The famous Heartburn and mysterious Celiac Disease.
GERD (gastroesophageal reflex disease) – one of the most frequent violations of the digestive system. About 40-60% of adults occasionally feel heartburn, 24% of which it is observed for more than 10 years; 17% of the population in need of medication over heartburn at least one time per week. However, patients typically dispose of heartburn symptoms themselves, which leads to the return and its progression esophagitis. Today GERD can be cured, but this patients better consult a doctor rather than a pharmacist.
Celiac disease or gluten intolerance – pathology caused by intolerance to gluten – a specific protein of wheat, rye, barley and oats. The disease is characterized by inflammatory changes in the wall of the small intestine epithelium atrophy of the villi and crypts hypertrophy. Patients with celiac disease significantly reduced quality of life, and mortality is 10-30% higher compared with the general population. The method of treatment of celiac disease is obvious – gluten-free diet. However, today the main problem remains the proper diagnosis of this disease.
– The main objectives of the treatment of GERD is possible more rapid relief of symptoms, prevention of relapses, the healing of erosions, and prevention of complications.
In accordance with the algorithm for the treatment of GERD, presented in 2006, the American Gastroenterological Association, the presence of heartburn more than 2 times a week for more than 3 consecutive weeks should seek help from a gastroenterologist. In the absence of anxiety symptoms patients received standard-dose PPI – 1 tablet 1 time per day. If persistent symptoms after 4 weeks of dose increased by 2 times. If after this manifestation is not eliminated, the diagnosis should be clarified with the help of endoscopy. In the case of a patient as a result of endoscopic reflux esophagitis A or B level do not change the treatment algorithm, with C or D degree of treatment lasts for at least 8 weeks (preferably 12) full dose PPIs. After achieving control of symptoms is necessary to carry out individual selection of doses and to appoint maintenance therapy. In case of failure to control the symptoms of STIs dose should be increased by 2 times and taken twice a day – morning and afternoon for 30-40 minutes before eating (80 mg / day rabeprazole). In the absence of results is necessary to clarify the diagnosis.
– Today, GERD is a very urgent problem. Only in our Gastroenterological Center every day with this problem comes about 10 patients. According to the manual, published by the American Gastroenterological Association (2006), patients young and middle (45-50 years of age) with a relatively short (up to 5 years) history, as well as the absence of alarm symptoms of GERD endoscopy should not be spending enough empirical treatment purpose. In the case of clinical response to PPI therapy for GERD diagnosis is established and appointed by the 4-8-week treatment with standard doses of PPI in the morning for 30-40 minutes before eating. However, according to different authors, in 25-42% of cases, this treatment is not effective enough.
To subsequently these cases could be classified as refractory GERD, we must be sure that the patient complies with the recommendations. A recent study showed that about 70% of family physicians and 20% of gastroenterologists prescribed PPI at night or do not consider the important relationship of the drug from the meal. This is a misconception, and we need to inform their colleagues.
In case of insufficient therapeutic effect of the majority of doctors increase the dose PPI 2 times. Medications taken before breakfast and dinner. In this treatment regimen are responsible for approximately 25% of patients. Patients who in this reception mode do not respond to treatment, should be considered as refractory GERD.
The subsequent correction of the treatment of the data subject may include cancellation of medicines, diet modification, the appointment of another STI, adding H2-blocker or pro-kinetics.
Early diagnosis of refractory GERD, revealing its probable causes and subsequent drug correction with the help of modern anti-secretory drugs can improve the results of treatment of these patients.
An important point in the treatment of patients with celiac disease is the presence on the market of a sufficient number of gluten-free products and informing the public about this disease.