees acidity depending on where the casting comes from. GERD in terms of incidence is compared with peptic ulcers and cholelithiasis.

Causes of reflux

If this mechanism of opening/closing of the sphincters is disrupted, gastric juice and other contents are thrown back. This is called reflux. As a result, the mucous membrane is damaged, erosions and ulcers can form on it, and sometimes even internal bleeding. The causes of GERD are as follows:

1. Eating food in large quantities and at a hasty pace. This leads to the swallowing of air, which causes an increase in intra-abdominal pressure and the reflux of stomach contents.
2. Decreased tone of the lower esophageal sphincter, slower gastric emptying. This pathology can be caused by:

• the toxic effect of nicotine on muscle tone when smoking;
• taking calcium antagonists, antispasmodics, nitrates, analgesics;
• drinking alcohol;
• pregnancy.

1. Diaphragmatic hernia. A hiatal hernia is detected when pressure on the lower part of the esophagus in the chest decreases. It occurs in half of people over 50 years of age.
2. Duodenal ulcer.
3. Abuse of foods with a lot of fat, peppermint, fried, spicy, carbonated drinks, mineral water. They lead to increased intra-abdominal pressure.

Risk factors

In addition to the specific reasons why gastroesophageal reflux disease of the stomach develops, there are aggressive factors that increase the risk of its occurrence. Contribute to the appearance of this disease:

• professional activity in which one is forced to be in an inclined position;
• experiencing stress;
• bad smoking habit;
• pregnancy;
• excess body weight;
• abuse of alcohol, coffee, chocolate, fruit juices, fatty foods;
• taking drugs that cause the concentration of dopamine in the periphery.

Gastroreflux disease - symptoms

Signs of reflux disease are divided into two large groups - esophageal and extra-esophageal. In the first case, the symptoms are related to the functioning of the gastrointestinal tract. Characteristic signs on the part of the digestive system, they are divided into two more subgroups. Clinical (esophageal) symptoms resemble upper gastrointestinal motility disorder:

• heartburn - a burning sensation behind the sternum, aggravated by bending over, after a heavy meal, lying down and during physical exertion;
• sour or bitter belching;
• nausea and vomiting;
• hiccups;
• regurgitation of food;
• feeling of heaviness in the stomach after eating food;
• swallowing disorder;
• non-coronary chest pain;
• bad breath;
• increased drooling during sleep.

Esophageal manifestations of reflux disease include the development of syndromes of damage to the structure of the esophagus. Their list includes the following:

• Barrett's esophagus;
• reflux esophagitis;
• peptic stricture and adenocarcinoma of the esophagus.

Extraesophageal, or extraesophageal, manifestations are a consequence of the entry and irritation of stomach contents into the respiratory tract, activation of the esophagocardial and echobronchial reflexes. In this case, gastroesophageal reflux disease is manifested by the following symptoms:

1. Otolaryngological. Otolaryngopharyngeal syndrome – development of laryngitis, otitis, pharyngitis, reflex apnea, rhinitis.
2. Manifestations from the lungs. They are a pulmonary syndrome with cough and shortness of breath that occurs when in a horizontal position. This also includes
3. Coronarogenic pain. Feel behind the sternum, similar to symptoms during angina attacks, with coronary disease heart disease (CHD) and myocardial infarction. Against this background, an increase in heart rate and arrhythmia occurs.

Symptoms of GERD with esophagitis

Reflux disease and GERD with esophagitis have a similar development mechanism, but with the first disease, the contents of the stomach are simply thrown into the esophagus, and with the second, because of this, the mucous membrane of the latter becomes additionally inflamed. Reflux causes a number of reactions in its area:

• ulcerative lesions of the walls;
• inflammatory process;
• narrowing of the lower esophagus;
• modification of the lining layer, which is in contact with the refluxate, into a form unusual for a healthy state.

Esophagitis is detected after reflux disease, when the refluxed contents cause damage to the esophageal mucosa. The resulting inflammatory processes are manifested by the following symptoms:

• heartburn;
• sour belching;
• stomach pain;
• nausea.

Gastroesophageal reflux in children

The development of gastroesophageal reflux disease in infants is considered normal. Anatomical and physiological features predispose to regurgitation, which is the main manifestation of the pathology. The reason is an incompletely developed esophagus, a small volume of the stomach and low acidity of gastric juice. The symptom of regurgitation disappears on its own by the end of the baby’s first year of life. Other signs of the disease in infants:

• lack of appetite;
• vomiting blood;
• intense vomiting;
• slow weight gain;
• anxiety;
• cough;
• tearfulness.

Classification of the disease

The general classification of gastroesophageal reflux disease divides it into types depending on the presence or absence of signs of inflammation of the esophagus. Based on it, three forms of this pathology are described:

1. Non-erosive reflux disease. It is observed more often than others, in approximately 70% of cases of gastroesophageal reflux. The pathology occurs without the manifestation of esophagitis.
2. Erosive-ulcerative. It is a gastroesophageal reflux disease complicated by stricture and ulcers.
3. Barrett's esophagus. The disease is a metaplasia of stratified squamous epithelium. The cause is esophagitis.

Degree of change in the esophagus

Damage to reflux disease of the esophagus can have varying degrees. If inflammation of the mucous membrane has already occurred, then in terms of the volume of affected tissues it can be:

1. Linear. In this case, it is noted separate areas inflammation of the esophagus. The lesion does not affect more than two folds of the distal mucosa.
2. Drain. The pathological process continues to spread, covering a larger surface due to the connection of several foci into continuous inflamed areas.
3. Circular. Inflammation covers almost the surface of the esophagus from the inside, approximately 75%.
4. Stenotic. It is characterized by complete damage to the mucosal surface, which is already accompanied by the development of peptic ulcers, bleeding and stricture.

Diagnostics

To make a correct diagnosis, you need to visit a gastroenterologist. Additionally, the patient may need to consult other specialists, such as an otolaryngologist, cardiologist, pulmonologist and surgeon. An appointment with the last doctor is necessary in case of ineffectiveness of drug treatment, diaphragmatic hernia and other complications. Methods for differential diagnosis of gastroesophageal reflux disease include:

1. Test containing a proton pump inhibitor. On initial stage the diagnosis is made taking into account the typical manifestations of gastroesophageal reflux disease that the patient complains about. Next, the standard dosage of the proton pump is prescribed - Pantoprazole, Omeprazole, Esomeprazole, Rabeprazole. They are taken for 2 weeks, which allows the disease to be diagnosed.
2. Intrafood pH daily monitoring. Necessary for determining the number of refluxes per day and their duration. This method is considered the main one; it determines the connection between typical and atypical symptoms and the reflux of contents into the esophagus. If within an amount of time equal to 4.2% of the entire recording period, a pH level of 4 is reached, then such reflux is considered to be outside the norm.
3. Fibrogastroscopy. Prescribed to patients with esophagitis, detects cancer and precancerous diseases. Used in case:

• ineffectiveness of empirical treatment with proton pump inhibitors;
• long-term treatment of the disease;
• controversial diagnosis;
• non-food and other alarming symptoms– gastrointestinal bleeding, pain when swallowing, weight loss.

1. Chromoendoscopy of the esophagus. Used in cases of recurrent and long-term reflux disease. The goal is to identify areas of intestinal metaplasia, i.e. precancerous condition, using endoscopic examination and biopsy.
2. ECG and ultrasound of the heart. Detect arrhythmia and other problems of the cardiovascular system. Digestive diseases are confirmed by ultrasound of the abdominal organs.
3. X-ray examination of the esophagus. Detects ulcers and narrowing of the esophagus, hiatal hernia.
4. General blood test. A slight increase in ESR is a sign inflammatory process. In men it is more than 10 mm/h, and in women it is more than 15 mm/h. If the level of hemoglobin and red blood cells has decreased, this indicates a deficiency of red blood cell oxygen carrier cells.
5. Test for Helicobacter pylori. If the analysis confirms the presence of this microorganism, then radiation treatment is prescribed.

Drug treatment of GERD

Treatment is aimed at quickly eliminating the symptoms of the disease, eliminating its relapses and complications. According to the generally accepted scheme, therapy is carried out with antisecretory drugs, which include proton pump inhibitors and H2-histamine receptor blockers. Treatment involves the use of other drugs:

• prokinetics in case of bile reflux;
• antacids to relieve symptoms of the disease;
• reparatives necessary to restore the inner layer of the esophagus.

H2-histamine receptor blockers

The function of these drugs is to reduce the production of hydrochloric acid in the stomach. In order to prevent relapses, they can be prescribed a repeat course. These could be:

1. Famotidine. The drug reduces the activity of pepsin and reduces the secretion of hydrochloric acid. Take the medicine orally 0.02 g twice a day or 0.04 g before bedtime. Possible digestive problems after consumption, genitourinary system and sense organs.
2. Cimetidine. It acts similarly to Famotidine. The therapeutic regimen is determined individually. The average dosage is 200-400 mg. As a result of taking it, dyspepsia, myalgia, pancreatitis, nausea and a number of other problems may develop.
3. Nizatidine. Suppresses the production of hydrochloric acid. The dosage is 0.15 g 1-2 times a day. Nausea and liver tissue damage may occur after administration.

Proton pump inhibitors

As a result of taking a proton pump inhibitor, the proton pump of the cells in the mucous membrane of the stomach and esophagus is blocked. The result is a decrease in the secretion of hydrochloric acid. The table describes these drugs in more detail:

Prokinetics

Strengthen the tone and contract the lower esophageal sphincter. This helps reduce the incidence of reflux. The following products have these properties:

1. Domperidone. It is an antiemetic. Take the medicine before meals. Daily dose – 80 mg. After taking it, stomach upsets and skin rashes may occur.
2. Metoclopramide. Stimulates esophageal peristalsis. The list of side effects is large, they relate to the digestive, circulatory, cardiovascular and nervous systems. You need to take 5-10 mg 3-4 times a day.
3. Cisapride. The medicine stimulates motility and tone of the gastrointestinal tract and has a laxative effect. It is recommended to take 5-20 mg of the drug. After taking it, there is a risk of a large number of side effects.

Antacids

This category of drugs neutralizes hydrochloric acid gastric juice, reducing its acidity. They are symptomatic. Canceling medications returns acidity to its previous levels. This group includes the following funds:

1. Phosphalugel. It has an enveloping, absorbent and antacid effect. It is recommended to take 1-2 sachets 2-3 times a day. This dosage is for children and adults over 6 years of age. Side effects are rare. It could be constipation.
2. Gaviscon. Forms a protective layer on the mucous membrane that prevents the development of reflux disease. Children over 12 years of age and adults are recommended to take a dosage of 2-4 tablets after meals and, if necessary, before bedtime. adverse reaction may be an allergy.
3. Rennie. Neutralizes the effect of hydrochloric acid in excess. Chew 1-2 tablets per day. After administration, hypersensitivity reactions are possible.

Medicines for bile reflux

In case of bile reflux, the patient is prescribed Domperidone from the prokinetic category or Ursofalk. The last drug is a hepatoprotector. Its function is to dissolve gallstones and reduce cholesterol in the blood. Gastroesophageal reflux disease is treated by taking 1 Ursofalk capsule for 10 days to six months. Side effects after taking are diarrhea, calcification of stones, urticaria.

In what cases is surgery necessary?

The main indication for surgery is the ineffectiveness of drug treatment. Surgical intervention consists of restoring the necessary barrier that will prevent stomach contents from entering the esophagus. Other indications for surgery:

• epithelial cells take on a cylindrical appearance, which is Barrett's esophagus;
• the presence of ulcers of the surface layer of the esophagus;
• third or fourth degree of esophagitis;
• stricture, i.e. narrowing of the esophagus where the aggressive effect of reflux is noted.

Diet for GERD

Diet is no less important in the treatment of gastroesophageal reflux. It is recommended not to overeat and not to lie down immediately after eating. Heavy lifting, constipation and flatulence should be avoided. The last meal should be 4 hours before bedtime. You need to avoid the following products:

• juices;
• spicy dishes;
• chocolate;
• citrus fruits;
• radishes;
• coffee;
• alcohol;
• fried;
• flour

Instead of harmful products It is necessary to include healthy and nutritious foods in your diet. Its list is as follows:

• milk, cream, low-fat kefir;
• steamed dishes from lean fish;
• vegetable broth soups;
• sweet fruits;
• alkaline low-mineralized waters;
• tea with milk;
• lamb, lean pork, beef;
• dried wheat bread;
• butter;
• cereals – semolina, rice, buckwheat.

Treatment of gastroesophageal reflux disease with traditional methods

Traditional medicine recipes can also be used against the background of drug treatment. They speed up recovery, relieve symptoms, alleviating the patient’s condition. The following remedies are effective in this case:

1. Flax seed decoction. Makes the esophageal mucosa more stable. Take 2 tbsp. raw materials, mix with 0.5 liters of boiling water, leave for 8 hours. Take half a glass up to 4 times a day before each meal. The duration of therapy is 5-6 weeks.
2. Sea buckthorn oil or rosehip oil. You need to take 1 tsp. three times a day or the entire portion at night. Oils exhibit anti-inflammatory, healing, antibacterial and strengthening effects.
3. Marshmallow root decoction. Has a calming effect. Grind the raw materials to make 6 g. Dissolve them in a glass of warm water, simmer in a water bath for 30 minutes. Take the decoction chilled, 0.5 tbsp. three times a day.
4. Celery root juice. Reception is carried out at 3 tbsp. 3 times a day. The remedy relieves the symptoms of the disease.

Prevention

In order to prevent the development of the disease, it is necessary to observe several simple rules. Doctors have approved the following recommendations:

• exclude alcohol and cigarettes;
• do not stay in a bending position for a long time;
• do not abuse fried and spicy foods;
• do not lift heavy things;
• wear clothes that do not compress the stomach area and lower part of the esophagus;
• monitor your weight;
• do not eat later than 2 hours before bedtime.

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The proper functioning of the digestive system provides the body with a complete set of nutrients and energy. But unfortunately, there are a lot 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) separating 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. All troubles should be blamed on both forced snacking at work (sandwiches and dry lunches) and the completely natural desire to look slim and fit (poor diet leading to a deficiency of vital nutrients). Also, gastroesophageal reflux can develop due to the predominance of fatty, spicy and excessively salty foods in the diet.

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

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

4. Side effect from taking certain medications that reduce sphincter tone (another confirmation that reading the accompanying instructions for medications is not a whim, but an urgent necessity).

5. Hereditary predisposition (this 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 central nervous system disorders;

• 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 according to the degrees of the Los Angeles classification.

The following degrees of GERD are distinguished:

• zero - symptoms of reflux esophagitis are not diagnosed;

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

• the total area of ​​erosive areas occupies less than 10% of the entire area of ​​the distal part of the esophagus;

• second - the area of ​​erosion ranges from 10 to 50% of the total surface of the mucosa;

• 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:

• degree A - there are no more than several defects of the mucous membrane up to 5 mm long, each of which extends to no more than two of its folds;

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

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

• grade D - the area of ​​defects exceeds 75% of the circumference of the esophagus.

Symptoms of reflux disease

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

- when eating heavy food;

- when bending;
- when climbing;
- lying down, especially on your back.

All patients with GERD tend to experience 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 pre-cancerous changes in the esophagus, may show only a few symptoms, especially in older people. On the other hand, people can have severe heartburn without damage to the esophagus.

- Dyspepsia. About half of people with GERD 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 spewed into the mouth and may be perceived as a "wet burp." It may come out as vomit. People without GERD may also have dyspepsia.

- Feelings of pain in the chest. Patients may have the 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, heart attack, etc.).

- Symptoms in the throat. Less commonly, GERD may cause throat symptoms:

- Acid laryngitis. A condition that is accompanied by hoarseness, dry cough, a feeling of a lump in the throat and a frequent need to cough;
- problems with swallowing (dysphagia). In severe cases, patients may go into shock and food may become stuck in their esophagus, causing severe chest pain. This may indicate a temporary spasm that narrows the tube, or serious damage or abnormality to the esophagus;
- chronic sore throat;
- persistent hiccups;
- cough and respiratory (breathing) symptoms - coughing, 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 must be excluded, including ulcers, stomach cancer, obstruction, and 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. Because clinical picture GERD is quite specific, and already at this stage, with a high degree of probability, the correct diagnosis can be established.

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

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

Additional research methods:

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

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

Treatment of reflux disease

1. Lifestyle changes

Includes sleeping with the head of the bed elevated, eating food at least an hour and a half before bedtime, avoiding foods that cause heartburn (fatty, flour, citrus fruits, coffee, chocolate, carbonated drinks)

2. Proton pump inhibitors (blockers) (abbreviated as PPIs, BPPs)

These drugs reduce the production of hydrochloric acid gastric glands. PPIs are not suitable for immediate relief because their effects take several days to develop.

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

IPPs include:

• Omeprazole (Omez) 20 mg 1-2 times a day;
• Lansoprazole (Lanzap, Acrylanz) 30 mg 1-2 times a day;
• Pantoprazole (Nolpaza) 40 mg once a day;
• Rabeprazole (Pariet) 20 mg once a day. If necessary, continuous administration at half the dose is possible.
• Esomeprazole (Nexium) 20-40 mg once a day. Swallow without chewing and wash down with water.

3. Antacids

Drugs in 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 initially in conjunction with proton pump blockers, since the latter do not begin to act immediately.

Of the medications in this group, available without a doctor’s prescription, the following have proven to work best:

Aluminum and magnesium hydroxide in the form of gels:

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

• Almagel 1-3 dosage 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: simaldrat (Gelusil, Gelusil varnish) 1 tablet (500 mg) 3-6 times a day an hour after meals or situationally if heartburn occurs, 1 tablet.

4. Alginic acid preparations

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

If a patient with GERD does not have erosions or ulcers in the esophagus according to endoscopic examination, 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 tablets. after meals and before bedtime, chew thoroughly;

• Gaviscon forte – 5-10 ml after each meal and before bedtime (maximum daily dose 40 ml).

5. III generation H2-histamine receptor blockers

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 occurs as a result of 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 to duodenum. Drugs in this group are also effective in those patients who have reflux of duodenal contents into the stomach, and then into the esophagus.

Medicines in this group include:

• Metoclopramide (Cerucal, Reglan) 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 erosions and ulcers of the esophageal mucosa switch to situational use of proton pump blockers (better), or antacids or alginates. For patients with erosive and ulcerative forms of GERD, proton pump inhibitors are prescribed for continuous use, and 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:

• Flaxseed decoction. This therapy with folk remedies is aimed at increasing the resistance 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;

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

• Decoction of marshmallow root. Therapy with folk remedies that include this drink will not only help get rid of unpleasant symptoms, but will 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, involves taking a chilled decoction of ½ cup 3 times a day;

• When using folk remedies, celery root juice is effective. 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

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

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

• don't overeat;

• if the doctor has prescribed you certain medications, take them with a sufficient amount of regular 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 undergo outpatient treatment, do not refuse;

• remember the benefits healthy eating. Let us especially note that “diet” and reasonable limitation of spicy, salty and excessively cold foods are not at all the same thing. But it’s still better to avoid soda and strong coffee;

• treatment with folk remedies (no matter how harmless it may seem to you) should always be agreed with your doctor.

– a frequently occurring symptom, its appearance is usually associated with episodic reasons, for example, overeating. But regularly occurring heartburn can signal a dangerous condition - damage to the wall of the esophagus by acidic gastric juice, which is an aggressive environment.

GERD is a chronic condition that requires treatment throughout your life.

What is gastroesophageal reflux disease (GERD)?

The term gastroesophageal reflux disease refers to a condition in which gastric contents constantly enter the esophagus, causing irritation of the mucous membrane, inflammation, and dysplasia of the epithelial layer.

Reflux can be an independent disease or a manifestation of tumor processes in the abdominal cavity.

Causes of GERD

The main cause of GERD is cardiac sphincter insufficiency.

The cardiac sphincter is called this very conventionally. This is the area where the esophagus enters the stomach.

Actually, there is no sphincter, or muscle ring, but the esophagus narrows, its muscle layer strengthens, and the diaphragm additionally helps contract the muscles of the esophagus.

At rest, the opening of the cardia (the name comes from the proximity of the heart) is completely closed, opening only with the passage of food. This mechanism prevents gastric contents from entering the esophagus.

When the muscular layer of the esophagus is weakened, the opening of the cardia - the entrance of the esophagus to the stomach - remains open constantly; in the absence of food, gastric contents freely penetrate into the esophagus and cause heartburn.

Symptoms of GERD worsen at night, during physical activity, and after a heavy meal. Relieved by sitting. The intensity of heartburn is not an indicator of the degree of damage to the esophageal mucosa.

A possible cause of cardia insufficiency is a hiatal hernia. The esophagus passes through the diaphragm, forming an opening.

Unlike the other two openings, vascular, there is no connective tissue in the esophageal opening; muscle fibers continue; contractions of the diaphragm during inhalation and exhalation help the passage of food through the esophagus and create additional muscle force.

If the muscles in this area are damaged or weakened, the esophageal opening expands, the cardia closes incompletely, and penetration from the abdominal cavity into the thoracic part of the stomach occurs.

This form of GERD is accompanied by chest pain, shortness of breath, palpitations - stomach.

In addition, there are occasional causes of heartburn in healthy people, which may simultaneously be the first sign of GERD:

• Overeating;
• Consumption of sour, spicy foods, smoked foods, alcohol;
• when eating in a hurry;
• Wearing clothes that compress the stomach;
• Physical effort after eating;

This condition can be aggravated overweight, smoking, constant stress. By themselves, they do not cause heartburn, but contribute to its appearance in the situations described above.

Women may experience heartburn during pregnancy; this is normal, and after childbirth in healthy women it goes away.

Tissue changes

Gastric juice contains hydrochloric acid, which is necessary for the digestion of protein. Acid - extremely aggressive environment, which can damage the body’s own tissues.

Accordingly, the gastric mucosa has a protective layer that prevents it from being damaged by acid.

The esophageal mucosa does not have the same protective barrier as the stomach, since it does not normally come into contact with acidic gastric contents. The ingress of gastric juice damages the mucous membrane, causing unpleasant symptoms- heartburn, belching, vomiting.

Soda neutralizes the acid of the gastric juice, but at the same time carbon dioxide is released, which stretches the stomach, creates pain, aggravates the course of gastritis, up to perforation of the ulcer.

Drugs that instantly reduce acidity (for example, Rennie) can only be used as an emergency remedy for the same reason. In addition, their effect is short-lived.

Taking painkillers for abdominal pain is dangerous. By relieving pain, these drugs have an ulcerogenic (ulcer-provoking) effect. They increase the acidity of gastric juice, so with GERD they only worsen the course of the disease.

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