Under normal circumstances, gastric juice should pass through the pylorus and down the duodenum, but for various reasons, it rushes through the cardia and flows into the esophagus, even reaching the oral cavity, going in the opposite direction from normal.
Under normal circumstances, the pylorus and lower esophageal sphincter and diaphragm act like a strong one-way gate, keeping the lower end of the esophagus tightly guarded, allowing food and liquid to enter the stomach by esophageal peristalsis when it is open, and not allowing gastric contents to regurgitate into the esophagus when it is closed, thus protecting the esophagus from the erosion of gastric acid and pepsin. Even if there is a small amount of reflux occasionally, the peristalsis of the esophagus can easily push these “unwanted guests” back to their “old home” – the stomach. For various reasons and diseases, the “gate” is loosened, the downward thrust (peristalsis) of the esophagus is weakened, and even the stomach moves in the opposite direction, not forward and backward, and these “reactionary” forces push the stomach acid to where it should not go -Esophagus.
The delicate mucous membrane of the esophagus is not acid-resistant and cannot withstand the digestion of pepsin, which leads to inflammation, erosion and even bleeding. Cancer can also occur in reflux esophagitis that is not treated for a long time.
One of the medications: suppression of stomach acid
Medication basis.
Stomach acid is a direct factor that damages the esophageal mucosa, and the stronger the acidity, the longer the exposure time, the more damage it causes. On the other hand, the weaker the acidity, the faster the mucosal damage is repaired. The strength of gastric acid also affects the activity of pepsin.
Drug types.
(1), proton pump inhibitors, can fundamentally inhibit gastric acid production, acid suppression is strong and fast, after stopping the drug, gastric acid secretion can still quickly return to normal. Smaller doses, less frequent dosing, the efficacy is certain, are the advantages of such drugs. The following are commonly used clinically (roughly in increasing order of acid suppression strength)
Omeprazole, 20mg, 1 to 2 times a day
Lansoprazole, 30mg, 1 to 2 times a day
Pantoprazole, 40mg, 1 time a day
Rabeprazole, 10-20mg, 1 time daily
Common adverse reactions include: abdominal distension, diarrhea, dry mouth, headache, dizziness, insomnia, leukopenia, and elevated transaminases, but they are uncommon and can mostly be recovered by stopping the drug.
Dosing tips.
The drug must be used after the diagnosis is confirmed. Mostly used as the first choice for this disease. Not used during pregnancy and lactation. Regular blood tests and liver function.
(2), H-2 receptor inhibitors, the drug name often ends with ‘titin’. Dosing basis: Inhibit some gastric acid secretion, so the strength is not as strong as the former. Commonly used drug types, roughly from weak to strong.
Cimetidine (metformin), 400mg twice a day, or 800mg once a night
Ranitidine, 4-10 times stronger than cimetidine, 150mg twice a day or 300mg once a night
Famotidine, in addition to acid inhibiting effect, there is also a reduction in pepsin secretion and increase in gastric mucosal blood flow, acid inhibiting strength is 20-40 times that of cimetidine, sub 20mg, 1 time daily, or 40mg, 1 time evening
Nizatidine, acid inhibiting strength and dose, dosing method is the same as ranitidine
Roxatidine, 75mg twice a day or 150mg once a night.
Adverse drug reactions in this group were rare except for metformin, which was slightly more frequent. The types of adverse reactions are similar to those of proton pump inhibitors.
Dosing tips.
The development of the “titin” family is “three small”, “two strong” trend, that is, less and less interference with drug enzymes, less and less adverse reactions, the dose is getting smaller and smaller. The “two strong” is that the strength of acid inhibition is getting stronger, and other effects are getting more and more. Some of these drugs can still be effective in cases where the proton pump is not effective.
Drug treatment of the second: gastrointestinal power drugs
Medication according to: the application of gastrointestinal motility drugs for this disease can.
(1) strengthen the tone of the lower esophageal sphincter.
(2) Promote the positive peristalsis of the esophagus to ‘push back’ the gastric acid refluxed into the esophagus to the stomach and reduce the contact time between the gastric acid and the esophageal mucosa.
(3) Strengthening the positive peristalsis of the stomach, allowing the acid in the stomach to take the right path into the duodenum.
This triple action all helps to reduce reflux, which can be said to ‘kill three birds with one stone’.
Commonly used drugs and adverse effects.
Domperidone (morpholine), sub 10mg, 3 to 4 times a day. It also has good antiemetic effect. Occasional abdominal pain, dry mouth, headache and overflow of milk. It is the most used one.
Cisapride (Prevacid), 5-10mg times, 3-4 times a day, may have diarrhea, bowel rumbling, abdominal pain, and be used with caution in elderly people with cardiac insufficiency.
Mosapride, 5mg, 3-4 times a day
Metoclopramide (Gastrofluan), 5-10mg, 3 times a day, more adverse reactions, constipation, diarrhea, high dose may cause convulsions, strabismus.
Erythromycin series, including roxithromycin, clarithromycin, azithromycin, etc., gastrointestinal adverse reactions are slightly more.
Dosing tips.
All drugs in this class should be taken 15 to 30 minutes before meals. Do not stop taking them as soon as your symptoms get better. Cardiac patients, especially those with heart rhythm disorders, are prohibited from taking these drugs.
Drug therapy No. 3: Mucosal protective agents
Medication basis.
These drugs have a barrier and protective effect on the mucous membrane without damage, and have the effect of promoting the repair of damaged mucous membrane, which is due to the fact that most of these drugs can combine with the proteins on the surface of the lesion to form a protective film, such as anti-rust paint. And the promotion of repair effect is related to increase intracellular prostaglandin production. Drug type.
Aluminum thioglycollate, sub 0.5~1.0g,3~4 times a day, powder or suspension is better, while tablets should be chewed into a paste and swallowed with warm water.
Colloidal bismuth, there are bismuth citrate, bismuth subnitrate, compound preparations such as gastric bismuth, gastric dextral, dextral stomach, etc., see the instructions for serving method.
Aluminum, magnesium preparations: aluminum hydroxide suspension, 10 ml, 3 to 4 times a day, or its tablets. Compound preparations have gastric Shu Ping, aluminum magnesium plus, compound aluminum magnesium tablets, etc., the tablets should be chewed into a paste after flushing.
Other are montmorillonite (Simethicone), sub 3g, 3 to 4 times a day. Magnesia, etc.
Dosing tips.
When taken with other drugs, other drugs should be taken first, at least 15-30 minutes before taking the ministry protector, so as to avoid other drugs being adsorbed and affecting the efficacy.
Bismuth makes the tongue and stool darker, magnesium and aluminum preparations lighter in color in stool.
Aluminum thiosulfate, aluminum hydroxide can occur constipation, bismuth agent may occur diarrhea.
Pay attention to the contraindications of different drug combinations.
Metal-containing drugs should not be taken for more than half a month in a row, such as the need for continuous use, at least 1 to 2 weeks between.
Precautions for pharmacotherapy
For each specific patient, a treatment plan should be developed by the physician based on the main symptoms, the duration of the disease, what is seen in the gastroscopy, and the medication used in the past treatment. In mild cases, one type of drug alone is sufficient, while in more severe cases, the efficacy can be improved by combining different types of drugs. Most doctors now advocate a course of treatment of more than two months and regular liver function and blood tests for early detection of adverse drug reactions.
Daily health care is indispensable
Attention to daily health care is indispensable for the treatment of this disease. This includes, in particular
Dress loosely and do not tighten the leather (pants) belt.
Eat less sweets or acid-producing foods, such as sweet potatoes, potatoes, strong acidic vinegar, lemon juice, coffee, chocolate, carbonated beverages are not recommended. Quit smoking, alcohol, strong tea. Do not eat a full meal or a large number of night meals, do not enter greasy food.
Serious patients can be padded with bed head, but not with high pillows. Do not lie in bed immediately after meals, it is best to take a short walk.
It is necessary for obese people to lose weight. Do not overexert physically and mentally. Keep a happy and optimistic spirit, regular and orderly life and living.
Be careful with medication, you can take the initiative to tell your doctor that you have GERD, so that other medications do not aggravate your condition.