Statistics from the last decade show a high incidence
of gastric ulcers among the population worldwide. Among the most common gastric
problems are gastroesophageal reflux disease and gastritis. Dr. Estera Jeledințan, provides useful information
regarding these two medical problems that often underlie other
gastroenterological conditions or hide in the background serious gastric
diseases. If you are interested in detailed information on
gastric conditions in general, or reflux disease and gastritis in particular,
you can schedule an online consultation for a health assessment for
yourself or for your loved one.
Gastroesophageal reflux versus gastritis
Gastroesophageal reflux disease is represented by the set of
symptoms and signs given by acid reflux of food from the stomach into the
esophagus. The diagnosis is made following an endoscopy, which indicates the
existence of lesions - ulcerations, edema, erythema, streaks - on the
esophagus, and depending on the severity of these lesions, the
gastroenterologist prescribes the necessary treatment. Gastritis, often associated with duodenal ulcer, is on the
other hand, an inflammation of the stomach. The diagnosis is also made after a
double endoscopy and a biopsy, in short, a histopathological examination.
Without the latter, the doctor will only make the diagnosis of dyspepsia, which
does not mean gastritis, and therefore neither the administration of
gastritis-specific treatment. Risk factors and causes In the case of gastroesophageal reflux disease, there
are several contributing factors that lead to the appearance of this problem: • Physiological factors:pregnancy, rare diseases
(scleroderma, Zollinger Edison syndrome, certain surgical interventions -
bariatric gastrectomy/stomach reduction surgery in obese patients).
"Pregnancy causes gastroesophageal reflux in 80% of cases in women in the
first trimester of pregnancy", says dr. Estera Jeledințan. • Dietary factors – consumption of animal fats, citrus
fruits, tomatoes, hot or sour spices, concentrated sweets. • Genetic factorscan cause gastroesophageal reflux.
"If one parent or both or other relatives in the family suffer from
gastroesophageal reflux, there is a genetic predisposition in the child for the
appearance of such digestive problems," explains dr. Jeledințan. Regarding the occurrence of gastritis, there are two
types of acute gastritis and chronic gastritis. Acute gastritis is rarer and is caused by invasive bacteria or
fungal infections - Cryptococcus neoformans, Candida Albicans, Aspergillus,
viruses - Herpes Simplex category, Epstein Barr, Cytomegalovirus, parasites
such as Giardia, Ascaris. All these intruders give serious forms of gastritis
that cause very high mortality among patients and the need for the intervention
of emergency doctors in a hospital. Fortunately, however, more than 70% of
gastritis are chronic gastritis, the doctor assures us. Chronic gastritisoccurs as a result of Helicobacter Pylori
infection, or due to the administration of drugs - iron supplements,
bisphosphates, chemotherapy, anti-inflammatories, heavy metals, drug ingestion
- cocaine, alcohol. "Also, there is a gastritis caused by the reflux of
bile from the duodenum into the stomach. Patients may even have bile reflux
into the mouth, in which case the biliary problem must be treated. The
treatment of gastritis in general must be differentiated according to all these
causes", explains gastroenterologist Estera Jeledințan.
Symptoms specific to gastroesophageal reflux versus
those of gastritis
Symptoms for gastroesophageal reflux disease: • burning sensation in the chest
both after consuming certain drinks or foods and at night; the sensation occurs
more than twice a week • pain when swallowing • feeling unable to swallow food
• strong sour/salty taste in the mouth • nausea • hiccups. "Unfortunately, older patients may not have these
symptoms and for this reason they present themselves to the doctor later, i.e.
they come directly with complications", draws the attention dr. Estera
Jeledințan. "Furthermore, there can be a series of symptoms that don't
even seem to be related to the digestive tract. That is, patients may
experience chest pain that can be caused by esophageal spasm and be mistaken
for heart pain, or they may present to the pulmonologist with aspiration pneumonia
(lungs aspirate stomach contents due to gastroesophageal reflux in during the
night), chronic bronchitis or patients present to the ENT specialist with
hoarseness, chronic cough, laryngitis, all due to reflux disease.” The symptoms of gastritis are: stomach pain, nausea, vomiting,
epigastric pain, sometimes anemia, caused by blood loss in the stool or an
upper digestive haemorrhage. To them is added loss of appetite, weight loss, in
which case rare diseases or even gastric cancer are hidden in the gastritis
subsidiary.
Treatment of gastroesophageal reflux and gastritis
In the case of reflux disease/esophagitis, the
treatment depends on the severity of the lesions on the esophagus and their
cause. In short, the treatment is individualized, depending on the patient. In
acute situations are recommended H2 receptor beta blockers from the
Ranitidine, Famotidine or Gaviscon that do not heal, but quickly reduce the
burning sensation. Also prokinetic drugs - Metoclopramide, Domperidone - help
the rapid evacuation of gastric contents so that there is no more gastric
pressure in the stomach that pushes the content into the esophagus. "For patients with nocturnal reflux, it is
recommended not to eat too late, not to overeat, and for those with a looser
esophageal sphincter (the part that blocks the passage of gastric contents from
the stomach to the esophagus), it helps a lot to raise the pillow or the bed to
15° from the horizontal. In addition, for all patients with reflux disease the
recommendation is not to eat before going to bed, the last meal should be at
least four hours before sleep. Likewise, if we have eaten, we do not quickly
sit down in bed or horizontally (either on the back or on the stomach), nor do
we immediately start exercising. Do not wear anything tight on the abdomen to
put pressure and cause reflux. And obviously, obese people must try to lose
weight", adds dr. Estera Jeledințan. Gastritis is generally treated with proton pump
inhibitors, unless the gastritis was caused by infectious factors such as
Helicobacter Pylori or it is not associated with Crohn's disease, collagenosis
or other diseases. A double dose (twice a day) of proton inhibitors is given
for 1-2 months, then the dose is reduced. If gastritis is caused by Helicobacter Pylori - the
most common cause - then, because the bacteria is quite resistant to
antibiotics, the treatment must be strictly followed. There are only a few
antibiotics to which Helicobacter is sensitive, so three antibiotics are
combined in three types of treatment. Treatment plan I includes: Amoxicillin,
Metronidazole/Tinidazole and Clarithromycin, for 14 days. Has results in 70-80%
of cases. Treatment plan II (the most frequently given, being
more effective than the first scheme) includes: Bismuth, Tinidazole and
Tetracycline. It is more difficult to do, because the drugs must be taken
strictly every six hours for 14 days. Treatment plan III consists of: Tinidazole, Levoxacin
and Amoxicillin, doubled by proton pump inhibitors such as Pantoprazole,
Omeprazole.
Diet in the case of gastroesophageal reflux disease
and gastritis
To be avoided:alcohol (even in small quantities),
cigarettes, coffee - especially in the second part of the day - red meat (beef,
pork, sheep, poultry), citrus fruits, tomatoes, carbonated drinks, minced meat,
salami and smoked products , spicy, irritating or acidic spices such as
vinegar, fast food. Also, dairy products and fermented cheeses are not
indicated either! Allowed:fruits and vegetables, especially boiled,
fish cooked in the oven, on the grill, or boiled or steamed. Olive or sunflower
oil is allowed, but it must not be a reused oil. These dietary recommendations
are supplemented by exercise and weight loss, where patients suffer from
obesity. If you suffer from heartburn or occasional stomach
pain and want to clear any doubts about their cause, or if you often experience
one of the symptoms listed above, you can schedule an online consultation with one of the doctors available
on the Digital Clincis platform for competent advice.
Remember!
1. The fact that a patient tested for Helicobacter
Pylori came out positive does not mean that he has an indication for antibiotic
treatment. "Half of the world's population is infected with this bacterium
and it is very difficult to treat. In order for there to be an indication for
antibiotic treatment, the patient must have a duodenal ulcer - caused by
infection with this bacteria - a situation in which it is absolutely mandatory
to administer one of the antibiotic treatments", underlines doctor Estera
Jeledințan. 2. Once a treatment scheme for Helicobacter Pylori is
decided, the patient must follow it strictly, even if adverse reactions and
inconveniences such as nausea, vomiting, the need to administer medicines at
fixed times also occur. Otherwise, we are only increasing the bacteria's
resistance to antibiotics. 3. Even following strict treatment, 20-30% of patients
may relapse, either because they are infected with a resistant strain or
because they have been reinfected with another strain. 4. Any treatment for esophageal reflux or gastritis
must be individualized by the gastroenterologist who knows the causes and the stage
of the patient's disease.
