Reflux esophagitis, medically known as gastroesophageal reflux disease, is a common clinical disease, with heartburn and reflux (gastric contents flowing in the direction of the pharynx or oral cavity) as the typical clinical symptoms, other uncommon symptoms include chest pain or epigastric pain, nausea and vomiting, dyspepsia, throat discomfort, cough, etc. It is important to note that the severity of esophageal injury is sometimes inconsistent with the clinical presentation.
The treatment of reflux esophagitis mainly includes lifestyle adjustment and drug treatment, lifestyle adjustment is the basis for the treatment of such diseases, including weight loss, smoking cessation, raising the head of the bed, etc. Raising the head of the bed due to positional reasons can reduce the exposure of the esophagus in gastric acid, and reduce the stimulation of gastric acid to the esophagus. Weight loss helps reduce reflux caused by increased intra-abdominal pressure, and nicotine in tobacco can reduce the pressure on the subesophageal sphincter, making it relax and induce reflux, so smoking cessation helps relieve the symptoms of reflux esophagitis.
In terms of drug treatment, it mainly includes two categories of drugs with antagonistic acid effects and gastric motility drugs.
Drugs that antagonize gastric acid mainly include drugs that inhibit gastric acid secretion and antacid drugs.
Drugs that inhibit gastric acid secretion mainly include proton pump inhibitors and P-CAB drugs fumarate vonoracin (Walker). Proton pump inhibitors mainly include omeprazole, lansoprazole, pantoprazole, rabeprazole, eprazole and other pazolium drugs, P-CAB (potassium ion competitive acid blocker) fumarate vonorasin is a new type of anti-gastric acid secretion drugs, compared with prazole drugs, its action on different points of the proton pump, inhibition of resting and active state of proton pumps, do not need activation, fast onset of action, long acid inhibition time, stable in gastric acid, do not need to be made into intestinal solvent type, not affected by food, There is no need to take them on an empty stomach, and these drugs can be changed to double doses for a course of 4-8 weeks if they do not respond to a single dose. Histamine H2 receptor antagonists such as cimetidine, famotidine, etc. can also inhibit gastric acid secretion, compared with the above two types of drugs, their acid-suppressing effect is weak, the maintenance time is short, the treatment course is longer, and it takes 8-12 weeks. Acid-suppressing drugs are not the preferred treatment regimen for reflux esophagitis. It is mainly used for alternative therapy in mild to moderate patients and patients who are intolerant to proton pump inhibitors.
Antacids mainly include aluminum magnesium carbonate chewable tablets (Daxi), aluminum hydroxide gel, alginate preparations such as aluminum magnesium alginate granules, etc., such drugs can quickly neutralize stomach acid, quickly relieve reflux symptoms, mainly for symptomatic treatment, short-term use, do not advocate long-term use, the reason is that although such drugs can quickly neutralize gastric acid, but can not control gastric acid production from the source of gastric acid secretion, the symptoms are not curative, and long-term use will cause the accumulation of aluminum and other metal ions and electrolyte disorders such as hypermagnesemia.
Gastric motility drugs mainly include drugs that antagonize dopamine receptors such as (gastric reassurance), domperidone (morphine), drugs acting on motilin receptors such as erythromycin and other macrolide drugs, moszapride acting on serotonin receptors, itoperide acting on dopamine receptors and cholinesterase at the same time, and acting on dopamine and serotonin receptors at the same time. Although prokinetic can not inhibit gastric acid secretion, but can improve nausea and vomiting, indigestion related reflux symptoms, such drugs are generally not used alone, are combined with drugs that inhibit gastric acid secretion.
As for whether it is necessary to continue to take the drug after 4-8 weeks, how long to take the problem, it needs to be decided according to the specific situation of the patient, for the initial treatment of effective and mild patients can be used on-demand treatment, proton pump inhibitors and vonorasin as the first choice, for patients with relapsed symptoms after discontinuation of the drug and severe esophagitis usually need long-term maintenance therapy, long-term use of various pazoli proton pump inhibitors inhibit gastric acid secretion, will lead to an increase in the pH in the stomach, excessive proliferation of bacteria, increased risk of Clostridium infection, It may also increase the risk of community-acquired pneumonia, gastric cancer and chronic kidney disease, can also lead to osteoporosis and fractures, increase the risk of nutritional malabsorption and dementia, funorracin fumarate has a short time to market, there is little data on related adverse reactions, short-term studies suggest that there may be hypergastrinemia associated with inhibition of gastric acid, in short, long-term medication should consider both the therapeutic effect of drugs on reflux esophagitis and the adverse reactions of long-term use of drugs. #Guardians of Health ##Very cases ##药事健康超能团 #