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 high recurrence rate after stopping the drugs. Therefore, it is necessary to strengthen recurrence prevention measures for reflux esophagitis, supplemented by the necessary treatment.
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 (LES) to prevent recurrence of reflux, it should be a habit to persist for a long time.
(1) Reduce body weight
Obese people have increased intra-abdominal pressure, which can contribute to the aggravation of LES insufficiency, and should actively reduce body weight. Women wearing tight underwear or constipation can increase abdominal pressure, so clothes should be loose, and bowel movements should be unobstructed.
(2) standing by gravity
Gastric residue rarely reflux. The head of the bed should be raised 15-20cm during sleep to enhance the clearing force of the esophagus and speed up 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 diet
Eat less and more meals, do not lie on your back immediately after eating, and forbid foods that cannot be tolerated to avoid inducing pain and prevent the occurrence of nausea and vomiting.
(4) Reduce fatty diet
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
Quit smoking to enhance the resistance of esophageal mucosa. Tobacco, alcohol, coffee, chocolate and strong tea can reduce LES pressure and should be used sparingly or prohibited.
2.Application of drugs
(1) Prokinetic drugs
Gastroesophageal reflux disease is a digestive tract power disorder, so we must first improve the power. Cisapride can promote the power of the whole gastrointestinal tract, increase LES pressure and the amplitude of esophageal peristaltic contraction, shorten esophageal acid exposure time, speed up gastric emptying, reduce reflux, and is better than ranitidine for the disappearance of symptoms and the 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
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+ and 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
Mucosal protective agent for the damaged esophageal mucosa, aluminum thioglycollate or magnesium aluminum 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 medical treatment is ineffective, or the symptoms appear soon after stopping the drug, or there are 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.
According to the above, medication can control the symptoms of reflux disease and cure esophageal inflammation, but it is easy to relapse after stopping medication, and the underlying factors that cause GERD still exist. Therefore, lifestyle changes and persistence are extremely necessary. Mild to moderate GERD symptoms can disappear completely, and can be relieved for a longer period of time by taking appropriate amounts of prokinetic and antacid medications when necessary. If there are obvious reflux symptoms, take antacids and prokinetic agents routinely, and pay more attention to food hygiene and eat more vegetarian food until the symptoms disappear. If there is erosion, ulcerated surface or complications, consider mucosal protective agents, increase the dosage of cisapride and omeprazole, and consider surgical treatment if necessary.
Warm tip: Please combine the specific medication with clinical and be guided by the doctor’s face-to-face consultation.