Gastroesophageal reflux
| Classification according to ICD-10 | |
|---|---|
| K20 | Esophagitis |
| K21.0 | Gastroesophageal reflux disease with esophagitis |
| K21.9 | Gastroesophageal reflux disease without esophagitis |
| K22.8 | Other specified diseases of the esophagus |
| R12 | heartburn |
| ICD-10 online (WHO version 2019) | |
Gastroesophageal reflux (GÖR, English GER, gastroesophageal reflux ) is the backflow of stomach contents into the esophagus (esophagus). It is heartburn , the cardinal symptom of gastroesophageal reflux. Thus typically associated adverse health effects, the term gastroesophageal reflux disease ( g astro e sophageal r efflux d isease, GERD summarized).
If such a return to not just occasionally, one is cardia - insufficiency based d. H. the internal sphincter ( esophageal sphincter ) that separates the esophagus from the stomach is not working properly. As a result, chyme flows from the stomach back into the esophagus and can lead to reflux esophagitis there, depending on the amount of gastric acid in the stomach contents, the frequency and duration of the reflux .
causes
- Immaturity of the sphincter in the first months of life
- Ejection of the stomach through the diaphragm , axial hiatal hernia , abnormally short esophagus (brachyesophagus)
- Overstrain due to the stomach filling up or high pressure in the abdomen, with obstruction of the drainage from the stomach.
Symptoms
A larger amount of reflux with filling of the entire esophagus up to the pharynx can lead to vomiting . In babies, for example, belching after drinking, but also when lying down, leads to "physiological" reflux.
A distinction is to be made between the “surge-like vomiting” as a result of massive reflux in the case of obstruction with flow obstruction, e.g. B. in pyloric stenosis .
If the reflux is limited to the esophagus, the clinical signs are not so obvious: Especially when lying down, after eating - especially after consuming "acid looseners" (very spicy, very sour or sweet, very hot or cold and very fatty Food, especially hot fats) - after smoking or consuming alcohol or when bending or lifting loads, gastric juices or heartburn may belch . In particularly severe cases, food components can regurgitate , called volume reflux . Even without heartburn, only unspecific chest pain can occur, rarely in the upper abdomen . In these cases, it is difficult to differentiate between heart disease.
Diagnosis
In typical cases, the uncomplicated GÖR is clinically sufficiently recognizable.
Imaging of the presence, extent and possibly the causes of reflux in infancy can be carried out by sonography , as well as by X-rays of the upper gastrointestinal passage . In addition or as an alternative, a 24-hour pH measurement (acid measurement) can be carried out.
Complications
The most important sequela of GOER is reflux oesophagitis . Analogous changes in the pharynx, gastric laryngitis, are possible . Both the diagnosis and the therapy are described in detail there. Prolonged reflux can also lead to non-inflammatory changes in the lining of the esophagus, Barrett's esophagus .
Unnoticed GOR in small children and infants can lead to repeated aspiration, possibly with aspiration pneumonia .
Apart from that, a pronounced reflux can hinder the build-up of food and make it difficult or even impossible to feed through a gastric tube or PEG . In these cases, surgery, usually a laparoscopic fundoplication , is an option , even without inflammatory changes .
Individual evidence
- ^ W. Pschyrembel, Clinical Dictionary, Verlag Walter de Gruyter, 265th edition (2014) ISBN 3-11-018534-2 .
- ↑ a b W. Schuster, D. Färber (Ed.): Children's radiology. Imaging diagnostics. Springer 1996, ISBN 3-540-60224-0 .
- ^ E. Richter, W. Lierse: Radiological anatomy of the newborn for X-rays, sonography, CT, MRI, 1990 Urban & Schwarzenberg, ISBN 3-541-13141-1 .
- ^ V. Hofmann, KH Deeg, PF Hoyer: Ultrasound diagnostics in paediatrics and pediatric surgery. Textbook and atlas. Thieme 2005, ISBN 3-13-100953-5 .
- ^ FC Sitzmann: Pediatrics. Diagnostics - therapy - prophylaxis. 6th edition, Hippocrates 1988, ISBN 3-7773-0827-7 .
