9 reasons not to ignore the symptoms of gastroesophageal reflux disease

There are times when our stomachs growl and we wonder why this is happening? While this sound isn't as socially stigmatized as, say, gas, when your stomach starts acting like a whale in the middle of a meeting or date, it's not very pleasant.

Loud rumbling in the stomach causes a person a lot of discomfort and trouble. The noisy digestive process makes itself felt at the wrong moment, especially often during times of psychological stress. This usually happens when you need to focus your efforts on an important task - an important exam, a presentation, a speech at a work meeting.

Current problem

For most people, heartburn is simply an occasional discomfort. Approximately 20% of the population of highly developed countries experience it at least once a month.

But for the 6% of people who have a chronic form of heartburn known as gastroesophageal reflux disease (GERD), unresolved (untreated) symptoms can lead to various health complications. People with erosions in the lining of the esophagus due to acid reflux often do not realize the harm of GERD until they have advanced stages of the disease.

If you experience frequent or prolonged heartburn (twice a week on a regular basis), consult your doctor. Here are nine reasons why you shouldn't ignore the symptoms of gastroesophageal reflux disease.

Drug therapy

When selecting medications, the root cause of the disorder and accompanying manifestations are taken into account. To make you feel better, your doctor may recommend symptomatic therapy. During pregnancy, you can only use safe medications that have undergone appropriate research. The following groups of medications may be recommended:

1. Antispasmodics: Drotaverine, No-Shpa.
2. Sorbents: Smecta, Enterosgel, Activated carbon are recommended.
3. Drugs with a carminative effect against flatulence: Espumisan.
4. Enzyme medications.
5. Probiotics.
6. Choleretic agents with mild action.
7. As a supplement, doctors often prescribe herbal sedatives based on valerian and motherwort.

Note!

If medications are ineffective and the symptoms of the disorder worsen, you should inform your doctor. Dosage adjustments or medication changes may be required.

A pregnant woman is contraindicated to self-medicate. Medicines are selected individually, taking into account the duration of pregnancy and general well-being. Traditional medicine can be used as a supplement to medications and diet, with prior agreement with your doctor.

Video: How to relieve gas during pregnancy

Development of inflammation in the esophagus (esophagitis)

In gastroesophageal reflux disease, food, acid, and digestive juices back up into the esophagus. Over time, this causes irritation and swelling of the mucous membrane lining the inside of the esophagus. This is esophagitis. If acid exposure in the esophagus is observed for just a few weeks, then inflammation of the mucous membrane can already develop. This can cause discomfort and even pain along the midline of the abdominal wall, “in the pit of the stomach,” where the right and left ribs meet at the sternum. This inflammation makes the esophagus vulnerable to even more dangerous conditions - erosions or scars.

Causes of belching air

Physiological belching

In most cases, the release of gaseous contents of the stomach is a natural process associated with a person’s eating habits or the way certain foods are digested. Perceptible air erection occurs up to 20 times a day, and unnoticeable release of gastric gases occurs even more often. As a variant of the norm, frequent belching is observed in some physiological conditions. The main prerequisites for non-pathological release of gas from the stomach are:

• Swallowing air when eating
  . Eating food quickly, frequent dry snacks, and talking while eating contributes to an increase in the gas bubble in the stomach. In such situations, the likelihood of swallowing not only food, but also more air, the accumulation of which stimulates a reflex contraction of the gastric wall, increases. The taste and smell of exhaust gases is neutral or with the taste of eaten food.
• Consumption of certain foods
  . Although flatulence is more common when eating legumes, they can increase gas formation in the stomach. Due to the presence of phytic acids and substances that inhibit proteases, the vegetable protein of peas, beans and lentils is less easily broken down by pepsin and is retained in the stomach. Eating vegetables, especially cabbage, with protein foods is accompanied by the retention of carbohydrates and their fermentation with the release of gases.
• Drinking highly carbonated drinks
  . The gastric wall reflexively contracts with the release of excess gaseous contents with the rapid accumulation of carbon dioxide. In addition to drinking carbonated drinks, drinking alkaline water and drinking soda, which reacts chemically with hydrochloric acid, contributes to the accumulation of carbon dioxide. As a rule, carbon dioxide belching occurs shortly after a food error.
• Physical exercise
  . When the abdominal tension is exerted during sports or heavy manual work, an increase in abdominal pressure is observed. Most often, belching is provoked by sudden muscle contractions, squeezing the stomach and promoting the opening of the cardiac sphincter. The risk of erection with the release of air and part of the chyme increases with physical activity immediately after eating.
• Pregnancy
  . Due to the growth of the uterus during gestation, intra-abdominal pressure increases, and internal organs shift towards the diaphragm. Mechanical compression of the stomach facilitates the occurrence of gastroesophageal reflux; additional factors are a change in the natural position of the organ and an increase in acidity. In pregnant women, belching air often has a sour taste and is combined with heartburn.
• Breastfeeding newborns
  . Sucking milk is often accompanied by swallowing air, which comes out with a belch after feeding. A prerequisite for easier release of gastric contents is age-related immaturity of the cardia. Eructation is promoted by improper attachment to the breast with insufficient nipple latching, hypogalactia, and non-compliance with the diet. Belching in babies is usually combined with regurgitation.

Belching with intestinal diseases

The release of gases into the oral cavity during intestinal pathology is associated with a reflex contraction of the stomach wall in response to an increase in intra-abdominal pressure, stagnation of liquid chyme in the small intestine and feces in the large intestine. In severe clinical cases of impaired bowel movement, a combination of air erection and upward reflux of intestinal contents is possible. The most common causes of pathological belching of gases are:

• Increased gas formation in the intestines
  . Eructation by air masses in chronic enterocolitis, transversitis and sigmoiditis, especially combined with dysbacteriosis, usually occurs against the background of flatulence and is of a reflex nature. Intraintestinal accumulation of gases increases pressure on the stomach, provokes its contraction and the release of air into the esophagus. Belching is often odorless and tasteless.
• Enteropathy
  . Dyspeptic disorders are the leading clinical syndrome of abdominal angina with predominant occlusion of the superior mesenteric artery. Violation of the secretory and absorption functions of the small intestine is accompanied by an increase in the volume of intestinal contents, a slowdown in the evacuation of chyme from the duodenum, and then the stomach. Gas belching is combined with flatulence, heartburn, and vomiting.
• Slowing down the passage of feces
  . Reflex belching of air in patients suffering from constipation is a reaction of the stomach to delayed emptying. With the development of intestinal obstruction against the background of intestinal pneumatosis, polyps and colorectal cancer, the situation is aggravated by insufficiency of the bauhinium valve and duodenogastric reflux, which lead to putrefactive belching and then fecal vomiting.
• Parasitic infestations
  . Dyspeptic regurgitation of air with the smell of hydrogen sulfide (rotten eggs) is characteristic of giardiasis and the acute phase of helminthiases. Its occurrence is caused by an increase in the volume of intestinal contents, a deterioration in the evacuation of chyme, and an increase in abdominal pressure due to flatulence. In addition to erection, patients experience non-localized abdominal pain, flatulence, and stool instability.

Belching with gastroduodenal pathology

Although belching of liquid contents is more typical for diseases of the stomach and duodenum, their initial symptom is sometimes belching of gases with a characteristic taste. In the early stages of Zollinger-Ellison syndrome, antral gastritis and other pathologies that occur with increased secretory function of the stomach, an acidic taste is often felt in the mouth during erection with air. With the onset of achlorhydria and atrophic gastritis, belching with the smell of rotten eggs is possible, which is subsequently aggravated by regurgitation of putrefactive contents.

A large amount of air, and then food, is regurgitated when chyme stagnates in the upper gastrointestinal tract. With gastric atony, duodenostasis and duodenal stenosis, fermentation and putrefactive processes quickly develop. In such patients, rotten belching is accompanied by heaviness, colicky epigastric pain, heartburn, and vomiting. If duodenogastric reflux occurs, especially in combination with cholecystitis, biliary dyskinesia, or other hepato-biliary pathology, a bitter taste may remain in the mouth after belching.

Belching in functional disorders

One of the common inorganic pathologies of the gastrointestinal tract, manifested by strong and persistent erection, is gastroneurosis with aerophagia. Due to the unconscious reflex swallowing of air, the volume of the gas bubble constantly remains increased, and the stomach reflexively contracts. In some of these patients, gastric belching is combined with supragastric (esophageal) belching. In severe cases of neurotic disorder, erection stops only during sleep. It is often accompanied by severe flatulence caused by the entry of excess gases into the intestines.

Neurogenic belching with neutral air can be observed during panic attacks and neurasthenia. A diagnostically complex autonomic disorder that occurs against the background of vagal dysfunction when the stomach is full is gastrocardial syndrome. His clinical picture is dominated by cardiosymptoms (rhythm disturbances, chest pain similar to angina pectoris, increased blood pressure), which develops after eating and goes away without drug correction after regurgitation of excess air and sometimes vomiting.

Esophageal stricture

If esophagitis continues for too long, the resulting scar tissue can narrow the esophagus. This stricture can lead to difficulty passing and swallowing food, which can become stuck at the level of scar tissue, causing pain.

Large pieces of food may become stuck and this situation may require endoscopic intervention to remove them. The stricture may cause frequent choking when eating. Because of this, patients often refuse to eat and lose a lot of weight.

Stricture is treated by widening or stretching the esophagus (bougienage or dilatation). These treatment procedures can have multiple effects on the stricture. But taking stomach acid blockers (proton pump inhibitors, PPIs, or H2 blockers) may prevent scarring in the esophagus from returning in the future.

Features of nutrition during flatulence

The first step in the treatment of intestinal flatulence for any reason is diet correction. It is important to completely avoid foods that stimulate increased gas formation:

• legumes: beans and peas, lentils;
• products rich in cellulose, coarse fiber, essential oils: sorrel, garlic, onions, radishes, gooseberries, dates, etc.;
• products that cause fermentation processes: kvass, black bread, grapes (including raisins);
• alcohol and soda;
• whole milk.

You should also stop chewing gum and smoking or limit the number of cigarettes you smoke.

There are dishes that can be consumed, but in smaller quantities. So, Gureev o (Gureev A.N., 2010, p. 306).

The diet should be based on fermented milk products, buckwheat and millet porridge, low-fat varieties of fish, meat and poultry. It is better to steam or boil food. It is important to choose bread made from wholemeal wheat flour. Vegetables and fruits should be consumed baked or boiled.

Throat and voice problems

The main symptom of gastroesophageal reflux disease is heartburn, but not all people feel or report it. They may have other symptoms that are more difficult to diagnose. Doctors call these cases "silent reflux," or asymptomatic reflux. The patient may not have heartburn as classically described in textbooks, but they may have various other problems that occur outside the esophagus, such as hoarseness, voice changes, sore throat, or chronic cough. They feel as if there is a lump or hair in their throat and constantly have to clear their throat by coughing and clearing their throat.

Breathing problems

If stomach acid accidentally flows into the windpipe after gastroesophageal reflux disease causes it to enter the esophagus, GERD can worsen asthma or pneumonia. Even without lung problems, GERD can cause shortness of breath and difficulty breathing. And treatment in this situation can be a double-edged sword. Because GERD medications, such as proton pump inhibitors, may actually increase the risk of pneumonia. (They can promote bacterial growth and suppress coughing, which is designed to help clear the lungs.)

Pay your doctor's attention to your lung function when treating reflux.

Esophageal ulcers

Stomach acid can erode the lining of the esophagus, causing sores and ulcers. Esophageal ulcers are different from stomach ulcers, which are usually caused by bacteria. People with wounds and sores may spit up blood and may also vomit blood. They may see blood in their stool. The blood may be red, cherry red, or like coffee particles. In stool, blood from the esophagus and stomach usually turns black when passing through the small intestine, the color and appearance of oil - viscous, slippery, and difficult to wash off.

Contact your doctor immediately if you have these symptoms. Endoscopy can detect ulcers of the esophagus. Acid-blocking or acid-lowering medications may make them disappear.

Stomach growls - what to do?

First of all, there is no need to be embarrassed because it happens to everyone. But sometimes it is necessary to avoid awkward sounds during an important event or meeting. We'll tell you how to stop your stomach from growling.

• Drink some water. This will improve intestinal motility and calm it. But don’t overdo it—too much liquid can have the opposite effect and your stomach will begin to gurgle even louder.
• Have a snack. To avoid a hungry stomach growling, carry a light snack with you made from foods that do not cause gas, such as vegetable chips or natural yogurt.
• Take probiotics. If your stomach is constantly rumbling, you should take a course of special medications and regularly consume foods that increase the number of beneficial bacteria in the intestines - cheese, yogurt, sauerkraut, kombucha.
• Control your hunger. Since an empty stomach growls louder than its full counterpart, try eating smaller portions, but more often. Or choose a healthy snack (a handful of nuts or an energy bar).
• Conquer stress. We've already said that your stomach gets nervous along with you, so if you're struggling with a constant rumbling stomach, why not take advantage of our stress management tips? Moreover, as a bonus, your overall well-being will improve.
• Take a walk after eating. Research from the University of Mannheim has shown that walking immediately after eating, even a fairly short 15-minute walk, can significantly speed up gastric emptying and therefore reduce the risk of awkward noises.

Normally, rumbling is constantly present in the stomach, only its severity varies. But if it is absent, this is a signal to action. Emergency medical attention may be required.

Barrett's esophagus

If left untreated for many years, persistent acid reflux can form changes in cells known as Barrett's esophagus, which is considered a precancerous condition. This condition does not cause many symptoms other than those of reflux. A doctor can diagnose it by performing an endoscopy.

If you have heartburn more than twice a week for a long time, or if you have symptoms of gastroesophageal reflux disease that are getting worse or you have discovered new ones that you didn't have before, these are all reasons to get checked and have an endoscopy.

What accompanying symptoms may there be?

Rumbling and gurgling cause disturbances in intestinal motility or excessive gas formation. Based on this, you can independently make an assumption about the possible causes of this condition. Concomitant manifestations can be intense or practically unnoticeable. Gurgling and rumbling during pregnancy may be accompanied by:

• nausea up to vomiting;
• soreness, bloating;
• bowel dysfunction;
• excessive gas formation;
• heartburn, belching.

Esophageal carcinoma

In very serious cases, untreated gastroesophageal reflux disease (and subsequent Barrett's esophagus) can lead to esophageal cancer. The main risk factors are alcohol consumption, smoking, poor nutrition, and chronic esophageal diseases with reflux.

Symptoms include weight loss, trouble swallowing, or gastrointestinal bleeding. This is something that happens over decades of untreated reflux (30-40 years), so those who are 30 and otherwise healthy have no reason to suspect cancer. But if you're over 50 and have had heartburn for years and suddenly lose weight, for example, this is definitely what your doctor will suspect first.

Survey

The diagnostic search to determine the causes of belching of gastric gases begins with excluding diseases of the gastrointestinal tract. The patient is prescribed a comprehensive examination to assess the functional viability of the digestive system and identify possible morphological changes in organs. The most valuable for making a diagnosis are:

• Endoscopic methods
  . During gastroscopy (EFGS), the mucous membrane of the esophagus, stomach, and duodenum is examined, inflammatory and ulcerative-destructive changes, deformations, and voluminous neoplasms are detected. If necessary, a biopsy is performed for histological examination of the material. Patients with suspected bowel disease undergo a colonoscopy.
• X-ray studies
  . If damage to a specific part of the gastrointestinal tract is suspected, radiography of the relevant organs (stomach, esophagus, study of the passage of barium through the small and large intestines) is performed. To study the features of the pancreato-biliary zone, retrograde cholangiopancreatography is performed. Using mesentericography, the condition of the mesenteric vessels is assessed.
• Study of gastric secretion
  . For possible acid-dependent diseases with increased or insufficient production of hydrochloric acid, intragastric pH-metry and gastric intubation are recommended. To detect gastroesophageal reflux, intraesophageal pH-metry is performed. Additionally, the levels of pepsinogens and gastrin in the blood are determined.
• Stool analysis
  . Digestive disorders that provoke belching with the release of air are often accompanied by changes in the coprogram. Pathological inclusions and impurities (undigested food, muscle fibers, mucus, etc.) may be found in the stool. The study is often supplemented with a stool test for occult blood and helminth eggs, and culture for dysbacteriosis.

As a non-invasive screening method for patients with air belching, abdominal ultrasound is recommended, and, if indicated, sonography of individual organs. After eliminating organic prerequisites for regurgitation of gases, an examination is prescribed to establish possible functional disorders (consultation with a neurologist, psychiatrist, comprehensive psychological study).

When burping air, the first step is to correct eating habits and diet