Gastroesophageal reflux disease (GERD) is a chronic relapsing disease caused by a violation of the motor-evacuation function of the organs of the gastroesophageal zone and is characterized by regularly repeated reflux of the stomach contents and sometimes the duodenum into the esophagus, which leads to the worsening of the quality of the patient’s clinical condition, which leads to impairment of clinical quality the shell of the distal esophagus with the development in it of dystrophic changes in the non-keratinized multilayer flat ep Elia, catarrhal erosive or ulcerative esophagitis (reflux esophagitis) and some patients - tsilindrokletochnoy metaplasia ( Barrett's esophagus ) [3] .
| Gastroesophageal reflux disease | |
|---|---|
| ICD-10 | K 21. |
| ICD-10-KM | and |
| ICD-9 | 530.81 |
| ICD-9-KM | |
| Omim | 109350 |
| Diseasesdb | 23596 |
| Medlineplus | |
| eMedicine | med / 857 ped / 1177 radio / 300 |
| Mesh | D005764 |
Content
- 1 Prevalence in the world
- 2 Etiology
- 3 Clinic
- 4 Diagnostics
- 5 Treatment
- 5.1 Lifestyle changes
- 5.2 Drug Therapy
- 5.3 Surgical treatment
- 6 notes
- 7 Sources
World prevalence
| Region | Prevalence,% |
|---|---|
| North America | 18.1—27.8 |
| European countries | 8.8-25.9 |
| South America | 23 |
| Middle East | 8.7–33.1 |
| Australia | 11.6 |
| East Asian countries | 2.5-7.8 |
| Russia | 18-46% |
In general, the prevalence of GERD among adults is up to 40%. However, there are significant geographical differences in the prevalence of GERD, with the number of patients in the Western Hemisphere and European countries significantly exceeding the East Asian region. According to the latest data, the prevalence of GERD in Russia is 18–46%, and esophagitis is found in 45–80% of patients with GERD [4] .
Among patients with esophagitis, the prevalence of Barrett's esophagus ranges from 5 to 30%. Against the background of this progression, dysplastic changes in the epithelium of the mucous membrane of the distal esophagus metaplastic in the intestinal type, an increase in the incidence of esophageal adenocarcinoma is observed [3] .
Etiology
The following causes contribute to the development of gastroesophageal reflux disease:
- Decreased tonus of the lower esophageal sphincter (NPS).
- Decreased ability of the esophagus to cleanse itself.
- The damaging properties of the refluxant, that is, the contents of the stomach and / or duodenum , are thrown into the esophagus .
- Inability of the mucous membrane to withstand the damaging effects of the reflux agent.
- Violation of the gastric emptying.
- Increased abdominal pressure.
The development of gastroesophageal reflux disease is also influenced by lifestyle features such as stress, work related to the inclined torso, obesity, pregnancy, smoking, nutrition factors (fatty foods, chocolate, coffee, fruit juices, alcohol, spicy foods), as well as taking drugs that increase the peripheral concentration of dopamine (phenamine, pervitin, other phenylethylamine derivatives).
Clinic
GERD is manifested primarily in heartburn , acidic belching , which often occur after eating, with the body tilted forward or at night. The second most common manifestation of this disease is chest pain, which radiates to the interscapular region, neck, lower jaw, left half of the chest.
Extra-esophageal manifestations of the disease include pulmonary symptoms ( cough , shortness of breath , often occurring when lying down), otolaryngological symptoms (hoarseness, dry throat, tonsillitis, sinusitis, white plaque on the tongue) and gastric symptoms (rapid satiety, bloating, nausea , vomiting ), lymphadenopathy and iron deficiency anemia also belong to the symptoms [5] .
Diagnostics
Diagnosis of GERD includes the following research methods: [6] [7]
| Research methods | Method Features |
|---|---|
| Daily pH monitoring in the lower third of the esophagus | A fragment of the daily pH-gram in a patient with gastroesophageal reflux disease |
| X-ray examination of the esophagus | It reveals a hiatal hernia, erosion, ulcers, stricture of the esophagus. |
| Endoscopic examination of the esophagus | Detects inflammatory changes in the esophagus, erosion, ulcers, stricture of the esophagus, Barrett's esophagus . |
| Manometric examination of the esophageal sphincter | Allows you to identify changes in the tone of the esophageal sphincter . |
| Esophageal scintigraphy | Allows you to evaluate the esophageal clearance . |
| Esophagus impedanometry | Allows you to explore the normal and retrograde motility of the esophagus and reflux of various origins (acidic, alkaline, gas). |
treatment
Treatment of GERD includes lifestyle changes, drug therapy, and, in the most difficult cases, surgical intervention. Treatment should be aimed at reducing reflux, reducing the damaging properties of reflux, improving esophageal clearance and protecting the mucous membrane of the esophagus [8] .
Lifestyle Change
Patients suffering from GERD are recommended:
- Normalization of body weight.
- It is necessary to exclude fatty, fried, spicy foods, chocolate, coffee, strong tea, carbonated drinks, citrus fruits, onions, garlic from your diet.
- It is important not to overeat, to eat food in small portions, with a break of 15-20 minutes between dishes, not to eat later than 3-4 hours before bedtime.
- Exclusion of loads associated with an increase in intra-abdominal pressure, as well as wearing tight belts, belts, etc.
- Elevated position (15-20 cm) of the head end of the bed at night.
Drug Therapy
Drug therapy for GERD is mainly aimed at normalizing acidity and improving motility. Antisecretory drugs ( proton pump inhibitors , H2-histamine receptor blockers ), prokinetics and antacids are used to treat GERD.
Proton pump inhibitors (PPIs) are more effective than H2-histamine receptor blockers and have fewer side effects. It is recommended to take PPI rabeprazole at a dose of 20-40 mg / day, omeprazole at a dose of 20-60 mg / day or esomeprazole at a dose of 20-40 mg / day for 6-8 weeks [7] . In the treatment of erosive forms of GERD, IITs are taken for a long time, several months or even years. In this situation, the safety issue of IDUs becomes important. Currently, there are suggestions of an increase in brittle bones, intestinal infections, community-acquired pneumonia, and osteoporosis. With prolonged treatment of GERD with proton pump inhibitors, especially in elderly patients, it is often necessary to consider the interaction with other drugs. If it is necessary to take other drugs at the same time as PPI for the treatment or prevention of other diseases, preference is given to rabeprazole and pantoprazole , as the safest in relation to interaction with other drugs [9] .
To protect the esophagus, it is possible to use drugs - esophagoprotectors (Alfazox) [10] .
In the treatment of GERD, nonabsorbable antacids are used - phosphalugel , maalox , megalac , almagel and others, as well as topalkan alginates, gaviscon and others. Nonabsorbable antacids, in particular, maalox, are most effective. It is taken 15-20 ml 4 times a day one hour and a half after eating for 4-8 weeks. With rare heartburn, antacids are used as it occurs [7] .
To normalize motility, prokinetics are used [7] - special medications that enhance the motility of the gastrointestinal tract . Some representatives of prokinetics: Domperidone and Metoclopramide .
Vitamin preparations may be prescribed: pantothenic acid (vitamin B5) and methyl methionine sulfonium chloride ( sometimes conditionally called vitamin U ). Pantothenic acid restores the mucous membranes and stimulates intestinal motility , which contributes to a more rapid removal of food from the stomach . This ensures the "locking" of the sphincter located between the stomach and esophagus [11] . Metilmetioninsulfoniya chloride helps to reduce gastric acid secretion and provides an analgesic effect [12] .
Surgical Treatment
Current proven treatments include:
- LINX magnetic bracelet [13] , worn on the esophagus and not allowing the contents of the stomach to be thrown into the esophagus, but not preventing food from getting inside.
- TIF operation using EsophyX [14] , which restores the natural state of the stomach and prevents the cause of the disease.
Currently, there is no consensus among specialists regarding the indications for surgical treatment. For the treatment of GERD, a fundoplication operation is performed, performed by a laparoscopic method. However, even surgical intervention does not guarantee a complete rejection of lifelong therapy for PIT. Surgery is performed for GERD complications such as Barrett's esophagus , grade III or IV reflux esophagitis , stricture or ulcer of the esophagus, as well as low quality of life due to:
- persistent or persistent symptoms of GERD that cannot be resolved through lifestyle changes or drug therapy,
- dependence on taking medications or in connection with their side effects,
- hiatal hernia.
The decision on the operation should be made with the participation of doctors of various medical specialties ( gastroenterologist , surgeon , possibly a cardiologist , pulmonologist and others) and after instrumental studies such as esophagogastroduodenoscopy , X-ray examination of the upper gastrointestinal tract , esophageal manometry and daily pH-meter [15] .
Notes
- ↑ Disease Ontology release 2019-05-13 - 2019-05-13 - 2019.
- ↑ Monarch Disease Ontology release 2018-06-29sonu - 2018-06-29 - 2018.
- ↑ 1 2 VT Ivashkin IV Maiev, AS Trukhmanov, E.K. Baranskaya, O.B. Dronova, O.V. Zairatyants, R.G. Sayfutdinov A.A. Sheptulin, T.L. Lapina, S.S. Pirogov, Yu.A. Kucheryavy, O.A. Storonova, D.N. Andreev. Clinical recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of gastroesophageal reflux disease. - 2017.
- ↑ Maev I.V., Barkalova E.V., Hovsepyan M.A., Kucheryavy Yu.A., Andreev D.N. Possibilities of high-resolution pH-impedanometry and manometry in the management of patients with refractory gastroesophageal reflux disease // Therapeutic Archive. - Therapeutic archive. - No. 89 (2) . - S. 76-83 . - ISSN 0040-3660 .
- ↑ http://www.worldgastroenterology.org/UserFiles/file/guidelines/gastroesophagel-reflux-disease-english-2015.pdf
- ↑ Mayev I.V., Vyuchnova E.S., Schekina M.I. Gastroesophageal reflux disease M. The Journal of the Treating Physician, No. 04, 2004.
- ↑ 1 2 3 4 Rapoport S.I. Gastroesophageal reflux disease . (Manual for doctors). - M.: Publishing House MEDPRAKTIKA-M. - 2009. −12 p. ISBN 978-5-98803-157-4 .
- ↑ Ivashkin V.T. GASTROESOPHAGEAL REFLUX DISEASE. Clinical recommendations for diagnosis and treatment. Moscow - 2014 .
- ↑ Bordin D.S. Safety of treatment as a criterion for choosing a proton pump inhibitor to a patient with gastroesophageal reflux disease . Consilium Medicum. - 2010. - Volume 12. - No. 8.
- ↑ Alfazox in the radar reference book . www.rlsnet.ru. Date of treatment June 18, 2019.
- ↑ And again the reporters ... - NB Gubergrits, S.V. Raids, P.G. Fomenko. Modern gastroenterology No. 1 (69), 2013.P. 157-165.
- ↑ Vitamins and coenzymes. Tutorial. Part II - Smirnov V.A., Klimochkin Yu.N. Samara: Samar. state tech. Univ., 2008 .-- 91 s
- ↑ Torax | The LINX Reflux Management System: Stop Reflux at its Source . www.toraxmedical.com. Date of treatment June 16, 2016.
- ↑ ESOPHYX Norwalk | Incisionless Acid Reflux Surgery New London | GERD Treatment Stamford | FCB Surgical Specialists Shelton, CT (Link not available) . www.antireflux.com. Date of treatment June 16, 2016. Archived March 21, 2016.
- ↑ Standards for the diagnosis and treatment of acid-dependent and Helicobacter pylori-associated diseases (Fourth Moscow Agreement) . Adopted by the X Congress of the Scientific Society of Gastroenterologists of Russia on March 5, 2010.
Sources
- Kalinin A.V. Gastroesophageal reflux disease, M., 2004. - 40 p.
- Ivashkin V.T. et al. Recommendations for the examination and treatment of patients with gastroesophageal reflux disease. M .: 2001.
- The standard of care for patients with gastroesophageal reflux. It is approved by the Order of the Ministry of Health and Social Development of 22.11.2004 N 247
- The standard of care for patients with gastroesophageal reflux (when providing specialized care). It is approved by the Order of the Ministry of Health and Social Development of the Russian Federation of June 1, 2007 N 384
- Grinevich V. Monitoring of pH, bile and impedance monitoring in the diagnosis of GERD . Clinical and experimental gastroenterology. No. 5, 2004.