The gastroesophageal reflux disease (GERD) is a condition in which the return of stomach contents into the esophagus causes troublesome symptoms or complications. The suffering occurs due to disorders in existing anti-reflux mechanisms that normally prevent the entry of gastric contents into the esophagus. The reflux itself is not an illness. About half of the population has these symptoms at least once a month. Pathological are considered symptoms occurring two or more times a week, lasting more than two or three months. The reflux disease may be combined with visible mucosal damage in the esophagus, but often mucous membrane is intact. In the presence of impaired mucosal integrity suffering is considered as reflux esophagitis, and in the absence of visible lesions – as non-erosive reflux disease.
The main and most common symptoms of GERD are acids and heartburn. The return of stomach contents into the esophagus and mouth is also not a rare symptom. The heartburn usually starts from epigastrium and spreads behind the breastbone and may radiate to the chest and neck, but rarely to the back. The complaints are usually after meals, especially after heavy intake of food and dietary mistakes with spicy food, citrus fruits, fats, concentrated sugar foods, chocolate (greasy and sweet) and alcohol. Supine position and bending the upper body intensifies the heartburn. These are a symptom of low sensitivity, but high specificity for the presence of GERD. Usually the disease is defined when symptoms occur two or more times a week, but a rarer occurrence does not preclude the presence of a health problem.
The frequency and intensity of the heartburns rarely correlates with the severity of mucosal injury. Pain is less common and often is a manifestation of a more pronounced damage to the esophagus. About 30% of the patients have differently expressed dysphagia. Usually the complaints are mild, occur slowly, mostly after eating solid foods, and sometimes gradually strengthen. Swallowing difficulty is rarely due to true stenoses, the dysphagia due to stenoses is also after fluid intake. Dysphagia can be combined with odynophagia. It is an alarming symptom and requires an exact diagnosis to exclude neoplasm. Belching, hiccups and vomiting also occur in reflux disease.
Sometimes even patients with expressed erosive inflammatory changes in the esophagus have no complaints. These are usually elderly patients, and they often develop complications of GERD.
Manifestation of GERD outside the esphageal is chest pain, and sometimes the differentiating the diagnosis of angina pectoris is difficult. The presence of chronic cough and asthma requires a distinction between pulmonary distress and reflux disease. About 30% of the patients with asthma induced by reflux have no changes in the esophagus. In these cases it is sometimes ex juvantibus diagnosis is required with administration of proton pump inhibitors. This is justified, especially in the absence of adequate response to treatment with typical bronchodilators and corticosteroids. The reflux can cause chronic pharyngitis, i.e. reflux laryngitis, sinusitis and damage to tooth enamel.
The diagnosis of GERD is most often based on the clinical picture. Complaints of heartburn and regurgitation of gastric contents for a long period of time suggests with high probability the existence of GERD.
The contrast x-ray of the esophagus can detect the presence of hiatal hernia and reflux pathological and exclude advanced cancer, but cannot help to clarify the subtle changes in the mucosa. 18- or 24-hour pH measuring with timing the pH below 4 (the normal is 4 to 5.5%) may be useful for the diagnosis of reflux disease. The endoscopy best diagnoses the extent of the damage, presence of complications, and the possibility of taking biopsies allows a complete picture of the state of the mucous membrane. About 70% of the patients with GERD have no endoscopic changes. These are more often women without hiatal hernia without obesity.
Non-erosive reflux disease usually does not cause complications. The most common benign complications of reflux esophagitis are peptic ulcer bleeding or perforation. The bleeding may occur from erosive changes and without an ulcer. Clinically significant bleeding is reported in 7% to 18% of the patients and can cause iron deficiency anemia. The peptic stricture of the esophagus occurs after prolonged reflux symptoms, most often in older men due to inadequate prior treatment.
Barrett’s esophagus is a complication of the reflux disease, which results in development of gastric mucosa (gastric metaplasia) in the lower part of the esophagus and can be precancerous in the presence of metaplasia.
The treatment of GERD is carried out with several groups of medicines. Antiacids and alginates are the oldest.
The main medicines for treatment of GERD are those that reduce stomach acid secretion. H2-receptor antagonists inhibit the hydrochloric acid secretion by reversibly competing with histamine for the capture of H2-receptors on the basolateral surface of the parietal cells. Most H2-blockers cross the placenta, and administration during pregnancy should be with caution.
The rapid development of tolerance (within 7-14 days), and the loss of suppressive effect on gastric acidity often explain the unsatisfactory results in the treatment of patients with GERD.
The proton pump inhibitors (PPIs) are the most effective drugs for treatment of GERD. Such PPI is Lansoprazole. Its active metabolite binds irreversibly to H+,K(+)-ATPase of the parietal cells and blocks the secretion of protons. As this is the final step in the formation of hydrochloric acid, Lansoprazole effectively suppresses gastric acid independent of other stimulatory factors. In normal doses this drug reduces gastric acidity (basal and stimulated) by 80-90%. Recent studies on the effects of long-term suppression of gastric acid indicate that Lansoprasole rarely has side-effects.
In pharmacy chains now the newest product of Tchaikapharma High Quality Medicines can be found – LanzAcid:
LanzAcid (Lansoprolol) – proton pump inhibitor.
LanzAcid is recomended in dieeases for which the inhibition of increased secretion of hydrochloric acid is indicated:
• Treatment of duodenal and gastric ulcers;
• Gastroesophageal reflux disease;
• Eradication of Helicobacter pylori (combination with antibiotics – Klacar);
• Syndrome Zollinger-Ellison and other conditions with an increased secretion of gastric acid;
• Treatment of NSAID-associated benign gastric and duodenal ulcers in patients requiring continued NSAID treatment;
• Prophylactic treatment when taking NSAIDs;
• Symptomatic gastroesophageal reflux disease.
LanzAcid has the most advantageous price for one-month treatment with proton pump inhibitor – BGN 9.75. For all other products of the same therapeutic class the patient has to pay additional amount for one-month of treatment between BGN 11 and BGN 46.