Many people know about gastritis and gastric ulcers, but may not know much about GERD.
Wang, male, 46 years old. Since childhood, he often has acid reflux, heartburn, pain in the front and back of the chest, and often feels bloated and hiccups, especially obvious after drinking and eating. Occasionally, food flowed back into the pharynx or mouth. The older the person is, the more pronounced the symptoms are.
Yang, female, 60 years old. For the past 10 years, she often feels uncomfortable in her throat, followed by coughing, coughing up sputum, and asthma when the cough is severe. She often feels tightness in the chest, breath-holding, the feeling that she cannot breathe in, and her throat is pinched when it is severe. Sudden attacks can occur at night while sleeping. Often, he could only lean against the wall or sit on the sofa all night long and sleep. He was diagnosed with “asthma” by several hospitals. After several trips, the treatment was not effective. In recent years, a new problem was added, and I felt my heart was beating randomly, and an electrocardiogram diagnosed “arrhythmia”. He was in pain and suffering.
All of these manifestations were diagnosed as GERD after systematic examination.
So, what is GERD? What are the symptoms, what are the risks, and how should it be treated?
We say that gastroesophageal reflux disease (GERD), in which the contents of the stomach and duodenum flow back into the esophagus, causes symptoms such as acid reflux, heartburn, regurgitation, belching, and can lead to damage to extraesophageal tissues such as esophagitis, pharynx, larynx, and airway. Therefore, esophageal lesions can be complicated by esophageal erosion, ulcer, esophageal cancer, etc. Extra-esophageal manifestations can be seen in chronic pharyngitis, chronic rhinitis, chronic laryngitis, chronic bronchitis, bronchial asthma, bronchiectasis, interstitial fibrosis, and other manifestations such as chest and back pain of non-cardiac origin, cardiac arrhythmias, and sudden deafness.
In Western countries, 7%-15% of the population has GERD symptoms, and in China, according to some regions, nearly 10% of people suffer from GERD. And in recent years, with the improvement of living standards, high protein, strong tea, coffee and other changes in the diet structure, work and life stress, the incidence of the trend has increased. In particular, white-collar workers are more at risk.
When you have the above symptoms, you should consider the possibility of GERD.
Diagnostic tests for GERD include.
(1) 24-hour pH monitoring in the esophagus: A test catheter is placed in the esophagus through the nose and a monitoring box is attached to the outside to record the acidity and alkalinity in the esophagus for 24 hours. It can clarify whether there is gastroesophageal acid reflux and whether the symptoms are related to reflux; 2) esophageal manometry: it can clarify the magnitude of pressure in the upper and lower esophageal sphincter and the peristaltic function of the esophagus; 3) gastroscopy: it can find out whether there is esophageal erosion and the degree of erosion, and whether the cardia opening (where the stomach joins the esophagus) is relaxed. Most patients with GERD do not have erosion of the esophageal mucosa.
The diagnosis of GERD should be determined by combining the medical history with several tests to clarify the diagnosis.
The goal of GERD treatment is to control symptoms, cure esophagitis, improve quality of life and prevent complications. Treatment methods include lifestyle changes, medications, endoscopic treatment and surgical treatment.
Firstly, for general treatment, in order to reduce the occurrence of reflux, one should do the following.
1) chew and swallow slowly, avoid swallowing; 2) prohibit eating sour, sweet, spicy, cold and other stimulating foods, and do not drink carbonated beverages such as cola and Sprite; 3) avoid high-fat foods, chocolate, coffee, strong tea, etc.; 4) should not lie down immediately after meals, and should not eat within 2 hours before bedtime; 5) quit smoking and alcohol; 6) reduce factors that lead to increased abdominal pressure, such as tight girdle, constipation and obesity; 7 ) To reduce reflux occurring at night and in the recumbent position, the head of the bed can be properly elevated (not padded with pillows).
Second, drug treatment. Medication has a history of several decades, and currently medication is the main treatment for GERD, but medication cannot cure the disease, and symptoms recur in about 70% of patients after stopping medication. Long-term medication can also bring unavoidable drug side effects. The main drugs include.
1) Acid suppressants or antacids to inhibit gastric acid secretion is the main treatment. Ranitidine, famotidine, etc. are a class of drugs that can effectively inhibit acid secretion, but are prone to drug resistance, so they are not used as routine treatment drugs for GERD. Proton pump inhibitors (PPIs) (such as omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole, etc.) have the strongest inhibitory effect on gastric acid secretion and are currently the most effective drugs for GERD. Magnesium aluminum carbonate (Daxi) can neutralize both acid and alkaline reflux, and can be used to treat patients with bile reflux.
(2) Promote gastrointestinal motility drugs such as morpholine, mosapride, etc., can stimulate esophageal and gastrointestinal peristalsis, increase the lower esophageal sphincter pressure and esophageal emptying speed, effective for GERD treatment, but the therapeutic effect of gastrointestinal motility drugs alone is not ideal, therefore, it is advisable to take them together with acid-suppressing drugs.
(3) Gastric mucosal protective agents such as thioglycollate, Lizudra and Schweser can protect the mucosa and promote mucosal repair.
Third, endoscopic treatment. It includes endoscopic esophageal micro radiofrequency treatment and total folding.
Esophageal micro radiofrequency therapy for GERD treatment is a minimally invasive endoscopic treatment. After determining the treatment site under the endoscope, the treatment catheter is applied to the lower esophageal sphincter through thermal energy treatment to reconstruct the tissue and regenerate the collagen tissue, thus increasing the thickness of the lower esophageal sphincter and the pressure of the lower esophageal sphincter; and by inactivating the nerve endings and inactivating the vagus nerve receptors, the occurrence of transient lower esophageal sphincter relaxation is reduced, thus preventing the effect of gastroesophageal reflux. Esophageal microfrequency therapy has been applied to GERD abroad for several years. We first introduced the American Stretta micro radiofrequency treatment instrument to perform radiofrequency treatment for GERD patients in China. This technology brings more simple treatment for GERD patients, with outstanding features such as safe and effective, easy operation and fast recovery.
Endoluminal folding gastroscopy (ELGP) for GERD is a procedure in which a suture is mounted on the front of the gastroscope and sutured to form a fold in the stomach wall near the dentate line under direct vision, increasing the tension near the cardia and allowing the fold to block reflux and play a therapeutic role. This is a new technique for minimally invasive treatment, but there is a high chance of bleeding.
Fourth, surgery. Some patients with GERD, especially those with esophageal hiatal hernia, have recurrent symptoms that cannot be stopped, or even have symptoms that remain uncontrolled when taking medication for treatment. Patients with severe or recalcitrant GERD need to be treated surgically with open surgery or laparoscopic fundoplication. The surgical approach is highly effective in the near term and provides rapid symptom relief, with approximately 90% relief of heartburn and regurgitation symptoms, but efficacy is greatly influenced by surgical experience. Laparoscopic fundoplication is relatively less invasive and is currently the preferred surgical treatment for GERD.
In patients presenting with respiratory symptoms, especially those with asthma-like attacks, aggressive esophageal microfrequency therapy or surgical fundoplication is recommended for better symptom control. When other asthma-causing factors are not excluded, in addition to the treatment of GERD, appropriate bronchodilator drugs should be applied and β2 receptor antagonists such as benztropine and betalactone should be contraindicated.