Filling meal and GeyouLying is a perfect match
Wine and eat with full meals, sip a cup of hot tea
Land on the sofa
As if time is quiet and time is long
In a moment, the wind and clouds rush
A hectares of sour waves against the current
Traveling over the sea, as if the momentum is broken
Crashing the
Steamed lamb steamed bear paw steamed deer tail roasted flower duck roasted Chicken roasted geese
whizzing wildly and whistling through
Wherever meridians are sour, heartburn is unbearable
This is a typical Gastroesophageal reflux disease
Educational experts have popularized your science
What is gastroesophageal reflux disease?
Why does gastroesophageal reflux disease occur?
What are the characteristics of gastroesophageal reflux disease?
How to determine whether you suffer from gastroesophageal reflux disease?
If I have gastroesophageal reflux disease, how should I treat it?
Gastroesophageal reflux disease, also known as GERD (gastroesophageal reflux), refers to the discomfort symptoms and/or complications caused by the reflux of the gastroduodenal content to the esophagus, oropharynx, or respiratory tract, and/or complications. The contents of the gastroduodenum include undigested food, gastric acid, bile, pancreatic juice, , etc. Reflux refers to the process in which the contents of the gastroduodenum flow from the stomach, through the esophagus, into the pharynx or the mouth when there is no nausea and without the force of the abdomen.
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Gastroesophageal reflux disease is relatively high worldwide. The prevalence of heartburn at least once a week in the overall population is 13%. In recent years, the prevalence of heartburn at least once a week in my country is 1.9%-7.0%. The probability of gastroesophageal reflux disease increases with age , and the ratio of men and women is close.
When discussing "who" is the culprit of gastroesophageal reflux disease, we have to start with an unknown but extremely important muscle - The inferior esophageal sphincter , also known as LES (low esophageal sphincter). As the name suggests, "under the esophagus" means that this is a muscle located at the lower end of the esophagus of ; "sphingochoracus" means that it surrounds the lower end of the esophagus and plays the role of in controlling the opening of between the esophagus and the stomach.
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It is about 3-4 cm long. Once shrinks , a pressure zone will be formed between the stomach and esophagus, similar to a closed valve. After we eat, this door closes well to to prevent gastric juice from flowing back to the esophagus .
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Usually, when food slides down to the end of the esophagus like a slide, the lower esophagus sphincter is in a relaxed state, just like opening a warm embrace to welcome the arrival of abundant foods. But if foods try to flow back from the stomach and return to their mouths, it would be so sorry. The lower esophageal sphincter will turn against each other in one second - changes from a relaxed state to a contracted state . This contraction creates a pressure zone that closes the return gate, forcing the food to stir, digest in the stomach, and finally enters the duodenum.
However, maintaining order is a difficult task, and the inferior esophageal sphincter cannot bear it alone. In order to ensure the normal operation of food transport in the digestive tract, the human body will also let diaphragm and diaphragm esophageal ligament to help, and even insert the esophagus obliquely instead of straight into the stomach. Together with the inferior esophageal sphincter, these tissues form a barrier against countercurrent.
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can also make mistakes in such a precise design.When the human body experiences pregnancy, obesity, vomiting, and weight-bearing labor, the stomach pressure will increase. If the stomach pressure is high, it will easily squeeze the food back to the esophagus. In addition, some foods, hormones, drugs, etc. can cause subesophageal sphincter dysfunction , which means that the door is not closed; or transient relaxation prolongs , which means that the door has been open for too long and has forgotten to close. Finally, hiatal hernia and achalasal surgery may lead to damage to the anti-reflux barrier, which will lead to gastroesophageal reflux disease.
Heartburn and reflux are the most common and typical symptoms of gastroesophageal reflux disease.
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Heartburn refers to a hot feeling behind the chest. Reflux refers to the gastric content entering the pharynx or mouth without any discomfort.
Generally, patients with gastroesophageal reflux disease will experience heartburn and reflux about 1 hour after eating . This situation may also be exacerbated by some activities, such as lying on your back, bent over, and increase abdominal pressure. Some patients even have symptoms when they go to bed at night.
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In addition to these two typical symptoms, some patients will also experience foreign body sensation in the pharyngeal, asthma , chronic cough, dysphagia , chest tightness palpitations, back pain and other discomforts.
If you have symptoms of heartburn and reflux that are very consistent with the above description, and appears more than twice a week, you can preliminarily judge that it is gastroesophageal reflux disease.
If you want to be diagnosed, you can go to the hospital for gastroscopy . gastroscopy can not only observe the health of your esophageal mucosa, but also help eliminate other organic diseases. If gastroscopy detects esophageal erosion or ulcer caused by reflux esophagitis , and other causes are ruled out, gastroesophageal reflux disease can be confirmed.
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However, some patients also have typical symptoms but no abnormalities were found in gastroscopy. What should I do? At this time, can be diagnosed through 24-hour esophageal PH+ impedance monitoring. If the above test results are negative, gastroesophageal reflux disease can be diagnosed based on the symptom scale score (GERD-Q or RD-Q) or proton pump inhibitor test. (That is, use traditional GERD medication for at least 2 weeks to see if the symptoms improve).
01
change life habits
In the treatment of functional diseases such as gastroesophageal reflux disease, changing life habits is the top priority! Many patients only rely on drugs to solve the problem after falling ill, and do not adjust their bad living habits, which does not help relieve the symptoms well.
To change your life habits, you must do it:
01
Do not lie down immediately after meals
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Do not lie down immediately after meals, nor do you eat within 2 hours before going to bed. In addition, in order to reduce the reflux during sleep, the pillow can be properly raised by 15-20 cm.
02
Exercise more, eat less irritating foods
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You should actively lose weight, exercise more, eat less chocolate or foods containing high fat, and drink less coffee and strong tea.
03
Avoid taking these drugs
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Try to avoid taking drugs that reduce the function of under-esophageal sphincter or affect gastric emptying of , such as: nitroglycerin , calcium channel blockers, anticholinergic drugs, etc.
04
No smoking and alcohol ban
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Smoking is prohibited, half of the pub can not work; drinking is prohibited, and a single sip cannot work.
02
drug treatment
01
acid suppression treatment
proton pump inhibitor (PPI, proton pump inhibitors) or potassium ion competitive acid blocker (potassium-channel acid blocker, P-CAB) is the preferred drug for for the treatment of gastroesophageal reflux disease . They have significant and lasting acid suppression effects, quickly relieve symptoms, and have a high healing rate of esophageal mucosa. The recommended course of treatment is 4-8 weeks.
In addition, H2 receptor antagonists (H2RA) are also commonly used acid inhibitors. It can inhibit nighttime gastric acid secretion and relieve symptoms in patients with mild to moderate GERD, but long-term use will lead to drug tolerance.
commonly used PPI is generally called "XXprazole" , such as omeprazole , pantoprazole , rabeprazole , esomeprazole , etc., while P-CAB currently on the market in my country is vonorasen; H2RA includes ranitidine , famotidine, etc.
PPI should be taken 30-60 minutes before breakfast, and P-CAB is not affected by food intake.
Note! ! acid inhibitors cannot be stopped suddenly! This will cause an increase in gastric acid secretion rebound and should be gradually reduced.
02
prodynamic drug
Generally, when the inhibitor of is not effective, can be considered in conjunction with the use of the prodynamic agent , especially patients with reduced LES pressure, weakened esophageal motility and delayed gastric emptying.
03
Other
Antacids can neutralize gastric acid. The commonly used drug is alkaline salts containing aluminum, magnesium, bismuth, and other alkaline salts and their composite preparations , which can relieve heartburn symptoms, such as magnesium aluminum carbonate.
03
Antirection surgery treatment
Generally speaking, most people can control their symptoms well by improving their lifestyle and taking medication on time. But there are also very few Some patients can consider anti-reflux surgery . Who are this?
① 3 has adverse reactions or allergic reactions to drug treatment. Although the treatment of
② acid inhibitors is effective, but it requires long-term treatment and patients are unwilling to take medication for a long time.
③3 patients who are not interested in drug treatment, have poor compliance or want to undergo surgery.
④ patients with large hiatal hernia, reflux as the main symptom, and positive reflux monitoring or RE.
⑤ PPI reached the maximum dose, but the symptoms still did not improve significantly.
Currently, Fundus folding is a safe and effective anti-reflux surgery method. Laparoscopic fundus folding is better than abdominal fundus folding.
Image source: Internet
This article is provided by: Zhu Siran, Li Saier, Bai Tao, Zhu Liangru
or above is only used as popular science knowledge
is not used as specific diagnosis and treatment opinions
Source: Wuhan Union Hospital
Producer: Sun Hui Wang Jiliang
Planning: Party Committee Propaganda Department
Information source: Gastroenterology
Editing and production: Peng Jinxian
Reviewed by: Nie Wenwen
