Can a loose anus become tight again
Gastroesophageal reflux disease (GERD)
As Gastroesophageal reflux disease (abbreviated GERD for gastroesophageal reflux disease) medical professionals describe the occurrence of increased reflux (Reflux) of acidic stomach contents into the esophagus as a result of a disturbed locking mechanism of the lower esophageal sphincter.
Symptoms such as heartburn, belching and difficulty swallowing are the result of irritation and damage to the esophageal lining. The transition to reflux-related esophagitis (Reflux esophagitis) is fluent.
Gastroesophageal reflux disease is one of the most common diseases of the digestive tract: around 10% of the population have symptoms of reflux disease, and around a quarter of those affected have symptoms of reflux-related esophagitis.
- Heartburn and acid regurgitation, especially after meals
- Difficulty swallowing (painful)
- Sensation of pressure behind the breastbone
- Possibly dry cough, hoarseness
- Possibly nausea and vomiting.
The discomfort increases when lying down as well as when bending, pressing or exerting yourself.
When to the doctor
In the next few days if
- heartburn occurs several times a week, difficulty swallowing, or chest pain.
Normally, the sphincter at the junction of the esophagus and stomach prevents stomach contents from entering the esophagus. Occasionally, however, this reflux barrier fails and acidic stomach contents flow back into the esophagus. The consequences are heartburn with burning pain and a feeling of pressure behind the breastbone. This reflux occurs occasionally, e.g. B. after a high-fat meal, however, can turn into a pathological form and then trigger the typical reflux symptoms: the heartburn accumulates, the affected person often has to burp, and it is not uncommon for chyme to flow back into the esophagus. He may also have difficulty swallowing. The feeling of pressure behind the breastbone can be so severe that a heart disease is initially suspected.
Accompanying symptoms such as dry cough (reflux cough) and hoarseness often occur, which can simulate a respiratory disease.
A threatening long-term complication is the transformation of the chronically inflamed esophageal mucosa into esophageal cancer.
Causes and Risk Factors
In the end, it often remains unexplained why the reflux barrier fails. What is undisputed, however, is a connection between lifestyle and the onset of illness, above all the frequent consumption of high-fat foods, regular nicotine, alcohol and / or heavy coffee consumption.
The reflux disease seems to be a typical "affluence disease", the incidence of which has increased tenfold in the last 30 years. Other favorable factors are obesity or the pressure caused by the greatly enlarged uterus in the last trimester of pregnancy.
Many medications that are often prescribed nowadays can also trigger or worsen reflux symptoms, e.g. B. antihypertensive drugs, drugs for the therapy of asthma, coronary heart disease and urinary incontinence, estrogen preparations, psychotropic drugs, analgesics of the NASR type such as acetylsalicylic acid or diclofenac, preparations against iron deficiency and some antibiotics.
Reflux disease also occurs as a result of an underlying disease such as scleroderma or a narrowing of the stomach outlet (Tightness of the stomach door) on. In this case, the chyme from the stomach no longer completely reaches the small intestine. As a result, the stomach fills up until there is so much pressure on the stomach entrance that some of the acidic stomach contents flow back into the esophagus. Sometimes reflux disease also occurs after gastric surgery.
In 90% of cases there is a diaphragmatic hernia at the same time as reflux disease (Hiatal hernia): The function of the esophageal sphincter remains intact, but the part of the stomach that has been displaced into the chest due to the tear in the diaphragm promotes the return of acidic stomach contents into the esophagus.
The constant wetting of the sensitive mucous membrane of the esophagus with aggressive, acidic gastric juice initially leads to individual, superficial, localized damage to the mucous membrane and later to large-area ulcers (tissue defects) and scarred constrictions.
As a result, the squamous epithelium in the lower third of the esophagus is pushed back and replaced by gastric mucous membrane-like columnar epithelium, which in this wrong place leads to the formation of ulcers (Barrett's ulcer) tends and eventually even to one Esophageal cancer can degenerate. This history is called Barrett's Syndrome designated. Barrett's syndrome is common: it affects around 15% of patients with gastroesophageal reflux disease (GERD), a significant proportion of whom will later develop esophageal cancer. To prevent this, reflux symptoms must be treated promptly and consistently, and chronic courses must be closely monitored endoscopically.
Other complications of reflux disease include chronic cough, asthma, and dental erosion.
Esophagoscopy. The diagnosis is made with the help of an esophagus (Esophagoscopy; Since the stomach is always examined at the same time, the doctor usually speaks of Esophagogastroscopy) secured with simultaneous tissue removal. To do this, a thin, flexible tube - the endoscope - is pushed into the esophagus. A small video camera on the tip of the endoscope shows changes in the inner wall of the esophagus, such as inflammation or narrowing. At the same time, other diseases can be excluded, e.g. B. Esophageal cancer. The esophagus can also be used to determine the severity of an existing reflux disease.
A look into the esophagus shows bloody, inflammatory (black arrows) and whitish-scarred foci (green arrow) caused by gastric acid flowing back in a patient with severe reflux disease.
Georg Thieme Verlag, Stuttgart
PPI test. Many doctors recommend trial proton pump inhibitors (PPIs). The patient takes proton pump inhibitors for about 2 weeks, which are drugs such as omeprazole that reduce the production of acid in the stomach. If the symptoms disappear after taking the medication, you are likely to have reflux disease. In this case, the medication is continued.
If the symptoms persist despite taking medication, further examinations are indicated, which provide information about the activity of the gastric sphincter or about the amount and frequency of acid backflow into the esophagus. These include long-term acid measurement (pH metry) and the combined pH-metry / impedance measurement (pH-metry-MII).
- pH metry. A pH probe is inserted through the patient's nose, a tube about 1.5 mm thin and equipped with a sensor. The probe measures the reflux of acid into the esophagus for 24 hours. A recording device that the patient hangs over his shoulder records the measured values, which are then later evaluated by the doctor using a computer. During the examination, the patient can move freely and eat and drink normally. To ensure correct catheter placement in the esophagus, an esophageal pressure measurement is usually carried out before the acid measurement. The pH-metry can be carried out in an inpatient or outpatient setting.
- pH-metry-MII. The process corresponds to pH metry. In contrast to this, however, in addition to the pH value, the alternating current resistance (impedance) is determined in various sections of the esophagus. The diagnostic value of the pH-metry MII is higher than that of the pH-metry, which is why it should be preferred if available.
Measurement of esophageal pressure (esophageal manometry). The esophageal pressure measurement is mainly used for differential diagnosis and before surgical interventions on the esophagus. It is considered the gold standard for determining the height of the lower esophageal sphincter for acute pH probe placement. The esophageal pressure measurement is a half-hour painless examination using a probe to measure the pressure at various points in the esophagus and in the stomach entrance to assess the activity of the lower esophageal sphincter and the mobility of the esophagus.
The thin-walled probe, which is pushed through the nose into the esophagus or stomach, contains a balloon with various sensors. For the measurement, the balloon is filled with water and then withdrawn bit by bit. The patient is given sips of water to drink. With every sip, pressure is created on the balloon, the measured values of which are then registered and documented in the computer.
Recently, the High resolution manometry an even more precise esophageal pressure measurement.
The therapy of reflux disease stands on 3 legs, so to speak: the backflow of gastric acid into the esophagus to stop 1. with medication and / or 2. with an operation and 3. minimize the risk of relapse by adopting healthier eating habits.
Initially, drug treatment is in the foreground. It usually leads to a rapid resolution of the symptoms. However, relapses are common if the medication is stopped too early. But relapses are not uncommon even after surgical therapy - and the acidic belching, heartburn and flatulence are back. It is therefore crucial that the doctor discusses lifestyle and eating habits with the patient and, where necessary, recommends improvements.
Drug treatment aims to reduce reflux, reduce its harmful effects and improve the ability of the esophagus to clean itself. The choice of medication also depends on the severity of the disease.
Proton pump inhibitors. If there are signs of regular reflux symptoms, proton pump inhibitors such as omeprazole or pantoprazole, which are the strongest and safest way to block acid production in the stomach, are used. To work properly, they must be taken on an empty stomach.
- Therapy is carried out for 4–8 weeks, depending on the severity of the symptoms. Then an attempt is made to get along without medication (omission attempt).
- To one Acid rebound To prevent excessive gastric acid build-up when the medication is stopped abruptly, the therapy can be gradually terminated.
- If there is a relapse, long-term therapy with a minimally effective dose can be initiated.
- The most common side effects include diarrhea, headache, and upper abdominal pain. If proton pump inhibitors are taken in high doses for a long time, the risk of bone fractures increases.
- Low-dose proton pump inhibitors have been available without a prescription since 2015.
H2 receptor blockers. H2-receptor blockers such as ranitidine or famotidine inhibit the formation of gastric acid and are considered to be the second choice if proton pump inhibitors cannot be used. They work after about 30 minutes and the effect lasts for up to ten hours. Therefore, they are particularly suitable for nighttime or prolonged heartburn. They can be taken with or without meals. Ranitidine is available in low doses without a prescription and should be used for a maximum of seven days.
Antacids. If reflux symptoms only occur occasionally without signs of inflammation of the esophageal lining, antacids help by neutralizing the stomach acid with basic minerals. They are well tolerated and available without a prescription. They take effect after just a few minutes, but are weaker than those of H2-receptor blockers or proton pump inhibitors.
If the drug therapy is not (no longer) tolerated, remains unsuccessful or there is a threat of serious complications, the doctor will suggest surgical constriction to permanently stop the reflux.
The standard operation is the Fundoplicationwhich is usually done in a minimally invasive manner via a laparoscopy. To strengthen the lower sphincter muscle of the esophagus, the doctor sews parts of the stomach in a cuff-like manner, completely or partially around the lower section of the esophagus. If the sewn-on stomach parts completely encase the esophagus, it is a question of one Fundoplication according to Nissen and Rosetti. A partial sheathing is called a Fundoplication according to Toupet. The latter is preferred when the mobility of the esophagus is impaired.
Left: Fundoplication technique: The base of the stomach is sewn around the lower esophagus like a cuff. Right: Endocinch technique: The stomach entrance is narrowed by an artificially created fold of the mucous membrane at the transition between the esophagus and the stomach.
Gerda Raichle, Ulm
The interventions mentioned are mostly successful: 80% of the patients are symptom-free after the operation and no longer need any medication, especially no proton pump inhibitors. With the others, however, the symptoms often worsen (Postfundoplication Syndrome) or it comes to Roemheld Syndromewhich is characterized by a feeling of pressure in the upper abdomen and flatulence due to the accumulation of air in the stomach. Because the air pushes upwards, patients sometimes have the impression that they are now also suffering from heart problems.
Therefore are increasing endoscopic anti-reflux therapies applied so:
- High frequency therapy according to Stretta. The surgeon endoscopically sticks the lower sphincter with needles in order to heat its muscle layer. When the provoked injury heals, scars form, which narrow the transition from the esophagus to the stomach entrance and thus prevent reflux.
- Injection of plastics. This is also done with the aim of sclerosing and scarring the transition from the esophagus to the stomach. The procedures used are Enteryx and Gatekeeper Reflux Repair. Alternatively, bovine collagen implants are also used. All 3 procedures are successful.
- Endocinch: Here the surgeon gathers the mucous membrane just above the stomach entrance and uses a special endoscope to model folds of the mucous membrane as a barrier for gastric juice. This narrows the entrance to the stomach and reduces reflux.
In the majority of those affected, the success rate of endoscopic anti-reflux therapies is comparable to that of fundoplication. However, there is still little long-term experience with these newer methods.
Your pharmacy recommends
What you can do yourself
Improve lifestyle and eating habits. Changing your lifestyle and eating habits is just as important as drug therapy. These measures are therefore part of the standard treatment:
- Eat frequent, small, high-protein, low-fat meals.
- Eat sitting down and do not lie down for 2 hours after meals. This is especially true for the evening meal.
- If you sleep at night with your upper body elevated, it is recommended that the head end be raised by 10–12 cm. If you still want to sleep flat, you can turn on your left side.
- It is better to crouch to bend over instead of bending your upper body down.
- Do not wear constricting clothing such as tightly fastened belts, tight trousers or skirts.
- Quit smoking.
- If you are overweight, it is helpful if you reduce it, preferably very gradually over months and together with a change in diet.
- Avoid alcohol, coffee, peppermint, stomach teas containing bitter substances, high-fat foods, fruit juices, carbon dioxide and tomato sauce, as these stimulate gastric acid production and relax the esophageal sphincter.
- Also, if possible, avoid pain medication - almost all of them put a strain on the stomach.
- If you have trouble coping with ongoing stress, mind-body therapy such as yoga, meditation or autogenic training is recommended to reduce stress.
Phytopharmaceuticals with Iberis amara extract as the main active ingredient are often recommended for reflux symptoms (such as the extract STW-5. Studies have shown that it is effective for irritable stomach and irritable bowel symptoms, but experience has shown that it also improves reflux symptoms.
For mild reflux symptoms, traditional naturopathy recommends a 14-day treatment Roll cure with chamomile flowers: Cook the strongest possible chamomile tea. After cooling down, drink a quarter of it on an empty stomach. Now lie on your back for ten minutes. Then drink the next quarter and now lie on your side. Then repeat the same procedure once more in the prone position and the right side position. So it takes 40 minutes until you have "rolled" around your own axis.
Since the effect is often only weak, you should mix fresh potato juice into the tea, because potato juice acts as an alkaline buffer against heartburn. Alternatively, some patients dissolve Talcid in chamomile tea, an over-the-counter heartburn medication with the active ingredient hydrotalcite. This also improves the relaxing effect.
In the case of regular heartburn, homeopathy recommends, among other things, for acute treatment. the close-knit intake of Acidum sulfuricum, Capsicum and Robinia pseudacacia in lower potencies or as individual constitution therapy. Collinsonia Oligoplex is suitable as a complex agent. Take 10–15 drops with 1 tablespoon of water 3 times a day before a meal.
Notes: All naturopathic procedures cannot cure a serious reflux disease, although they also alleviate the symptoms. Therefore, if the symptoms do not go away within 14 days despite naturopathic therapy, you should be referred to a gastroenterologist - because an endoscopic examination is then probably necessary (see above).
If conventional medical treatment has taken place - or a serious reflux disease has been ruled out - naturopathic methods to prevent relapses and consequential damage are (again) indicated.
- www.gesundheitsinformation.de - Information portal of the Institute for Quality and Efficiency in Health Care.
- www.dgvs.de - Guideline of the German Society for Gastroenterology, Digestive and Metabolic Diseases.
AuthorsDr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 17:54
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