Reflux esophagitis
Overview: Gastroesophageal reflux disease is caused by the reflux of stomach and/or duodenal contents into the esophagus, resulting in inflammation, erosion, ulceration and fibrosis of the esophageal mucosa.
Main symptoms.
1. Burning sensation or pain behind the sternum (heartburn): the main symptom of this disease. It can be triggered by semi-recumbency, forward bending of the torso or strenuous exercise, and can disappear after taking acid suppressants, while overheated and acidic food can make it worse.
2.Gastric and esophageal reflux: Every time after meal, lying body forward bending or sleeping in bed at night, there is acidic liquid or food reflux from the stomach and esophagus to the pharynx or mouth. This symptom mostly appears before the onset of burning sensation or burning pain behind the sternum.
3. Difficulty in swallowing: Intermittent difficulty in swallowing often occurs in the early stage due to secondary esophageal spasm caused by esophagitis. In the later stage, due to the narrowing of the esophageal scar, the burning sensation and burning pain can be gradually reduced and replaced by permanent dysphagia, which can cause blocking sensation or pain at the glabella when eating solid food.
4. Bleeding and anemia: Severe esophagitis may result in bleeding due to esophageal mucosal erosion, mostly chronic bleeding in small amounts.
Treatment plan
1.General treatment.
Change of living habits is the basis of treatment of reflux esophagitis. Eat less food and eat 80% full at each meal. Elevating the head of the bed 15-20cm can reduce recumbency and nocturnal reflux, should not eat before bedtime, and should not lie down immediately after eating during the day. The following measures can reduce reflux: quit smoking, abstain from alcohol, reduce abdominal pressure, avoid tight belts, reduce weight in obese people, avoid eating high fat, chocolate, coffee, stimulating foods, etc.
2.Drug treatment.
1, acid suppression therapy: the most important method for the treatment of reflux esophagitis at present.
Powerful acid suppressants (PPI): fast symptom relief, high healing rate of esophagitis, can be used for all patients with reflux esophagitis. Commonly used drugs are omeprazole (40mg/day), rabeprazole (20mg/day), esomeprazole (40mg/day), etc. (choose any one). Patients with reflux esophagitis require PPI at twice the dose of peptic ulcer treatment for at least 8-12 weeks. (The healing rate of 8 weeks of PPI treatment for esophagitis is about 90%. Gastroscopy needs to be repeated after 8 weeks of treatment to understand the healing situation, and if the esophagitis is not completely healed, the course of treatment should be extended to 12 weeks.)
2, prokinetic drugs: prokinetic drugs have some therapeutic effect, but poor efficacy when used alone. Such as mosapride, stomachic and antiphlogistic tablets, etc.
3, the other: acid making agent can neutralize stomach acid, commonly used drugs are containing aluminum, magnesium, bismuth and other alkaline salts and their compound preparations, can be used to lift the symptoms. Such as: aluminum magnesium carbonate: the role of adsorption of bile, can protect the esophageal mucosa, conducive to the healing of esophagitis.
The effect of PPI maintenance therapy is better than H2RA and prokinetic drugs, and there is no uniform standard for the dosage of maintenance therapy drugs, but the regular dose of PPI is used. It is a good choice to reduce the amount of medication and save money.
Prevention and precautions
1. Avoid alcohol and smoking.
2. Take care of small and frequent meals and eat a low-fat diet.
3.Dinner should not be too full and avoid lying down immediately after the meal.
4.Obese people should reduce their weight.
5, to maintain a relaxed mood, increase the appropriate physical exercise.
6.The head of the bed should be raised 10-15cm when sleeping, which is a proven way to reduce nighttime reflux.
7.Minimize activities that increase intra-abdominal pressure, such as excessive bending, wearing tight-fitting clothes and pants, tightening the belt, etc.
8.Medication should be used under the guidance of a doctor to avoid side effects from indiscriminate use of drugs.