Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease: symptoms, diagnosis and treatment

Gastroesophageal reflux disease (GERD) is a chronic relapsing disease that is caused by spontaneous, regularly repeated reflux of gastric and (or) duodenal contents into the esophagus. The main manifestations of GERD include heartburn, sour belching, a burning sensation or pain in the chest that occurs after eating (especially fatty food), when bending the body forward, often at night, as well as belching with air, dysphagia.

Etiology and pathogenesis of GERD

Gastroesophageal reflux develops mainly due to insufficiency of the lower esophageal sphincter. Relative insufficiency of the cardia occurs when intragastric pressure increases; absolute insufficiency can be caused by organic changes in the smooth muscle fibers of the esophagus (for example, due to surgery, bougienage of the esophagus, with systemic scleroderma) or a violation of its nervous regulation. The tone of the lower esophageal sphincter decreases when consuming certain foods (chocolate, coffee, citrus fruits, tomatoes), under the influence of alcohol, nicotine, and certain medications (calcium antagonists, nitrates, beta-adrenergic locators, anticholinergics, theophidline, etc.). In addition, a forced position of the body with a tilt of the body, obesity, and pregnancy predispose to the occurrence of the disease. The presence of a hiatal hernia may play a role.

Diagnosis of GERD

The diagnosis is clarified by x-ray examination, which reveals a hiatal hernia, daily monitoring of the esophageal pH (with acid reflux, the pH decreases to 4 or less) and by endoscopy, which confirms inflammation and ulceration of the esophageal mucosa. There are 4 degrees of reflux esophagitis: I - single non-confluent erosions; II - merging erosions that do not cover the entire surface of the mucous membrane of the distal esophagus; III - ulcerative lesions of the lower third of the esophagus, merging and covering the entire surface of the mucous membrane; IV - ulcerative lesions covering the entire circumference of the esophagus.

Treatment of GERD

Treatment of GERD should be comprehensive and include non-pharmacological and pharmacological measures.

Non-pharmacological measures include:

1. Avoiding foods that can cause reflux (chocolate, coffee, citrus fruits, tomatoes, fatty and spicy foods, etc.)
2. Avoiding eating 2-3 hours before bedtime
3. Avoiding excess alcohol and nicotine use
4. Weight loss for obesity
5. Avoiding bending over after eating

Pharmacological measures include:

1. Antacids, which neutralize stomach acid
2. Proton pump inhibitors, which reduce stomach acid production
3. Histamine receptor antagonists, which also reduce stomach acid secretion
4. Prokinetics, which improve motility of the esophagus and stomach, which helps avoid reflux
5. Pro-kinetic agents such as metoclopramide, which improve gastric and esophageal motility, speed up gastric emptying.

In severe cases where pharmacological treatment is ineffective, surgery such as a Nissen fundoplication may be required.

In general, treatment for GERD is effective and can significantly improve the patient’s quality of life. However, it must be remembered that the disease is chronic and requires long-term and regular treatment.