(lower esophageal sphincter), prolonged stagnation of food in the gastric cavity with consequent slow emptying, and incorrect functioning of peristalsis.
, dysphagia, inhalation of gastric contents in the trachea, pharyngitis, chronic inflammation of the vocal cords, irritation and burning behind the shoulder blades, ulcerative lesions in the last section of the esophagus (possible degeneration of Barret's esophagus) and odynophagia.
The extent of the lesions is directly related to the contact time of the acidic contents of the stomach with the mucous membrane of the esophagus.
(antisecretives)
- Lansoprazole (eg Pergastid, Lomevel, Lansox): it is recommended to take one 15 mg tablet once a day before the main meal, and to continue therapy for at least 4 weeks.
- Omeprazole (eg Antra, Nansen) initiate therapy by taking one 20 mg tablet daily (before the main meal, for 4-8 weeks). When necessary, it is possible to increase the dosage to 40 mg / day, as described by the doctor. In some cases, maintenance therapy (10-20 mg / day) is required for a longer period.
- Rabeprazole (eg Pariet): in case of gastroesophageal reflux disease, take 20 mg of the drug orally (recommended dose for adults and children over 12 years), once a day after breakfast. It is recommended to continue therapy for 4-8 weeks, as prescribed by the doctor.
Histamine H2-receptor antagonists (antisecretives)
- Nizatidine (eg. Nizax, Cronizat, Zanizal) the recommended dose of 150 mg of active ingredient twice a day. For children who have already turned one year and who suffer from gastroesophageal reflux diseases, it is recommended to administer 10 mg / kg per day divided into two doses, for 8 weeks. If the child is between the ages of 4 and 11, the recommended dose is 6 mg / kg per day, divided into two doses.
- Ranitidine (eg Zantac, Ranibloc): administer one 150 mg tablet (orally) twice a day, or 50 mg of active ingredient intravenously or intramuscularly every 6-8 hours (adult dose).
ALGINATES (eg Gaviscon advance): antacids containing alginates are able to reduce reflux while protecting the esophageal mucosa; moreover, the antacid-alginate association increases the viscosity of the gastric contents, protecting the mucosa of the esophagus from gastric reflux. The drug under consideration is an oral suspension of 100 mg of sodium alginate associated with 20 mg of potassium bicarbonate (per milliliter of product); take 5-10 ml of oral suspension after meals and at bedtime.
STIMULATING MOTILITY (prokinetics)
The administration of drugs capable of stimulating motility is recommended in the case of gastroesophageal reflux diseases because it improves the functionality of the cardia and accelerates gastric emptying.
- metoclopramide (eg Plasil, Isaprandil): take 10-15 mg of the drug orally up to 4 times a day, at least 30 minutes before meals and at bedtime. Do not continue therapy beyond 12 weeks. In children, administer orally, intravenously or intramuscularly 0.8 mg / kg per day in 4 divided doses.
- domperidone (eg Motilium, Peridon): take one tablet (10 mg) 3-4 times a day before meals, for no more than 4 weeks.
Over-the-counter antacids
Over-the-counter antacids are not the drugs of choice for the treatment of gastroesophageal reflux disease; however, their intake can sometimes alleviate reflux symptoms, decreasing gastric acidity. For example, remember:
- sodium bicarbonate (NaHCO3): this substance acts quickly by neutralizing acids, but has unpleasant side effects (alkalinization of the urine, swelling, hypersodemia). The use of sodium bicarbonate should not be a common practice, rather it can be used to temporarily reduce the symptoms of gastroesophageal reflux disease, after consulting a doctor.
- Calcium carbonate (CaCO3): compared to the previous one, the drug has a longer duration of action. When calcium carbonate is taken for long periods, in addition to causing swelling, it can cause constipation.
TRADITIONAL OR LAPAROSCOPIC SURGICAL THERAPY: useful in case of coexistence of hiatal hernia or when drug therapy is not able to control the complications deriving from gastroesophageal reflux diseases.
Here are some simple rules of gastroesophageal reflux disease prophylaxis:
- Abstention from smoking
- Increase physical activity
- Avoid alcoholic and carbonated drinks
- Avoid chocolate, coffee and hyperlipid foods
- Avoid going to bed after a meal
- Follow the rules dictated by food education
- Reduce weight (when needed)
The change in the lifestyle of the patient suffering from gastroesophageal reflux, together with the use of drugs, is essential to decrease the severity of the symptoms and to recover completely from the disease.
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