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Heartburn, burning, and acid regurgitation are not always the result of greed or a hard-to-digest diet. If they occur after and between meals – this requires treatment as it may herald gastroesophageal reflux disease.
Among patients over the age of 15, over 34% suffer from reflux disease. people. It is the most common upper gastrointestinal condition. The disease is quite common, but many people see a specialist late, because reflux symptoms include overeating, stress indigestion, and sometimes even cardiovascular ailments.
Meanwhile, these unpleasant symptoms are caused by the regurgitation of stomach contents into the esophagus. Characteristic in such a situation is heartburn, but reflux disease is referred to when the symptoms are severe or frequently recur. The disease occurs at any age, regardless of gender. Most often, however, it affects people over 40 years of age.
A bit of anatomy
Our esophagus is like a long tube through which food enters the stomach. When we are healthy, partially digested food travels from the stomach to the duodenum and small intestine. The lower sphincter, i.e. the muscular valve located between the abdominal esophagus and the stomach, prevents the stomach contents from flowing back into the esophagus. The muscle fold opens only during swallowing to allow food to pass, and then closes to prevent the ingested food from returning. When the sphincter is not working well (it is too weak or relaxes abnormally), the acid content in the stomach flows back into the esophagus, sometimes even reaching the throat. Such a regurgitation is precisely gastroesophageal reflux disease. The acidic content of the stomach irritates the esophagus, larynx, and sometimes even the bronchi and lungs, which can lead to inflammation of these organs.
The gastric mucosa is used to digestive enzymes and hydrochloric acid, but the lining of the esophagus is not. The stomach contents can erode it, which often turns into ulcers after a long time. Healing ulcers, in turn, lead to a narrowing of the esophagus, which sometimes even makes it impossible for food to reach the stomach. Sometimes a cylindrical epithelium (which normally lines the stomach) grows in the lower esophagus, forming the so-called Barrett’s esophagus. This disease is dangerous because 40 percent. cases may lead to the development of neoplastic disease.
Causes and symptoms
There are many of them. Occasionally, the cause of trouble may be alcohol abuse, gluttony, smoking. From a medical point of view, reflux occurs in people who have impaired functions of the lower esophageal sphincter, esophageal motility, gastric emptying, suffer from a hiatal hernia, have insufficient salivation, or are taking medication for high blood pressure or ischemic heart disease.
A characteristic symptom of reflux is heartburn, which affects over 90% of people. sick. Burning in the esophagus occurs after eating or at night. Patients feel bitterness or acid in their mouths. Others have difficulty swallowing or feel pain when swallowing. Chest pain can be sharp or dull and radiate to your back and shoulders. When thrown into the esophagus and mouth, gastric acid can damage tooth enamel and cause gingivitis. On the other hand, inflammation develops in the throat, which is manifested by hoarseness, swelling or the so-called scratching.
Gastric RefluxoHerbs – a herbal infusion mixture consisting of sage leaves, horsetail herb, lemon balm leaves, calamus rhizome and chamomile basket can help in treating heartburn and reflux.
Viewing the esophagus
In order to avoid the dangerous consequences of reflux, it must first be properly diagnosed. It begins with gastroscopy, i.e. inserting a thin, flexible tube with a mini-camera into the esophagus and stomach. The gastroenterologist checks for esophageal inflammation, erosions, ulcers, strictures, Barrett’s esophagus, or hiatal hernia. Next, you need to do a radiographic examination of the esophagus with the use of contrast material (the X-ray allows you to see if there is a hiatal hernia). Now it is the turn of the esophageal manometry – under local anesthesia, a multichannel probe is inserted into the esophagus for 10-15 minutes. It is connected to a computer and it is in the computer that a special program draws graphs, thanks to which the doctor can find out whether the sphincter is working, how long it is and whether the pressure of the lower sphincter is correct. An important test is 24-hour pH-measurement (a thin probe is inserted into the esophagus through the nose under local anesthesia for XNUMX hours. During this time, the patient can eat or drink, and the device records whether and how often episodes, do they occur only at night, etc.).
After performing these tests, the specialist knows whether it is enough to treat the patient by changing his eating and pharmacological habits, or whether an operation is necessary.
Treatment without surgery
Its basis is lifestyle change. Eliminate fatty foods, carbonated drinks, spicy spices, sweets, citrus fruits, coffee and alcohol from the menu. We eat our last meal no later than 3 hours before going to bed, and sleep on high pillows. Smoking is strictly forbidden.
Patients are also taking medications to reduce gastric acid secretion, to sooth (neutralize) the acid content in the esophagus and to cover the mucosa with a protective layer. Medicines are also available to increase the tone of the lower esophageal sphincter. Combination therapies, i.e. several drugs with different effects, are often used.
Most patients can be treated conservatively. Doctors are of the opinion, however, that if the treatments carried out twice within six months do not improve the patient’s condition, if the patient is young and the symptoms return quickly – there is no need to delay the operation.
Remedies for acid reflux
Surgery is required in patients with a severe form of the disease. This usually involves wrapping the upper part of the stomach around the esophagus to recreate the barrier that separates the esophagus from the stomach. In 90 percent in patients, surgery eliminates the symptoms of the disease.
Laparoscopic surgery (so-called Nissen fundoplication)
The patient falls asleep and the doctor makes five 1-2 cm incisions on his stomach. One just above the navel and two on its sides. Through these openings, he introduces a laparoscope, mini-camera and surgical instruments. He sees the entire operating field on the monitor under high magnification, which makes it easier for him to get to the hidden deep sphincter. It is repaired using … stomach fundus. A piece of this bottom is wrapped around the lower part of the esophagus, which is used to make an overlay, a sealing muff, i.e. fundoplication. It may wrap around the entire esophagus, or just part of it. The point is that the patient should be able to swallow freely after the surgery. If the lower esophagus is too tightly sealed, the food will not be able to squeeze into the stomach, and if it is too weak, the improvement in the patient’s well-being will be slight.
Gastroplication
The procedure is performed by a gastroenterologist, as it is like a longer-lasting gastroscopy, during which the patient is asleep. The point is that the patient should not move during the procedure, as this may prevent the doctor from placing precise sutures. The aim of the procedure is to narrow the part of the stomach under the inoperative sphincter, i.e. to extend the esophagus. Thanks to this, the pressure of gastric juices on the sphincter is neither high nor violent. This gives it a great anti-reflux effect. Part of the stomach is narrowed by the so-called files. The device for “sewing” the stomach is located in an additional channel attached to the gastroscope. The procedure takes about half an hour and is not strenuous for the patient
Ultrasonic method with the Stretta apparatus.
Using an endoscope, a thin probe is inserted into the patient’s esophagus, at the end of which there is a balloon with needles. These needles stick into the muscle layer of the lower esophagus and apply a certain amount of energy using a high-frequency ultrasound generator. This leads to hypertrophy, i.e. a thickening of the muscle layer, making the esophagus tighter. This improves the functioning of the sphincter, preventing acidic stomach contents from flowing back into the esophagus. The patient undergoes four such sessions with the use of the Stretta machine. The entire procedure is performed under intravenous anesthesia (but not under full anesthesia).
What diet?
Changes in diet and lifestyle reduce the symptoms of acid reflux. Base
Allowed products:
– Lean meats (veal, pork loin, rabbit), poultry (chickens, turkeys) and cold cuts (pork and poultry hams, sirloin).
– Lean dairy products – milk, yoghurt, kefir, reduced fat buttermilk.
– Boiled, stewed without browning, baked in foil, steamed, fried without fat.
– Carrots, beets, potatoes, cauliflower, spinach.
– Fresh spices – basil, oregano, garlic, dried herbs, e.g. fennel, tarragon, rosemary, sage, marjoram.
– Small portions of yeast or biscuit dough.
– Still mineral waters, herbal teas (except peppermint tea).
Read also:
- Does a low acid diet help with acid reflux?
- Functional disorders of the esophagus
Dishes not recommended:
– Fatty types of meat and poultry (e.g. fatty pork, goose, duck, pork knuckles, ribs), fatty sausages (e.g. ham, salami, pâtés, fatty sausages, brawn).
– Fatty dairy products – yellow cheeses, camembert and brie cheeses, melted and mold cheeses, fromage cheeses.
-Fast-food dishes – burgers, hot dogs, cheeseburgers, fries.
– Eating fried foods.
– Cucumbers, tomatoes, onions.
– Foods and products with added vinegar, e.g. mushrooms, vegetables, fruit and vinaigrette.
– Hot spices – pepper, chilli, curry.
– Chocolate, chocolate covered cookies, chocolate candies, bars, cakes or chocolate cakes (chocolate – containing caffeine, theobramine and fat – contributes to heartburn).
– Carbonated drinks – they cause belching and thus increase the risk of gastric contents being refluxed into the esophagus.
– Certain juices – the most common symptoms of heartburn occur after drinking orange, lemon, grapefruit and tomato juice.
– Strong coffee and tea (especially on an empty stomach) and alcohol (in any form).
– The abdomen should not be pressed against tight clothing or a belt.