GASTROESOPHAGEAL REFLUX
Esofagitis of refluxo, hernia of hiatus, acidity, refluxo.
That is?
It is a system of complaints that accompanies alterations in the esophagus resulting by the abnormal ebb tide (returned) of the stomach content until the esophagus. Nausea and vomit do not happen generally.
How develops or how it is acquired?
The esophagus of the adult is a channel of 35-40 centimeter that binds the mouth to the stomach. He is elastic and in the thickness of his wall it contains muscle litters covered by a called delicate skin mucous, similar to the coating of the mouth internally. The beginning of the esophagus is fixed to the most inferior part of the throat, descending through mediastino, crossing the diaphragm via a called orifice the hiatus, some centimeters before opening itself in the stomach. The mediastino is the region between both lungs, and the diaphragm is calota that separates the thorax of the abdomen. The esophagus has ligaments to fix it to the diafragmático hiatus, that contribute for the formation of a class of retention valve to prevent the ebb tide of the gastric content until the esophagus. When the esophagus slips more than 2 – 3 centimeters upwards, it throws of the stomach and both structures move to the thorax. From this anatomical alteration is hernia of hiatus, that by its time deteriorates the valve of the against-ebb tide. When the stomach content, in highly acid general, atinge the mucosa of the esofágica, this weave reacts, inflaming, originating esofagitis of ebb tide.
What feels?
The acidity is the main complaint and its technical name is pirosis. It can get worse, for example, when the chest is doubled on the belly, and when one lies down with the full stomach. Heat or quemazón in some point between the hole of the stomach and the chin has talked about like, happening behind the breastbone. The heartburn can be as intense as the pain chest, causing the impression of an infarct of the heart. An increase in the salivation (sialorrea) can also happen, that is a natural reflection because to swallow the saliva it releases the sensation of quemazón, as if outside antacid a natural one.
The ebb tide is the perception of the return of the content of the stomach towards the mouth, without nausea or vomits, often with a sour or bitter taste. Not rarely it determines cough, esputo and alterations of the voice. The breathlessness strong and sudden cough that deteriorate the breathing – can do that the wide-awake individual and mark a situation on a map of the gastro-esofágico ebb tide. The occurrence of short and sibilante breathing, like in asthma, can be driven by the ebb tide.
Sensations, as if there was a ball in the throat and malaise when swallowing until strong pain in espasmos – in means of the chest they represent a disorganization of the responsible contractions faringoesofágicasl to take to the stomach which we swallowed. These symptoms consider the complications of the ebb tide and they occur generally the name of “dismotricidade” of the esophagus. In infants, from the age of 1 year, the excessive gastroesofágico ebb tide can happen, leading around swallowed milk, strangling, griterío excessive, interrupted dream, and, when he is repeated, it prearranges to infections and respiratory disorders.
How the doctor diagnoses it?
The report of a young patient of the adult can lead to the diagnosis, without the necessity of examinations in a first episode. The x-ray of esophagus-gastric transition whereas a resistance of the radio-opaque one interferes can demonstrate so much hernia as the ebb tide. The superior digestive endoscopia is an examination to see the esophagus, the stomach and the duodeno, happening a fine optical fiber iron strap through the mouth. The evolution of the quality of the equipment, effectiveness of the local anesthesia to the mouth to avoid the reflection of the vomit and the sensation of the asphyxia, as well as the effectiveness and the security of the sedación of the patient without general anesthesia, transformed to the endoscopia into a simplified examination, of which the wide-awake patient, often, asking when it goes to be made. In addition, it can be repeated for the control of the treatment result, and, more recently, for special therapeutic procedures. A screen wittingly receives and heightens the images of areas under direct inspection, also allowing to photos and films to reexaminar the results. It can demonstrate the incapacity of the gastroesofágica valve of retention and hernia. Most important it is than it allows seeing of the red points, plates blanquecinas and ulcers, mainly in the mucosa of the inferior, suggestive esophagus of varied degrees of esofagitis of ebb tide. The endoscopia facilitates the coleta of material of these injuries for the microscopic examination, in which we can determine the inflammation, it evaluates a cancerigenic potential and to even diagnose the cancer.
I scintillate-grafía of the esophagus-gastric transit is a method that has been used with more frequency in children. A bottle of normal feeding is administered that it contains an inoffensive amount of radioactive substance. I scintillate-grafía capture and registers images of the radioactive substance I descend through stomach and that refunde of the stomach until the esophagus. It is a noninvading methodology, without pain ambulatory patient. Nevertheless, it can not be able to take the ebb tide, since this is not permanent. The study of the internal pressure throughout the esophagus (manometría) and the verification of the ebb tide of the acidity of the stomach until the esophagus (pHmetria of 24 hours) detected natural variations and the abnormalitys able to diagnose the ebb tide. These are the methods that arrived at the clinical routine does, relatively, some years. They before need to be used when the others show unsatisfactory results and for the study of parameters and after a possible surgical treatment of the disorder of the ebb tide.
How treats?
Clinical prática Na há to prevenção gives to recidiva two symptoms, that are transformed seguimento it do not give to measures instituídas educative bonds quando do primeiro tratamento. Generally, the treatment is clinical, with the educative measures associated to medications. Video has facilitated the surgical method, being applied to the cases selected with the very good results.
Besides to fight the obesity, it is important to avoid great amounts of food in the refecciones and to avoid to lie down before the 2 next hours. Some people have advantage to sleep in a bed with the elevated cover in 20 to 25 centimeters. Others do not adapt to this position: the feet are swollen, hurt the backs you pains. There are controversies on the restriction of several foods, particularly citric, sweet and greasy. Some measures help in the management of symptoms, for example: avoiding spirit, not drinking the too hot liquids, ingesting the minimum of liquids during or shortly after eaten, avoiding to take black tea or pure coffee with an empty stomach.
The drugs more widely used are those that diminish the level of the acidity already sent in the stomach (antacid the popular ones) and those that inhibit the production of acid by the cells of the stomach (“antacid sistémicos”). Other drugs of a called group pro-kinetic are destined to facilitate the evacuating of the content of the stomach towards the intestine, reducing to the minimum the amount that can refundir until the esophagus. An excellent complaint of the patients is relapse of the symptom, particularly the acidity, some days after the term of medications. At this moment it raises the question if we must resort to the treatment by an indetermine period or to the surgical treatment.
We must observe that the clinical treatment combat very well the symptoms, but does not modify hernia of hiatus and only some times changes the gastroesofágico ebb tide itself.
How is prepared?
In clinical practice, we made the prevention of the relapse of the symptom, that is transformed in following the instituted educative measures at the time of the first treatment.