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The high prevalence, severe clinic, which significantly worsens imuran quality of life of patients, the tendency to develop life-threatening complications, and frequent atypical clinical course make GERD one of the most urgent problems of modern gastroenterology. The constant increase in the incidence requires a thorough study of the mechanisms of GERD development, improvement of early diagnosis methods and the development of effective pathogenetic treatment measures.
Subjectively, reflux is felt as the occurrence of heartburn - a burning sensation behind the sternum - and belching. If heartburn occurs regularly (more than 2 times a week), it is suggestive of GERD and requires a medical examination. Chronic reflux that occurs for a long time leads to chronic esophagitis, and later changes in the morphological structure of the mucosa of the lower esophagus and the formation of Barrett's esophagus. Factors contributing to the development of pathology are violations of the motor functions of the upper digestive tract, hyperacidotic conditions, reduced protective function of the mucous membrane of the esophagus.
Most often, in GERD, there is a violation of two natural mechanisms for protecting the esophagus from the aggressive environment of the stomach. esophageal clearance (the ability of the esophagus to evacuate the contents into the stomach) and resistance of the mucosal wall of the esophagus. The likelihood of developing the disease is increased by stress, smoking, obesity, frequent pregnancies, diaphragmatic hernia, medications (beta-blockers, calcium channel blockers, anticholinergics, nitrates).
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The main factor in the development of gastroesophageal reflux disease is insufficiency of the lower esophageal sphincter. In healthy people, this muscular circular formation in the normal state keeps the opening between the esophagus and stomach closed and prevents the reverse movement of the food bolus (reflux). In case of insufficiency of the sphincter, the opening is open and when the stomach contracts, its contents are thrown back into the esophagus. Aggressive gastric environment causes irritation of the walls of the esophagus and pathological disorders in the mucosa up to its deep ulceration. In healthy people, reflux can occur when bending over, exercising, or at night.
The typical clinical picture of the disease is characterized by heartburn, which is aggravated by bending over, physical exertion, after heavy meals and in the supine position, belching with a sour or bitter taste. May be accompanied by nausea and vomiting. Depending on the severity of the course, dysphagia is noted - a swallowing disorder, which can be primary (as a result of impaired motor skills) or be a consequence of the development of strictures (narrowings) of the esophagus.
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GERD often occurs with atypical clinical manifestations. chest pain (usually after eating, aggravated by bending over), heaviness in the abdomen after eating, hypersalivation (excessive salivation) during sleep, bad breath, hoarseness. Indirect signs indicating a possible pathology are frequent pneumonia and bronchospasm, idiopathic pulmonary fibrosis, a tendency to laryngitis and middleotitis, damage to tooth enamel. Of particular danger in terms of the development of severe complications is azathioprine pills, which occurs without severe symptoms.
The most common (in 30-45% of cases) complication of azathioprine is the development of reflux esophagitis - inflammation of the mucous membrane of the lower esophagus, resulting from regular irritation of the walls by gastric contents. In the event of ulcerative-erosive lesions of the mucosa and their subsequent healing, the remaining scars can lead to strictures - narrowing of the lumen of the esophagus. Reduced patency of the esophagus is manifested by developing dysphagia, combined with heartburn and belching.
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Prolonged inflammation of imuran wall can lead to the formation of an ulcer - a defect that damages the wall up to the submucosal layers. An esophageal ulcer often contributes to bleeding. Long-term gastroesophageal reflux and chronic esophagitis provoke the epithelium normal for the lower esophagus to gastric or intestinal. This degeneration is called Barrett's disease. This is a precancerous condition, which in 2-5% of patients transforms into adenocarcinoma (cancer of the esophagus) - a malignant epithelial tumor.
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The main diagnostic method for detecting GERD and determining the severity and morphological changes in the wall of the esophagus is esophagogastroduodenoscopy. It is carried out after consultation with an endoscopist. During this study, a biopsy sample is also taken to study the histological picture of the condition of the mucosa and diagnose Barrett's esophagus.
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An x-ray of the esophagus can reveal an esophageal ulcer, the presence of strictures, and diaphragmatic hernia. In half of the cases, reflux can be noted. The pressure of the lower esophageal sphincter is determined using manometry. Characteristic of gastroesophageal reflux disease is a positive Bernstein test (with the introduction of a 0.1% solution of hydrochloric acid into the esophagus, a burning sensation appears), as well as the rapid disappearance of clinical symptoms when taking antacids (alkaline test). The motor function of the esophagus is examined using electromyography.
