The heartburn is linked to dysfunction of digestion. Chewing and saliva on the food are the first stage of digestion. You then divide the stomach work and food for it, it helps extremely acidic gastric juices. It is when these juices back into the esophagus we experience the unpleasant sensation of heartburn.

Indeed, while the stomach wall resists this acidity, the wall of the esophagus is much more fragile, which makes us feel more or less accentuated this acid reflux from the stomach. Then understand the importance of chewing food thoroughly, allowing the stomach and therefore less work to use less acidic gastric juices.

The role of the stomach

The stomach is an integral part of the digestive system, is a muscular organ located in the upper abdomen and connected to the esophagus on the one hand, and the other to small hail. It measures about 15 cm (6 inches) and about 30 cm (12 inches) long. The adult may even dress to contain up to one liter of food!

When food reaches the stomach, the small valve on the bottom of the esophagus is closed again, is the lower esophageal sphincter (YES) making this work. Some people have a more elastic sphincter other heartburn but also more generally be explained by diet and lifestyle.

But heartburn may also result in poor digestion, also hide more serious or more difficult diseases such as acidic reflux or ulcer.

Anxiety, stress and strain have an influence on the gastrointestinal system.

It is sometimes follow a healthy lifestyle and dietary practices relatively simple. Do not make too heavy meals, eat less fat, avoid soft drinks, clothes are not tight, do not smoke and limit coffee, tea, alcohol, chocolate.

Antibiotic treatment for H. pylori is in development. Simple agents should not be used because no single antibiotic can cure in a predictable way most infections H. pylori. At first it was recommended triple therapy based on bismuth. This approach has been tested with simple patterns of two drugs, which include the use of drugs blocking acid secretion. Whatever treatment is used, antibiotic resistance, the advice of the physician and patient compliance determines its success.

H2 blockers are important in the treatment of peptic ulcer disease, but are no longer the primary treatment when used alone, are often used as antisecretory drugs in a regimen anti-H. pylori. With power and different half-lives, all these drugs (cimetidine, ranitidine, famotidine and nizatidine) are competitive inhibitors of histamine H2 receptor. Histamine has an important role in acid secretion stimulated by vagal and gastrin, thus making H2 blockers effective in suppressing basal acid output and gastric acid production stimulated by food, the vagus nerve and gastrin. The volume of gastric juice is reduced proportionally. It also decreases the secretion of pepsin mediated by histamine.

H2 blockers are well absorbed from the GI tract with a bioavailability of 37 to 90%. The onset of action is 30 to 60 min after ingestion, and effects are maximum after 1-2 h. The administration i.v. produce an onset of action faster. The duration of the action is proportional to the dose and ranges from 6-20 h. There are several liver metabolites, inactive or less active than the parent compound, but most of the drug is eliminated via the kidneys, requiring dose adjustment to renal function. Haemodialysis removes H2 blockers, and is essential to examine the dose after dialysis. Doses should be reduced in the elderly often.

Cimetidine has weak adrenergic effects that are expressed in the form of a reversible gynecomastia and, less commonly, impotence in some patients treated with high doses for prolonged periods (eg., The hypersecretory). After administration i.v. quick all H2 blockers have been reported altered mental status, diarrhea, rash, drug fever, myalgia, thrombocytopenia, and sinus bradycardia with hypotension, usually in <1% of treated patients, but more often in the elderly

Symptoms depend on the location of the ulcer and the patient’s age, many patients, especially seniors, have few symptoms or none. Pain is the most common symptom, usually located in the epigastrium and is relieved by food or antacids. The pain is described as burning, burning or hunger. The course is usually chronic or recurrent. Only about half of the patients presented the characteristic pattern of symptoms.

The symptoms of gastric ulcers do not usually follow a uniform pattern (eg., Eating often exacerbates the pain instead of alleviating it.) This is especially true in ulcers of the pyloric canal, which are often associated with obstructive symptoms (eg., Fullness, nausea, vomiting) caused by edema and scarring.

In duodenal ulcer, the pain tends to be more uniform. The pain is absent when the patient awake, but appears at mid-morning, is relieved by food but recurs 2-3 h after the meal. The pain wakes the patient at night is common and highly suggestive of duodenal ulcer.

Diagnosis

The diagnosis of peptic ulcer is suggested mainly by history and confirmed by the studies described below. Stomach cancer may present with similar and must be discarded, especially in older patients who have weight loss or refer particularly severe or refractory symptoms. Endoscopy, cytology and multiple biopsies are reliable means of distinguishing the malignant gastric ulcers benign. The incidence of malignant duodenal ulcer is extremely low, so that biopsies are generally not justified. A malignant tumor secreting gastrin and Zollinger-Ellison syndrome should be considered in a patient with a severe ulcer diathesis, especially when the ulcers are multiple and occur in atypical sites (eg., Retrobulbar).

Fiberoptic endoscopy is a powerful tool for the diagnosis and treatment of peptic ulcer disease. An alternative diagnostic test is the double-contrast radiography with barium. Although endoscopy and radiography have similar sensitivities to detect ulcers, endoscopy is becoming the diagnostic modality of choice. Endoscopy detected more reliably esophagitis and esophageal ulcers and ulcers located in the posterior wall of the stomach and the sites of surgical anastomosis. Conversely, up to 10% of duodenal ulcers and may go unnoticed retrobulbar endoscopically, prompting a follow-up times radiological study with barium if clinical suspicion is high. Endoscopy also enables biopsies or brush cytology of gastric and esophageal lesions to distinguish between a simple ulcer and ulcerated gastric cancer. Endoscopy can also be used for definitive diagnosis of infection by H. pylori.

Ulcers can range in size from several millimeters to several centimeters. The sores are different from erosion by the depth of penetration, the erosions are superficial and do not affect the muscle layer of the mucosa.

Because the knowledge of the central role of H. pylori in the pathogenesis of peptic disease is increasing, diagnosis and treatment of peptic ulcer disease has changed dramatically.
Is an erosion in the lining of the stomach or the first part of the small intestine, an area called the duodenum.
If the ulcer is located in the stomach is called gastric ulcer.

Etiology and Pathogenesis

While traditional theories about the pathogenesis of peptic ulcers are concentrated in the acid hypersecretion, this finding is not universal, and today it is known that hypersecretion is not the primary mechanism by which produce most of the ulcerations. It appears that certain factors, namely H. pylori and NSAIDs, hinder the defense and repair of normal mucosa making the mucosa more susceptible to acid attack.

The mechanisms by which H. pylori causes mucosal injury are not entirely clarified, but several theories have been proposed. Urease produced by the microorganism catalyzes the conversion of urea to ammonia. Ammonia, while allowing the organism to survive in the acidic environment of the stomach, can erode the mucosal barrier and cause epithelial injury. Cytotoxins produced by H. pylori have also been implicated in the host epithelial injury. Mucolytic enzymes (eg., Proteases, lipases bacterial) appear to be involved in the degradation of the mucous layer, making the epithelium more susceptible to acid damage. Finally, the cytokines produced in response to inflammation may play a role in mucosal damage and subsequent ulcerogenesis.

NSAIDs probably cause mucosal inflammation and ulcers through topical and systemic effects. As NSAIDs are weak acids and are not ionized at pH gastric diffuse freely through the mucosal barrier within gastric epithelial cells, where H + ions are released leading to cell injury. Systemic effects appear to be mediated through its ability to inhibit cyclooxygenase activity and thereby the production of prostaglandins. By inhibiting the production of prostaglandins, NSAIDs induce various alterations of gastric microenvironment (eg., Reduced blood flow to the stomach, reducing the secretion of mucus and HCO3, reduced repair and cell replication), leading to deterioration of the mucosal defensive mechanisms.

Doctors refer to “lifestyle change” as the first treatment for reflux. A 2006 study suggested that most of the dietary changes were anecdotal, and only weight loss and elevation of the head of the bed were tested as effective. A randomized study of transition had the advantage of avoiding meals two hours before going to bed.

Positional therapy, sleeping on the left side, has proven to drastically reduce nighttime reflux episodes. The elevation of the head of the bed is also an effective measure. Combining drug therapy, meals just before bedtime, and elevation of the head of the bed, over 95% of patients have complete relief. If not fully improved, additional measures may be considered.

The elevation of the head of the bed can be done using various items: plastic or wooden props to support the legs of the bed, pillows, wedges, lifts, inflatable or a spring mattress. The lift height is very important and should be at least 15 to 20 inches to be minimally effective in preventing the rise in gastric fluids. Some mattresses are not suitable when inclined and tend to cause back pain, and are therefore preferred foam mattresses. Some people tip the bed more than 20 cm, and argue that the efficiency is higher.

Up to 2 / 3 of patients experience some degree of difficulty swallowing after surgery, especially with solid foods. This dysphagia is usually temporary and most patients can eat and swallow normally after six weeks. Another potential problem is the gastric distension associated with the inability to burp. Many patients with reflux esophagitis swallow as unconscious in an effort to acid reflux with alkaline saliva. This may bring with it the swallowing of large amounts of air. If the fundoplication is adjusted, it is very difficult to remove the gas belching. This usually disappears over time.

In most patients without surgical risk, the fundoplication requires a short hospital stay of approximately 3 days after laparoscopic surgery and 5 after the open. The hospitalization may be longer in patients with high surgical risk due to the presence of associated pathologies or if you have some postoperative complications.

The limited results so far suggest that long-term results are equivalent independent traveler type of surgery chosen (laparoscopic or open). Recurrence of reflux is uncommon after fundoplication, and if it happens means that the same is very floppy, has disappeared (dehiscence), or has slipped into the stomach. In these cases over diagnostic studies are needed to diagnose the cause of the recurrence of symptoms and plan the best solution posuble, both medical and surgical.

The surgery is best known Nissen fundoplication or modifications of this technique. The technique includes the mobilization and fondus fundoplication of the stomach around the ISS. As the pressure increases in the stomach, creating a pressure aumneto fundolicatura in closing the EEI, preventing reflux. The procedure is performed after the placement of a candle in the esophagus as a measure to prevent a too tight fundoplication. Fundoplication can be performed through open surgery or laparoscopy. The advantage of open surgery include the possibility palpation. Laparoscopy allows a clear view of the anatomical structure exist, less pain and faster recovery.

The tto. doctor is directed to reduce the acidity of the refluxed material using H-2 blockers, or inhibitors of the proton pump. The success of tto. be related to the ability to cause increased inhibition of acid. In theory, drugs that promote esophageal motility (including cisapride, metoclorpropamida, domperidone) improve esophageal evacuation, decrease LES tone and improve gastric emptying, but in practice are of little benefit for these patients.

Although tto. physician is very effective in controlling the signs and symptoms of gastroesophageal reflux, aproximadanmente 80% of patients will have recurrence of symptoms within 3 months if therapy is discontinued. Either way the total control of symptoms can be achieved Medinat the tto. inhibitors continuous proton pump.

The group of patients with documented reflux esophagitis are dependent on tto. doctor, or can not be controlled with tto. physician or regurgitation and aspiration of gastric contents into the airway can be successfully treated by a surgical procedure directed to recreate a functioning lower esophageal esfincter.

While acid reflux is the expulsion of caustic stomach acids into the esophagus, bile reflux occurs when the flow of bile from the small intestine flow upward into the stomach and esophagus. Bile is a greenish yellow substance that plays an important role in digesting food, absorbing fat and eliminating red blood cells wear and certain toxins from the body. Bile is produced in the liver and stored in the gallbladder in a concentrated form, and even a modest amount of fat in a meal, activates the gallbladder to release bile.

This phenomenon can also occur during pregnancy or occur due to obesity and excessive bending over and lifting heavy weights. A peptic ulcer can also contribute greatly – and be a cause of – reflux of bile. The frequent heartburn, nausea, vomit bile and an occasional cough or hoarseness may be symptomatic of reflux of bile.

Help bile reflux natural remedies

This herbal ingredient is excellent at relaxing cramps, improves digestion problems and tries to gastric complaints. A homeopathic remedy as mag Phos. (A tissue salt), quickly helps relieve digestive discomfort including cramps, excessive flatulence and hiccups. It also helps improve the overall functioning of the intestines.

Tips to avoid reflux of bile

• When is the reflux of bile, avoid smoking, which causes excess stomach acid, also dries the saliva – the natural agent for the protection of the esophagus.

• Eat smaller portions of food more frequently, can help greatly to reduce the pressure on the esophageal sphincter and to help prevent the valve from opening at the wrong time.

• After a meal, wait at least three hours before taking a nap or bedtime. This gives a deadline for your stomach is empty while you are still vertical!

• The meals of high fat relax the esophageal sphincter and slow the exit of food from your stomach, so try to reduce the fat content in their daily consumption.

• Certain foods can exacerbate the reflux of bile. The culprits include caffeinated beverages, chocolate, onions and spicy foods while increasing the production of stomach acid. Alcohol also relaxes the esophageal sphincter and irritates the esophagus.

• Heartburn and acid regurgitation are more likely to occur when there is excess weight, which puts pressure on his stomach, so keeping a healthy weight is ideal. If you are overweight, try to lose weight naturally.

• When under stress, digestion slows, worsening reflux symptoms. Recent studies suggest that relaxation techniques such as deep breathing or meditation can help.