Reflux esophagitis Treatment
Reflux esophagitis Treatment include increase of esophageal and gastric emptying such as dopamine antagonist, Cisapride, bethanechol; Reduce gastric acid such as antacids, histamine H2 receptor antagonists, proton pump inhibitors; medication; Surgery and Supportive care.
Increase of esophageal and gastric emptying:
1. dopamine antagonist. These drugs can promote reflux, emptying Office to increase the LES tension. Such drugs, including metoclopramide (metclopramide, metoclopramide) and domperidone (domperidone, domperidone), are 10 ~ 20mg, each days 3 to 4 times, bedtime and fasting take. The former agent, such as excessive or long-term use can lead to extrapyramidal neurological symptoms, it is used with caution in elderly patients; the latter long-term use can also be caused by hyperprolactinemia, resulting in hyperplasia of mammary glands, lactation and amenorrhea, such as adverse reactions.
2. Cisapride through postganglionic myenteric plexus nerve to release acetylcholine and the promotion of esophageal, gastric motility and emptying, thereby reducing reflux .10 ~ 20mg, day 3 to 4 days, almost no side effects.
3. cholinergic drugs. bethanechol can increase the tension of the LES, the promotion of esophageal contraction in esophageal acid to speed up the emptying of food in order to improve symptoms, per 25mg, day 3 to 4 times. This I will be able to stimulate gastric acid secretion, long-term use should be carefully .
Reduce gastric acid:
1. antacids: and acid can reduce the activity of pepsin, acidic stomach contents to reduce the esophageal mucosa to damage. Alkaline drug itself has increased the role of LES tension. Aluminum hydroxide gel 10 ~ 30ml and Magnesium 0.3g, daily 3 to 4 times. algal acid protein foam (gariscon, alginate) acid protein containing algae, algal sodium and antacids, can float on the surface of the stomach contents, stomach contents to prevent anti-flow.
2. histamine H2 receptor antagonists: cimetidine (cimetidine), furostanol Nitramine sulfur (ranitidine) and famotidine (famotidine), etc. can be chosen, the dose of 200mg, 3 ~ 4 / d; 150mg, 2 times / d and 30mg / d. treatment of 6 to 8 weeks. The drugs can strongly inhibit gastric acid secretion and improvement of acid gastroesophageal reflux. can not improve these symptoms, such as when to increase dose 2 ~ 3 times.
3. proton pump inhibitors: these drugs can block the cell wall of the H +-K +-ATP enzyme and the United States and Latin America triazole (omeprazole) and lansoprazole (lansoprazole) has been widely used in clinical, the former 20mg / d, which 30mg / d, can improve their symptoms.
Combined medication:
The promotion of esophageal, gastric emptying antacids drugs and synergistic combination to promote the healing of esophagitis. Can also be used dopamine antagonists or cisapride with histamine H2 receptor antagonist or proton pump inhibitors in combination. The disease and drug use as a turn for the better, because the LES has not been fundamentally improved tension, so about 80% of cases relapse within 6 months. such as histamine H2 receptor antagonists, proton pump inhibitor or a dopamine antagonist anti-Japanese optional account the maintenance of a medication, or have symptoms of drug use in time out, you can achieve better effect.
Surgery:
Mainly applicable to esophageal cicatricial stenosis (dilatation or surgery feasible corrective surgery), as well as medical treatment is invalid and repeated bleeding, repeated concurrent illness such as pneumonia.
The most effective surgery treatment is the restoration of intra-abdominal segment of the distal esophagus and esophagogastric valve between the composition of organizations, so that reflux and decreased to normal levels in order to avoid gastric distension, may be abdominal or thoracic surgery, surgical methods are folded Nissen fundoplication operation, Belsey Mark Ⅳ surgery, Hill operation, Collis-Belsey operations.
Nissen fundoplication gastric plication is folded from a one-way valve to prevent reflux. Belsey Mark Ⅳ esophageal surgery is to the rear leg joints reduce the diaphragm, esophagus and stomach in order to restore the acute angle and the lower esophageal high pressure zone. Hill is folded esophageal surgery, and at the same time, with the diaphragm patch right in the middle of arch ligament fixed, in order to maintain intra-abdominal esophageal length, so that lower esophageal sphincter hypertension cavity section, to regain the role of the sphincter. Reflux esophagitis caused by the merger of esophageal stenosis and shortening of the patients to choose Collis-Belsey operation, which is to cut down esophagogastric angle to re-suture of the esophagus and stomach forming a new angle.
Supportive care:
Aller meals spread throughout the day, should not be over-fed; anti-tobacco, alcohol, coffee, chocolate, sour food and too much fat; avoid meal that is lying; lying bed elevation at 20 ~ 30cm, avoid excessive abdominal pressure caused by a variety of state.