Gastroesophagic reflux – is a condition in which gastric material enters the esophagus. Reflux becomes a disease when it becomes a chronic disorder. The incidence of Gastroesophageal reflux disease among the population of industrialized countries is high and ranges from 20 to 40% in groups aged 45 - 65 years with a further age-related increase. Given these epidemiological data, the high importance of the problem is obvious.
Risk factors
The factors that contribute to gastroesophagic reflux are:
- esophageal hernia;
- overweight;
- pregnancy;
- taking calcium antagonists, beta blockers and anticholinergics.
Factors
The symptoms of this pathology are divided into typical and atypical for the esophagus. Typical are acid indigestion and belching, nausea. Atypical - chest pain, pharyngitis, dysphonia, cough. With the abuse of fatty foods, alcohol, carbonated drinks and wearing a tight belt, the symptoms of the disease intensify.
Gastroesophagic disease requires a respectful attitude, because without proper attention carries the risk of serious complications, including cancer of the esophagus. The danger can be aggravated by the fact that many patients drown out heartburn with drugs, postponing a visit to the doctor.
Diagnosis and therapy
Fibrogastroscopy is the main diagnostic method for Gastroesophageal reflux disease; the histology of the mucous membrane of the esophagus makes it possible to assess the degree of dystrophy of the epithelium. X-ray examination helps to identify the hernia of the esophagus, its stricture, diffuse esophagospasm of the phyaphragm.
Gastroesophageal reflux disease therapy is aimed at eliminating symptoms and preventing complications; it can be conservative and surgical. With a mild to moderate degree of the disease, medication is selected that can reduce reduce reflux, lower the acidity of the contents of the stomach and protect the mucous membrane of the esophagus. It is based on the use of antacids, antisecretory drugs and prokinetics. The therapeutic course should last at least four weeks, and then for six months the patient receives supportive treatment. Without this, the probability of relapse is 90% during the year. It must be remembered that the uncontrolled intake of antacids containing aluminum, leads to the accumulation of metal in the body and the risk of Alzheimer's disease.
If conservative treatment does not give the desired effect, there is a need for surgical intervention. Indications for surgery are:
- bleeding;
- ulcerative lesion of the esophagus;
- esophageal structure;
- epithelial dysplasia;
- gastroesophageal hernia.
В At the Bogoliuby MC, surgeons perform laparoscopic surgery on the esophagus and stomach - fundoplication. This intervention helps eliminate any type of reflux, not just acid.
Fundoplication is a minimally invasive procedure that does not require incisions; it adapts individually to the patient's anatomy.
Contraindications to fundoplication: stenosis of the respiratory tract, Barrett's syndrome, dysphagia with peptic stenosis of the esophagus, varicose veins of the esophagus, previous cardiothoracic surgery, obesity with a BMI above 40. After the operation, the patient must make changes in lifestyle: adjust body weight, volume and time of admission food, be careful about fatty and sour foods, gas-enhancing products, chocolate, coffee. Abdominal stress should also be avoided.
