Gastroesophageal reflux disease (GERD): treatment

The goal of treatment of gastroesophageal reflux disease is to stop symptoms, improve quality of life, treat esophagitis, prevent or eliminate complications.

Basic principles of treatment:

• decrease in the volume of gastric contents;
• increased antireflux function of the lower esophageal sphincter;
• increased esophageal cleansing;
• protection of the esophagus mucosa from damage.

Methods of treatment of gastroesophageal reflux disease

Conservative treatment	Surgery
Recommendation for the patient a certain lifestyle and diet	Lumbar and laparoscopic fundoplication according to Nissen, Toupet, Door
Reception of antacids and alginic acid derivatives
Antisecretory drugs (blockers of H 2 receptor histamine and proton pump inhibitors)
Prokinetics (Cerucal, Motilium, Coordinus)

The clinical symptomatology of gastroesophageal reflux disease, both typical and poorly diagnosed, reduces the quality of life of patients. Therefore, one of the promising areas of therapy for patients with GERD is the dominance of clinical evaluation of its effectiveness. According to J. Collins, a study conducted using the quality of life questionnaire 8 weeks after the treatment of reflux esophagitis reliably showed an improvement in the quality of life of patients.

Conservative treatment

The success of therapy is not only in the adequately conducted drug correction, but also in changing the lifestyle and dietary habits of the patient.

Recommendations for a patient of a certain lifestyle:

• changes in the position of the body during sleep;
• changes in nutrition;
• refraining from smoking;
• abstaining from alcohol abuse;
• if necessary, weight loss;
• refusal of medications that induce the onset of gastroesophageal reflux disease;
• exclusion of loads increasing intra-abdominal pressure, wearing corsets, bandages and tight belts, lifting weights of more than 8-10 kg on both hands, work involving a torso bending forward, physical exercises associated with overstrain of abdominal muscles.

To restore the muscle tone of the diaphragm, special exercises are recommended that are not related to the torso of the trunk.

Conservative treatment of gastroesophageal reflux disease

Surgery

When deciding on the question of surgical treatment, other possibilities for treating patients should be carefully considered, since the symptoms can be associated not with GERD, but with other diseases.

Surgical treatment of gastroesophageal reflux disease

Further management

In the case of non-erosive reflux disease with complete relief of clinical symptoms, the control of PHEGDS is not necessary. The remission of reflux esophagitis should be: endoscopically confirmed.

Conducting maintenance therapy is mandatory, since without it the disease recurs in most patients within the next six months.

Dynamic monitoring of the patient is performed to monitor complications, identify the Barrett's esophagus, and medication control of the symptoms of the disease.

The patient should be deliberately asked about the presence of symptoms suggesting the development of complications. If these signs are present, specialist consultations and further diagnostic studies may be required.

Intestinal metaplasia of the epithelium serves as the morphological substrate of Barrett's esophagus, which can not be clinically distinguished from gastroesophageal reflux disease. Risk factors for Barrett's esophagus: heartburn more often 2 times a week, male sex, duration of symptoms more than 5 years.

When the diagnosis of Barrett's esophagus is established to detect dysplasia (a potentially curable precancerous condition) and adenocarcinoma of the esophagus, endoscopic studies with biopsy should be performed annually against a background of constant maintenance therapy with a full dose of proton pump inhibitors. In the detection of low-grade dysplasia, repeated PEGD with biopsy and histological examination of the biopsy specimen is performed after 6 months. With the preservation of low-grade dysplasia, repeated histological examinations are performed annually. In the case of high-grade dysplasia, the result of the histological examination is independently assessed by two morphologists. When the diagnosis is confirmed, the question of endoscopic or surgical treatment of Barrett's esophagus is solved.

Forecast

Gastroesophageal reflux disease is a chronic disease; In 80% of patients there are relapses after discontinuation of medication. Therefore, many patients need long-term medication or surgery. Non-erosive reflux disease and a mild degree of reflux esophagitis, as a rule, have a stable course and a favorable prognosis, in a small number of patients esophagitis develops over time. The disease does not affect the life expectancy of patients, but significantly reduces its quality during the period of exacerbation.

In patients with severe esophagitis, complications such as esophageal strictures or Barrett's esophagus may develop. The prognosis worsens for a long time of the disease in combination with frequent long-term relapses, with complicated forms of gastroesophageal reflux disease, especially in the development of Barrett's esophagus due to the increased risk of esophageal adenocarcinoma.

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