How Do I Treat Acid Reflux During Pregnancy?

The disease of clinical gastroesophageal reflux disease and esophageal mucosal damage caused by gastroesophageal cavity caused by excessive contact (or exposure) to gastric fluid is called gastroesophageal reflux. Gastroesophageal reflux and its complications are multifactorial. These include defects in the anti-reflux mechanism of the esophagus itself, such as inferior esophageal sphincter dysfunction and abnormal movement of the body of the esophagus, etc .; there are also disorders of many mechanical factors outside the esophagus.

Basic Information

nickname

Gastroesophageal reflux disease

English name

gastroesophageal reflux

Visiting department

Gastroenterology

Common locations

Gastroesophageal

Common causes

Esophageal anti-reflux barrier, esophageal acid clearance, esophageal mucosal defense function and other abnormalities

Common symptoms

Heartburn, acid reflux, swallowing pain, difficulty swallowing, hoarseness, throat discomfort or foreign body sensation, etc.

Contagious

no

Clinical manifestations of gastroesophageal reflux

Heartburn and acid reflux

Heartburn refers to the burning sensation behind the sternum and under the xiphoid process, which usually occurs one hour after a meal. It is easy to occur when lying flat, bending down, or increased abdominal pressure. The gastric contents that flow back into the mouth are often acidic. Acid often accompanied by heartburn is the most common symptom of this disease.

2. Swallowing pain and difficulty swallowing

Swallowing pain may occur when there is severe esophagitis or esophageal ulcers, which is caused by acid reflux to stimulate the sensory nerve endings under the esophagus. Reflux can also stimulate mechanoreceptors to cause esophageal spasmodic pain. In severe cases, it can cause severe tingling, which radiates to the back, waist, shoulders, and neck, just like angina. Due to esophageal spasm or dysfunction, some patients may have difficulty swallowing, and when esophageal stricture occurs, difficulty in swallowing continues to increase.

3. Other

Reflux stimulates the mucous membrane of the pharynx, which can cause sore throat, hoarseness, pharynx discomfort or foreign body sensation. Inhalation of the respiratory tract can cause cough, asthma, this asthma is not seasonal, and paroxysmal cough and asthma often occur at night. Individual patients have recurrent aspiration pneumonia and even pulmonary interstitial fibrosis.

Gastroesophageal reflux diagnosis

The clinical manifestations of gastroesophageal reflux are complicated and lack specificity. It is difficult to distinguish between physiological gastroesophageal reflux or pathological gastroesophageal reflux based on clinical manifestations alone. Comprehensive diagnostic techniques must now be used. The possibility of gastroesophageal reflux should be considered when clinically found unexplained repeated vomiting, difficulty in swallowing, recurrent chronic respiratory infections, refractory asthma, stunted growth, repeated asphyxia, and apnea. The necessary auxiliary examinations must be selected for different situations to clarify the diagnosis.

Gastroesophageal Reflux Therapy

General treatment

Lifestyle changes should be used as a basic measure of treatment. Raising the head of the bed 15-20 cm is a simple and effective method. This can use gravity to enhance acid scavenging ability during sleep and reduce night reflux. Fat, chocolate, tea, coffee and other foods will reduce LES stress and should be appropriately restricted. Patients with gastroesophageal reflux disease should quit smoking and drinking. Avoiding eating 3 hours before bedtime can also reduce reflux at night. 25% of patients can improve their symptoms after changing the above lifestyle habits.

2. Drug treatment

If reflux symptoms cannot be improved by lifestyle changes, systematic medication should be initiated.

(1) H ₂ receptor blocker H ₂ receptor blocker is currently the main drug for clinical treatment of gastroesophageal reflux. These drugs compete with histamine for H ₂ receptors on gastric parietal cells and bind to them, inhibiting histamine to stimulate parietal cells to secrete acid and reduce gastric acid secretion, thereby reducing the effect of reflux fluid on esophageal mucosa, alleviating symptoms and promoting Damage healing of esophageal mucosa.
There are currently four widely used H2 receptor blockers in clinical applications, namely cimetidine, ranitidine, famotidine, and nizatidine.

(2) Proton pump inhibitor Proton pump inhibitor (PPI) inhibits the proton pump in gastric parietal cells through a non-competitive and irreversible antagonistic effect, producing a stronger and longer-lasting acid suppression effect than H ₂ receptor blockers. Omeprazole, lansoprazole, and pantoprazole are currently used in clinical practice.

(3) Prokinetic drug Gastroesophageal reflux disease is a dysmotility disorder. Esophageal and gastric motor abnormalities often exist. When H ₂ RAS and PPI treatment is ineffective, prokinetic drugs can be applied. The efficacy of prokinetic drugs in treating GERS is similar to that of H2RAS, but it is significantly better than those of acid inhibitors in those with symptoms of dysfunction such as abdominal distension and belching. For example, metronidazole, domperidone, cisapride, levosulbide, erythromycin and so on.

(4) Mucosal protective agent Sucralfate is a topical preparation. The administration of sucralfate to control the symptoms of gastroesophageal reflux and the healing of esophagitis is similar to the efficacy of standard dose of H2RAS. However, some scholars believe that sucralfate is not effective for gastroesophageal reflux.
Magnesium aluminum carbonate can combine with reflux bile acid, reduce its damage to the mucosa, and can adhere to the mucosal surface as a physical barrier. Now widely used in clinical practice.

(5) Other drugs TLESR is now considered to be the main pathophysiological basis for reflux, and many researchers are working to find drugs that can reduce TLESR for the treatment of gastroesophageal reflux. Among them, atropine and morphine were the first drugs to target TLESR. Baclofen is expected to be an effective drug for the treatment of gastroesophageal reflux.

(6) Combination therapy The treatment of acid inhibitors is not effective, and patients with abnormal esophageal motility confirmed by esophageal manometry can try prokinetic drugs combined with acid inhibitors. After the treatment of cimetidine and cisapride in patients with grade 2 to 3 esophagitis, the relief of symptoms and the healing of esophagitis were better than that of cimetidine alone.

3. Treatment of complications

Common complications of gastroesophageal reflux include esophageal strictures, esophageal ulcers, shortening of the esophagus, and Barrett's esophagus. For mild esophageal stricture, it can be improved by dietary restriction and medication (PPI) treatment. Short-term simple stenosis can be treated with a Teflon dilator (such as Hurst-malonney), and stent implantation can be used if necessary. Some patients also undergo surgical anti-reflux surgery.

For esophageal ulcers, large doses of PPI and mucosal protective agents are usually required. Barrett's esophagus is a serious complication of gastroesophageal reflux. Because of the possibility of malignant changes, endoscopic follow-up and biopsy should be performed to detect dysplasia and adenocarcinoma early. When patients have low-grade dysplasia, a large dose of PPI can be used. In the case of moderate to severe dysplasia or nodular hyperplasia, endoscopic laser, electrocoagulation, ion coagulation, and even partial esophagectomy can be performed.

4. Surgical treatment

Those who do not respond to long-term medication or who need to take it for life, or who cannot tolerate expansion, or who need repeated expansion, can consider surgery.
The advent of laparoscopic anti-reflux surgery provides clinicians with a new surgical treatment method. Some clinicians have adopted laparoscopic surgery as one of the first choice for anti-reflux surgery.

Gastroesophageal reflux prevention

1. Obese people will increase abdominal pressure and promote reflux, so you should avoid ingesting high-fat foods that promote reflux and reduce weight.

2. Eat less and eat more. It is not advisable to eat within 4 hours before going to bed to reduce the stomach contents and stomach pressure to a minimum at night. If necessary, raise the bed head 10 cm. This is very important for regurgitation during supine at night, using gravity to remove harmful substances in the esophagus.

3. Avoid a variety of actions and postures that increase abdominal pressure in life, including wearing tights and belts to help prevent reflux.

4. Quit smoking and drinking, and eat less chocolate and coffee.