Gerb on mkb 10 in adults. Gerb what is it in gastroenterology? What you need to know about gastroesophageal reflux disease. Is it possible to cure herb in a conservative way

Before you know how GERD is classified according to the ICD 10 code, you need to consider what kind of disease it is.

It is a lesion of the mucous membrane of the esophagus. The abbreviation can be deciphered as follows: gastroesophageal reflux disease.

It is characterized by periodic reflux of stomach contents back into the esophagus. In this case, the sphincter is affected, inflammation develops.

Features of the classification according to the ICD code

Reflux esophagitis is a complex disease characterized by unpleasant symptoms and painful sensations. A person cannot eat what he wants, because after that there is severe discomfort.

Pathology is manifested by heartburn, regurgitation, bad breath. In some cases, there is an increase in temperature, the urge to vomit, the inability to swallow food.

Classification of esophagitis will help determine the direction of treatment. International code diseases - K21.

However, this pathology can have various forms, which also need to be considered:

1. ICD K-21. This is refractory GERD, in which the patient not only develops inflammatory process in the area of ​​the sphincter. Erosions appear on this part of the organ.
2. K-21.2. In this case, the esophageal component is absent. That is, there are unpleasant symptoms, but they are not associated with damage to the inner surface of the esophagus, since they are not.

Clinical manifestations of the disease are present in both cases, but they are different. In the second case, there is no threat to life.

Important! The cause of GERD can be both a physiological factor and a psychosomatic one. The cause of the development of pathology must be clarified before treatment is carried out.

Classification of pathology according to the degree of development

If the pathology is not treated, it will progress. It has several stages in its development. The classification of GERD in this case is as follows:

1. first degree - the last areas are characterized by reddening of the tissues, small erosions, although sometimes such signs cannot be detected);
2. the second stage - damage extends to more than 20% of the esophagus, the patient develops persistent heartburn;
3. third degree - not only the upper layer of the mucous membrane is destroyed, but also deeper tissues; ulcers appear that affect the muscles. The stage is characterized by burning, pain in the chest, aggravated at night;
4. the fourth - is characterized by damage to almost the entire surface of the mucous membrane, while the symptoms are significantly enhanced;
5. the fifth stage is the most severe form of pathology, in which various complications of GERD already appear.

Note! This classification is the most common and understandable. On its basis, therapeutic measures are prescribed to help eliminate damage to the mucous membrane and symptoms.

Los Angeles Classification

This classification was proposed in the last century in Los Angeles. It has its own characteristics. The Los Angeles classification proposes to define the disease by the parameter of how extensive the lesion is.

With any type of lesion according to this classification, various complications are possible.

Any classification of GERD according to the ICD code or other parameters provides for easier diagnosis for doctors. They have the opportunity to quickly begin treatment and eliminate the cause of the development of pathology.

Organ diseases digestive system ubiquitous among both adults and children. Such a pathology as duodenogastric reflux causes a lot of discomfort and contributes to the development of serious complications from the stomach and esophagus.

A timely visit to the doctor will allow you to recognize the disease in the early stages and prevent its progression.

What is duodenogastric reflux (DGR): this term refers to the pathological reflux of bile, gastric and pancreatic juices into the stomach and lumen of the esophagus due to weakness of the obturator sphincters.

Normally, digested and crushed food (chyme) enters the lumen small intestine through the pyloric part of the stomach, which is represented by a powerful circular muscle - the pyloric sphincter. Its contraction prevents the reverse flow of intestinal contents.

Many scientists are inclined to believe that biliary or biliary reflux is not an independent disease, but a syndrome that occurs against the background of existing pathologies of the gastrointestinal tract. In some cases, it is considered to be a gastroesophageal reflux disease, in which the reflux of bile into the stomach is quite common.

The urgency of the problem lies not only in the high prevalence, but also in the fact that the presence of duodenogastric bile reflux contributes to the development of concomitant pathologies, a deterioration in the quality of life. With untimely diagnosis, DGR acquires chronic course with frequent relapses, which ultimately entails an increase in the duration and cost of treatment.

ICD-10 code

According to the tenth revision of the International Classification of Diseases Board, biliary reflux does not have its own ICD code, which once again confirms the secondary nature of its occurrence. The syndrome may be part of such diagnoses:

• Gastroesophageal reflux disease(K.21).
• Duodenitis(K.29).
• Gastritis(K.29.3).
• Gastroduodenitis of unknown etiology(K.29.9).

Causes of the disease and risk factors

An independent course of gastroduodenal reflux occurs in 25% of cases of all violations of the valvular apparatus of the digestive system. Otherwise, the pathology is due to the presence of other diseases of the gastrointestinal tract in the patient.

These include:

• chronic gastroduodenitis, gastritis;
• chronic pancreatitis and cholecystitis;
• functional dyspepsia and irritable bowel syndrome;
• peptic ulcer duodenum, stomach;
• giardiasis, helminthic invasion;
• congenital anomalies of the gastroduodenal zone.

The main causes of bile (alkaline) reflux also include:

Among the provoking factors, it is worth noting elderly age, irregular rough nutrition, overeating, alcohol abuse, smoking, long-term and uncontrolled use of NSAIDs (non-steroidal anti-inflammatory drugs). An important role in the genesis of reflux is played by the high acidity of gastric juice, undergone operations on the stomach, intestines.

The mechanism of development of duodenogastric reflux

The work of the digestive organs is a complex and multi-stage mechanism that is implemented through nervous regulation, the effects of hormones and neuropeptides. The work of the pyloric sphincter is influenced by the branches of the vagus nerve, the autonomic nervous and endocrine systems.

The stomach, in turn, produces a hormone - gastrin, which regulates the peristalsis of the organ and has a direct effect on the tone of the pyloric sphincter. Normalizes the motility of gastric sphincter glucagon, cholecystokinin, secretin, histamine. The work of the muscular apparatus of the digestive tube depends on their concentration.

Hormonal imbalance, disturbed nervous regulation - all this contributes to the occurrence of pathological reflux of duodenal contents into the stomach cavity, often into the lumen of the esophagus.

Pregnancy is another common factor in pathology. An enlarged uterus leads to an increase in intra-abdominal pressure in abdominal cavity and squeezing the duodenum, causing bile regurgitation, digestive enzymes up and symptoms.

Useful video

What is the danger: possible complications of the disease

The most common complication of duodenogastric reflux is erosive gastritis. This is a chronic inflammation of the gastric mucosa with the appearance of small shallow defects on it - erosions. This consequence is due to the action of aggressive bile acids with hydrochloric acid.

Pictured is Barrett's esophagus.

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2017

Gastroesophageal reflux (K21), Gastroesophageal reflux without esophagitis (K21.9), Gastroesophageal reflux with esophagitis (K21.0)

Gastroenterology

general information

Short description

Approved
Joint Commission for Quality medical services
Ministry of Health of the Republic of Kazakhstan
dated June 29, 2017
Protocol No. 24

Gastroesophageal reflux disease is a chronic relapsing disease caused by a violation of the motor-evacuation function of the organs of the gastroesophageal zone and is characterized by spontaneous or regularly repeated throwing of gastric or duodenal contents into the esophagus, leading to the development of inflammatory changes in the distal esophagus and / or characteristic clinical symptoms.

INTRODUCTION

ICD-10 code(s):

Date of development/revision of the protocol: 2013/ revision 2017.

Abbreviations used in the protocol:

Classification

Classification of GERD:

according to clinical forms:
non-erosive reflux disease (NERD) (60-65% of cases);
erosive (reflux esophagitis) (30-35% of cases);
Barrett's esophagus (5%).

to assess severity:
clinical criteria:
mild - heartburn less than 2 times a week;
medium - heartburn 2 times a week or more, but not daily;
severe - heartburn daily.

endoscopic criteria:
Currently, a modified Savary-Millera classification or Los Angeles classification of esophagitis, 1994 is used. (Table 1).

Table 1. Modified classification of esophagitis according to Savary-Miller

Diagnostics

METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSIS AND TREATMENT

Diagnostic criteria: collection of complaints according to Table 3.

Table 3 Clinical manifestations of GERD

Differential Diagnosis

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Treatment

Drugs ( active substances) used in the treatment

Treatment (ambulatory)

TACTICS OF TREATMENT AT OUTPATIENT LEVEL:
Treatment tactics include non-drug methods and pharmacotherapy.

Non-drug treatment:
Non-drug treatment consists of following recommendations for lifestyle and dietary changes (anti-reflux measures), which should be followed. special meaning in GERD therapy (Table 5).

Treatment (hospital)

TACTICS OF TREATMENT AT THE STATIONARY LEVEL

Non-drug treatment: see Table 5 ambulatory level.

Goals, treatment tactics, other methods of treatment, criteria for the effectiveness of treatment: see ambulatory level.

Surgical intervention:
Surgical GERD treatment it is an equally effective alternative to medical treatment and should be offered to eligible patients (Grade A).

Indications:
With a specified diagnosis of GERD, the indications for surgical (surgical) treatment are:
ineffective medical treatment (inadequate symptom control, severe regurgitation, uncontrolled acid suppression and side effects from taking medication)
selection of patients despite successful medical treatment (for reasons of quality of life, which is affected by the need to take medicines throughout life, the high cost of medicines, etc.) (Grade A);
the presence of complications of GERD (for example, Barrett's esophagus, peptic strictures, etc.);
The presence of extraesophageal manifestations ( bronchial asthma, hoarseness, cough, chest pain, aspiration).

Preoperative examination:
The purpose of the preoperative examination is to select suitable patients with reflux for surgical treatment.

Approaches to the scope and order of preoperative examinations:
EGDS with biopsy - confirms the diagnosis of GERD, and also identifies other causes of disorders of the esophagogastric mucosa and allows you to take a biopsy;
· pH-metry;
Esophageal manometry - more often performed before surgery and allows you to determine conditions that may be contraindications to fundoplication (such as esophageal achalasia), or change the type of fundoplication, according to an individual approach based on esophageal motility;
· barium suspension study - for patients with large hiatal hernia who have a shortened esophagus.

Patients undergoing laparoscopic antireflux surgery should be informed prior to surgery of the possible frequency of symptom recurrence and return to acid-reducing drugs (Grade A).

Identification of Barrett's esophagus with adenocarcinoma involving the submucosal layer or deeper excludes the patient from those scheduled for antireflux surgery and requires full oncotherapy (esophagectomy, chemotherapy, and/or radiation therapy) appropriate to the stage of the process.

Preventive actions:
anti-reflux measures;
antisecretory therapy;
Mandatory maintenance therapy;
· dynamic observation of the patient for monitoring (endoscopic with biopsy according to indications) complications (detection of Barrett's esophagus).

Further management:
Follow-up of patients to monitor complications, identify Barrett's esophagus and control symptoms with medication. Intestinal metaplasia of the epithelium is the morphological substrate of Barrett's esophagus. Its risk factors: heartburn more than 2 times a week, duration of symptoms for more than 5 years.
When the diagnosis of Barrett's esophagus is established, to detect dysplasia and adenocarcinoma of the esophagus, control endoscopic and histological studies should be carried out after 3, 6 months and then annually against the backdrop of PPI maintenance therapy. With the progression of dysplasia to a high degree, the question of surgical treatment(endoscopic or surgical) in a specialized institution of the republican level.

Indicators of treatment efficacy and safety of diagnostic and treatment methods:
relief of clinical symptoms;
erosion healing;
prevention or elimination of complications;
Improving the quality of life.

Hospitalization

INDICATIONS FOR HOSPITALIZATION (AH)

Indications for emergency hospitalization:
bleeding from ulcers of the esophagus;
strictures of the esophagus.

Indications for planned hospitalization:
· failure of medical treatment (inadequate symptom control, severe regurgitation, uncontrolled acid suppression and/or side effects of medical treatment);
Complications of GERD (Barrett's esophagus, peptic strictures);
if there are extraesophageal manifestations (asthma, hoarseness, cough, chest pain, aspiration).

Information

Sources and literature

1. Minutes of the meetings of the Joint Commission on the quality of medical services of the Ministry of Health of the Republic of Kazakhstan, 2017
   1. 1) Gastroenterology. National leadership / edited by V.T. Ivashkina, T.L. Lapina - M. GEOTAR-Media, 2012, - 480 p. 2) Diagnosis and treatment of acid-dependent Helicobacter-associated diseases. Ed. R. R. Bektaeva, R. T. Agzamova, Astana, 2005 - 80 p. 3) C.P.L. Travis. Gastroenterology: Per. from English. / Ed. S.P.L. Travis and others - M .: Med lit., 2002 - 640 p. 4) Manual of gastroenterology: diagnosis and therapy. Fourth edition. / CananAvunduk–4th ed., 2008 - 515 p. 5) Practical Manual of Gastroesophgeal Reflux Disease /Ed.by Marcelo F. Vela, Joel E. Richter and Jonh E. Pandolfino, 2013 –RC 815.7.M368 6) Prevention and management of chronic upper gastrointestinal disease / edited by B .T.Ivashkina.-3rd ed., revised. and additional - MEDpress-inform, 2014.-176 p. 7) Dyspepsia and gastrooesophageal reflux disease: investigation and management of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease, or both Clinical guideline (update) Methods, evidence and recommendations September 2014 https://www.nice.org.uk/guidance /cg184/chapter/1-recommendations 2.Evidence-Based Gastroenterology and Hepatology, Third Edition John WD McDonald, Andrew K Burroughs, Brian G Feagan and M Brian Fennerty © 2010 Blackwell Publishing Ltd. ISBN: 978-1-405-18193-8 8) Diagnosis of extraesophageal manifestations of gastroesophageal reflux disease / N.A. Kovaleva [et al.] // Ros.med. magazine - 2004. - No. 3. - S. 15-19. 9) Diagnosis and treatment of gastroesophageal reflux disease: a guide for doctors / V.T. Ivashkin [and others]. - M., 2005. - 30 p. 10) The montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus / N. Vakil // Am. J. Gastroenterol. - 2006. - Vol. 101. - P. 1900-2120. 11) Peterson W.L. Improving the Management of GERD. Evidence-based therapeutic strategies / W.L. Peterson; American Gastroenterological Association. – 2002. – Access mode: http://www.gastro.org/user-assets/documents/GERDmonograph.pdf. 12) Gastroesophageal reflux disease: textbook.-method. allowance / I.V. Maev [and others]; ed. I.V. Maeva. - M. : VUNMTs of the Ministry of Health of the Russian Federation, 2000. - 52 p. 13) L I Aruin V A Isakov. Gastroesophageal reflux disease and Helicobacter pylori. Klin medicine 2000 No. 10 C 62 - 68. 14) V T Ivashkin AS Trukhmanov Diseases of the esophagus Pathological physiology clinic diagnostics treatment. M: "Triad - X" 2000 178 p. 15) Kononov A V Gastroesophageal reflux disease: a morphologist's view of the problem. Russian Journal of Gastroenterology, Hepatology and Coloproctology 2004.- T 14 No. 1 C 71 - 77. 16) Maev I V, E S Vyuchnova E G Lebedeva Gastroesophageal reflux disease: a teaching aid. M: VUNMTsMZRF 2000 52 p 17) C.A. Fallone, A.N. Barkun, G. Friedman. Is Helicobacter pylori eradication associated with gastroesophageal reflux disease? Am. J. Gastroenterol. 2000 Vol. 95. P. 914 - 920. 18) Bordin D.S. A new approach to increasing the effectiveness of proton pump inhibitors in a patient with gastroesophageal reflux disease. Attending doctor. 2015.- №2. pp. 17-22. 19) 19. Lazebnik L.B., Bordin D.S., Masharova A.A. and others. Factors affecting the effectiveness of the treatment of GERD with proton pump inhibitors// Ter.arhiv.- 2012.- 2: 16-21. 20) www.drugs.com Drug database maintained by the FDA (USA) 21) Instructions for use of drugs from the database of the National Center for Expertise of Medicines and Medical Devices of the Republic of Kazakhstan (www.dari.kz) 22) Gastroesophageal Reflux Disease Treatment & Management (www.http://emedicine.medscape.com/article/176595-treatment?src=refgatesrc1#d11) 23) Gastroesophageal reflux disease (GERD) / University of Michigan Health System (UMHS) and the National Guideline Clearinghouse (NGC) / Agency Healthcare Recearch and Qlity (AHRQ) / USA 24) O'Mahony D., O'Sullivan D., Byrne S. et. al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2 // Age and Aging. 2014. DOI: 10.1093/ageing/afu145. 25) Körner T1, Schütze K, van Leendert RJ, Fumagalli I, Costa Neves B, Bohuschke M, Gatz G. / Comparable efficacy of pantoprazole and omeprazole in patients with moderate to severe reflux esophagitis. Results of a multinational study / Digestion. 2003;67(1-2):6-13.

Information

ORGANIZATIONAL ASPECTS OF THE PROTOCOL

List of protocol developers with qualification data:
1) Bektaeva Roza Rakhimovna - Doctor of Medical Sciences, Professor, Head of the Department of Gastroenterology and Infectious Diseases, Astana Medical University. Chairman of the National Association of Gastroenterologists of the Republic of Kazakhstan.
2) Iskakov Baurzhan Samikovich - Doctor of Medical Sciences, Professor, Head of the Department of Internal Diseases No. 2 with courses of related disciplines of the Kazakh National Medical University named after S.D. Asfendiyarov, Chief Freelance Gastroenterologist of the Health Department of Almaty, Deputy Chairman of the National Association of Gastroenterologists of the Republic of Kazakhstan.
3) Makalkina Larisa Gennadievna - Candidate of Medical Sciences, Associate Professor of the Department of Clinical Pharmacology internship JSC "Astana Medical University", Astana.

Indication of no conflict of interest: no.

Reviewers:
1) Shipulin Vadim Petrovich - Doctor of Medical Sciences, Professor, Head of the Department of Internal Medicine No. 1 of the National Medical University named after A.A. Bogomolets. Ukraine. Kyiv.
2) Bekmurzayeva Elmira Kuanyshevna - Doctor of Medical Sciences, Professor, Head of the Bachelor Therapy Department of the South Kazakhstan Pharmaceutical Academy. The Republic of Kazakhstan. Shymkent.

Conditions for revision of the protocol: revision of the protocol 5 years after its publication from the date of its entry into force or in the presence of new methods of diagnosis and treatment with a level of evidence.

Appendix 1

ALGORITHM FOR DIAGNOSIS AND TREATMENT AT THE STAGE OF EMERGENCY MEDICAL CARE:

Diagnosis and treatment at the ambulance stage emergency care:
collection of complaints, anamnesis of the disease and life;
physical examination.

Diagnostic criteria (LE - D) :
Complaints and anamnesis:

Complaints:
heartburn (stubborn, painful) both after eating and on an empty stomach;
pain in the chest (burning character) aggravated by physical exertion and bending over;
a feeling of discomfort in the chest area;
· weight loss;
Decreased appetite
Coughing and shortness of breath at night
hoarseness of voice in the morning;
vomiting of blood.

Anamnesis:
Constant use of acid-lowering drugs and antacids;
The patient may have Barrett's esophagus.

Attached files

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They can hurt both children and adults. The disease is usually accompanied by heartburn, vomiting and belching. Esophagitis code according to the international classifier ICD-10: K20.

• intake of acids or alkalis (chemical burn);
• physical injury;
• infections, eg HIV, appendix;
• inflammatory processes in the intestines;
• food irritants (allergens).

The course of the disease is classified into acute and chronic forms.

Classification of esophagitis according to morphological forms:

• catarrhal-edematous (the mucous membrane becomes red, begins to swell);
• erosive (ulcers appear on the esophagus);
• hemorrhagic (blood is visible on the walls of the esophagus);
• necrotic (black ulcers);
• phlegmonous (esophagus swells, begins to fester);
• exfoliative (a film forms on the esophagus, if it is torn off, wounds will appear). Is a sign of diphtheria;
• pseudomembranous (typical for scarlet fever).

Esophagitis code according to ICD-10

According to ICD-10 (International Classification of Diseases), the disease refers to diseases of the esophagus, stomach and duodenum. Reflux esophagitis according to ICD-10 has the following classification: K21.0 - reflux with esophagitis, K21.9 - without esophagitis.

Classification of esophagitis according to Savary Miller:

1. Grade A: the affected area of ​​the esophagus is relatively small (about 4 mm), there are several ulcers (erosions) that do not merge with each other.
2. Grade B: the area increases to 5 mm, erosions can merge.
3. Grade C: The ulcer affects already about ½ of the esophagus.
4. Grade D: The esophagus is 75% affected.

Acute reflux esophagitis is accompanied by diseases in the stomach. Causes of chronic - alcohol consumption, smoking, unhealthy diet.

The most important thing is not to overwork your body, to give up active physical exertion. Mineral water is also an indispensable assistant in this matter. It helps to reduce the acidity of gastric juice, helps the intestines to function normally. If you have this disease or at the slightest suspicion of it, immediately consult a doctor. Only he can prescribe the right treatment.

The number of patients with esophagitis began to increase annually. Many are in no hurry to be treated, believing that discomfort.

Esophagitis is an inflammatory disease of the walls of the esophagus, the inflammatory process affects the walls of the mucous membrane. At.

One of the inflammatory diseases of the gastrointestinal tract, namely the esophagus, is esophagitis. It arises from.

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PANCREATITIS

TYPES OF PANCREATITIS

WHO HAPPENS?

TREATMENT

NUTRITION BASICS

CONSULT YOUR PHYSICIAN!

Gastroesophageal reflux (K21)

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is accepted as a unified normative document to account for morbidity, the reasons for the population's appeals to medical institutions of all departments, and the causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

What is reflux esophagitis? Who does it occur and why is it dangerous?

Diseases of the digestive tract are increasingly reminding themselves of modern man. Due to malnutrition and an unhealthy lifestyle, the gastrointestinal tract suffers primarily.

One of the most common diseases of the esophagus is reflux esophagitis (gastrointestinal reflux, gastroesophageal reflux disease, GERD, reflux esophagitis, reflux gastroesophagitis).

Let's figure out what reflux esophagitis is, what kind of disease it is, what are its symptoms, treatment and diet.

What is reflux esophagitis in adults, ICD-10 disease code

Reflux esophagitis is a disease that occurs due to contact of the mucous membrane of the esophagus with the contents of the stomach, when, due to the weakness of the lower esophageal sphincter, part of the gastric contents is thrown up into the esophagus.

Due to increased acidity, the lower part of the esophagus becomes inflamed, and this leads to the appearance of pain. Often gastroduodenitis, gastritis, esophagitis and reflux develop and proceed simultaneously with each other.

According to the International Classification of Diseases 10 revision, reflux esophagitis belongs to the group of diseases of the esophagus, stomach and duodenum, which have a code (K20-K31). Code K20 refers specifically to esophagitis, but to identify the main cause of the appearance, an additional code is used related to external reasons and XX grade.

In code K20 there are exceptions for: erosion of the esophagus, reflux esophagitis and esophagitis with gastroesophageal reflux. Gastroesophageal reflux disease has a separate code - K21.

Causes of reflux esophagitis in adults

To protect yourself from the appearance of reflux esophagitis, you need to know the main risk factors for developing this disease and possible reasons its development. Experts note that the main factors that provoke the appearance of such an inflammatory process are:

• obesity;
• frequent vomiting;
• installation of a nasogastric tube (for enteral nutrition);
• pregnancy;
• hernia of the diaphragm of the food opening.

All this can provoke the appearance of reflux esophagitis. There are a number of reasons due to which this disease can appear, regardless of the above factors:

• stomach or duodenal ulcer;
• pylorospasm;
• surgical interventions associated with the esophageal opening of the diaphragm;
• taking medications that reduce the tone of the esophageal sphincter;
• gastritis with pathogenic development Helicobacter bacteria pylori;
• tobacco and alcohol abuse.

Inflammation of the lower esophagus can appear both against the background of existing diseases and as a result of an unhealthy lifestyle.

How the disease develops

As statistics show, almost half of the adult population has manifestations of gastroesophageal reflux. Of this number, 10% of people have endoscopic signs of the disease. This suggests that the mechanism of development of this disease is quite imperceptible.

Sometimes people after eating feel the appearance of heartburn or nausea, but they do not see the point in going to the doctor. Often, this disease of the esophagus is diagnosed already as a result of the development of more complex inflammatory processes in the gastrointestinal tract.

Nature has given our body several protective functions against the appearance of reflux.

First, the lower esophageal sphincter must establish an anti-reflux barrier in a timely manner.

If the relaxation of this part of the esophagus occurs for a long time, then its mucous membrane is longer exposed to the negative effects of acids.

Secondly, saliva is able to neutralize the negative effect of hydrochloric acid, which is important when throwing the contents of the stomach into the esophagus. In people who already have developed reflux esophagitis, doctors note unsatisfactory gastric motility and disruptions in the volume of salivation.

What is the importance of psychosomatics in development

Even Cicero in the 1st century BC. it has been proven that all diseases of the body are due to pain in the soul. The psychological state plays an important role not only in terms of the treatment of diseases, but also at the stage of their appearance. Diseases of the gastrointestinal tract are often referred to as diseases associated with psychosomatics.

American psychotherapist Milton Erickson claims that every disease initially occurs in our head, and only then it manifests itself on the body. As for reflux esophagitis, he is sure of its psychosomatic origin. The main problem of this disease is the direction of the contents of the stomach not towards the intestines, but towards the esophagus. That is, there is a misdirection of processed food.

This condition may occur as a result of changes in gastric motility. Often, the appearance of gastro-food reflux at the subconscious level is due to a person’s desire to turn back time in order to correct some actions in their lives.

Treatment of psychosomatic disorders is carried out by a psychotherapist. He has many in his arsenal. various methods treatment. The brightest are: NLP, art therapy, hypnosis, psychoanalysis, family therapy, etc.

Varieties of the disease

When it comes to reflux esophagitis, few people know that this disease has several varieties.

Superficial reflux esophagitis

Superficial or catarrhal reflux esophagitis: what is it? Often the disease is a mechanical damage to the mucous membrane of the esophagus. This type of disease is not characterized by the appearance of erosion. It can often appear due to trauma to the mucous membrane, for example, fish bones.

Also, this disease can manifest itself due to excessive consumption of fatty foods, coffee, hot spices and alcohol.

Erythematous form

Erythematous reflux esophagitis is characterized by the presence of hemorrhages in the esophagus. It also manifests itself due to the long stay of the contents of the stomach in the lower esophagus. When an endoscopic examination is performed, the esophagus of such patients has red edema and traces of hemorrhage. The mucous membrane has a purulent exudate.

Peptic reflux esophagitis

Peptic reflux esophagitis is most often chronic, as the reflux of stomach contents occurs constantly. Also, this disease is progressive.

Also, the disease can have different degrees of severity - 1, 2, 3 or 4th degree. Details about the degrees of the disease and the symptoms of each of them are described in this article.

Why is reflux esophagitis dangerous?

Often patients with reflux esophagitis do not consider this disease dangerous, but this is absolutely not the case. For a long time, such inflammation of the esophagus may generally not declare itself in any way.

The person will think that he just has heartburn or nausea due to overeating. Of course, such cases are possible, but if such symptoms persist long time, then you should consult a gastroenterologist.

When the disease is in a state of neglect, erosion may appear on the walls of the esophagus, that is, erosive reflux esophagitis is formed. They cause hemorrhages, provoking an even greater growth of the ulcer. In places of ulcers in the absence proper treatment and non-compliance with the diet, oncological neoplasms may appear in the future.

In addition, in advanced cases of the disease, such serious complications of GERD as Barrett's esophagus, as well as achalasia of the cardia, can form. Therefore, the appearance of this disease should be taken seriously!

It is impossible to postpone a visit to the doctor, since in the early stages this disease can be cured much faster and easier.

How the disease manifests itself: symptoms

The symptoms of this disease are as follows:

• heartburn (can be both during the day and at night),
• burp,
• hiccups after eating
• aching pain in the sternum (reminiscent of pain in the heart),
• difficulty in swallowing,
• nausea.

It is worth remembering that sometimes the symptoms of gastro-food reflux may not be related to the digestive tract at all. Rarely, but toothaches, rhinitis, pharyngitis, cough appear.

Useful video

We offer you to watch an interesting and useful video about what reflux esophagitis is and what is important to know about this disease:

How does a doctor diagnose reflux esophagitis?

Any diagnosis of the disease should begin with a consultation with a doctor. The doctor will clarify the nature of the pain, its frequency and duration. Also, the doctor can find out the patient's dietary habits in order to determine his lifestyle. After the conversation, the doctor may conduct a tongue examination.

With gastro-food reflux, the tongue may be covered with a white coating. To exclude other diseases, the doctor must palpate the abdomen.

If none pain not detected, then the patient is sent for instrumental examination.

With the help of a probe and a camera at its end, you can see a clear picture of the disease of the gastrointestinal tract. With reflux, the lining of the esophagus will be red. In some cases, the doctor may order tissue sampling in this area for additional research.

Also used for diagnosis:

• x-ray,
• daily pH-metry (determination of the level of acidity),
• esophagomanometry (determination of the functionality of the lower esophageal sphincter),
• ECG (to rule out heart disease),
• Chest x-ray (to rule out lung disease).

In the complex, all diagnostics will allow you to see an accurate picture of the course of the disease. The main thing is to see a doctor in time.

Treatment of the disease

Proper treatment of GERD should be carried out according to the following schemes (see the link for more details). It should be comprehensive and include the appointment of certain drugs, including antacids. In addition, with this disease, a special therapeutic diet is prescribed to alleviate the condition.

ICD code: K21.0

Gastroesophageal reflux with esophagitis

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Unified Tariff and Qualification Directory of Works and Professions of Workers

Gastroesophageal reflux. Other diseases of the esophagus

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)

Version: Archive - Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan (Order No. 239)

general information

Short description

GERD (gastroesophageal reflux disease) is a complex of characteristic symptoms with an inflammatory lesion of the distal esophagus due to repeated reflux of gastric and, in rare cases, duodenal contents into it.

Protocol "Gastroesophageal reflux. Other diseases of the esophagus"

K21.0 Gastroesophageal reflux with esophagitis

K21.9 Gastroesophageal reflux without esophagitis

K 22.0 Achalasia of the cardia

K22.1 Esophageal ulcer

Classification

Classification of GERD (according to Tytgat, modified by V.F. Privorotsky et al. 1999)

According to endoscopic signs:

Grade 1: moderately severe focal erythema and (or) friability of the mucous membrane of the abdominal esophagus. Moderately pronounced motor disturbances in the region of the lower esophageal sphincter, briefly provoked subtotal (along one of the walls) prolapse to a height of 1-2 cm, decreased sphincter tone.

Grade 2: signs characteristic of grade 1, in combination with total hyperemia of the abdominal esophagus with focal fibrinous plaque. Perhaps the appearance of focal surface erosions, often linear in shape, located on the tops of the folds of the mucous membrane of the esophagus. Motor disorders: distinct endoscopic signs of insufficiency of the gastric valves, total or subtotal provoked prolapse to a height of 3 cm with possible partial fixation in the esophagus.

Grade 3: signs characteristic of grade 2, in combination with the spread of inflammation to the thoracic esophagus. Multiple, sometimes confluent, erosions not circular. Increased contact vulnerability of the mucous membrane is possible. Motor disorders: distinct endoscopic signs of gastric valve insufficiency, total or subtotal provoked prolapse to a height of 3 cm with possible partial fixation in the esophagus, there may be pronounced spontaneous or provoked prolapse above the crura of the diaphragm with possible partial fixation.

Grade 4: esophageal ulcer. Barrett's syndrome. Esophageal stenosis.

1. By origin: primary, secondary.

2. Downstream: acute (subacute), chronic.

3. By clinical form: painful, dyspeptic, dysphagic, oligosymptomatic.

4. According to the period of the disease: exacerbation, subsidence of exacerbation, remission.

5. According to the presence of complications: uncomplicated, complicated (bleeding, perforation, etc.).

6. By the nature of changes in the mucous membrane of the esophagus: catarrhal, erosive and ulcerative, hemorrhagic, necrotic.

7. According to the localization of the pathological process: diffuse, localized, reflux esophagitis.

8. By severity: light, moderate, severe.

Diagnostics

In history - pathology of the upper digestive tract: chronic gastritis, gastroduodenitis, peptic ulcer of the stomach and duodenum, etc.

Complaints of pain in the epigastric region, an unpleasant feeling of "soreness, burning" behind the sternum immediately after swallowing food or during a meal. With severe pain, children may refuse to eat. Pain behind the sternum can occur with fast walking, running, deep bending, lifting weights. Often after eating there is pain behind the sternum and in the epigastric region, aggravated by lying down and sitting.

Other dyspeptic phenomena: nausea, sonorous belching, vomiting, hiccups, dysphagia, etc.

The "extraesophageal" manifestations of gastroesophageal reflux disease include reflux laryngitis, pharyngitis, otitis media, and nocturnal cough. In 40-80% of children with gastroesophageal reflux disease, symptoms of bronchial asthma are recorded, which develops as a result of microaspiration of gastric contents into the bronchial tree.

Physical examination: painful palpation in the epigastrium.

Laboratory examination: KLA, OAM, fecal occult blood test (possibly positive), H. pylori diagnostics (cytological examination, ELISA, urease test).

Instrumental examination: esophagogastroduodenoscopy in the esophagus - focal erythema and (or) friability of the mucous membrane of the abdominal esophagus, the presence of erosion, motor disorders - insufficiency of cardiac sphincter, reflux of gastric contents into the esophagus.

Biopsy of the mucous membrane of the esophagus - according to indications, X-ray of the esophagus - according to indications.

Indications for consultation:

The required amount of research before planned hospitalization:

1. General analysis blood (6 parameters).

2. General analysis of urine.

4. ALT, AST, bilirubin.

5. Scraping for enterobiasis.

List of main diagnostic measures:

1. UAC (6 parameters).

3. Examination of feces for occult blood.

4. Scraping on the egg worm.

5. Examination of feces for worm eggs.

7. Cytological diagnostics to determine the degree of damage and inflammatory changes in the gastric mucosa of the esophagus, reflux, diagnosis of H. pylori.

8. Endoscopic biopsy.

9. Histological studies.

10. ELISA for H.pylori.

List of additional diagnostic measures:

1. Determination of cholesterol.

2. Determination of bilirubin.

3. Thymol test.

4. Definition of ALT.

5. Definition of AST.

6. Determination of alpha-amylase.

7. Determination of total protein.

8. Determination of glucose level.

9. Determination of protein fractions.

10. Determination of alkaline phosphatase.

11. Determination of B-lipoproteins.

12. Determination of iron.

13. Definition of diastase.

14. A smear for candida from the pharynx and pharynx, tongue.

15. Test for HBs Ag.

16. Ultrasound of the liver, gallbladder, pancreas.

17. X-ray of the esophagus.

Differential Diagnosis

Treatment

Hospitalization

Prevention

Prevention of the occurrence of erosive and ulcerative esophagitis;

Barrett's esophagus prevention.

Gastroesophageal reflux disease

K21.0 Gastroesophageal reflux with esophagitis.

Gastroesophageal reflux disease (GERD) is a chronic relapsing disease characterized by esophageal and extraesophageal clinical symptoms and various morphological changes in the esophageal mucosa due to retrograde reflux of gastric or gastrointestinal contents,

The incidence of GERD in children with lesions of the gastroduodenal zone in Russia ranges from 8.7 to 49%.

Etiology and pathogenesis

GERD is a multifactorial disease directly caused by gastroesophageal reflux (acid reflux is a decrease in pH in the esophagus to 4.0 or less due to acidic gastric contents entering the organ cavity; alkaline reflux is an increase in pH in the esophagus to 7.5 or more when it enters the organ cavity duodenal contents, more often bile and pancreatic juice).

There are the following forms of reflux.

Physiological gastroesophageal reflux,

not causing the development of reflux esophagitis:

occurs in completely healthy people of any age;

observed more often after meals;

characterized by low intensity (no more than 20-30 episodes per day) and short duration (no more than 20 s);

has no clinical equivalents;

does not lead to the formation of reflux esophagitis.

Pathological gastroesophageal reflux (provokes damage to the mucous membrane of the esophagus with the development of reflux esophagitis and related complications):

occurs at any time of the day;

often independent of food intake;

characterized by a high frequency (more than 50 episodes per day, the duration is at least 4.2% of the recording time according to daily pH monitoring);

leads to damage to the mucous membrane of the esophagus of varying severity, the formation of esophageal and extraesophageal symptoms is possible.

Leading factor in the occurrence of gastroesophageal reflux

violation of the "locking" mechanism of the cardia due to the following causes.

Immaturity of the lower esophageal sphincter in children under 12-18 months.

Disproportion of increase in body length and esophagus (heterodynamics of organ development and growth).

Relative insufficiency of the cardia.

Absolute insufficiency of the cardia due to:

malformations of the esophagus;

surgical interventions on the cardia and esophagus;

connective tissue dysplasia;

morphofunctional immaturity of the vegetative nervous system(VNS), CNS lesions;

taking certain medications, etc.

Violation of the regimen and quality of nutrition, conditions accompanied by an increase in intra-abdominal pressure (constipation, inadequate physical activity, prolonged inclined position of the body, etc.); respiratory pathology (bronchial asthma, cystic fibrosis, recurrent bronchitis, etc.); some medications(anticholinergics, sedatives and hypnotics, β-blockers, nitrates, etc.); smoking, alcohol; sliding hernia of the esophageal opening of the diaphragm; herpesvirus or cytomegalovirus infection, fungal infections.

The pathogenesis of GERD is associated with an imbalance of aggression and defense factors.

Factors of aggression: gastroesophageal reflux (acid, alkaline); hypersecretion of hydrochloric acid; aggressive action of lysolecithin and bile acids; medications; some food.

Protective factors: antireflux function of the lower esophageal sphincter; mucosal resistance; effective clearance (chemical and volume); timely evacuation of gastric contents.

The severity of gastroesophageal reflux:

with esophagitis (I-IV degree).

The severity of clinical symptoms: mild, moderate, severe.

Extraesophageal symptoms of GERD:

Diagnosis example

The main diagnosis: gastroesophageal reflux disease (reflux esophagitis II degree), moderate form.

Complication: posthemorrhagic anemia.

Concomitant diagnosis; bronchial asthma, non-atopic, moderate form, interictal period. Chronic gastroduodenitis with increased acid-forming function of the stomach, Helicobacter pylori, in the stage of clinical subremission.

Esophageal symptoms: heartburn, regurgitation, “wet spot” symptom, belching with air, sour, bitter, periodic chest pain, pain or discomfort when food passes through the esophagus (odynophagia), dysphagia, halitosis.

Bronchopulmonary - bronchial asthma, chronic pneumonia, recurrent and chronic bronchitis, protracted bronchitis, cystic fibrosis.

Otorhinolaryngological - constant coughing, a feeling of "stuck" food or a "lump" in the throat, developing as a result of increased pressure in the upper esophagus, a feeling of itching and hoarseness, ear pain.

Cardiovascular signs - arrhythmias due to the initiation of the esophagocardiac reflex.

Dental - erosion of tooth enamel and the development of caries. Young children often vomit, are underweight

body, regurgitation, anemia, respiratory disorders up to apnea and sudden death syndrome are possible.

In older children, complaints are predominantly esophageal, respiratory disorders and posthemorrhagic anemia are possible.

Conduct research? ^ '^ oitekogtya and zhelugsk ^ with bapium in direct and lateral projection? ‘small compression of the abdominal cavity. Passability of the esophagus, diameter, relief of the mucous membrane, elasticity of the walls, the presence of pathological narrowing, ampulla-shaped extensions, the nature of the peristalsis of the esophagus are assessed. With obvious reflux, the esophagus and stomach radiologically form an “elephant with a raised trunk” figure, and on delayed radiographs, a contrast agent is again found in the esophagus, which confirms the presence of reflux.

Below is a system of endoscopic signs of gastroesophageal reflux in children (according to J. Tytgat, modified by V.F. Privorotsky and others).

I degree - moderate focal erythema and / or friability of the mucous membrane of the abdominal esophagus.

II degree - total hyperemia of the abdominal esophagus with focal fibrinous plaque, single superficial erosions may occur, more often of a linear form, located on the tops of the mucosal folds.

III degree - the spread of inflammation to the thoracic esophagus. Multiple (sometimes merging) erosions located non-circularly. Increased contact vulnerability of the mucous membrane is possible.

IV degree - ulcer of the esophagus. Barrett's syndrome. Esophageal stenosis.

Moderate motor disturbances in the region of the lower esophageal sphincter (rise of the 2nd line up to 1 cm), short-term provoked subtotal (along one of the walls) prolapse to a height of 1-2 cm, decreased tone of the lower esophageal sphincter.

Distinct endoscopic signs of cardial insufficiency, total or subtotal provoked prolapse to a height of more than 3 cm with possible partial fixation in the esophagus.

Severe spontaneous or provoked prolapse above the crura of the diaphragm with possible partial fixation.

An example of an endoscopic conclusion: reflux esophagitis P-B degree.

A targeted biopsy of the mucous membrane of the esophagus in children with subsequent histological examination of the material is carried out according to the following indications:

discrepancy between radiological and endoscopic data in unclear cases;

atypical course of erosive and ulcerative esophagitis;

suspicion of a metaplastic process in the esophagus (Barrett's transformation);

suspicion of malignant tumor of the esophagus.

To reliably determine the condition of the esophagus, it is necessary to take at least two biopsies 2 cm proximal to the 2nd line.

"gold standard" definition of pathological gastroesophageal reflux.

According to T.R. DeMeester (1993) normal daily pH monitoring values ​​are:

maximum gastroesophageal reflux (time) - 00:19:48.

For kids early age developed a separate normative

scale (J. Bua-Oshoa et al., 1980). The indicators of daily pH monitoring in children under one year of age differ from those in adults (fluctuations of ±10%, Table 1).

The method of intraesophageal impedancemetry is based on registering changes in intraesophageal resistance as a result of reflux, restoring the initial level as the esophagus clears. A decrease in the impedance in the esophagus below 100 ohms indicates the fact of gastroesophageal reflux.

Esophageal manometry is one of the most accurate methods for studying the function of the lower esophageal sphincter, allowing

Table 1. Normal daily pH monitoring values

in children according to J. Bua-Oshoa et al. (1980) Indicators Mean value Upper limit of normal Total pH time

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Gastroduodenitis ICD-10 code

When it comes to inflammation of the duodenal mucosa and the pyloric part of the stomach, gastroduodenitis is diagnosed. its types are classified according to the endoscopic picture. Until recently, this pathology was not distinguished into a separate group. The International Classification of Diseases (ICD-10) lists the diagnosis of "gastritis" (K29.3) and the diagnosis of "duodenitis" (K29). Now gastroduodenitis also has an ICD-10 code. A possible combination of gastritis and duodenitis is distinguished in the ICD-10 by paragraph K29.9 and is indicated by the phrase "gastroduodenitis unspecified", what it is, we will tell in the article.

In ICD-10, unspecified gastroduodenitis has been recently identified. Doctors are still arguing about whether the combination of two pathologies (inflammation of the gastric mucosa and duodenum) is justified. Those who vote "yes" pay attention to common pathogenetic mechanisms:

Domestic medicine, given that pathological processes in the stomach cause and support pathological processes in the duodenum, considers the disease as a whole. A disease such as gastroduodenitis is classified according to various factors, so it makes sense to list them all.

Detailed classification of gastroduodenitis:

For example , superficial gastroduodenitis is diagnosed if the inflammation affects only the walls of the gastric mucosa, while the walls of the intestine simply thicken, its vessels overflow with blood, and this causes swelling. In this case, a pastel regimen and a therapeutic diet will be effective.

The erosive type is accompanied by the appearance of painful scars, erosions and ulcers throughout the gastrointestinal tract. They can form for various reasons: due to insufficient secretion of mucus, the presence of reflux, the penetration of infections. Treatment should help eliminate the root cause of the disease. It is this stage that is distinguished by ICD 10, gastroduodenitis in this case is capable of provoking the development of peptic ulcer.

Catarrhal gastroduodenitis is diagnosed in the process of exacerbation, when the inflammatory process affects the walls of the stomach and the initial part of the duodenum. It can be caused by improper diet or overuse of medications. And here the therapeutic diet becomes the right lifeline.

The erythematous variety is diagnosed when the inflammation of the mucosa of the gastrointestinal tract is in the nature of a focal formation. In this case, a large amount of mucus is formed, it causes swelling of the walls. Such a clinical picture signals that the disease is turning into chronic stage. Treatment in this case will be complex.

Source: http://zhkt.guru/gastroduodenit-2/mkb-10-vidy

Duodenogastric reflux (DGR)

Physiological duodenogastric

Duodenogastric reflux (DGR) - throwing the contents of the duodenum into the stomach. Valid option spellings: duodeno-gastric reflux. Incorrect names: duodeno gastric reflux, duodenal reflux, gastric reflux, gastroduodenal reflux.

Duodenogastric reflux occurs in 15% of healthy people. At the same time, duodenogastric reflux is often a syndrome that accompanies many diseases of the upper gastrointestinal tract: chronic gastritis. peptic ulcer of the stomach and duodenum, gastroesophageal reflux disease.

If the contents of the duodenum are thrown not only into the stomach, but also into the esophagus, then such a reflux is called duodenogastroesophageal.

Existing for a long time duodenogastric reflux leads to reflux gastritis. stomach ulcers and gastroesophageal reflux disease.

In the clinical picture, with pronounced duodenogastric refluxes, there is a high frequency and severity of pain and dyspeptic syndromes, tongue coating with a yellow coating, diffuse abdominal pain on palpation. Duodenogastric refluxes are very often combined with pathological gastroesophageal refluxes (Pakhomovskaya NL and others).

pH-gram of the body of the patient's stomach, duodenogastric refluxes at night and in the morning (Storonova O.A. Trukhmanov A.S.)

Acidity index and number of duodeno-gastric refluxes in healthy people

The table shows the average quantitative estimates of acidity and duodenogastric reflux in "healthy" (without complaints of gastroenterological problems and without any subjective sensations) people (Kolesnikova I.Yu. 2009):

Source: http://www.gastroscan.ru/handbook/117/361

Clinical picture of duodeno-gastric reflux

There are similar signs in gastritis and duodenitis. Only fibrogastroduodenoscopy helps to identify gastroduodenitis reflux. If the described phenomenon proceeds independently, its treatment is reduced to observing a strict sparing diet. It is based on several rules, which should be discussed separately.

Treatment of reflux gastroduodenitis

The menu for DGR and GERD will have to include only easily digestible dishes. The main amount of food should be divided into three parts, it is important to organize snacks between them. They will prevent starvation - the main provocateur. For snacks, it is better to choose foods that promote the excretion of bile. These are crackers, rye crackers, bran and oat liver.

What can you eat with reflux gastroduodenitis?

So, for example, both there and here you can eat only low-fat varieties of meat and fish, they must be steamed. Forbidden dairy products and sour juices. From dairy products are allowed: milk, low-fat cottage cheese and yogurt. You can form a menu by studying the diet "Table No. 1" and "Table No. 2", and coordinate all incomprehensible points with a gastroenterologist.

It is important to understand that the diet will not be able to help if the causes of the disease have not been eliminated. Almost all symptoms will return immediately after it ends. Therefore, it is so important not to self-medicate. You should always remember that the first mild stages of pathology, such as superficial reflux gastroduodenitis, are easily treated. If no steps are taken towards recovery, the superficial form of the disease quickly develops into a chronic one, which is characterized by a protracted course.

Dealing with them will be much more difficult. Help will have to call for drug therapy. It is complex. The doctor will advise taking prokinetics, antacids, histamine receptor blockers. Physiotherapy, traditional medicine helps well. But they must be paired with medications.

ICD code 10 functional dyspepsia

Functional dyspepsia is a symptomatic complex of disorders in the digestive process that are functional in nature. Dyspeptic syndrome of a functional type is manifested by discomfort, heaviness in the epigastric region of the abdomen and other symptoms. Nausea, bouts of vomiting, heartburn, belching, excessive gas formation, and bloating may occur. Dyspepsia of this type is considered one of the most common pathologies of the gastrointestinal tract. provoke development functional dyspepsia may disrupt the motor function of the digestive organ.

The main causes of the development of the disease

According to the international classification of diseases ICD 10, functional dyspepsia has the code K30.

Dyspepsia according to the ICD implies a complex type of disorder of the gastrointestinal tract. Dyspeptic syndrome is a kind of indigestion, a general disorder of the digestive system. Pathology has a similar clinical picture with many other diseases of the gastrointestinal tract.

Of particular importance in the formation of functional dyspepsia are bad habits, as well as a set of alimentary errors. Often this is smoking, alcohol abuse and drugs.

A similar disorder of the gastrointestinal tract occurs against the background of a lack of digestive enzymes, due to which there is a violation of the absorption process. nutrients, minerals and vitamins in the intestinal cavity. In some cases, the banal indigestion of the digestive system provokes the disease. Failures can be caused by the abuse of fatty and heavy products, as well as overeating. One of the main reasons for the development of pathology is an improper or unbalanced diet.

Functional dyspepsia is common in newborns. In this case, the inconsistency of food with the capabilities of the gastrointestinal tract acts as a provocateur. The reason may be early feeding or overfeeding.

There are several types of non-ulcer dyspepsia of a functional form. The fermentation type develops in case of abuse of carbohydrates, which provoke bouts of strong fermentation. These products include cabbage, fruits, sweets, yeast dough, and legumes. Putrefactive dyspeptic syndrome manifests itself against the background of consumption a large number protein (red meat). This type of food is hard to digest, which allows bacteria to actively multiply in the intestines. The cause of fatty dyspepsia is the consumption of indigestible fats.

A disorder of the gastrointestinal tract, which is directly related to a deficiency of food enzymes, may be the result of pathologies of the intestines, gallbladder, liver, and stomach.

Clinical picture of functional dyspepsia

Dyspeptic syndrome is based on a variety of disorders and failures in gastroduodenal motility, manifested as follows:

The clinical picture of dyspeptic functional syndrome depends on the disorders that provoked it. To common features disorders of the gastrointestinal tract include nausea, vomiting, belching, pain and a feeling of heaviness in the stomach.

The cause of heartburn may be the penetration of the food bolus from the stomach cavity back into the esophagus. From the side of the intestine there are the following signs:

Diarrhea is a characteristic symptom of any kind of dyspeptic syndrome. Abdominal pain, excessive formation of intestinal gases, taste in the mouth, lack of appetite, nausea are also observed. In some cases, intolerance to fried and fatty foods occurs.

Features of diagnosis and treatment

Before starting therapy, it is important to undergo a complete diagnosis. It is necessary to conduct a blood test for biochemistry to determine inflammation and malfunctions in the functioning of the kidneys, liver, stomach, and pancreas. Based on the analysis of fecal masses, diseases manifested by dyspepsia can be detected.

Corpogram can detect undigested food in the stool, as well as dietary fiber and fat. Measurement of acidity will help determine the pathological syndrome of functional dyspepsia. Esophagogastroduodenoscopy allows you to assess the condition of the mucosa of the organ. For this, an endoscope is used, and tissue is taken (biopsy).

Of particular importance is pH-metry, which helps to determine the level of acidity of gastric secretions. An important diagnostic indicator is a test for Helicobacter pylori, a peculiar microorganism that provokes the development of gastritis, duodenal ulcer and stomach ulcers. Thanks to ultrasound, there is a chance to detect malignant tumor in the gastrointestinal tract, occurring against the background of functional dyspepsia.

Upon discovery of the listed clinical picture urgent need to contact a gastroenterologist. Therapy medications selected based on the cause of the disease. Basically, doctors prescribe drugs that increase the motility of the digestive tract.

In the treatment of functional dyspepsia, it is important to adhere to a strict diet. Fractional and frequent meals are shown, at least five times a day. It is strictly forbidden to overeat, starve, and eat before bedtime. It is forbidden to drink alcohol and soda, as well as smoke cigarettes. If the cause of the pathology is considered to be a lack of enzymes, then special drugs are prescribed without fail that can make up for the lack of these substances in the human body.

If the disease is detected in a child, severe dehydration of the body may begin against the background of diarrhea. You need to see a doctor urgently. As a rule, various medications are prescribed that eliminate the cause of dyspepsia, as well as prevent dehydration. You can give your child Regidron, rice water or sweet tea. Vitamins B are well suited to enhance motility and peristalsis. In the case of pathogenic microflora, the use of Enterofuril, dill water is required.

Dyspeptic functional syndrome is a combination of pathogenic manifestations of the gastrointestinal tract. It is important to consult a doctor in time and not self-medicate.

Source: http://vashzhkt.com/bolezni/dispepsiya-kod-po-mkb-10.html

Duodeno gastric reflux

Duodenogastric reflux is a functional disorder of the gastrointestinal tract. It occurs when the contents of the duodenum, along with bile salts, instead of passing into the small intestine, return to the stomach. This content mixes with digestive acids and has a toxic effect on the stomach.

Causes of the disease

The causes of duodeno-gastric reflux are not entirely understood. This disease can be caused by a disorder in the nerve signals to the duodenum and bile ducts(hence, reflux occurs in patients after gallbladder removal). In addition, it occurs with excessive relaxation of the pylorus, changes in its motility or peristaltic strength.

Duodenogastric reflux can cause gastric hyperplasia or blood stasis. In addition, the composition of bile that enters the stomach affects the secretion of prostaglandins, which are responsible for the activity of the protective mechanisms of the gastric mucosa, which further exacerbates the problem and makes treatment more difficult.

Symptoms

Duodenogastric reflux causes:

It should be noted that these symptoms do not appear immediately, but as the disease progresses.

Treatment at home

This ailment can be easily treated on its own, following a diet and using folk remedies. Duodenogastric reflux is not a complex disease - it is rather a violation of the gastrointestinal tract, which in the future can lead to diseases. Until that happens, take responsibility for your health into your own hands.

Diet

An important step in treatment is changing eating habits. A sensible diet minimizes the symptoms of duodenogastric reflux and helps to improve the functioning of the digestive system.

1. Margarine, lard, lard should be excluded from the diet - it is better to replace them with olive oil. Butter can be eaten in limited quantities (it is very important not to fry anything on it).
2. Avoid smoked and fried foods.
3. You can eat lean poultry, but avoid fatty meats and products made from them (e.g. duck, goose, pork, organ meats, patés).
4. From fish, choose low-fat varieties: cod, trout, pollock. Canned fish should be excluded from the diet.
5. The diet limits processed cheeses.
6. Eliminate strong coffee, cocoa, strong tea from drinks.
7. From carbohydrates, wheat-rye bread or wholemeal bread, durum pasta, brown rice will be useful for you.
8. You should minimize the consumption of chocolate, cakes, cakes with fatty creams.
9. Of vegetables, cucumbers, all types of cabbage, green beans and citrus fruits are contraindicated. Hot spices (curry, red pepper) can be used in limited quantities.
10. The diet completely bans carbonated drinks. Alcohol in small doses is not contraindicated.

Phytotherapy

Treatment medicinal herbs, roots, honey and other folk remedies gives a stunning effect, which in many respects exceeds the effect of medical procedures. After all, it is best to improve the functioning of the body in natural ways - this will help eliminate side effects.

Yarrow, chamomile and St. John's wort

These three herbs are the three "pillars" on which the health of our digestive system is built. They can treat many diseases - gastritis, heartburn, indigestion, nausea, dysbacteriosis and, of course, duodenogastric reflux. Mix yarrow, chamomile and St. John's wort in any proportions (that is, take the ingredients "by eye"), pour boiling water, and make delicious tea with honey. Drink this drink every morning and evening.

Herbs for bilious vomiting

If the disease has become so aggravated that you have not only pain, but also vomiting with bile, treat with fume herb. You need to make infusions from it (2 tablespoons of the plant per half liter of boiling water, hold it under the lid for 1 hour). Take 50 ml of infusion every 2 hours until vomiting and pain subside. Then move on to treatment with chamomile, yarrow and St. John's wort (as described in the previous recipe).

The root of marshmallow is no less effective. You need to make cold infusions from it - that is, pour the plant with cold water at the rate of 2 tablespoons of crushed roots per half liter of water. The mixture should be infused for 5-6 hours. Take it in small portions throughout the day until the bilious vomiting stops.

Flax seed

Flaxseed treatment is effective for heartburn, gastritis and all types of reflux (including duodenogastric reflux). It envelops the gastric mucosa, protecting it from the negative effects of bile salts. Pour a tablespoon of seeds with cool water (about 100 ml) and wait until they swell and mucus comes out of the seeds. This mixture should be drunk on an empty stomach before meals. In addition, treat with other plants that would support duodenal peristalsis.

Plants for peristalsis

Mix these herbs:

Warm infusions should be made from this mixture - 1 tsp. pour a glass of boiling water over the herbs, cover with a lid, strain and drink after 20 minutes. For taste, you can add honey to the drink. Drink the medicine 3 times a day, one hour after meals.

Rue also has a stimulating effect on duodenal motility. It can be brewed instead of tea. But the easiest way is to just chew 1-2 leaves of the plant each time after a meal.