Гастроэзофагеальная рефлюксная болезнь: симптомы, диагностика и лечение.

Treatment options include lifestyle changes, medications, and sometimes surgery for those who do not improve with the first two measures. Lifestyle changes include not lying down for three hours after eating, lying down on the left side, raising the pillow or bedhead height, losing weight, and stopping smoking. Foods that may precipitate GERD symptoms include coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods. Medications include antacids, H2 receptor blockers, proton pump inhibitors, and prokinetics. In the Western world, between 10 and 20% of the population is affected by GERD. Occasional gastroesophageal reflux without troublesome symptoms or complications is even more common. In 1934 gastroenterologist Asher Winkelstein described reflux and attributed the symptoms to stomach acid.

GERD may be difficult to detect in infants and children since they cannot describe what they are feeling and indicators must be observed. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems, such as wheezing. Inconsolable crying, refusing food, crying for food and then pulling off the bottle or breast only to cry for it again, failure to gain adequate weight, bad breath, and burping are also common. Children may have one symptom or many; no single symptom is universal in all children with GERD. Of the estimated 4 million babies born in the US each year, up to 35% of them may have difficulties with reflux in the first few months of their lives, known as 'spitting up'. About 90% of infants will outgrow their reflux by their first birthday.

[[File:GERD 2. png|thumb|Severe tooth erosion in GERD Less common symptoms of GERD include difficulty in swallowing, water brash, chronic cough, hoarse voice, nausea and vomiting. It will be evident in people with restorations as tooth structure typically dissolves much faster than the restorative material, causing it to seem as if it "stands above" the surrounding tooth structure.

GERD may lead to Barrett's esophagus, a type of intestinal metaplasia, Due to the risk of chronic heartburn progressing to Barrett's, EGD every five years is recommended for people with chronic heartburn, or who take drugs for chronic GERD.

thumb|Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach: This is a complication of chronic gastroesophageal reflux disease and can be a cause of dysphagia or difficulty swallowing. The diagnosis of GERD is usually made when typical symptoms are present. Esophageal manometry is not recommended for use in the diagnosis, being recommended only prior to surgery.

Other causes of chest pain such as heart disease should be ruled out before making the diagnosis. Differential diagnosis of GERD can also include dyspepsia, peptic ulcer disease, esophageal and gastric cancer, and food allergies.

The treatments for GERD may include food choices, lifestyle changes, medications, and possibly surgery. Initial treatment is frequently with a proton pump inhibitor such as omeprazole. Some evidence suggests that reduced sugar intake and increased fiber intake can help. Breathing exercises may relieve GERD symptoms.

The primary medications used for GERD are proton pump inhibitors, H2 receptor blockers and antacids with or without alginic acid. The overuse of acid suppression is a problem because of the side effects and costs. They may also be taken only when symptoms occur in those with frequent problems.

The evidence for antacids is weaker with a benefit of about 10% (NNT=13) while a combination of an antacid and alginic acid (such as Gaviscon) may improve symptoms by 60% (NNT=4). It is recommended only for those who do not improve with PPIs. When comparing different fundoplication techniques, partial posterior fundoplication surgery is more effective than partial anterior fundoplication surgery, and partial fundoplication has better outcomes than total fundoplication. Esophagogastric dissociation is an alternative procedure that is sometimes used to treat neurologically impaired children with GERD. Preliminary studies have shown it may have a lower failure rate and a lower incidence of recurrent reflux. Adverse responses include difficulty swallowing, chest pain, vomiting, and nausea. Contraindications that would advise against use of the device are patients who are or may be allergic to titanium, stainless steel, nickel, or ferrous iron materials. A warning advises that the device should not be used by patients who could be exposed to, or undergo, magnetic resonance imaging (MRI) because of serious injury to the patient and damage to the device. Some patients who are at an increased surgical risk or do not tolerate PPIs may qualify for a more recently developed incisionless procedure known as a TIF transoral incisionless fundoplication. Benefits of this procedure may last for up to six years.

GERD is a common condition that develops during pregnancy, but usually resolves after delivery. The severity of symptoms tend to increase throughout the pregnancy. and PPIs.

Babies may see relief with smaller, more frequent feedings, more frequent burping during feedings, holding the baby in an upright position 30 minutes after feeding, keeping the baby's head elevated while laying on the back, removing milk and soy from the mother's diet or feeding the baby milk protein free formula. They may also be treated with medicines such as ranitidine or proton pump inhibitors. Proton pump inhibitors, however, have not been found to be effective in this population and there is a lack of evidence for safety. The role of an occupational therapist with an infant with GERD includes positioning during and after feeding. One technique used is called the log roll technique, which is practiced when changing an infant's clothing or diapers.

In Western populations, GERD affects approximately 10% to 20% of the population and 0.4% newly develop the condition. In the United States 20% of people have symptoms in a given week and 7% every day.

An obsolete treatment is vagotomy ("highly selective vagotomy"), the surgical removal of vagus nerve branches that innervate the stomach lining. This treatment has been largely replaced by medication. Vagotomy by itself tended to worsen contraction of the pyloric sphincter of the stomach, and delayed stomach emptying. Historically, vagotomy was combined with pyloroplasty or gastroenterostomy to counter this problem.

A number of endoscopic devices have been tested to treat chronic heartburn. Endocinch puts stitches in the lower esophogeal sphincter (LES) to create small pleats to help strengthen the muscle. However, long term results were disappointing, and the device is no longer sold by Bard. The Stretta procedure uses electrodes to apply radio frequency energy to the LES. A 2015 systematic review and meta analysis in response to the systematic review (no meta analysis) conducted by SAGES did not support the claims that Stretta was an effective treatment for GERD. A 2012 systematic review found that it improves GERD symptoms. NDO Surgical Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fixates the plication with a suture based implant. The company ceased operations in mid 2008, and the device is no longer on the market. Transoral incisionless fundoplication, which uses a device called Esophyx, may be effective.