The role of gastroesophageal reflux disease in the course of chronic pharyngitis

gastritis

bloating

diarrhea

sour taste in mouth

Helicobacter pylori

What are the consequences of changes in stomach acidity?

The main danger of increasing the secretory function of the stomach is the development of an inflammatory process in the mucous membrane of the organ, followed by its damage and the development of structural defects. A change in the pH of the gastric environment is always accompanied by clinical symptoms, the severity of which depends on the severity of the inflammatory process and the nature of the structural and functional disorders.

Causes of heartburn and nausea at the same time

Heartburn and nausea after eating can occur at the same time, and in some cases, nausea can begin after the burning sensation in the chest. Common causes of symptoms:

• binge eating;
• abuse of fatty, fried, difficult-to-digest foods;
• smoking;
• alcohol consumption;
• taking medications that relax the sphincter between the stomach and esophagus;
• consumption of products containing caffeine and cocoa beans;
• pregnancy, especially the last trimester;
• overweight;
• tight clothing that puts pressure on the stomach 5.

Mechanism of symptom formation

The main component of gastric juice is hydrochloric acid. It works as an activator of digestive enzymes and is an important part of food digestion. Thanks to it, an acidic environment is formed in the stomach, and the organ itself has a special mucous layer that protects against irritation.

Under the influence of certain factors, a bolus of food with enzymes and hydrochloric acid enters the esophagus from the stomach. This organ does not have a protective layer, and the environment is normally alkaline. Therefore, the acid chemically burns the walls of the esophagus, which causes a burning sensation1.

Most often, the symptom occurs 15-30 minutes after eating and may be accompanied by nausea6. The association of a burning sensation behind the sternum with food intake makes it possible to distinguish the condition from heart problems5.

What other symptoms might bother you?

The causes of heartburn and nausea after eating can be either physiological or indicate serious illnesses. Additionally, symptoms such as:

• one-time vomiting;
• pressure in the abdomen, feeling of fullness;
• pain in the upper abdomen;
• pain behind the sternum (with the formation of erosions and ulcers of the esophagus);
• belching acid;
• sour feeling in the mouth5.

Warning symptoms requiring professional intervention:

• burning is accompanied by dark vomit like “coffee grounds” or blood;
• the appearance of tarry stools (black);
• the symptom bothers you continuously for several days;
• difficulty swallowing food, shortness of breath;
• severe abdominal pain, associated and not associated with heartburn;
• continuous noticeable weight loss for no apparent reason;
• connection of heartburn not with food intake, but with medications3.

If at least one of the listed manifestations occurs, you should undergo a special examination to identify the exact cause of the condition.

Advantages of laparoscopic surgery

• Less traumatic and no pain in the postoperative period;
• Short period of hospitalization - no more than three days;
• Rapid recovery - after two weeks, patients return to their normal lifestyle.

Since patients often have other diseases that require surgical treatment, so-called simultaneous operations can be performed using laparoscopic access. I have been performing similar interventions for more than two decades. When performing a simultaneous operation during one anesthesia, you can immediately get rid of 2-5 surgical pathologies (for example, calculous cholecystitis, cholelithiasis, tumors, cysts, etc.).

Many, even experiencing painful attacks of heartburn, are in no hurry to see a doctor, trying to alleviate the condition in various ways, including with the help of medications. Is it necessary to treat reflux esophagitis if the symptoms are eliminated with the help of drugs that can be bought at any pharmacy? Of course, since there is a risk of developing severe complications. In addition, in the absence of adequate treatment, you will have to take medications throughout your life and adhere to strict dietary restrictions. At the same time, the effect of the drugs is very short-lived, and any physical activity immediately causes unpleasant and even painful sensations. To determine the extent of the disease and choose the most appropriate treatment tactics, just contact me by email or by scheduling a consultation.

Carrying out surgical interventions for diseases of the esophagus and stomach requires excellent command of surgical techniques, including endoscopic suture, which is impossible without appropriate experience. Over more than 25 years of experience, I have performed more than 2000 surgical interventions for reflux esophagitis, GERD and hiatal hernia. I am the author of monographs and more than 50 scientific papers devoted to these problems. I also regularly conduct seminars and master classes on these diseases, which are attended by specialists from various clinics and centers.

Why do heartburn and nausea need to be treated?

Even if the cause of heartburn and nausea is not diseases of the gastrointestinal tract (GIT), the problem should not be ignored. Frequently recurring symptoms gradually lead to the formation of the following problems:

• Esophagitis is inflammation of the walls of the esophagus. Due to constant burns, wounds are formed into which bacteria enter and an inflammatory process develops3.
• GERD – gastroesophageal reflux disease. Develops due to persistent relaxation of the esophageal sphincter6. Most often it accompanies diseases of the digestive system, that is, it occurs secondarily. But there are cases of the development of primary GERD, which is a chronic disease that requires an integrated approach.
• Narrowing of the esophagus. Ulcers on the walls of the organ become scarred, causing the lumen of the esophagus to narrow. It is difficult for a person to pass food, which significantly impairs the quality of life.
• Barrett's esophagus. Long-term damage to an organ by hydrochloric acid can provoke degeneration of the epithelial cells lining the walls. The disease is considered precancerous and can lead to the development of cancer1.

Classification

To assess the patient’s condition and unify data, a classification is used; depending on the degree of damage to the esophagus, several stages of reflux esophagitis are distinguished.

• I - rounded and longitudinal delimited, non-merging foci of inflammation, spreading to the mucous membrane of the esophagus from the Z-line - the border of the transition of the multilayered squamous epithelium of the esophageal mucosa into the columnar epithelium of the gastric mucosa;
• II - lesions in the Z-line zone merge, but do not cover the entire circumference of the esophagus;
• III - merging lesions covering the entire surface of the mucosa;
• IV - chronic damage to the esophagus, in which fibrous stenosis, shortening of the esophagus, peptic ulcers, and Barrett's esophagus develop.

To determine the stage of reflux esophagitis, it is necessary to undergo an examination, based on the results of which treatment is prescribed.

Principles of heartburn treatment

Medicines for heartburn and nausea are not enough to fully combat the unpleasant condition. The basis of treatment is lifestyle correction and diet. Recommendations include:

• eating small portions 3-4 times a day;
• refusal of sour, spicy, smoked foods and foods with chemical additives, carbonated drinks, alcohol, cabbage, onions, tomatoes;
• limiting the consumption of baked goods, coffee, tea, fatty foods, sweets, sausages, fried foods;
• after eating, a quiet walk in the fresh air is recommended; it is forbidden to take a horizontal position;
• normalization of work and rest, sleep, avoidance of stressful situations;
• avoiding intense physical activity after meals, especially bending forward;
• increasing the motor activity of the body as a whole5.

Proton pump inhibitors are considered one of the most effective medications for treating heartburn6. The action of these drugs allows not only to remove the symptom, but also affects the mechanism of burning sensation. One of the representatives of the group is Omez 10 mg, a drug based on Omeprazole. It is convenient to take 2 capsules once a day, which helps eliminate the symptoms of heartburn within 24 hours2. The drug allows treatment courses of up to 14 days without consulting a specialist.

Diagnostics

One of the key methods for determining the acidity of the stomach is to conduct a urease breath test to identify the bacterium Helicobacter pylori. Also, PCR and ELISA studies are performed to identify antibodies to this microorganism. Other mandatory research methods for suspected gastritis with high acidity include:

1. Endoscopic examination of the stomach (gastroscopy). Using this method, the condition of the stomach, esophagus and duodenum is assessed. If necessary, during the examination, fragments of the mucous membrane are taken (biopsy).
2. Intragastric pH-metry. To conduct the study, a pH-metric transnasal probe is used, which is connected to an autonomous recording unit. If the pH of the gastric contents is less than 1.5 units, then the diagnosis of hyperacid gastritis is confirmed.

An ultrasound examination of the abdominal organs may be prescribed as an auxiliary examination method.

Why can't you use soda?

The most famous home remedy for eliminating a burning sensation behind the sternum is baking soda. Alkali neutralizes hydrochloric acid, thereby eliminating the unpleasant symptom. However, it has been proven that the use of this method of treatment only causes harm. In the process of neutralizing the acid, a large amount of carbon dioxide is released, which distends the stomach. This can cause damage to the mucous membrane, and in the presence of an ulcer, even bleeding5. In addition, the environment in the stomach must remain acidic. Therefore, after using soda, the compensatory mechanism for the production of hydrochloric acid starts almost immediately. The result may be even more severe discomfort in the stomach and esophagus5.

How is the operation performed using a modified technique?

During the operation, a symmetrical cuff is formed from the upper part of the stomach, covering the esophagus at 270°. The anterior right side of the esophagus remains free; The cuff created in this way strengthens the lower esophageal sphincter and prevents the backflow of stomach contents. In the presence of a hiatal hernia, the lower part of the esophagus and the upper third of the stomach are first separated from the adhesions and returned to their natural position. The diaphragmatic hole is sutured to normal size. To prevent relapse and perform diaphragmocruroplasty, I use mesh implants, which reduces the risk of recurrence of the disease from 65% to 1%.

Surgery for reflux esophagitis is performed through laparoscopic access: all manipulations are performed through several small punctures on the anterior abdominal wall. In the future, the puncture marks become almost invisible. The operation is performed using endoscopic equipment equipped with a miniature video camera, which allows all manipulations to be carried out under visual control as accurately as possible. Since important structures (vagus nerve, blood vessels) are located in the surgical area, there is virtually no risk of damage to them.

During the operation, when isolating the esophagus and stomach, I use a dosed tissue ligation device LigaSure (USA), which is capable of “sealing” vessels without the risk of damage to surrounding tissues, as well as the development of bleeding. At the same time, the duration of the operation is reduced. The use of modern suture material promotes rapid recovery.

Prevention

Proper diet and nutrition are the basis for successfully preventing heartburn and nausea. Additional recommendations:

• rejection of bad habits;
• correct work and rest schedule;
• weight loss;
• refusal of uncontrolled use of NSAIDs;
• wearing loose clothing without tight belts or corsets.

Timely treatment of diseases of the digestive system accompanied by heartburn, including recommendations for the use of Omez 10 mg, helps relieve heartburn.

THERE ARE CONTRAINDICATIONS, YOU MUST READ THE INSTRUCTIONS FOR MEDICAL USE OR CONSULT A DOCTOR.

Bibliography:

1. Strugala V. et al. A randomized, controlled, crossover trial to investigate times to onset of the perception of soothing and cooling by over-the-counter heartburn treatments // Journal of International Medical Research. - 2010. - T. 38. - No. 2. - P. 449–457.
2. INSTRUCTIONS for the use of the medicinal product for medical use. OMEZ 10 mg LP 00328 dated 07/11/17 Date of appeal 11/26/18.
3. Komarov F.I., Osadchuk M.A., Osadchuk A.M. Practical gastroenterology. Medical news agency. Moscow, 2010. - 480 p.
4. Lazebnik L.B., Masharova A.A., Bordin D.S. and others. Results of the multicenter study “Epidemiology of gastroesophageal reflux disease in Russia” (MEGRE). Therapeutic archive. — 2011. No. 1.— P. 45-50.

Osadchuk A.M., Davydkin I.L., Gritsenko T.A., Khairetdinov R.K., Kurtov I.V., Danilova O.E., Rogozina L.A., Kosyakova Yu.A., Krivova S. .P. HEARTBURN SYNDROME. CURRENT ISSUES OF PATHOGENESIS, DIFFERENTIAL