Everything you need to know about heartburn today to avoid future complications
Heartburn as a sign of gastroesophageal reflux is experienced by 20–40% of the adult population of developed countries. According to international studies, about 161 million people in Europe and the United States suffer from heartburn. This burning sensation behind the sternum, which is familiar to almost everyone. Someone just came to terms with this symptom, but it turns out that if you don’t pay attention to it in time, the complications can be dire. All you need to know about heartburn – in the material of Alexander Kochatkov.Heartburn – a frequent “satellite” of pregnant women – occurs in 25–80% of cases during pregnancy. The frequency and intensity of symptoms depend on the duration of pregnancy, they usually disappear completely after delivery. Heartburn begins to disturb pregnant women from about 20-22 weeks, appearing periodically. From the 30th week about a third of all expectant mothers complains of heartburn and related discomfort, and by the 38th week their number is growing, up to 98%, according to different authors. Heartburn and other signs of gastroesophageal reflux (GERD) increase with age.
The cause of heartburn is the throwing of the acidic contents of the stomach into the esophagus, this phenomenon has a medical name – gastroesophageal reflux, which occurs in almost half of the country’s population. It is difficult to meet an adult who has not experienced this feeling at least once in his life. Reflux can be caused by functional insufficiency of the lower esophageal sphincter (valve – approx. Ed.), Hernia of the esophageal opening of the diaphragm, shortening of the esophagus, etc. These reasons will help establish a doctor.
With GERD, because the sphincter between the stomach and the esophagus does not close tightly, the contents of the stomach are thrown back into the esophagus, which causes a burning sensation. The walls of the stomach are protected from the acidic environment, which is necessary for the digestion of food, and the walls of the esophagus are not ready for such an effect.— Ed.
In addition to the unpleasant sensations, acid, falling from the stomach into the esophagus, causes reflux esophagitis – inflammatory changes in the esophagus against the background of the irritating action of gastric juice. In the absence of proper treatment, severe forms of esophagitis, complicated by bleeding, cicatricial strictures, or the development of gastric metaplasia of the epithelium, Barrett’s esophagus, which can later be transformed into esophageal cancer, can develop.
When symptoms such as heartburn, belching air, burning sensation behind the sternum, which are aggravated after eating, should be addressed to a team of specialists, including a gastroenterologist and a surgeon.
In the diagnosis of gastroesophageal reflux are used:
– esophagogastroscopy (FGDS – “swallowing” the probe) to assess the condition of the mucous membrane of the esophagus and stomach, the condition of the cardiac pulp, identify indirect signs of a hernia of the esophageal opening of the diaphragm, – X-ray examination of the esophagus, stomach with barium to detect reflux, hernia of the esophageal opening of the diaphragm and shortening the esophagus, – if necessary, use daily pH-metry (measuring the acidity of the stomach or duodenum using a probe). This allows you to identify and eliminate the causes of reflux and begin treatment.
To eliminate the causes of heartburn, most patients should take antisecretory drugs. The complex of conservative and preventive measures allows to achieve good results in 65-80% of patients with mild to moderate reflux esophagitis. There are patients to whom the most modern schemes of conservative (drug) therapy provide only a short-term effect and do not prevent the development of complications. A large number of studies indicate that remission of the disease is possible only in 70% of patients, provided that lifelong administration of antisecretory drugs and at least 15% of patients require surgical treatment.
Surgical treatment is indicated for:
the failure of conservative therapy;
severe reflux esophagitis;
hernia of the esophageal opening of the diaphragm with reflux esophagitis;
shortening of the esophagus.
The operation of choice in this case is a fundoplication, which consists in creating an extended symmetric cuff from the cardial part, the bottom and the body of the stomach, shaped like a “glass-not-sprinkle”. If necessary, the operation can be supplemented with posterior crurophy, selective proximal vagotomy. These are laparoscopic operations – that is, minimally invasive, which are done through small incisions. They are carried out under general anesthesia.