Bile reflux into the stomach: symptoms and treatment. Reflux esophagitis - symptoms, causes and treatment

Bile reflux and the reflux of bile contents into the stomach cavity are potentially dangerous and serious conditions.

Often occurring after acid reflux, symptoms of bile reflux and the backing up of bile into the stomach cause inflammation and discomfort in the stomach.

When there is a reflux of bile into the stomach, treatment usually involves administering certain medications to the patient to relieve symptoms.

If the patient has severe bile reflux and bile in the stomach, the causes and treatment of serious manifestations of this condition may require additional diagnostics and even surgery to prevent further damage to the upper digestive system.

It is important to identify the causes of such a condition in time in order to implement the correct and effective treatment. Below in the article we will find out why bile is thrown into the stomach.

Causes and symptoms

To aid the digestion process, the liver produces a substance known as bile, which remains in the gallbladder until it is needed to absorb digested food.

The pyloric sphincter (pylorus), located between the stomach and duodenum, serves as the main valve that controls the passage of food from the stomach to the intestines. It also prevents the reflux of intestinal contents into the stomach.

When this valve is faulty, the released bile flows back into the gastrointestinal tract, which can cause inflammation of the stomach.

If the gastric sphincter does not work properly and bile enters this organ, inflammation and erosion can occur.

In most cases, people who have undergone surgery gastrointestinal tract or who have diagnosed themselves with a peptic ulcer, the risk of developing bile reflux and the likelihood of bile reflux into the stomach are significantly increased.

Also, quite often, this type of condition can occur in patients after removal of the gallbladder and in the presence of erosions in the duodenum.

Other reasons for the reflux of bile into the stomach area include spasms of the gallbladder due to the development of liver diseases, stressful situations or simple emotional stress.

The diagnosis of “bile reflux” can be made to a person only after a thorough medical examination and appropriate diagnostics of internal organs.

Only a gastroenterologist, after the patient has passed all the tests and examinations, is able to answer questions about why this condition arose and what its causes are.

Tests and examinations, which most often include endoscopy, are usually used to assess the condition of the upper digestive system, verify and confirm inflammatory process or ulceration after the first symptoms are detected.

Because of the associated risk of stomach cancer, tissue samples (biopsies) are examined under a microscope.

When bile contents back up into the stomach area, people with it often experience some signs and symptoms that may be mistaken for reflux.

As a rule, certain patients with such reflux experience discomfort in abdominal cavity accompanied by pain, nausea, and sometimes vomiting. This, in turn, can lead to unintentional weight loss.

The intensity of stomach pain can vary from mild to severe depending on the frequency and duration of bile reflux episodes.

Symptoms of bile reflux should not be ignored due to the serious risks of complications.

Those patients who experience chronic symptoms, are at increased risk of developing gastritis and stomach cancer. It is also possible for a narrowing to form in the pyloric region of the stomach.

As previously noted, bile is a fluid produced by the liver that helps digestive process in the small intestine.

Gastritis can occur when it acidic substance abnormally flowing back from small intestine and then enters the stomach. This condition is bile reflux.

Gastritis caused by chronic bile reflux into the stomach, can lead to frequent symptoms heartburn in patients. Symptoms of heartburn usually include a burning sensation in the upper stomach, chest, or throat.

Patients with this condition may notice that heartburn symptoms worsen after eating or at night.

Bile contents in the stomach due to reflux can cause significant irritation, which can lead to symptoms of nausea or vomiting in patients with gastritis.

Vomit that contains blood or is similar in color and consistency to coffee grounds, may indicate gastrointestinal bleeding.

In this case, you must immediately contact medical care. The doctor will determine the reasons this state and prescribe the required treatment.

When inflammation of the stomach occurs, caused by symptoms of gastritis due to bile reflux, it can cause indigestion, a condition also called indigestion.

As a result, patients with this disease may experience a loss of appetite accompanied by significant, unintentional weight loss.

In general, people with bile reflux may experience some relief by taking medications designed to inhibit bile acid production.

Medicines such as ursodeoxycholic acid may be prescribed to improve digestion and relieve abdominal discomfort.

People who have severe reflux symptoms may undergo surgery if complications of the process are detected.

Treatment

Endoscopic ultrasonography may also be performed. It helps to identify the size of stones in the gallbladder area (if present, of course).

Medications to treat the above reflux most often consist of ursodeoxycholic acid, which helps move bile through the digestive tract and can relieve the discomfort associated with this disorder.

Sometimes patients who have difficulty emptying their stomach are prescribed a combination of medications.

The main function of proton pump inhibitors such as Omeprazole, Lansoprazole, Esomeprazole is to reduce acid production in the digestive system.

Because the backflow of bile into the stomach is not caused by excess acid, proton pump inhibitors are usually ineffective in treating bile reflux, although they can be used in combination with other drugs and therapies to help reduce the pain.

Among other things, the patient may be prescribed drugs such as choleretics that help increase gallbladder motility.

If there is no effect from drug treatment Surgical intervention may be considered.

There are also many home remedies that can help patients with bile reflux. Doctors recommend that patients sleep with their heads elevated to keep the bile at rest at night.

Abstaining from eating food for a period of time at least, three hours before bedtime can significantly reduce the likelihood of bile reflux into the stomach after falling asleep.

If the patient has overweight, losing a few kilograms will reduce the pressure on his stomach and other organs. This may help keep bile in reserve.

It is also important to avoid foods that relax the stomach sphincter, such as caffeine, chocolate, tomatoes, carbonated drinks and spices.

You need to follow a low-fat diet and reduce your alcohol intake.

Treatment with medications and surgical methods It's always possible. However, you can add some positive changes into your lifestyle to relieve existing symptoms.

No smoking. When a person smokes cigarettes, they increase the production of stomach acid and also dry out saliva, which helps protect the esophagus.
Do not eat as much food as before the disease was discovered. Why is this so necessary? The fact is that when a person eats large portions of food, it puts pressure on the stomach and especially on the esophageal sphincter, causing it to open at the wrong time.
Does not lie down immediately after eating. It is advisable to delay your bedtime and fall asleep at least two or three hours after eating.
Reduce consumption fatty foods. A diet containing foods high in fat negatively affects the esophageal sphincter, which slows down the digestion process. The need to remove all fatty foods from the menu is very high.
Use bran to improve the functioning of the gastrointestinal tract and avoid the formation of sediment in the gallbladder area.

Changing your sleeping position can also help relieve symptoms once you fall asleep. A person needs to raise his head 18 centimeters above the level of the bed.

This tilt and the natural force of gravity can prevent a condition such as the reflux of bile contents into the stomach cavity.

Regular pillows are often not enough to create the right angle. It is recommended to purchase a special wedge-shaped pillow to change the position of the head during sleep.

If the reflux of bile contents into the stomach cavity is associated with the process of removing the gallbladder, the patient must contact a surgeon to exclude possible complications after surgery, as well as to a nutritionist to prescribe an appropriate diet.

Before proceeding directly with treatment of the condition, it is necessary to consult a professional physician.

He will determine the exact reasons pathological process and make the correct diagnosis with a view to further prescribing the most effective scheme treatment.

The German physician, surgeon and scientist Heinrich Quincke in 1879 described the physiological process that occurs in the digestive system of people after eating and called it gastroesophageal reflux (abbreviated as GER). A synonym for this difficult-to-pronounce term is gastrointestinal esophageal reflux. The word “reflux” in Latin means “reverse flow,” and in medicine this term refers to movement in the opposite direction compared to the normal course of movement of the contents of any hollow organs. If you have been diagnosed with this, there is no need to be upset, since GER itself is not a disease and does not require treatment. But sometimes the mechanisms of this physiological process malfunction, food returning from the stomach to the esophagus begins to corrode its epithelial cells, and the person experiences quite discomfort. In these cases, the diagnosis indicates gastroesophageal reflux with esophagitis - a disease that is quite serious and can lead to esophageal cancer.

Mechanism of gastroesophageal reflux

From anatomy lessons, we know that food crushed in the mouth, when swallowed, enters the esophagus, which is a hollow tube. Its functions are limited to the rapid delivery of a bolus of food to the stomach, where it begins to be digested. The length of the esophagus in most people is 30 cm. In the lower part, the muscle fibers of its walls are arranged in such a way that they act as a valve (sphincter). When a bolus of food moves, they relax, allowing it to enter the stomach, and then contract, preventing food from exiting back into the esophagus. If the passage is not blocked enough, the contents of the stomach (food and gastric juice) partially move back into the esophagus, that is, gastroesophageal reflux occurs. Symptoms and treatment for this condition depend on how well the defense mechanisms in the esophagus work.

For most people, this process does not cause any discomfort or pain, and therefore does not require treatment at all. However, for some, the return of part of the food back from the stomach to the esophagus is accompanied by painful or simply unpleasant sensations. In these cases, consultation with a doctor and treatment are necessary.

How defense mechanisms work

Why is gastrointestinal reflux harmless in some cases, and dangerous in others? The fact is that the human esophagus is “programmed” by nature to contact only an alkaline environment, which is chewed food entering it from the mouth. The stomach not only accepts food lumps, it begins to digest them, for which it produces gastric juice - a liquid from a mixture of enzymes, mucus and the main component - of hydrochloric acid. Once in the esophagus, it begins to “digest” the epithelial cells of its walls in the same way as food fragments. If a person has against aggressive acidic environment protective mechanisms, food reflux is not scary for them. Such mechanisms are:

A sufficiently high tone of the esophageal sphincter, which does not allow food to leave the gastroesophageal zone;

Good ground clearance ( quick cleansing esophagus from the incoming stomach contents);

Resistance of esophageal epithelial cells to hydrochloric acid;

Acidity control gastric juice.

Signs of GER that is not a disease

The person does not feel any discomfort (this is one of the dominant signs);

The reflux of food into the esophagus from the stomach is observed only immediately after a meal;

Reflux does not last long and occurs only a couple of times a day;

Reflux does not occur at night during sleep.

It should be noted that physiological reflux of food from the stomach into the esophagus is observed in people of any age, including children.

Prevention of harmless GER

Even in cases where gastroesophageal reflux does not cause problems, you can take a number of simple efforts to help your gastrointestinal tract function. The following simple steps can help reduce the symptoms of reflux:

Do not go to rest immediately after a meal;

Don't start physical work, especially associated with bending over, having barely finished eating;

Don't overeat;

Reduce the consumption of foods (chocolate, alcohol, some specific sauces) that relax the esophageal sphincter;

Do not start eating in clothes that are too tight or with a tightly tightened belt;

Reduce portion sizes and increase the number of meals.

Signs of GER, which is a pathology

The disease is considered to be gastroesophageal reflux with esophagitis. It happens when the protective mechanisms of the esophagus malfunction and can no longer protect the epithelial cells from being corroded by hydrochloric acid. U of this disease there are two types of symptoms.

1. Esophageal. Patients report the following unpleasant sensations:

There is a sour taste in the mouth;

Belching (mostly sour);

Dysphagia (choking is possible when eating);

Pain behind the sternum (tends to intensify when bending over and lying down, and can spread to the arms and neck).

2. Non-esophageal. Patients may experience some or all of the following symptoms:

Dental problems (caries, enamel defects);

Sinusitis;

Laryngitis;

Pharyngitis;

Coughing;

Pain in the heart area.

Because of these manifestations, GER is often misdiagnosed and people are treated for diseases that do not exist.

Causes

Pathological gastroesophageal reflux may appear for the following reasons:

Obesity;

Alcohol, smoking;

Holes;

Unbalanced diet;

Medicines that reduce sphincter tone;

Profuse vomiting (occurs with poisoning);

Systemic scleroderma;

Nasogastric tube.

Gastroesophageal reflux in infants

In the first days and months of life, approximately 80% of babies experience regurgitation after feedings. Most often, gastroesophageal is not a pathology and occurs due to the imperfection of its gastrointestinal tract system. Also, regurgitation protects the baby from overeating and air entering his intestines.

It is often enough for parents to simply hold the baby upright for about 10 minutes after feeding so that regurgitation does not occur. Oh more serious problems with the stomach and esophagus are indicated by the following signs:

Constant crying and restlessness of the baby;

Belching;

Vomiting (not to be confused with regurgitation) after feeding;

Refusal to eat;

Unreasonable cough;

The child sleeps poorly and gains little weight.

According to indications, the doctor may prescribe mixtures with thickeners and medications for the baby: Cisapride, Domperidone, Metoclopramide, Cimetidine. If reflux is caused by pathologies in the structure of the gastrointestinal tract, it is possible surgical intervention.

Gastroesophageal reflux in children older than one year

In most children, by 12-18 months, regurgitation after feedings completely disappears. Babies grow healthy and do not experience any discomfort after eating. But some children have other complaints that indicate problems with the stomach or esophagus:

Heartburn (the child explains this symptom as “fire” or “fire”);

Belching sour;

Chest pain;

Nausea;

Feeling of fullness in the abdomen;

Spitting up at night while sleeping (this can be seen by marks on the pillow).

Often indicate gastroesophageal completely unrelated to the digestive organs:

Lump and sore throat;

Hard breath;

Difficulty swallowing;

Frequent pneumonia.

Usually, with these symptoms, they begin to treat a cold, but with GER, such therapy does not produce results.

Diagnostics

If the patient has unpleasant or painful symptoms gastroesophageal reflux, diagnosis should be carried out using modern laboratory and instrumental methods. At the first stage, the gastroenterologist collects an anamnesis, including information about similar diseases in the patient’s relatives, the duration and intensity of reflux symptoms.

The second stage is to carry out laboratory research, such as:

Blood test (biochemical and general);

Coprogram;

Analysis of urine.

The third stage of diagnosis includes instrumental studies:

Esophageal manometry;

EGDS (esophagogastroduodenoscopy);

Provocative test;

X-ray using barium suspension;

Treatment

If pathological gastroesophageal reflux is diagnosed, treatment is carried out in three directions:

1. Non-drug. Includes the following items:

Weight correction;

Diet (no chocolate, alcohol, fatty, spicy, coffee, garlic, citrus fruits);

Organizing nutrition;

Exclusion from the wardrobe of tight clothes and narrow belts;

Raise the head of the bed by 20 cm.

2. Medication:

Proton pump inhibitors (reduce the secretion of hydrochloric acid in the stomach “Rapeprazole”, “Omeprazole”);

Antacids (these medications neutralize hydrochloric acid “Phosphalugel”, “Almagel”);

Prokinetics (accelerate the movement of food from the stomach to the intestines “Metoclopramide”).

3. Surgical. It is used if the two previous types do not provide visible improvements.

If the disease is not treated, hydrochloric acid entering the esophagus can cause ulceration of its walls, perforation, bleeding, the so-called Barrett's esophagus, which increases the risk of a malignant tumor by 10 times.

Reflux esophagitis is a chronic disease that involves pathological reflux of gastric contents into the esophagus.

Since the mucous membrane does not have protection against such aggressive substances, epithelial damage occurs due to contact with them. further inflammation and correspondingly, painful sensations.

When reflux esophagitis occurs, the acidity level of the esophagus drops noticeably due to the mixing of the contents of the esophagus with acidic gastric refluxate and digestive enzymes. The result of prolonged contact of the esophageal mucosa with such an irritant is its inflammation and trauma.

In this article we will look at reflux esophagitis, its first symptoms and the basic principles of treatment, including at home.

Causes

Why does reflux esophagitis occur, and what is it? The cause of reflux esophagitis usually lies in excessive relaxation of the esophageal sphincter at the entrance to the stomach. This muscle should be in a compressed state most of the time. A healthy esophagus only relaxes for 6-10 seconds to allow food or liquid to pass through. If the sphincter remains relaxed longer (for patients - up to a minute after each swallow), this causes a regression of the acidic contents of the stomach into the esophagus.

Often reflux esophagitis accompanies gastrointestinal diseases such as:

or stomach cancer;
damage to the vagus nerve;
violation of duodenal patency of the esophagus;
pyloroduodenal stenosis;

It is not uncommon for reflux esophagitis to occur after gastric surgery. The disease can also be the result of smoking, drinking alcohol and large quantity coffee. In some cases, sphincter relaxation occurs in people suffering from a hiatal hernia or from penetration of part of the stomach into the chest. This is observed in obese people because big belly increases pressure on the diaphragm.

Erosive reflux esophagitis

A complicated form of the disease in which small ulcers (erosions) form on the esophageal mucosa. With erosive reflux esophagitis, all of the above symptoms become more pronounced, bringing significant discomfort to the patient. Manifestations of the disease intensify after eating, as well as certain medicines, for example, aspirin.

Degrees

The course of the disease is characterized by several stages, with gradually increasing symptoms and erosive damage to the esophagus becoming more pronounced.

degree - manifested by individual non-merging erosions and erythema of the distal esophagus;
degree - merging, but not covering the entire surface of the mucous membrane of erosive lesions;
degree - manifested by ulcerative lesions of the lower third of the esophagus, which merge and cover the entire surface of the mucosa;
degree - chronic ulcer of the esophagus, as well as stenosis.

Symptoms of reflux esophagitis

When reflux esophagitis occurs, the symptoms of this disease may include pain behind the sternum, extending closer to the heart and even into left shoulder, can also suck in the pit of the stomach. Very often the patient does not even associate these symptoms with problems with the esophagus; they are mistaken for an angina attack.

So, the main signs of reflux esophagitis in adults are:

belching of air or food;
heartburn;
nausea;
regurgitation;
sour taste in the mouth;
incessant hiccups.

Symptoms of reflux esophagitis often worsen when lying down (especially after eating) and disappear when sitting in a sitting position.

Chronic reflux esophagitis

Esophagitis in chronic form, with a characteristic alternation of periods of exacerbation with periods of remission, can either be a consequence of acute untreated reflux esophagitis, or develop against the background of alcoholism and consumption of rough, low-quality food.

According to the types of changes, reflux esophagitis can be:

superficial (distal);
erosive;
hemorrhagic;
pseudomembranous, etc.

Signs of reflux esophagitis in chronic stage, during a medical examination using X-rays, there may be a violation of the mucous membranes of the esophagus, the appearance of ulcerations and erosions.

Diagnostics

To detect gastroesophageal reflux, today they use enough different methods. Thanks to x-rays of the esophagus, it is possible to record the penetration of contrast from the stomach into the esophagus or to find a hiatal hernia.

A more reliable method is long-term pH-metry of the esophagus (measurement of acidity in the lumen of the esophagus using a probe). This allows you to determine the frequency, duration and severity of reflux. And yet, the main method for diagnosing reflux esophagitis is endoscopic. With its help, you can obtain confirmation of the presence of the disease and determine the degree of its severity.

In general, the symptoms and treatment of reflux esophagitis depend on the severity of the disease, the patient's age and concomitant pathology. In some forms, no therapy is prescribed, while in others, surgery is required.

How to treat reflux esophagitis

When symptoms of reflux esophagitis appear, treatment consists of eliminating the disease that caused it (gastritis, neurosis, peptic ulcer or gastroduodenitis). Proper therapy will make reflux symptoms in adults less pronounced and help reduce harmful effect gastric contents thrown into the esophagus, increase the resistance of the esophageal mucosa and quickly cleanse the stomach after eating.

Conservative treatment indicated for patients with uncomplicated disease. It includes general recommendations:

after eating, avoid bending forward and do not lie down for 1.5 hours
sleep with the head of the bed raised at least 15 cm,
do not wear tight clothes and tight belts,
limit the consumption of foods that have an aggressive effect on the mucous membrane of the esophagus (fats, alcohol, coffee, chocolate, citrus fruits, etc.),
quit smoking.

Drug therapy for reflux esophagitis, at least 8-12 weeks are carried out, followed by maintenance therapy for 6-12 months. Prescribed:

proton pump inhibitors (omeprazole, lansoprazole, rabeprazole) in regular or double dosage,
antacids (Almagel, phosphalugel, Maalox, Gelusil-lac, etc.) are usually prescribed 1.5-2 hours after meals and at night,
prokinetics - domperidone, metoclopramide.

To reduce the appearance of supine position symptoms such as heartburn and chest pain should be taken correct posture– the upper part of the body should be slightly elevated, for which you can use several pillows.

Operation

This treatment method is rarely used. Basic indications for surgery:

Ineffectiveness of long-term drug treatment.
Development of Barrett's esophagus with a risk of malignancy (development of esophageal cancer).
Esophageal strictures.
Frequent esophageal bleeding.
Frequent aspiration pneumonia.

Main method surgical treatment is a Nissen fundoplication, which restores the normal functioning of the cardiac sphincter.

Diet

For reflux esophagitis, the diet is quite strict and prohibits eating a certain amount of food. Among them:

alcoholic drinks, natural juices from fruits, carbonated drinks;
pickled and smoked products, pickles;
strong broths and soups cooked with them;
fatty and fried foods;
fruits (especially citrus fruits);
spices, sauces;
chewing gum;
foods that increase gas formation (cabbage, brown bread, milk, legumes, etc.);
foods that relax the lower gastric sphincter and provoke stagnation of food masses in the stomach (sweets, strong tea, chocolate, etc.).

The diet of a person suffering from reflux should include the following foods:

soft-boiled eggs,
low-fat milk and pureed low-fat cottage cheese,
dairy products,
porridge,
meat and fish soufflé,
steamed cutlets and meatballs,
crackers or stale bread soaked in water,
baked apples.

The diet of patients suffering from reflux disease should be divided and include five to six meals a day, the last one four hours before bedtime.
portions should be small so that the stomach is filled to only a third of its volume.
It is better to replace the afternoon nap with a quiet walk. This helps food move faster from the stomach into the intestines, and acidic contents will not be refluxed into the esophagus.

To reduce gastroesophageal reflux, you must:

lose weight,
sleep on a bed with a high headboard,
maintain time intervals between eating and sleeping,
quit smoking,
stop drinking alcohol, fatty foods, coffee, chocolate, citrus fruits,
Eliminate the habit of drinking water with food.

Folk remedies

Treatment of reflux esophagitis folk remedies can only be performed as an auxiliary procedure. Traditional treatment reflux esophagitis is based on taking decoctions that soothe the mucous membrane of the esophagus, products that stimulate sphincter tone, reduce acidity and fight heartburn.

Forecast

Reflux esophagitis, as a rule, has a favorable prognosis for work ability and life. If there are no complications, then it does not shorten its duration. But with inadequate treatment and non-compliance with the recommendations given by doctors, new relapses of esophagitis and its progression are possible.

During normal functioning of the body, bile is transported through the ducts to gallbladder and duodenum to break down fats, vitamins and amino acids. But sometimes there is a reflux of bile into the esophagus.

Causes

The reasons for the release of bile can be divided into 2 groups: those requiring and those not requiring treatment. Reasons that do not require treatment:

unhealthy diet (presence of fatty, fried, spicy, smoked foods in the diet);
bad habits ( frequent use alcohol, smoking, overeating);
drinking strong coffee, tea and carbonated drinks;
last trimester of pregnancy;
uncomfortable posture during sleep;
taking certain medications;
exercise immediately after eating.

These causes can be eliminated by lifestyle changes.

But there are causes of reflux that require correction with medical intervention:

various inflammations of the liver, gall bladder (cholecystitis, hepatitis);
obesity 2 or 3 degrees;
disruption of the sphincter located between the duodenum and stomach;
hernia located in the digestive tract;
increased pressure inside the stomach;
biliary dyskinesia.

Most often, the release of bile occurs due to several reasons. You also need to remember that this is not an independent disease, but only a consequence of some disturbances in the body, therefore, it is not the release of bile that needs to be treated, but the cause must be eliminated.

Symptoms of bile reflux into the esophagus

On early stages the disease is not noticeable to a person and does not manifest itself in any way; it can only be detected during a routine examination. As this condition progresses Clinical signs will already be noticeable.

If you detect even mild and intermittent signs, it is better not to wait for self-cure (of course, if bile reflux is not associated with pregnancy), but to seek medical help. At early diagnosis the doctor will prescribe treatment that will be more effective than in advanced cases.

Possible signs that may indicate bile reflux into the esophagus:

heartburn - felt strong and behind the sternum. Most often occurs after meals or at night;
Incessant hiccups are another typical sign. Most often appears when the stomach is full;
the pain is moderate, similar to heart pain, but occurs after eating. Strong pain syndrome occurs with serious changes in the gastric mucosa - ulcers, erosions and atrophies;
belching with bitter or sour taste, happens even with little physical activity, overeating or stress;
vomiting with bile occurs already at late stages and indicates serious pathological disorders in the digestive tract;
also in the later stages, a narrowing of the food tube appears, which is expressed by the sensation of a foreign body;
tooth enamel deteriorates;
persistent cough.

If signs appear, there is no need to postpone a visit to the doctor; inaction in this case can lead to attacks of angina and tachycardia, and to the formation of adhesions in the esophagus. These adhesions can subsequently lead to cancer of the esophagus or stomach.

Diagnosis of the disease

If reflux symptoms do not go away within a few days, you should consult a gastroenterologist. The doctor will prescribe general analysis urine, biochemical and general blood tests.

But the most informative will be the following diagnostic methods:

Ultrasound of the abdominal organs. The accuracy and correctness of the study depends, first of all, on the preparation of the patient himself for the procedure. The day before you must comply special diet, in which foods that contribute to gas formation in the intestines are excluded.
Contrast radiography. This method of determining the reflux of bile into the esophagus using a contrast agent. The study is carried out on an empty stomach; you should not eat food 7 hours before the x-ray.
Gastroscopy - using this method, the doctor evaluates the entire digestive tract. The procedure is performed using a gastroscope and a computer monitor. At the end of the flexible hose there is a camera that transmits images to the screen. Using this method you can commit all changes digestive tract, including reflux.

It is gastroscopy that provides a 100% opportunity to see abnormalities and problems in the gastrointestinal tract. The presence of bile can also be determined by examining gastric juice in the laboratory.

Treatment of bile reflux into the esophagus

Regardless of the reasons that caused this disease, the patient will have to go on a diet to prevent irritation of the mucous membrane from the effects of bile. Meals should be divided into 6-7 meals, and fried, spicy, smoked, sour, and chocolate should be completely excluded.

Vegetables and fruits should also be temporarily excluded from the diet. It is better to give preference to liquid foods - porridges and jelly, dairy and fermented milk products. You will also have to exclude excessive loads– You should not lift weights or play sports.

Along with the changed diet, the doctor will prescribe medications.

Several groups of drugs are used to treat reflux:

prokinetics (“Motilium”, “Ganaton”). These drugs are used to normalize intestinal motility;
antacids (Maalox, Almagel) reduce stomach acidity;
proton pump inhibitors (Omez, Gastrozol) - reduce acidity and the aggressive effects of gastric juice.
drugs containing ursodeoxycholic acid (“Ursosan”, “Ursofalk”) – normalize bile secretion and relieve bitter belching;
for spasm and pain, the doctor will prescribe antispasmodics (“No-shpa”, “Baralgin”).

Treatment of reflux with traditional methods

Traditional treatment methods can be supplemented with folk remedies. Traditional methods Treatments are aimed at expelling bile from the stomach. Best suited for this herbal infusions And blind sensing. Instead of tea and water, it is better to drink decoctions from different choleretic herbs– currants, cranberries, raspberries, lingonberries.

Blind probing is carried out in several stages;

Drink 10 drops of wormwood tincture and then eat 0.5 tsp. honey
After 20 minutes, repeat the procedure, at the end you need to drink a little hot water.
After that warm heating pad heat the liver area for 2 hours.
After 2 hours, drink Activated carbon at the rate of 1 tablet for every 15 kg of weight.
Repeat this procedure for 4 days in a row. After a 2-week break, repeat.

Surgical intervention

In cases where the release of bile is caused by a hernia or tumor in the duodenum, surgical intervention is necessary. During the operation, the formation that caused the reflux is removed.

Today, laparotomy is considered the safest. Thanks to it it reduces the risk side effects after surgery.

Prevention of bile reflux into the esophagus

At the first sign of bile release, you need to drink 2 glasses of water. This helps return bile to the stomach.
If you are prone to this disease, you need to change your usual diet. In the morning you can drink kefir, jelly or cook oatmeal.
It is strictly forbidden to overeat, this causes a strong release of bile;
Stop smoking and drinking alcohol;

The reflux of bile negatively affects the human body, causing many problems - abdominal pain, heartburn, feeling of heaviness, nausea, vomiting. All this disrupts the digestive system, which affects overall well-being and health. To avoid negative consequences, you must consult a doctor to receive adequate treatment and adhere to a strict diet.

One of the most common gastrointestinal diseases is reflux esophagitis, which is registered in almost half of the population. Appears as a result of inflammation of the mucous membrane of the esophagus, which develops due to the entry of hydrochloric acid and other components of gastric juice into the esophagus.
According to numerous studies conducted in Europe, the USA, and Russia, the prevalence of this disease among the adult population is 40-60%, and beyond last years there has been a significant increase in this indicator.

However, patients often hesitate to consult a doctor when symptoms of reflux esophagitis appear, and treatment is delayed or requires more radical measures due to total damage to the esophagus and the occurrence of complications.

What is reflux esophagitis?

Reflux esophagitis is a disease of the esophagus, accompanied by the development of an inflammatory process on its mucosa. According to statistics, 2% of adults have reflux esophagitis, which is more often (2 times) detected in men. Often, the symptoms of this disease become familiar and become part of the daily norm. A person does not pay attention to a slight afternoon heartburn that goes away after taking an Almagel tablet or water and soda.

At normal operation In the digestive system, this sphincter opens only when food and water enter the stomach from the esophagus. The weakening of the sphincter muscle ring leads to the fact that the gastric contents:

semi-digested food remains,
hydrochloric acid,
pepsin and other components of gastric juice,

enters back into the esophagus, irritates its mucous membrane and causes a lot of discomfort in the patient. Sphincter insufficiency can be provoked by: when the latter expands, reflux of the stomach contents occurs.

Thanks to the sphincter, which is located at the junction of the stomach and esophagus, reflux esophagitis occurs very rarely and lasts no more than five minutes. This condition is considered quite normal. A deviation from the norm is food reflux, which occurs daily and lasts at least one hour.

Types of disease

Clinical forms:

Chronic reflux inflammation esophagus is accompanied by periodic painful sensations behind the sternum. Symptoms intensify when running, lifting weights, or eating.
Acute reflux esophagitis characterized by inflammatory changes directly in the esophageal wall. When a person takes food, he feels that the movement of the food bolus stops behind the sternum. At the same time, the temperature rises, salivation increases, and swallowing problems occur. Belching is observed in the final stage of the disease.

Non-erosive reflux esophagitis

What is non-erosive reflux esophagitis? This complex term refers to one of the types of GERD, characterized by specific clinical symptoms, in the absence of damage to the tissues of the esophagus. Serious therapy is usually not needed. As a rule, patients recover after normalizing their diet and eliminating spicy, fatty and salty foods.

Erosive reflux esophagitis

The erosive form is one of the most dangerous, because with it the mucous membrane begins to become covered with ulcers. If left untreated, they can bleed or lead to more serious consequences. The aggravation of the disease is provoked by errors in nutrition, which consist in the use of acidic foods various types, caffeine and alcohol.

Often the course of the disease is aggravated by medications, even such harmless ones, at first glance, as paracetamol, analgin, aspirin, etc. The disease may for a long time proceed without symptoms or have the same symptoms as those.

If left untreated, this disease can affect not only the upper cells of the esophagus, but also the deeper layers. Therefore, treatment is carried out under the strict supervision of a doctor.

Causes

The occurrence of reflux esophagitis can be caused by any factors that reduce or completely eliminate the effectiveness of the listed protective mechanisms. They may be:

Chemical, nutritional factors;
Nervous stress;
Increased pressure in the peritoneum.

Often reflux esophagitis accompanies gastrointestinal diseases such as:

ulcer or;
damage to the vagus nerve;
violation of duodenal patency of the esophagus;
chronic pancreatitis, cholecystitis;
pyloroduodenal stenosis;
hiatal hernia.

Symptoms of reflux esophagitis

With exacerbation of reflux esophagitis, inflammation of the walls of the esophagus and pain when eating and drinking occur. Patients complain of a general deterioration in health, fever, and chest pain. Additionally, symptoms include heartburn, profuse salivation, impaired swallowing functions.

Common symptoms in adults:

constant heartburn from almost all foods,
feeling of heaviness in the stomach,
feeling of overcrowding
overeating,
feeling of a lump in the throat,
constant obsessive belching of air or sour.

In addition, there is pain in the area chest, which is often perceived as cordial. Sometimes the listed symptoms are completely absent, but there is a violation of the swallowing process

Reflux esophagitis can occur completely hidden, and can annoy the patient with many clinical manifestations. In this case, its symptoms are divided into:

esophageal;
extraesophageal.

Esophageal reflux esophagitis

Esophageal symptoms are often provoked by overeating, late dinner, dietary errors, alcoholic or carbonated drinks, psycho-emotional disturbances or physical overload. Characteristic features:

heartburn or a burning sensation in the chest associated with food;
pain in the chest after eating;
nausea, belching, impaired movement of food;
regurgitation or retrograde (reverse) entry of the contents of the esophagus into the oral cavity.

Extraesophageal

Symptoms:

Pain of unknown etiology – reflux esophagitis may occur painful sensations, arising in lower jaw, neck and other organs.
Cough;
Hoarse voice;
Dental diseases and bad smell from the mouth - a persistent, unpleasant odor from the patient’s mouth is one of the characteristic extra-esophageal symptoms of the disease.

In addition to the listed symptoms of reflux esophagitis, the patient may show signs of damage to the bronchi, lungs, vocal cords and trachea. Acid reflux can enter the respiratory tract and cause inflammation of these organs. As a result, a person may be treated for a long time without success. chronic bronchitis, asthma, recurrent pneumonia, etc.

Degrees

Symptoms of GERD () - their severity and impact on general state patient - directly depend on the degree of damage to the esophageal mucosa.

The disease goes through several stages, depending on which its manifestations change:

Stage 1. The formation of individual small-sized erosions, as well as erytherms, localized in the distal esophagus.
Stage 2. The erosions gradually increase and merge with each other, but do not cover the entire surface of the esophageal mucosa.
Stage 3. The spread of erosion to the lower third of the esophagus, which leads to complete damage to the mucosa.
Stage 4. Characterized by chronic peptic ulcer and stenosis.

Diagnostics

If the mentioned symptoms are present, the patient must certainly be examined, since the severity of clinical manifestations does not always correspond to the severity of damage to the mucosa. Therefore, even banal heartburn can be a dangerous symptom.

For staging accurate diagnosis and determining the degree of damage to the mucous membrane, the patient is prescribed:

X-ray diagnostics with contrast agents– this is necessary to identify ulcers, narrowings, inflammatory changes in the esophagus and assess its patency;
Daily pH-metry, which allows you to study the esophagus throughout the day to identify the total time of manifestation of symptoms of reflux esophagitis and the maximum duration of the episode.
Fibrogastroduadenoscopy - FGDS - one of the most informative methods, allows a specialist to see and evaluate the condition of the esophageal mucosa and the presence of erosions, inflammation and other changes.
Esophagomanometry, a special catheter is inserted that measures the pressure in the lumen of the esophagus; with reflux, the pressure is reduced.
Acid perfusion test - Bernstein test for the early detection of reflux esophagitis in children using a duodenal tube.

Treatment of reflux esophagitis

How to treat the disease? The treatment regimen for reflux disease includes a complex effect aimed at eliminating its cause and symptoms. For a complete cure, long-term adherence to all points of the treatment regimen is necessary:

lifestyle correction;
drug treatment;
surgery.

Lifestyle correction

To prevent relapses of the disease and alleviate the condition, the patient should:

get rid of excess weight,
observe the work and rest schedule,
quit smoking,
consumption of alcohol or any psychoactive substances,
avoid increased physical and neuropsychic stress
adjust the intake of medications that aggravate the manifestation of the disease.

You can independently alleviate the manifestations of reflux esophagitis and reduce the frequency of relapses (exacerbations) by performing the following manipulations:

Sleep on a bed with the head end raised (10–15 cm);
Do not wear restricting clothing, belts, belts;
Stop smoking and drinking alcohol;
Get rid of excess weight;
Avoid after eating food physical activity, in particular, slopes;
Avoid drinking plenty of liquids;
Do not take medications that cause reflux.
Follow a proper diet.

Drug treatment

Can be used to treat reflux esophagitis various groups drugs, but one of them is prescribed to almost all patients - these are proton pump inhibitors (abbreviated as PPIs). These medications effectively reduce the acidity of gastric juice. By influencing the cells that produce hydrochloric acid, they reduce its concentration. Thanks to this effect, the reflux of gastric contents causes less damage to the mucous membrane.

Drug therapy for reflux esophagitis is carried out for at least 8-12 weeks, followed by maintenance therapy for 6-12 months.

Tablets used to treat reflux esophagitis:

Blockers of histamine H2 receptors (antisecretory drugs), which reduce the flow of hydrochloric acid into the lumen of the stomach (Ranitidine, Fatodin, Omez). Ranitidine is prescribed to adults and children under 12 years of age, 150 mg 2 times a day. Treatment lasts from 4 to 8 weeks.
Antacids that protect the gastric mucosa from hydrochloric acid: , almagel, .
Prokinetics increase pressure in the lower esophageal sphincter and reduce intragastric pressure. Increase the tone of the lower esophageal sphincter. the following drugs: motilium, genaton, motilak. Motilak, 10 mg: adults 20 mg 3-4 times a day, children over 5 years old 2.5 mg/kg body weight three times a day;

If symptoms of reflux esophagitis are detected, drug treatment is recommended to be carried out very carefully so as not to further irritate the esophageal mucosa.

Operation

If there is no effect from drug therapy, shown surgical treatment, the essence of which is to restore normal anatomical relationships in the area of the esophagus and stomach.

Advantages of endoscopic surgery for complications of reflux esophagitis:

invisible post-operative scars;
minor blood loss;
minimum postoperative pain;
high accuracy of diagnosis and treatment;
high organ-preserving principle.

Indications for radical surgical interventions consider:

persistence of symptoms and endoscopic manifestations of esophagitis, subject to adequate drug treatment for six months;
development of complications (repeated bleeding, contractions, etc.);
Barrett's esophagus with established severe dysplasia;
frequent pneumonia developing due to aspiration of gastric acid contents;
combination of reflux esophagitis with bronchial asthma that cannot be adequately treated;
personal desire of the patient.

Diet

The diet for reflux esophagitis excludes all foods that can increase stomach acidity and cause bloating. The diet of a patient with esophagitis is 4-5 times a day, in small portions. Evening reception should be no later than 2-4 hours before bedtime.

If reflux esophagitis is detected, the patient is advised reduce consumption dairy and other products, causing bloating belly:

fresh or sauerkraut;
black bread;
green peas;
beans;
mushrooms;
fresh berries, fruits;
carbonated drinks.

If discomfort occurs after eating, you need to pay attention to what foods were eaten and, accordingly, exclude them from the diet.

The diet for reflux esophagitis should include the following foods:

Low-fat pureed cottage cheese
Milk and sour cream with a small percentage of fat content
Fresh eggs (chicken or quail), soft-boiled
Crackers
All kinds of cereals
Steam cutlets (preferably veal)
Baked sweet apples
Baked vegetables
Boiled and baked fish.

During the diet, you must adhere to the following recommendations:

You can diversify your diet with foods that do not cause discomfort after consumption.
You should not eat too cold or hot food, as this irritates the esophagus.
eliminate nervous overload at work, get good sleep,
In addition, you need to pay attention to your diet. Eat 4-5 times a day (eat slowly, avoid rushing),
After a meal, it is recommended to walk or work while standing (you cannot sit).

Folk remedies

There are many ways to treat reflux esophagitis, even with folk remedies, but before using them it is better to consult a doctor.

Take a tablespoon each of oregano, calendula, calamus rhizome, anise, fireweed, white marigold, mint. Grind the ingredients. The decoction is prepared as in the previous recipe, but first it is infused and then boiled. Drink the medicine 50 ml up to 6 times a day;
You need to pour 3 tbsp boiling water. spoons of flax seeds and wait 3 hours, strain, use 2 tbsp. spoons in 20 minutes. before eating. This jelly envelops the mucous membrane.
A good folk remedy for chronic reflux esophagitis. A medicinal mixture of herbs and celery root juice. The juice of dandelion flowers with sugar will help in treating the disease. Drink 1 tbsp. a spoonful of celery root juice 30 minutes before a meal.
Papaya contains a special enzyme that helps treat reflux esophagitis naturally and effectively. Just eat this wonderful fruit every day. Additionally, you can use other folk remedies to combat this esophageal disease.
The disease can be treated with a collection based on marshmallow and linden roots. The collection also includes yarrow, licorice root, horehound herb, centaury herb, wheatgrass rhizome and St. John's wort. Pour a tablespoon of the mixture into a glass of boiling water and cover with a lid. Take the medicine twice a day, half a glass.

Forecast

Possible complications:

formation of Barrett's disease;
high risk of developing a malignant tumor;
strangulation and development of esophageal ulcers.

Paying attention to your health will help you avoid dangerous consequences and complications of reflux esophagitis. It is not recommended to try to treat this disease yourself; its complications can be very serious.