I. Typical symptoms
The clinical manifestations of GERD vary in severity, and once symptoms appear, they are often very typical and different from other disease manifestations, sometimes with more obvious symptoms of complications.
1.Heartburn
The most common and characteristic symptom is heartburn, which is a burning pain behind the sternum, often moving from the saber area to the upper sternal notch, sometimes radiating to the neck and interscapular area. It appears mostly one hour after meals, and is especially aggravated after a full meal, when the torso is bent forward, when lying down, or when the air is exerted, and can be triggered by the intake of tea, wine, coffee and aspirin, unlike peptic ulcer which is seasonal. It can also occur as a spasmodic pain in the esophagus, resembling angina-like chest pain, and in some cases, earache. When esophageal erosion occurs, there may be painful swallowing with difficulty in swallowing, which is caused by acid reflux stimulating localized constrictive narrowing of the esophagus. Sometimes there is a sensation of obstruction in the pharynx, and a “hysterical ball” may also occur, which is caused by an increase in pressure in the upper esophageal sphincter due to acid reflux. Although heartburn is the main manifestation of GERD, its degree does not represent the severity of the lesion, sometimes the heartburn is severe but the tissue is not damaged; in severe GERD, there may be no or only mild heartburn.
2. Gastric reflux symptoms
It is acid reflux, hiccups or regurgitation with sour or bitter taste, and in severe cases, talking while regurgitating food with strong stomach acid taste. Regurgitation symptoms may appear simultaneously with or 1-2 years before heartburn symptoms.
3. Airway symptoms
Sometimes reflux symptoms are not obvious or neglected, while airway symptoms are obvious, manifested as paroxysmal cough, recurrent pneumonia, non-seasonal asthma, often at night, and in severe cases, interstitial fibrosis of the lungs. Sometimes oral ulcers or pharyngitis are the main manifestations, but they are alleviated or healed after anti-reflux treatment.
Complications of reflux esophagitis
(1) Long-term recurrent reflux can cause esophageal mucosa congestion, edema, erosion, ulceration, increased fibrous tissue, scar formation, and stenosis. The stenosis is often circumferential, 2-4 cm long or longer, and is seen in the distal segment of the esophagus, while other inflammatory-induced stenoses are mostly seen in the upper middle segment of the esophagus. The clinical manifestations are gradual swallowing difficulties, regurgitation may occur with slightly fast food intake, and sometimes difficulty in eating liquid food, but heartburn symptoms are no longer evident. It can be treated by endoscopic dilatation, and anti-reflux treatment is still needed after dilatation.
(2) Bleeding reflux esophagitis may cause a small amount of blood leakage, and there may be mild iron deficiency anemia in the clinic. In the presence of esophageal ulcers, hemorrhage may occur and can be treated routinely as a bleeding emergency.
(3) In severe esophagitis with ulceration, perforation may occur and requires emergency surgical management.
(4) Barrett’s esophagus is a long-term chronic gastroesophageal reflux, which can cause the squamous epithelium of the lower esophagus to be replaced by the chemosis of columnar epithelium and become Barrett’s esophagus to enhance acid resistance.
Prevention and treatment measures
Currently, reflux esophagitis and peptic ulcer are collectively referred to as “acid-related diseases”, which have in common that although acid-suppressing drugs can achieve satisfactory recent results, they cannot change the natural course of the disease and have a higher recurrence rate after stopping the drugs. Therefore, it is necessary to strengthen recurrence prevention measures for reflux esophagitis, supplemented by the necessary treatment of boils.
Doctors need to work closely with patients to take the following measures.
1. Lifestyle changes
To reduce acid reflux and increase the pressure of the lower esophageal sphincter to prevent recurrence of reflux, it should be habitual and long lasting to.
(1) reduce weight obese people increased intra-abdominal pressure, which can contribute to the aggravation of LES insufficiency, should actively reduce weight. Women wearing tight underwear or constipation can increase abdominal pressure, so clothes should be loose, and bowel movements should be unobstructed.
(2) when standing by gravity gastric residue rarely reflux. The head of the bed should be raised 15 to 20 cm when sleeping to enhance the force of esophageal clearance and accelerate the emptying of the stomach, which is a simple and effective method. But it should be noted that sleep more pillows are not effective, because it only elevates the head, neck, chest, and the stomach did not put down, but caused the thoracoabdominal junction fold concave, so that the stomach is in a high position and promote reflux.
(3) Control the diet to eat less and more meals, do not lie on your back immediately after eating, forbid food that cannot be tolerated to avoid inducing pain and prevent the occurrence of nausea and vomiting.
(4) Fatty diet can promote increased secretion of cholecystokinin and gastrin and reduce LES pressure, so the intake of fat should be reduced.
(5) Quit smoking to enhance the resistance of the esophageal mucosa. Tobacco, alcohol, coffee, chocolate and strong tea can reduce the LES pressure and should be used sparingly or prohibited.
2, the application of drugs
(1) Pro-dynamic drugs gastroesophageal reflux disease is the digestive tract power disorder disease, so we must first improve the power. Cisapride can promote the power of the whole gastrointestinal tract, which can increase LES pressure and the amplitude of esophageal peristaltic contraction, shorten the time of esophageal acid exposure, speed up gastric emptying and reduce reflux, which is better than ranitidine for the disappearance of symptoms and cure of esophagitis. Due to diarrheal side effects, the treatment dose should be individualized. Domperidone and gastrofluan can increase gastric emptying, but the improvement of esophageal dynamics is not significant, if the dose is increased, it is possible to achieve the efficacy of improving esophageal dynamics.
(2) Acid-suppressing drugs can reduce the stimulation of esophageal mucosa by acid reflux and improve the symptoms H2 receptor blockers such as cimetidine and proton pump H+, K+-ATPase inhibitors such as omeprazole are effective. The dose and method are the same as for the treatment of peptic ulcer, but taking the drug twice a day is more effective than once.
(3) mucosal protective agents for the damaged esophageal mucosa, aluminum thioglycollate or aluminum magnesium carbonate tablets are effective, colloidal bismuth subcitrate has a similar effect.
3.Surgical treatment
Symptoms are serious, the LES pressure is very low, by the internal treatment is not effective, or symptoms soon after discontinuation, or serious comorbidities, etc., should consider anti-reflux surgical treatment, the short-term effect may be satisfactory, but the long-term effect is difficult to determine.