How Effective Is Domperidone for Reflux?

Symptoms of gastroesophageal reflux disease include chest burning, snoring, nausea, vomiting, chest pain, and gastric acid reflux. In addition, eating fast or being full can also cause gastroesophageal reflux disease. Typical heartburn symptoms usually occur after a meal, especially when lying down or when the abdomen is strained.

Gastroesophageal reflux disease

Symptoms of gastroesophageal reflux disease include chest burning, snoring, nausea, vomiting, chest pain, and gastric acid reflux. In addition, eating fast or being full can also cause gastroesophageal reflux disease. Typical heartburn symptoms usually occur after a meal, especially when lying down or when the abdomen is strained.

Western Medicine Name

Gastroesophageal reflux disease

English name

Gastroesophageal Reflux Disease

Other name

GER

Affiliated Department

Internal Medicine-Gastroenterology

Disease site

Gastroesophageal

The main symptoms

Burning chest, nausea

Gastroesophageal reflux disease disease overview

Clinical manifestations: 1. vomiting; 2. reflux esophagitis: burning sensation; swallowing pain; vomiting and blood in the stool; 3. Barrette's esophagus: the squamous epithelium at the lower end of the esophagus is replaced by a hyperplastic cylindrical pith. The main complications are esophageal ulcers, stenosis and adenocarcinoma. Ulcers can often be deep and esophageal and tracheal fistulas can occur; some patients can develop mental and neurological symptoms.

Treatment: Patients diagnosed with pathological gastroesophageal reflux must be treated in time. Including position therapy, diet therapy, medication and surgery. (I) Posture treatment: The most effective positions in the awake state are the upright and sitting positions. Keep the right side when sleeping. Raise the head of the bed by 20 ~ 30cm. Use the mattress companion (for the patient's comfort). mattress genie) to promote gastric emptying, reduce the frequency of reflux and inhalation of reflux. (B) Diet therapy. (3) Drug treatment includes three categories: namely gastrointestinal motility drugs, antacids or acid suppressants, and mucosal protective agents. (4) Surgical treatment: After early diagnosis and timely use of body position, diet, medicine and other treatment methods, it is not effective, and severe complications are surgical treatment.

Disease classification

Gastroenterology

Disease description

Gastroesophageal reflux disease (GERD) refers to excessive stomach and duodenal contents flowing back into the esophagus causing heartburn and other symptoms, and can cause esophagitis and damage to tissues outside the esophagus such as the pharynx, larynx, and airways. Gastroesophageal reflux disease is very common in Western countries. About 7% to 15% of the population has symptoms of gastroesophageal reflux. The incidence increases with age. The peak age of onset is 40-60 years old. There is no difference between men and women, but there is reflux esophagus. There are more men than women in inflammation (2: 1 to 3: 1). Compared with western countries, the incidence of gastroesophageal reflux disease is lower in our country, and the disease is relatively mild.

About half of patients with gastroesophageal reflux disease see esophageal mucosal erosions, ulcers and other inflammatory lesions under endoscopy, which is called reflux esophagitis; but a considerable part of patients with gastroesophageal reflux disease may not have reflux esophagitis under the endoscope. Such gastroesophageal reflux The disease is called endoscopic negative gastroesophageal reflux disease.

Signs and symptoms

The clinical manifestations of gastroesophageal reflux disease are diverse and different in severity. Some symptoms are more typical, such as heartburn and acid reflux, and some symptoms are not easy to recognize, so the diagnosis and treatment of this disease are ignored. Many patients have a chronic relapse course.

Heartburn and acid reflux

Is the most common symptom of gastroesophageal reflux disease. Heartburn refers to the burning sensation behind the sternum or under the xiphoid process, which often extends upward from the lower part of the sternum. It usually appears 1 hour after a meal. It can be aggravated when lying, bending or abdominal pressure increases. The influx of gastric contents into the cavity without nausea and effort is collectively referred to as nausea. The disease countercurrent is mostly acidic, which is called acid reflux. Acid reflux is often accompanied by heartburn.

Difficulty swallowing and swallowing

Some patients have difficulty swallowing, which may be due to esophageal spasm or dysfunction, and the symptoms are intermittent, and myopia can occur with solid or liquid food. Dysphagia in a small number of patients is caused by esophageal stenosis, at which time dysphagia can be progressively exacerbated. Severe esophagitis or esophageal ulcers may be associated with swallowing pain.

Retrosternal pain

Pain occurs behind the sternum or under the xiphoid. In severe cases, it can be a severe tingling, which can be radiated to the back, chest, shoulders, neck, and ears. At this time, it resembles angina. Most patients develop heartburn, but some patients may not accompany the typical symptoms of heartburn and acid reflux associated with gastroesophageal reflux disease, making diagnosis difficult.

other

Some patients complain of pharyngeal discomfort, a foreign body sensation, a cotton swelling sensation, or a sense of obstruction, but no real swallowing difficulties, known as hydatid disease, which may be related to elevated sphincter pressure in the upper esophagus caused by acid reflux. Countercurrent stimulation of the throat can cause pharyngitis, hoarseness, countercurrent inhalation of organs and lungs. Recurrent pneumonia and even pulmonary interstitial fibrosis may occur; some non-seasonal asthma may also be related to countercurrent. In the above cases, if the accompanying reflux symptoms are not obvious or ignored, they will last for a long time due to improper treatment.

(1) Patients with upper gastrointestinal bleeding who have reflux esophagitis may have vomiting blood and / or black feces due to inflammation, erosion, and ulcers of the esophageal mucosa.

(2) Recurrent esophageal esophagitis causes fibrous tissue hyperplasia, which eventually leads to scar stenosis, which is a manifestation of severe esophagitis.

(3) Barrett's esophagus During the repair of esophageal mucosa, the squamous epithelium is replaced by columnar epithelium, which is called Barrett's esophagus. Barrett's esophagus can develop peptic ulcers, also known as Barrett's ulcer. Barrett's esophagus is the main precancerous lesion of esophageal adenocarcinoma, and the incidence of adenocarcinoma is 30-50 times higher than that of normal people.

Cause of the disease

Gastroesophageal reflux disease is a gastrointestinal dysfunction disorder caused by a variety of factors. The presence of acid or other harmful substances such as monoacid, pancreatin, and other esophageal reflux diseases. The esophagus has the function of preventing the invasion of gastric acid and duodenal contents. , Including resistance to countercurrent barriers, esophageal clearance, and resistance to esophageal mucosa. The onset of gastroesophageal reflux disease is the result of the decline in anti-reflux defense mechanisms and the effect of countercurrent on the esophageal mucosa.

Pathophysiology

Esophagogastric reflux barrier

Refers to a complex anatomical area at the junction of the esophagus and stomach, including the lower esophageal sphincter (LES), diaphragmatic foot, sacral esophageal ligament, acute angle (His angle) between the esophagus and gastric fundus, etc. Defects can cause gastroesophageal reflux, the most important of which is the functional status of LES.

(1) LES and LES pressure LES refers to a circular muscle bundle about 3-4 cm long at the end of the esophagus. The LES pressure of a normal person at rest is 10-30mmHg, which is a high-pressure band to prevent gastric contents from flowing back into the esophagus. When the structure of the LES site is damaged first, the LES pressure can be reduced. For example, reflux esophagitis is easy to occur after achalasia. Some factors can affect the reduction of LES pressure, such as certain hormones (such as cholecystokinin, pancreatin, vasoactive intestinal peptide, etc.), food (such as high fat, chocolate, etc.), drugs (such as calcium channel blockers, ground Xiqiao) and so on. Increased intra-abdominal pressure (such as pregnancy, ascites, vomiting, weight-bearing labor, etc.) and increased internal pressure (such as gastric dilatation, delayed gastric emptying, etc.) can affect the corresponding reduction in LES pressure and cause gastric test tube reflux.

(2) Transient LES relaxation (TLESR) Under normal circumstances, LES is relaxed when swallowed, and things can enter the stomach. TLESR is different from LES relaxation caused by swallowing. It has no current swallowing action and stimulation of esophageal peristalsis, relaxation time is longer, LES pressure decreases faster, and LES minimum pressure is lower. Although normal people also have TLESR without, but less, and TLESR is more frequent in patients with gastroesophageal reflux disease. TLESR is currently considered to be the main cause of gastroesophageal reflux.

(3) Foramen hernia can increase reflux and reduce acid removal from the esophagus, which can cause gastroesophageal reflux.

Esophageal acid removal

Under normal circumstances, the contents of the esophagus are partly discharged into the stomach by gravity, and most of the contents of the esophagus are discharged into the stomach through spontaneous and secondary advancing peristalsis of the esophagus. This is the method of clearing the volume and clearing the esophagus. Swallowing action induces autonomous peristalsis, countercurrent flowing back into the esophagus causes the esophagus to dilate and stimulates the esophagus to cause secondary peristalsis. The volume clearance reduces the capacity of acidic substances in the esophagus, and the remaining acid is neutralized by the swallowed saliva.

Esophageal mucosal defense

In gastroesophageal reflux disease, only 48% -79% of patients develop esophageal inflammation, while other patients have symptoms of reflux, but there is no obvious esophageal mucosal damage, suggesting that the esophagus mucosa has a defensive effect on reflux items. This defensive effect Called esophageal mucosal tissue resistance. Including esophageal epithelial surface mucus, immovable water layer and surface HCO3, stratified squamous epithelial structure and functional defense ability, and protection of mucosal blood supply.

Delayed gastric emptying

Gastroesophageal reflux occurs more frequently after meals, and the frequency of reflux is related to the content and composition of gastric contents and gastric emptying. Delayed gastric emptying can promote gastroesophageal reflux.

pathology

In patients with gastroesophageal reflux disease with reflux esophagitis, the pathohistological changes may include: stratified squamous epithelial cell hyperplasia; the nipple extending to the deep skin cavity surface; the inflammatory cells in the lamina propria are mainly neutral Granulocyte infiltration; Squamous epithelial balloon changes; Erosion and ulcer. Endoscopic esophagitis was manifested as edema, flushing, erosion, ulcers, thickening to white, and scarring. Barrett's esophagus refers to the occurrence of columnar epithelium instead of squamous epithelium above the dentate line at the junction of the esophagus and stomach. Histological manifestations are special columnar epithelium, cardia epithelium, or fundus epithelium. Endoscopy typically presents a pinkish reddish-white esophageal mucosa that is orange-red in color of the gastric mucosa and can be ring-shaped, tongue-shaped, or island-shaped.

Gastroesophageal reflux disease

Endoscopy

Endoscopy is the most accurate method for diagnosing reflux esophagitis, and can judge the severity and complications of reflux esophagus. Combined with biopsy, it can be used with other causes of esophagitis and other esophageal diseases (such as esophageal cancer, etc.). Identification. Endoscopic regurgitation of esophagitis can establish the diagnosis of gastroesophageal reflux disease, but no reflux esophagitis cannot rule out gastroesophageal reflux disease. The classification of reflux esophagitis according to the degree of damage to the esophageal mucosa seen under the endoscope is helpful for the judgment of the condition and the guidance of treatment. There are many proposed grading standards. The long-standing Savary-Miller classification method is used to classify reflux esophagitis into 4 grades: Grade is a single or several non-fusion lesions, showing erythema or superficial erosion; Grade is fusion Sexual lesions, but not diffuse or peripheral; Grade III lesions are diffuse pericyclic, with erosion but no stenosis; Grade IV is a chronic lesion with ulcers, stenosis, esophageal contraction, and Barrett's esophagus.

24- hour esophageal pH monitoring

Using a portable pH recorder to continuously monitor patients' esophageal pH under physiological conditions for 24 hours can provide objective evidence of the presence of excessive acid reflux in the esophagus. It is currently recognized as an important diagnostic method for the diagnosis of gastroesophageal reflux disease, especially in Patients with atypical symptoms, no reflux esophagitis, and although the symptoms are typical but the treatment is ineffective have more important diagnostic value.

It is generally believed that the pH in the normal esophagus is 5.5-7.0, and when pH <4 is considered as an indicator of acid reflux, the parameters of pH monitoring in the esophagus in 24 hours are based on this. The following 6 parameters are commonly used to determine the indicators: total percentage time of pH <4 in 24 hours; percentage time of pH <4 in the upright position; percentage time of pH <4 in the supine position; countercurrent times; longer than 5 The number of minutes of countercurrent; the longest countercurrent time. Among the 6 diagnostic pathological reflux parameters, the total positive rate was the highest in pH <4, and the overall score could also be obtained by combining the parameters according to the Demeester score method. The above parameters can be compared with normal values to evaluate whether there is excessive acid reflux in the esophagus.

X- ray examination of esophagus barium swallowing

The test is not very sensitive to the diagnosis of reflux visual inflammation, and it is the test for those who are unwilling to accept or cannot tolerate endoscopy. The purpose is to exclude other esophageal diseases such as esophageal cancer. Severe reflux esophagitis objectively detected positive X-ray signs.

Esophageal drip acid test

Patients who developed posterior chest pain or heartburn during the acid drip were positive and more than the first 15 minutes of acid drip, suggesting the presence of active esophagitis.

Esophageal manometry

Can measure the length and location of LES, LES pressure, LES relaxation pressure, esophageal body pressure, and esophageal sphincter pressure. The LES resting pressure is 10-30mmHg. If the LES pressure is less than 6mmHg, it will easily cause backflow. Gastroesophageal reflux disease can be used as an auxiliary diagnostic method when the medical treatment is not effective.

treatment plan

The purpose of the treatment of gastrointestinal reflux disease is to control symptoms, cure esophagitis, reduce recurrence and prevent complications.

General treatment

In order to reduce the lying position and nighttime reflux, the foot at the head of the bed can be raised 15-20cm, and the patient can be comforted by using a mattress companion (mattress genie) to assist. It is easy to cause reflux after a meal, so it is not advisable to eat before bedtime, and it is not advisable to stay in bed immediately after meals during the day. Pay attention to reducing the factors that generally affect the increase in abdominal pressure, such as obesity, constipation, and tightening the teacher's belt. Avoid eating foods that reduce LES pressure, such as fat, chocolate, coffee, and strong tea. Quit smoking and drinking. Avoid using drugs that reduce LES pressure and drugs that affect delayed gastric emptying. For example, some senile patients are prone to gastroesophageal reflux due to LES dysfunction, and taking nitroglycerin or calcium channel blockers at the same time with cardiovascular disease can aggravate reflux symptoms and should be appropriately avoided. Some patients with bronchial asthma, such as gastroesophageal reflux, may aggravate or induce asthma symptoms. Try to avoid theophylline and 2 receptor agonists, and add anti-reflux treatment.

medical treatement

(1) H2 receptor antagonists (H2RA) such as cimetidine, ranitidine, famotidine, etc. H2RA can reduce gastric acid secretion by 50% -70% for 24 hours, but it can not effectively suppress the gastric acid secretion stimulated by eating. Therefore, it is suitable for patients with mild to moderate disease. It can be used according to the conventional dosage of peptic ulcer, but it should be taken in divided doses to increase the Can improve the efficacy, but increase adverse reactions, the course of treatment is 8-12 weeks.

(2) Promoting gastrointestinal motility drugs The role of such drugs is to increase LES pressure, improve esophageal peristalsis, and promote gastric emptying, thereby reducing gastric contents and esophageal reflux and reducing their exposure time in the esophagus. Although there are many types of these drugs, according to the results of a large number of clinical studies, the drug recommended for the treatment of this disease is currently cisapride. The effect of cisapride is similar to that of H2RA, and it is also suitable for patients with mild to moderate symptoms. The usual amount is 5-15mg each time, 3-4 times a day, and the course of treatment is 8-12 weeks.

(3) Proton pump inhibitors (PPI) include omeprazole, pantoprazole and so on. These drugs have a strong acid suppression effect, so the effect on this disease is better than H2RA or cisapride, especially for patients with severe symptoms and severe esophagitis. Generally according to the conventional dosage for the treatment of peptic ulcer, the course of treatment is 8-12 weeks. For individual patients with poor efficacy, double the amount or use with cisapride.

(4) Antacids are only used for patients with mild symptoms and intermittent attacks to temporarily relieve symptoms.

Gastroesophageal reflux disease has a chronic recurrence tendency. According to western countries, the recurrence rate is as high as 70% -80% in the six months after discontinuation. In order to reduce the recurrence of symptoms and prevent complications caused by repeated recurrence of esophagitis, it is necessary to consider the maintenance treatment. Those who relapse soon after discontinuation and the badge persists often need long-term maintenance treatment. There are complications of esophagitis such as esophageal ulcer, esophageal stricture Barrett's esophagus definitely needs long-term maintenance treatment. H2RA, cisapride, and PPI can all be used for maintenance treatment, with PPI being the best. The dose of maintenance treatment varies from patient to patient, and the lowest dose adjusted to the asymptomatic patient is the optimal dose.

Anti-reflux surgery

Anti-reflux surgery is a different type of fundoplication, designed to prevent the stomach contents from flowing back into the esophagus. Anti-reflux surgery indications are: Strict medical treatment is ineffective; Although the medical treatment is effective, the patient cannot tolerate the precipitation medication; The esophageal stenosis that repeatedly occurs after dilation treatment, especially in young people; The seriousness caused by reflux is confirmed Respiratory diseases. With the exception of item 4 as an absolute indication, the rest have become relative indications due to the use of PII in recent years.

Treatment of complications

(1) Except for a few severe fibrous stenosis that require surgical resection, the majority of stenosis can be treated with endoscopic esophageal dilatation. Long-term PPI maintenance after dilatation can prevent recurrence of stenosis, and reflux surgery can also be considered for young patients.

(2) Barrett's esophagus Barrett's esophagus often occurs in the deep foundation of severe esophagitis. Therefore, active drug therapy for basic diseases is an important measure to prevent the occurrence and development of Barrett's esophagus. At this time, PPI treatment and long-term maintenance treatment must be used. Consider anti-reflux surgery. The risk of esophageal adenocarcinoma in Barrett's esophagus is greatly increased. Although there have been various reports of removing Barrett's esophageal molecules, their transport has not been confirmed. Therefore, intensified follow-up is currently the only way to prevent Barrett's esophageal cancer. The focus is on early identification of dysplasia and finding severe dysplasia or early esophageal cancer with timely surgical resection.

Nursing measures

[Treatment]

(1) The general treatment diet should be a small number of meals, not too full; avoid tobacco, alcohol, coffee, chocolate, sour food and excessive fat; avoid lying flat after a meal; raise the bedside 20-30cm when lying, to patients Feeling comfortable, you can use a mattress companion (mattress genie) to assist, the belt should not be too tight, to avoid all kinds of conditions that cause high abdominal pressure.

(2) Promote emptying of the esophagus and stomach ^[1]

1. Dopamine antagonists These drugs can promote emptying of the esophagus, and increase the tension of LES. Such drugs include metoclopramide (metopramide) and domperidone (domperidone), both 10 to 20 mg, 3 to 4 times a day, taken before bedtime and before meals. If the former is overdosed or taken for a long time, it can cause extrapyramidal neurological symptoms, so it should be used with caution in elderly patients; the latter can cause hyperprolactinemia with long-term administration, which can cause adverse reactions such as breast hyperplasia, lactation and amenorrhea.

2. Cisapride (cisapride) through the intestinal plexus nerve can release acetylcholine to promote esophageal and gastric motility and emptying, thereby reducing gastroesophageal reflux. 10 to 20 mg every day for 3 to 4 days with few adverse reactions.

3. The pseudocholinergic drug bethanechol can increase the tension of LES, promote the contraction of the esophagus, accelerate the emptying of acidic food in the esophagus to improve symptoms, 25mg each time, 3 to 4 times a day. This mouth can stimulate gastric acid secretion, so take it cautiously for a long time.

(3) Reduction of gastric acid The antacid can neutralize gastric acid, thereby reducing the activity of pepsin and reducing the damage of acid gastric contents to the esophageal mucosa. Alkaline drugs also have the effect of increasing LES tension. 10 to 30 ml of aluminum hydroxide gel and 0.3 g of magnesium oxide, 3 to 4 times a day. Alginic acid foam (gariscon, alginate) contains alginic acid, sodium alginate and acid generator, which can float on the surface of gastric contents and can prevent the reflux of gastric contents. Histamine H2 receptor antagonists cimetidine, ranitidine, and famotidine can be selected, and the dosages are 200mg, 3 4 / d; 150mg, 2 times / d and 30 mg / d. The course of treatment was 6-8 weeks. This class of drugs can strongly inhibit gastric acid secretion and improve acid reflux in the gastroesophagus. If the above symptoms cannot be improved, the dose can be increased to 2 to 3 times. Proton pump inhibitors These drugs can block the H + -K + -ATPase of parietal cells, while omeprazole and lansoprazole have been widely used clinically, the former 20mg / d and the latter 30mg / d, you can improve its symptoms.

(4) Combination of drugs to promote esophagus, gastric emptying and antacids has a synergistic effect and can promote the healing of esophagitis. Dopamine antagonists or cisapride may also be used in combination with histamine H2 receptor antagonists or proton pump inhibitors.

After the disease was improved and discontinued, about 80% of the cases relapsed within 6 months because their LES tension had not been fundamentally improved. If histamine H2 receptor antagonists, proton pump inhibitors or dopamine antagonism are used for any of the maintenance medications, or if they are used in a timely manner when symptoms strike, a better effect can be achieved.

Health Tips

The diet is mainly thick, with small meals and frequent meals. Babies increase the number of feedings and shorten the interval between feedings. Artificially fed children can add dried cereal or processed cereals to the milk. Elderly children should also eat a small number of meals, mainly high-protein low-fat diet, do not eat 2 hours before bedtime, keep the stomach in a non-filled state, avoid eating foods that reduce LES tension and increase gastric acid secretion, such as acid drinks, high Fat diet, chocolate and spicy food.

Gastroesophageal reflux should pay attention to:

The influence of psychological factors on the digestive system is also very large. Anxiety and depression can cause adverse reactions in the digestive system, so it is equally important to pay attention to relieve stress when you are nervous.

It is important to prevent gastroesophageal reflux. Lifestyle changes are the best way to prevent pantothenic acid and heartburn. Try to eat less high-fat meals, chocolate, coffee, sweets, sweet potatoes, potatoes, and taro; strictly quit smoking and stop drinking; eat more meals, do not lie down immediately after meals, it is best not to eat 2--3 hours before going to bed; If it is easy to acid reflux at night, it is best to raise the bedside 10--20 cm during sleep, which will help.

In addition, we think that psychological factors are also very important. The influence of psychological factors on the digestive system is also very large. Anxiety and depression can cause adverse reactions in the digestive system, so it is equally important to pay attention to relieve stress when you are nervous.

Gastroesophageal reflux prescription

(1) Sancao soup: 60g of Cloverleaf, 30g of dandelion, 15g of mischievous grass, 10g of Chuanxiongzi, 10g of Yuanhu, 20g of white lotus, 3g of licorice Shuijianbi, 1 dose per day. Suitable for esophagitis and gastritis

(2) Baiyao powder paste: Yunnan Baiyao 1g, pure spoon powder 2spoon. Take the loquat powder and add a little warm water, mix well and then add cold boiling water, heat it to a paste on a small fire, and mix with the appropriate amount of white medicine and sugar. Make the medicine fully act on the affected area, do not drink water for 1 hour. Suitable for esophagitis and cardia.

(3) Difficulty swallowing, there is a fiery sensation near the pharynx, and 9g of Pinellia ternate can be fried with good vinegar. Fry for 30 minutes, remove pinellia with vinegar, beat eggs while hot, stir well. Once a day, take before bed at night.

(4) 15 g each for Shi Jianchuan, Scutellaria barbata, and acute. Decoction for difficult swallowing.

(5) An appropriate amount of egg shells, roasted and ground, 3g each time, 2 to 3 times a day.

(6) Dogwood, Yuanhu and Chuanxiongzi each 9g. Shuijianbi for vomiting in cold stomach.

(7) 9g each of Baikouren, Su Ye, and Vermiculite. Shuijianbi for vomiting in cold stomach.

(8) Raw pears and watermelons, which can be eaten in an appropriate amount, can alleviate vomiting.

(9) 6g each of Magnolia flower and rose flower. Boiling water for frequent drinking can be used for those with full chest pain.

(10) 60 g of borax, 10 g of agarwood, 30 g of fire nitrate, 5 g of vermiculite, 6 g of vermiculite, 10 g of borneol, total fines, containing 1 g each time, slowly swallowing, and have analgesic effect.

(11) Bamboo leaches 30g, boiled in water, 2 times a day, for those with phlegm and chest tightness.

(12) Newly ordered ginseng seawater dispersion: red ginseng, seaweed 60g each, water leeches 90g. It is divided into 70 bags, 1 bag each time, and boiled water twice a day. For swallowing, nausea and vomiting.

(13) Mung beans and japonica rice are in proper amounts and boiled into gruel for consumption, which has the effect of clearing heat and reducing inversion.

(14) Baohe Pill, or Xiangsha Liujunzi Pill (prescription medicine), 6-9g each time, 3 times a day, used for spleen and stomach deficiency and vomiting.

(15) 15g of vermiculite and 30g of loess loess. Decoction 2 times, take the supernatant and take it separately. It has the effects of vomiting and stomach.

(16) Su leaves 9g, Lai Gardenia 9g. Shuijianbi, used for chest tightness and phlegm.

treatment

Children diagnosed with pathological gastroesophageal reflux must be treated promptly. Including position therapy, diet therapy, medication and surgical treatment. (I) Posture treatment: The most effective postures in the awake state are the upright and sitting positions. While sleeping, keep the right side, and raise the bed head 20 ~ 30cm to promote gastric emptying and reduce the frequency of countercurrent and inhalation of countercurrent. .

(B) Diet therapy.

(3) Drug treatment includes three categories: namely gastrointestinal motility drugs, antacids or acid suppressants, and mucosal protective agents.

(IV) Surgical treatment: Early diagnosis and timely use of body position, diet, medicine and other treatment methods are not effective, and severe complications are surgical treatment

How children prevent gastroesophageal reflux

1. Most babies will have milk spillage because the baby's lower esophageal sphincter is underdeveloped and cannot be controlled well, and it is easy for the food to flow up from the stomach and form a gastroesophageal reflux. The baby still vomiting for 5 or 6 months, and nausea is caused by improper feeding methods and diaper changing. As long as the mother adjusts her own way, the baby will avoid gastroesophageal reflux. If the baby vomits severely, she needs to go to the hospital in time.

2. Feed your baby to eat a small number of meals, eat less each time, but you can increase the number of times you eat every day. Every time the baby eats, the mother should hold it for about half an hour before lowering it. When holding the baby, pay attention to adopting the upright or semi-upright holding posture.

3. When the baby has severe vomiting, it will be sprayed directly from the nasal cavity. The mother needs to remove the debris in the nasal cavity in time to keep the baby's breathing unblocked. At the same time, tilt the baby's body forward, which will help the vomit to flow smoothly and avoid the formation of aspiration pneumonia .