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"code": "K21",
"name": "Гастроэзофагеальный рефлюкс",
"icd_name": "Гастроэзофагеальный рефлюкс",
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"lead": "Нарушение здоровья, относящееся к группе болезни пищевода, желудка и двенадцатиперстной кишки",
"description": "<p>Гастроэзофагеальная рефлюксная болезнь – хроническое рецидивирующее заболевание пищевода, обусловленное забросом агрессивного желудочного или желудочно-кишечного содержимого в просвет пищевода и характеризующееся пищеводными и внепищеводными симптомами.</p>",
"etiology": "<p>Развитию гастроэзофагеальной рефлюксной болезни способствуют следующие причины: </p>\r\n<ul>\r\n<li>Снижение тонуса нижнего пищеводного сфинктера (НПС). </li>\r\n<li>Снижение способности пищевода к самоочищению. </li>\r\n<li>Повреждающие свойства рефлюктанта, то есть содержимого желудка и/или двенадцатиперстной кишки, забрасываемого в пищевод. </li>\r\n<li>Неспособность слизистой оболочки противостоять повреждающему действию рефлюктанта. </li>\r\n<li>Нарушение опорожнения желудка. </li>\r\n<li>Повышение внутрибрюшного давления.</li>\r\n</ul>\r\n<p>На развитие гастроэзофагеальной рефлюксной болезни влияют и особенности образа жизни, такие как стресс, работа, связанная с наклонным положением туловища, ожирение, беременность, курение, факторы питания (жирная пища, шоколад, кофе, фруктовые соки, алкоголь, острая пища), а также приём повышающих периферическую концентрацию дофамина препаратов (фенамин, первитин, прочих производных фенилэтиламина). </p>",
"pathogenesis": "<p> Основным фактором развития гастроэзофагеальной рефлюксной болезни является недостаточность нижнего сфинктера пищевода. У здоровых людей это мышечное циркулярное образование в обычном состоянии держит в сомкнутом состоянии отверстие между пищеводом и желудком и препятствует обратному движению пищевого комка (рефлюксу). </p>\r\n<p>В случае недостаточности сфинктера отверстие открыто и при сокращении желудка происходит обратный заброс его содержимого в пищевод. Агрессивная желудочная среда вызывает раздражение стенок пищевода и патологические нарушения в слизистой вплоть до ее глубокого изъязвления. У здоровых людей рефлюкс может возникать при наклоне туловища, физических упражнениях, ночью.</p>",
"diagnostics": "<p>Диагностика ГЭРБ включает: </p>\r\n<ul>\r\n<li>Суточный внутрипищеводный рН-мониторинг – основной метод исследования, подтверждающий у больного ГЭРБ. В ходе этого исследования определяется количество и длительность рефлюксов в течение суток, а также продолжительность времени, в течение которого уровень рН падает ниже 4. </li>\r\n<li>Тест с ингибитором протонного насоса. Пациенту на 2 недели назначается прием препарата из группы ингибиторов протонной помпы (омез, нексиум) в стандартной дозе. Эффективность терапии является подтверждением заболевания. </li>\r\n</ul>\r\n<p>Помимо этих методов диагностики больному могут назначаться и другие исследования. Обычно они необходимы для оценки состояния пищевода и других органов пищеварительной системы, выявления сопутствующих заболеваний, а также для исключения болезней, с похожей клинической картиной: </p>\r\n<ul>\r\n<li>ЭФГДС (эзофагогастродуоденоскопия) с уреазным тестом; </li>\r\n<li>хромэндоскопия пищевода; </li>\r\n<li>рентгенологические исследования пищевода и желудка с использованием контраста; </li>\r\n<li>ЭКГ и суточное мониторирование ЭКГ; </li>\r\n<li>ультразвуковое исследование органов брюшной полости. </li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p>Пациентам, страдающим ГЭРБ, рекомендуется: </p>\r\n<ul>\r\n<li>Нормализация массы тела. </li>\r\n<li>Необходимо исключить из своего рациона жирную, жареную, острую пищу, шоколад, кофе, крепкий чай, газированные напитки, цитрусовые, лук, чеснок. </li>\r\n<li>Важно не переедать, принимать пищу малыми порциями, с перерывом в 15-20 минут между блюдами, не есть позже, чем за 3-4 часа до сна. </li>\r\n<li>Исключение нагрузок, связанных с повышением внутрибрюшного давления, а также ношение тесных поясов, ремней и т. п. </li>\r\n<li>Приподнятое положение (15-20 см) головного конца кровати ночью. </li>\r\n</ul>\r\n<p>Медикаментозная терапия ГЭРБ направлена, в основном, на нормализацию кислотности и улучшение моторики. Для лечения ГЭРБ применяются антисекреторные средства (ингибиторы протонного насоса, блокаторы H2-гистаминовых рецепторов), прокинетики и антациды. </p>\r\n<p>Для нормализации моторики принимают прокинетики - специальные лекарственные препараты, которые усиливают перистальтику желудочно-кишечного тракта. </p>\r\n<p>Хирургические вмешательства при гастроэзофагеальной рефлюксной болезни: эндоскопическая пликация гастроэзофагиального соединения (накладываются швы на кардии), радиочастотная абляция пищевода (повреждение мускульного слоя кардии и гастроэзофагеального соединения, с целью рубцевания и уменьшения рефлюкса), гастрокардиопексия и лапароскопическая фундопликация по Ниссену. </p>",
"prevention": "<p>Профилактикой развития ГЭРБ является ведение здорового образа жизни, исключающего факторы риска, способствующие возникновению заболевания (отказ от курения, злоупотребления алкоголем, жирной и острой пищей, переедания, подъема тяжестей, продолжительного нахождения в наклонном состоянии и др.). Также способствуют профилактике своевременные меры по выявлению нарушений моторики верхних отделов пищеварительного тракта и лечение грыжи диафрагмы.</p>",
"clinical_picture": "<p>Пищеводные (эзофагеальные) проявления ГЭРБ: </p>\r\n<ul>\r\n<li>изжога (чувство жжения за грудиной) – основной симптом; она может принимать разнообразный характер: как возникать несколько раз в течение дня, так и быть постоянной. Отличительная особенность – связь эпизодов изжоги с изменением положения тела (с наклоном вперед, в положении лежа), употреблением провоцирующих продуктов питания или лекарственных препаратов. </li>\r\n<li>отрыжка кислым, горьким, едой (срыгивание) или воздухом; </li>\r\n<li>разнообразные нарушения глотания; </li>\r\n<li>одинофагия (ощущение боли или неприятные ощущения при прохождении пищи по пищеводу, что обычно встречается при выраженном поражении слизистой пищевода); </li>\r\n<li>боли в области желудка или в проекции пищевода; </li>\r\n<li>рвота, упорная икота; </li>\r\n<li>ощущение кома за грудиной. </li>\r\n</ul>\r\n<p>Внепищеводные проявления: </p>\r\n<ul>\r\n<li>легочной синдром [кашель, одышка, эпизоды спонтанной остановки дыхания (апноэ), рефлекторный бронхоспазм, у некоторых пациентов развиваются аспирационная пневмония, бронхиальная астма]; </li>\r\n<li>отоларингологический синдром, так называемая отоларингологическая маска ГЭРБ (грубый лающий кашель, осиплость голоса по утрам, першение, рецидивирующие отит, ринит); </li>\r\n<li>стоматологический синдром (разрушение зубной эмали); </li>\r\n<li>анемический синдром (снижение количества эритроцитов и гемоглобина вследствие микрокровотечений из изъязвлений слизистой оболочки пищевода); </li>\r\n<li>кардиальный синдром (загрудинные боли, имитирующие стенокардию). </li>\r\n</ul>",
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