Treatment of reflux esophagitis with the most effective drugs. Gaviscon or Fosfalugel: which is better for treating gastrointestinal disorders Reflux drugs for treatment

Heartburn and a feeling of discomfort in the throat are among the main signs of inflammatory processes in the esophageal mucosa, and require treatment by qualified specialists. Moreover, the symptoms and treatment of reflux esophagitis must be constantly monitored by doctors. This is the only way to avoid irreversible changes in the tissues of the esophagus, and the development of complications requiring surgical intervention.

Let's try to figure out what reflux esophagitis is. Esophagitis is an ancient Greek word for esophagus. The term "reflux" is borrowed from Latin and translates as "backward flow."

Thus, both concepts reflect the process that occurs during the development of the disease - food masses, gastric juice and enzymes move back from the stomach or intestines, penetrate into the esophagus, irritating the mucous membrane and causing its inflammation.

At the same time, the lower esophageal sphincter separating the esophagus and stomach does not properly interfere with the movement of acid masses.

In official medicine, reflux esophagitis is a complication of gastroesophageal reflux disease, which is characterized by the reflux of the acidic contents of the stomach or intestines into the esophagus.

The periodically repeated aggressive effect gradually destroys the mucous membrane and epithelium of the esophagus, contributing to the formation of erosive foci and ulcers - potentially dangerous pathological formations that threaten degeneration into malignant tumors.

Causes of occurrence

Under certain circumstances, gastroesophageal reflux can also occur in healthy people. Frequent cases of the onset of the disease indicate the development of inflammatory processes in the gastroduodenal region.

Among the possible causes of reflux, gastroenterologists identify the following pathological changes in the structure and functionality of the digestive tract:

  • decreased tone and barrier potential of the lower esophageal sphincter;
  • violation of esophageal cleansing, redistribution and removal of biological fluids from the intestine;
  • violation of the acid-forming mechanism of the stomach;
  • decrease in the resistance of the mucous membrane;
  • narrowing of the lumen of the esophagus (stenosis);
  • an increase in the size of the esophageal opening of the diaphragm (hernia);
  • violation of gastric emptying;
  • high level of intra-abdominal pressure.

Most often, reflux esophagitis occurs as a result of a weakening of the muscle tone of the esophagus against the background of a crowded stomach.

Provoking factors

There are several etiological types of factors that provoke the throwing of acid masses into the esophagus: physiological characteristics of the body, pathological conditions, lifestyle.

Reflux development is facilitated by:

  • pregnancy;
  • allergy to certain types of food;
  • binge eating;
  • obesity;
  • smoking and alcohol;
  • poisoning;
  • unbalanced diet;
  • stress;
  • work associated with frequent bending of the torso;
  • autoimmune diseases;
  • taking medications that weaken the muscles of the cardiac sphincter.

In addition, reflux disease can occur as a result of prolonged use of a nosogastric tube.

In men, gastroesophageal reflux is observed more often than in women, although a direct relationship between the disease and the sex of a person has not been established by science.

Symptoms and signs of the disease

When gastric masses hit the surface of the mucous membrane, a burning sensation occurs in the esophagus, since acid exposure causes tissue burns.

With a long course of the disease, the symptoms of esophagitis reflux become more pronounced, and other pathological manifestations are added to heartburn:

  • sour eructation. May indicate the development of esophageal stenosis against the background of erosive and ulcerative lesions of the mucosa. The appearance of belching at night is fraught with the ingress of acid masses into the respiratory tract;
  • pain in the sternum, often radiating to the neck and the area between the shoulder blades. Usually occurs when leaning forward. In terms of clinical characteristics, it resembles the symptoms of angina pectoris;
  • the appearance of difficulty swallowing solid foods. In most cases, the problem occurs against the background of narrowing of the lumen of the esophagus (stenosis), which is considered a complication of the disease;
  • bleeding is a sign of an extreme degree of development of the disease, requiring urgent surgical intervention;
  • foam in the mouth is the result of increased productivity of the salivary glands. It is rarely observed.

In addition to standard clinical signs, extraesophageal symptoms may indicate the development of the disease.

Signs of an extraesophageal nature

The occurrence of pathological processes in areas of the body that are not directly related to the gastrointestinal tract is not always associated with pathological processes in the esophagus - especially in the absence of severe heartburn.

In the absence of full diagnostic studies, adequate treatment of reflux esophagitis is not possible.

Extraesophageal symptoms of inflammatory processes on the esophageal mucosa differ not only in the nature of their severity, but also in localization:

  • ENT organs. In the early stages of the disease, rhinitis, laryngitis and pharyngitis develop, a feeling of a lump or cramps in the throat appears. As the pathology develops, ulcers, granulomas and polyps may develop in the area of ​​the vocal cords, as a result of which the patient's voice changes, becomes hoarse and rough. In the later stages of the disease, cancerous lesions of the ENT organs are possible;
  • oral cavity. On the tissues of the oral cavity, when gastric juice enters, erosive foci appear, periodontitis, caries and salivation develop. Pathological processes are accompanied by bad breath;
  • bronchi. Possible nocturnal attacks of choking or severe coughing;
  • sternum, heart. Pain in the sternum is identical to the manifestations of coronary heart disease. The appearance of additional signs indicating cardiac pathology is possible - hypertension, tachycardia. It is almost impossible to establish the cause of the disease without special diagnostic studies;
  • back. Back pain is caused by innervation from the gastrointestinal tract, the source of which is located in the sternal spine.

In addition, symptoms may appear that indicate a violation of the functionality of the stomach - nausea, vomiting, bloating, a quick feeling of fullness.

Reflux Esophagitis Grades

The level of complexity of the course of the disease is determined by the stages of its development. In most cases, the development of gastroesophageal reflux disease takes about three years, during which the pathology takes on one of four forms classified by WHO.

Reflux esophagitis of the 1st degree is characterized by intense reddening of the epithelium of the esophagus and a relatively small, up to 5 mm, area of ​​the mucosal lesion zone by point erosions.

The second degree of the disease is diagnosed in the presence of erosions and ulcerative areas against the background of edema, thickening and bruising of the mucous membrane. With vomiting, partial rejection of small fragments of the mucous membrane is possible. The total area of ​​the lesions occupies about 40% of the surface of the esophagus.

For the third degree, reflux esophagitis is characterized by an increase in the affected area up to 75% of the surface of the esophagus. In this case, ulcerative formations gradually merge into one whole.

The development of the fourth degree of the disease is accompanied by an increase in the size of the ulcerative areas. Pathological formations occupy more than 75% of the mucosal surface and affect the esophageal folds.

In the absence of treatment, necrotic processes develop in the tissues of the esophagus, leading to the degeneration of cells into malignant ones.

Disease types

The development of reflux esophagitis can be acute or chronic

The acute form of reflux is the result of a burn of the mucous membrane under the influence of gastric juice. It is most commonly seen in the lower esophagus and responds well to treatment.

The chronic form can occur both against the background of an untreated exacerbation, and in the form of an independent primary process. The chronic course of the disease is characterized by periodic exacerbations and remissions.

Diagnostic measures

Despite the possible severity of the clinical manifestations of reflux esophagitis, additional information is needed to make an accurate diagnosis, which is obtained through examination.

The most informative are studies such as:

  • blood test;
  • Analysis of urine;
  • chest x-ray;
  • endoscopy - a procedure that allows you to identify erosive and ulcerative formations, as well as other pathological changes in the state of the esophagus;
  • biopsy;
  • manometric analysis of the state of the sphincters;
  • scintigraphy - a method for assessing esophageal self-cleaning;
  • pH-metry and impedance pH-metry of the esophagus - methods for assessing the level of normal and retrograde peristalsis of the esophagus;
  • daily monitoring of the acidity level in the lower esophagus.

Reflux esophagitis is diagnosed in the presence of histological and morphological changes in the esophageal mucosa.

Reflux Esophagitis Treatment

Successful treatment of reflux esophagitis involves an integrated approach - the use of drug therapy against the background of changes in the patient's lifestyle.

Drug treatment with drugs

Prescribing medications for gastroesophageal reflux disease pursues several objectives - improving the self-cleaning of the esophagus, eliminating the aggressive effects of gastric masses, and protecting the mucous membrane.

The following drugs are most effective for treating reflux:

  • antacids - Phosphalugel, Gaviscon, Maalox;
  • antisecretory agents - Omeprazole, Esomeprazole, Rabeprazole;
  • prokinetics - Domperidone, Motilium, Metoclopramide.

In addition, the intake of vitamin preparations is shown - pantothenic acid, which stimulates peristalsis and promotes the restoration of the mucous membrane, as well as methyl methionine sulfonium chloride, which reduces the production of gastric secretion.

Surgical intervention

With the development of reflux esophagitis of the third and fourth degrees, surgical methods of treatment are shown - an operation that restores the natural state of the stomach, as well as putting on a magnetic bracelet on the esophagus, which prevents the throwing of acid masses.

Folk remedies

For the treatment of reflux with folk remedies, it is recommended to use decoctions and infusions from plant materials.

A teaspoon of chopped dill seeds, boiled in boiling water, effectively eliminates heartburn and stops inflammation in the esophagus.

During the day, you should take herbal teas from the rhizomes of the mountaineer, plantain leaves, yarrow, oregano and chamomile. Before going to bed, teas from mint leaves, fireweed, calendula flowers and calamus root are shown to be taken.

The rule for preparing broths is that one tablespoon of the herbal mixture is poured with a glass of boiling water and kept in a water bath for 15 minutes.

Diet for illness

Nutritional therapy is designed to eliminate from the diet foods that have an irritating effect on the mucous membrane, as well as enhance the production of gastric secretion.

Good results are brought by a diet for reflux esophagitis, which includes the following foods:

  • soft-boiled eggs;
  • fat-free fermented milk products;
  • liquid and semi-liquid cereals;
  • steamed fish and meat;
  • baked apples;
  • white bread crackers.

Prohibited are coffee, alcohol, soda, any sour drinks, beans and peas, spicy, fried, smoked and salty foods, chocolate and black bread.

Prophylaxis

Living the right lifestyle is essential to healing and preventing reflux recurrence. Patients are advised to maintain physical activity, monitor weight, do not overeat, and after eating, take walks in the fresh air.

In addition, any stress on the stomach area should be avoided, including tight clothing and tight belts. Leaning after eating is unacceptable. The head of the bed for a night's rest must be raised by 10-15 cm.

And most importantly, you need to regularly visit a gastroenterologist and undergo all scheduled examinations in a timely manner.

The principle of treatment is based on relieving symptoms and reducing the risk of multiple exacerbations of the disease.

General principles of treatment

Positive qualities of cytoprotectors:

  • Increased mucus secretion.
  • Decrease in acidity in a short period of time.
  • Acceleration of the healing process, for example, with ulcers.

You can use one of the drugs: Dalargin or Misoprostol.

Symptomatic treatments

If the disease is combined with additional pathology or disease, then doctors resort to symptomatic therapy.

Indications:

  • Prescribe a short course of antidepressants if neurological or psychological problems are present.
  • In addition, a short course of antibacterial drugs is prescribed.

If the esophagus has undergone a third-party negative effect, in which there was a sharp decrease in immunity, then immunostimulating drugs are prescribed.

Homeopathy and multivitamins

The main goal of homeopathy treatment is to maintain and maintain the overall therapy. Are used:

  • Magnesium phosphate.
  • Veratrumalbum.
  • Argentumnitricum.

When choosing a medicine, it is necessary to take into account not only the physical, but also the psychological state of the patient.

Multivitamins are prescribed to accelerate tissue regeneration processes, as well as to replenish useful vitamins and minerals.

Supportive therapy

The main goal of therapy is to reduce the aggressive effect of previously taken drugs. At the first or second degree of severity of the disease, prokinetics are prescribed as maintenance therapy.

If the disease proceeds in a more severe stage, it is necessary to additionally take medications from the group of H2-histamine blockers of a wide spectrum of action.

Treatment of esopharitis in children

Therapy for reflux esopharitis in childhood should be carried out under the strict supervision of a pediatrician.

With a mild degree, antacids are prescribed, if necessary, a short course of histamine blockers is prescribed.

Treatment of esophagitis in children is carried out with the following drugs:

  • Ranitidine.
  • Famotidine.

At an early age, non-schematized treatment is carried out, therefore, antireflux mixtures are prescribed, as well as correction of the drinking regimen.

At an older age, an integrated approach is used:

  • The drinking regimen is monitored.
  • Diet food is prescribed.
  • Reflux esophagitis can be treated with herbal medicinal tinctures and decoctions prepared at home.

Drug therapy includes antacids, PPIs, and histamine blockers.

As you can see, the treatment for esophagitis consists of several stages that help prevent recurrence of the disease. Remember, you cannot use medications on your own, because this can provoke the development of a chronic form or more serious health problems arise. Therefore, the medicine and dosage for adults and children are prescribed on an individual basis.

Reflux esophagitis is an inflammation of the esophageal mucosa due to the reflux of the contents of the stomach and duodenum 12 into it. Appropriate treatment is important to prevent dangerous complications.

Reflux symptoms cause severe discomfort to the patient and significantly impair the quality of life. With reflux, there is not only heartburn, pain syndrome, but also the danger of developing adenocarcinoma of the esophagus.

Signs of reflux esophagitis

Gastric juice has a low pH, which indicates an acidic reaction. Its ingress into the alkaline environment of the esophagus causes symptoms of pain and discomfort in the xiphoid process or epigastrium.

Reflux disease manifests itself with frequently recurring symptoms:

  • Heartburn after eating, especially after eating fatty or hot foods, coffee and alcoholic beverages.
  • Sour eructation or regurgitation of air, feeling of nausea.
  • Lump in throat, difficulty swallowing.
  • Pain in the chest after eating.

The symptoms of this disease are noticeably worse when a person lies down after eating.

Treatment principles

The causes of reflux and its treatment are inextricably linked, and therapy should be comprehensive:

  • First of all, the regimen of physical activity and nutrition are normalized. It is necessary to take food in small quantities and fractionally.
  • The next component of therapy is the use of medications that reduce the severity of symptoms. Their reception is carried out situationally. For example, for heartburn, patients are prescribed tablets and suspensions with an antacid effect (Phosphalugel, Almagel, Maalox, etc.).
  • There are drugs used for basic treatment. Reflux esophagitis requires the appointment of antisecretory drugs (Omeprazole, Pantoprazole, etc.). Gastroenterologists recommend taking prokinetics (Cerucal, Domperidone).
  • The doctor with esophagitis due to reflux should also try to heal the accompanying imbalance in the intestinal microflora. For this, probiotics and eubiotics are used, for example Hilak forte.

These medications should be taken for no more than two weeks. During the day, these drugs are taken often: up to 3-4 times. This is due to the fact that the therapeutic effect after taking the drug lasts no more than 4-6 hours.

With pain

In case of severe pain, Almagel A should be taken with an anesthetic effect. This tool has a more pronounced effect than just Almagel.

Medicines for pain relief and healing of mucous membranes with erosions: Drotaverin, Solcoseryl, sea buckthorn oil, Actovegin, pantothenic acid.

Sorbents

When drug treatment of reflux esophagitis, it is necessary to use adsorbents. This group of agents has a therapeutic effect due to the binding of bile acids and other aggressive components of gastric or duodenal contents.

In addition, such drugs reduce the severity of the clinical manifestations of esophageal reflux by forming a semblance of a film. These medications should be taken according to the situation, but no longer than a week.

With nausea

With severe nausea and the urge to vomit, you can give the patient an injection of Cerucal. An injection with this compound suppresses the center of vomiting and eliminates unpleasant symptoms. The dose of the drug is the average therapeutic dose, according to the instructions for the drug.

Basic treatment, main course

After the symptoms of esophageal lesions subside, doctors prescribe basic therapy. It includes the use of antisecretory drugs. These drugs are effectively used for long-term treatment of pathology.

Reflux esophagitis can occur in two ways.

  1. With the formation of erosion.
  2. No mucosal defects.

Regardless of the form, reflux esophagitis should be treated with antisecretory agents. They are aimed at reducing acid production in the stomach. The aggressive factor becomes weaker, the symptoms are eliminated, conditions are created for the healing of the mucous membrane of the organ in the presence of erosive defects.

Let's talk about the drugs that are most often used to treat esophagitis. The first line is proton pump inhibitors. These include:

  • Rabeprazole;
  • Lansoprazole;
  • Pantoprazole;

Any of these drugs are effective and efficient in the fight against acid aggression.

To cure the erosive variant, you must take proton pump inhibitors at least twice a day. The dosage must be adequate. It depends on the presence / absence of erosion. For instance:

  • Omeprazole should be taken twice a day (morning, evening) at 20 mg.
  • Lansoprazole is prescribed at 30 mg, taken twice a day.

The dosage and frequency of admission is chosen only by the doctor, depending on the situation!

The form of reflux esophagitis without the formation of mucosal defects requires the following use of drugs:

  1. The course of treatment takes place within a month.
  2. Proton pump inhibitors are taken once a day.
  3. The dosage for other drugs can be from 10 mg to 40 mg. The amount depends on the characteristics of the inflammatory process and is chosen by the doctor.

The question of whether it is possible to replace drugs of this group with histamine blockers can only be answered by the attending physician, who will take into account the indications and contraindications.


Typical treatment regimens

  1. One drug therapy. Such a scheme is far from the most effective, since individual symptoms are not taken into account.
  2. Dynamic therapy. Prescribed drugs of different strength, depending on the intensity of the inflammatory process. Treatment involves a strict diet and antacids. If there is no effect, stronger drugs are prescribed, similar in principle of action.
  3. The third scheme involves taking strong proton pump blockers. When severe symptoms go away, weak prokinetics are taken.

Traditional methods and homeopathy

The two should not be confused. Homeopathy is a complex of therapeutic effects based on the fact that like is cured by like. That is, when using drugs that cause the same changes that are observed with an illness, there is a chance of curing or significantly alleviating the condition and symptoms. The homeopathic approach is not supported by all doctors, as there is a danger of causing serious complications.

Traditional methods are based on the principles of traditional medicine, but at the same time plants and their parts are used. For instance:

  • Celery root. Drink juice on an empty stomach, 1 tbsp. spoon 30 minutes before meals.
  • Collection of herbs: chamomile flowers (1 teaspoon), bitter wormwood (2 teaspoons), mint (2 teaspoons). Pour this mixture with 1 liter of boiling water. Then let it stand for two hours. Healing infusion is filtered. Take 1/2 cup 30 minutes before meals.

    • Dill seeds. Take 2 teaspoons of seeds and grind. Brew with one glass of boiling water. Let it brew for 2-3 hours, filter. Take 1 tbsp. spoon 4 times a day.

Mainly used are agents that reduce acid production in the stomach.

- This is a fairly common disease in modern people. It is characterized by a periodic pathological release of stomach contents back into the esophagus, which provokes irritation, inflammatory and erosive processes.

Modern gastroenterologists have developed several of the most effective courses of treatment in several stages, which successfully help to cope with unpleasant symptoms and eliminate the cause of the pathology.

Basic principles of drug therapy

Depending on the stage of the pathology, the following standardized courses of treatment are used:

  1. Erosive stage ... At this stage, drug therapy is used for 2 months. Proton pump inhibitors, which suppress additional production of hydrochloric acid in the stomach, are used twice a day.
  2. Non-erosive stage ... Since the trauma to the esophagus is significantly less, the course of treatment is shorter by a month than in the case of the erosive stage of the pathology. Proton pump inhibitors are used only once a day. The dose is selected depending on the intensity of the acid release.

During the course of treatment, prokinetic agents are additionally prescribed to normalize the motility of the gastrointestinal tract, as well as antacids to lower the concentration of gastric hydrochloric acid. This stimulates the restoration of normal functioning of the digestive system and prevents the destruction of cells and tissues of the mucous membranes of the stomach, esophagus and intestines.

Subsequently, these drugs are used as maintenance therapy to reduce the risk of remission of the pathological process.

In cases where the condition is chronic or there is a risk of esophageal cancer, maintenance drugs are taken for life.

How to treat reflux esophagitis

The duration of the course of drug therapy and the dose of the selected pharmacological drugs can only be selected by the doctor, based on the results obtained after a thorough diagnosis of the patient.

Experts classify the complexity of drug therapy according to several treatment regimens:

  • single drug therapy (usually prokinetics or antacids). Effective only in cases of a one-time problem. Not suitable for long-term treatment of difficult cases;
  • intensifying therapy. It represents the gradual addition of a new drug at each stage, depending on the aggressiveness of the pathological processes. Treatment begins with the normalization of the daily regimen, adherence to the diet and monotherapy of the antacid agent, gradually adding one pharmaceutical product at a time if the desired therapeutic effect is not achieved;
  • the third scheme implies taking strong proton pump inhibitors from the first day of treatment to temporarily block the production of excessive amounts of irritating hydrochloric acid by the stomach. After the severity of symptoms is significantly reduced, prokinetic agents are gradually introduced. Restoration of gastrointestinal motility is accompanied by adherence to diet and refusal from heavy physical exertion. The return to the usual way of life occurs with the intake of antacids;
  • the fourth treatment regimen is exclusively surgical intervention due to irreversible destructive destruction of the esophagus and subsequent restorative therapy with stronger drugs.

In any method of treatment, the most important stages are the neutralization of hydrochloric acid or the suppression of its production by the stomach and the restoration of the mucous membrane after the irritating effect of aggressive substances.

Proton pump inhibitors

The use of proton pump inhibitors is the basis of drug therapy for reflux esophagitis, especially if the problem becomes protracted and threatens with a significant deterioration in the state of the body.

For reflux disease, drugs, most often produced in capsules coated with soluble membranes, are administered orally by mouth. The absorption of active substances occurs in the intestine, from where the reagents enter the liver, are metabolized in the secretory tubules, suppressing their activity and preventing the formation of gastric juice. As a result, the contents of the stomach gradually become less aggressive, the intensity of its effect on the mucous membranes decreases and the rate of return ejection decreases.

The principle of operation of all proton pump inhibitors is the same; the rates of absorption and action of drugs, the degree of their purification and the duration of effectiveness differ. Each drug reduces the level of acidity in the stomach, depending on the dose and brand, so only a specialist doctor can select them, having previously changed the pH of the stomach contents.

The duration of taking proton pump inhibitors can be from 1 month to several years, depending on the course of the pathology and the degree of damage to internal organs. Medicines are safe for the body and, which is typical, do not provoke addiction.

There are several of the most popular drugs containing the same active ingredient:

note

Despite the positive effects of omeprazole, experts recommend using drugs of a newer generation, since they are characterized by higher purification and when they are taken, the risk of developing numbness of the tissues of the gastrointestinal tract is significantly reduced.

Thanks to convenient doses, these drugs are used only 1-2 times a day, without causing discomfort in the patient. They have practically no contraindications, except for pregnancy, lactation, children under 12 years of age and individual intolerance to the components of medicines.

Prokinetic drugs

Prokinetics are known to be able to influence the motor activity of the gastrointestinal tract. They speed up the movement of food through the stomach and intestines and stimulate the process of emptying. Also, prokinetics are used to eliminate pyloric and esophageal reflux, since they are able to affect the nerve endings that control the mechanical activity of the stomach.

Depending on the mechanism of action, prokinetics are subdivided:

Since prokinetics affect the nervous system, they cannot be selected independently to eliminate reflux disease. They do not solve the problem of the negative effect of acid on the mucous membranes, but they can reduce the intensity of the release and normalize the motor activity of the stomach.

Antacids

Antacids are drugs, the main mechanism of action of which is a significant decrease in the concentration of hydrochloric acid in the stomach by partially or completely neutralizing it. These drugs are considered the safest, are among the most popular symptomatic drug lists, and have a minimal list of side effects.

Depending on the therapeutic effect of the drug, they are divided into:

Antacids are the drugs of choice for stomach upsets associated with a sharp increase in acid levels, due to their fast and gentle action.

Since reflux esophagitis can be caused by various reasons, the therapeutic approach is complex. It includes dietary and postural therapy, medication and auxiliary treatment, and surgical correction. The choice of a drug, dosage and duration of its use also depend on many factors. Therefore, it is necessary to take medications after consulting a specialist.

The main principles of reflux esophagitis treatment are:

  • imposing dietary restrictions and maintaining a certain lifestyle;
  • reducing the acidity of the contents of the stomach by prescribing appropriate drugs;
  • stimulation of motility of the digestive tract organs, strengthening of evacuation activities;
  • the appointment of medicines that ensure the restoration and protection of the gastric mucosa.

It should be noted that all the principles of treatment are closely interconnected. Failure to comply with one of them significantly reduces the effectiveness of therapy.

The main course of medical therapy

The duration of the main course of reflux esophagitis therapy is 4 weeks. If an erosive form of the disease is observed, then the duration of treatment is increased to 8 weeks, while an increase in the dosage of drugs is possible. If there are changes outside the esophagus (especially in elderly patients), then therapeutic treatment can last up to 12 weeks. When the effect is achieved, the patient is prescribed supportive therapy.

It should be noted that in many patients with reflux, the disease is chronic and accompanied by relapses. In this case, if the symptoms of esophagitis are not observed, then drugs are prescribed as needed.

At the erosive stage

In the presence of minor and single erosions, reflux esophagitis treatment can also last 4 weeks. Otherwise, the duration of treatment is 2 months. Prescribe proton pump inhibitors (morning and evening). Additionally, the administration of omeprazole, lansoprazole, pantoprazole, esomeprazole is shown. These drugs are also taken twice a day. Rabeprozole is considered the most effective in this case, which is sufficient to take once a day.

Even after successful treatment of erosive reflux esophagitis, the vast majority of patients remain at risk of recurrence for a year. These people need long-term therapy with PPI drugs taken in half doses. The treatment regimen is selected by the doctor taking into account many individual parameters (age, complications, etc.).

In the non-erosive stage

If there is no erosion, then the PPI is taken once a day for 4 weeks. The amount of the drug taken depends on the intensity of the inflammation and is in the range of 10 - 40 mg. Without fail, after the main course, supportive therapy is shown, the duration of which is determined by the attending physician and can last up to six months.

Possible treatment regimens

In the treatment of reflux esophagitis, the following schemes can be used.

  1. The same drug is used. The accompanying symptoms, complications and changes in the mucous membrane are not considered. This is an ineffective approach.
  2. It implies diet therapy, taking antacids. Medicines are prescribed with varying degrees of effect, depending on the severity of the inflammatory process.
  3. Effective in the treatment of severe forms of the disease. The reception of strong PPIs is shown first. After removing the inflammatory process, weak prokinetics are prescribed.

The choice of the scheme is carried out by the attending physician based on the clinical picture and examination data.

Classic scheme in 4 steps

The classical treatment regimen for reflux esophagitis, presented in 4 stages, depends on the degree of the disease.

As can be seen from the table, the higher the degree of development of the disease, the stronger the drugs.

Important milestones

Drug treatment is carried out in 2 stages. The first is aimed at eliminating provoking factors and ensuring the healing process of the mucous membrane of the organ. At the second stage, the goal of therapy is to achieve remission. In this case, 3 treatment options are possible:

  • taking PPIs for a long time at a high dosage;
  • short-term (5 days) taking PPIs as needed;
  • taking the drug only if symptoms appear.

The doctor chooses the required option, having previously coordinated it with the patient.

Drugs

For the drug treatment of reflux esophagitis, different groups of drugs are used, which differ in many factors. They can have a different mechanism of action, the duration of the onset of the effect, differ in the time of admission, price, and so on.

Antacids and alginates

The purpose of antacids is to neutralize hydrochloric acid. In addition, they promote the release of bicarbonates, bind bile acids, and inactivate pepsin. Preference is given to non-systemic drugs that contain aluminum and magnesium, for example: Gastal, Fosfalugel, Maalox. Experts recommend using liquid preparations for the treatment of reflux esophagitis.

Alginates are also designed to reduce the acidity of stomach contents. They contain alginic acid. These include: sodium alginate, Gaviscon, Topolcan. They are preferred over aluminum-containing antacids.

PPI - proton pump inhibitors

Proton pump inhibitors - PPIs - drugs designed to reduce the acidity of gastric juice by blocking the secretion of hydrochloric acid by organ cells. They have a number of advantages:

  • fast action;
  • are not absorbed into the bloodstream;
  • have a minimum of side effects.

The most common inhibitors are: Rabeprazole, Omeprazole, Pantoprazole, Lanzoprazole.

H2-histamine receptor blockers

H2-histamine receptor blockers are drugs whose purpose is also to reduce the acidity of gastric juice. They act on the H2-histamine receptors, block them, as a result of which the release of hydrochloric acid stops. Today there are 5 generations of drugs in this group, the most preferred of which are: Ranitidine and Famotidine.

NOTE! A characteristic feature of H2-histamine receptor blockers is to cause a reverse reaction in the event of an abrupt cessation of their intake (rebound syndrome).

Prokinetics

Prokinetics include drugs that enhance gastric motility and its evacuation activity. In addition, they act in the following directions:

  • reduce the time of contact of the contents of the organ with the inner wall of the esophagus;
  • help cleanse the mucous membrane of the esophagus;
  • increase the tone of the lower esophageal sphincter.

Often, prokinetics are prescribed concomitantly with PPIs. Among them are: Domperidon, Itoprid, Tegaserod.

Cytoprotectors

This group of drugs includes drugs, the action of which is aimed at increasing the protective properties of the inner wall of the esophagus and stomach. Their use allows:

  • increase mucus secretion and enhance its protective properties;
  • improve blood circulation in the esophageal mucosa;
  • reduce acidity in the stomach (misoprostol);
  • accelerate the healing of erosions and ulcers on the mucous membrane of the esophagus and stomach.

Among the drugs are: Dalargin, Misoprostol.

Symptomatic treatment

Reflux esophagitis can be caused by another disease or occur with concomitant pathology in its background. In this case, the treatment will be symptomatic:

  • If the cause is a nervous, neurological or psychological problem, then an appropriate specialist consultation is required. Sedatives, antidepressants, and others may be prescribed.
  • In the presence of a stomach ulcer, the administration of antibacterial drugs is additionally indicated.
  • If the mucous membrane of the esophagus is exposed to external influences on the background of reduced immunity, then in parallel it is recommended to take immunostimulating agents.

According to the same principle, treatment is carried out if any other disorder is a prerequisite for reflux esophagitis.

Homeopathy for reflux esophagitis

When prescribing homeopathic medicines, the symptoms present at the moment and the prescribed medications must be taken into account. The task of homeopathy in this case is to preserve and maintain the ongoing therapy, to accelerate the regeneration of the tissues of the esophagus and stomach, as well as to normalize the motor function of the gastrointestinal tract. In the course of treatment, the following means can be used:

  • magnesium phosphate (relieves pain);
  • iris versicolor, veratrumalbum (for heartburn and chest pain);
  • potassium bichromicum (heartburn, increased production of hydrochloric acid);
  • belladonna, argentumnitricum (severe inflammation, erosion in the esophagus).

Homeopathic remedies are selected in strict accordance with the characteristics of the patient's constitution. They pay special attention to the physical and mental state, the intensity of the disease. At the first stage, symptomatic agents are selected, and then, as the condition improves, the main drugs are prescribed, as a rule, in high dosages (no more than three drugs).

Multivitamins

To accelerate tissue regeneration, restore general and local immunity and ensure a speedy recovery, vitamins and macro- and microelements are needed. The usual diet does not provide a sufficient intake of these compounds in the body, especially in case of diseases of the digestive tract. Therefore, in addition, you need to take multivitamin complexes.

Approaches

Today, there are various approaches to drug treatment of reflux esophagitis. The choice of either method is due to the severity of the disease, morphological changes in the esophageal tissue, secretion characteristics and other factors:

  • According to Sheptulin. The essence of the approach: prescribing drugs of varying degrees of aggressiveness in several stages.
  1. Combining antacids with diet therapy and lifestyle changes.
  2. Use of prokinetics or H2-histamine receptor blockers.
  3. The use of proton pump inhibitors or blockers of H2-histamine receptors in conjunction with prokinetics.
  • According to Grigoriev. Therapy is based on the stage of the disease and its form.
  • According to Titgat:
  1. At the initial stage of development of reflux esophagitis, diet therapy is indicated in combination with taking antacids. The latter can be replaced with a short course of H2-histamine receptor blockers.
  2. In the second degree, a long course of prokinetics and H2 blockers is prescribed. Possible short course of treatment with proton pump inhibitors.
  3. At the third stage of the disease, the intake of H2 blockers is combined with PPIs. Another option: high-dose prokinetics and blockers.

If the effect of drug therapy is absent, then surgical intervention is indicated. In case of deterioration of the patient's psychological state, Eglonin or Grandaxin with Teralen is prescribed.

Supportive therapy

The tasks of maintenance therapy include reducing the aggressive effects of drugs. In the first two stages of the disease, this function is performed by prokinetics in the usual dosage. With a more severe course of reflux esophagitis, strong H2-blockers are added to the prokinetics. Reception - constant, under diagnostic control of the state of the mucous membrane.

Pregnancy and GERD

During pregnancy, the appointment of high doses of antacids with aluminum, as well as sodium bicarbonate, is contraindicated. Taking antacids with magnesium will lead to a mild laxative effect. For treatment, you can use medicinal and herbal remedies such as:

  • chamomile flowers;
  • alginates;
  • starch;
  • alder seedlings.

The greatest effect is achieved with a combination of alginates and astringents.

Children

Drug therapy for reflux esophagitis in children should be carried out only under the supervision of a doctor. The diagnosis is made after a thorough examination. With a mild degree of the disease, antacids or blockers of H2-histamine receptors (Ranitidine, Famotidine) are most often prescribed. When used independently, it must be remembered that these funds eliminate only the symptoms of the disease, and not the cause.

Early age

In infants, reflux is a normal physiological phenomenon, but its course also requires special attention. In the event of its transition to a pathological form, urgent measures will be required to prevent the further development of the disease. Treatment of reflux esophagitis in infants is not schematized, since it is performed only according to strict indications and in accordance with a specific case. Basically, postural therapy, antireflux mixtures, correction of the diet are used.

Older age

For older children, as well as for babies, the treatment of reflux esophagitis begins with a change in diet, diet therapy, and the use of herbal decoctions. If non-drug therapy does not lead to relief of the condition, then drugs are used. At an older age, according to the testimony of a doctor, it is possible to use drugs such as:

  • antacids and alginates;
  • blockers of H2-histamine receptors.

The main drugs for treatment in this case are antacids. If the symptoms of reflux esophagitis in a child appear regularly, then the use of PPIs and blockers is additionally indicated.

ATTENTION! The choice of the drug, its dosage and the duration of the course of treatment is carried out only by a doctor!

Conclusion

Reflux esophagitis treatment is a lengthy process that requires a medication stage. If the drugs and the treatment regimen are selected correctly, then this contributes to a faster recovery and prevention of relapses. Otherwise, the disease can take on a chronic form and / or move to the next stage. Therefore, it is very important to contact a specialist on time and fulfill his instructions in a timely manner. Today there are a sufficient number of medications and methods to get rid of pathology at any age.

Loading ...Loading ...