Heartburn, abdominal pain, discomfort, nausea and vomiting after eating are often the result of poor motility of the stomach and esophagus. Acid is thrown up, burns the walls of the esophagus, changes its epithelium. Outcome: gastroesophageal reflux disease (GERD) with reflux esophagitis. This painful disease for the patient reduces the quality of life, and in a few years or decades it can lead to oncology. Therefore, it must be treated promptly. In order for the treatment to be successful, it is necessary to reduce acid production and increase the protection of the esophagus.
Mucosal permeability and heartburn
Heartburn is the main symptom of gastroesophageal reflux disease. The prevalence of GERD in Russia is 14.5%. Proton pump inhibitors (PPIs) are the standard treatment for this disease. They block the production of hydrochloric acid in the stomach. But there is a problem: drugs have to be taken for years, and with many years of use, they increase the risk of bone demineralization.
The permeability of the mucous membrane of the gastrointestinal tract plays a significant role in the development of GERD. It is bad when acid is thrown into the esophagus. Even worse, when the esophageal mucosa is not ready for this. When the protective properties of the mucosa of the esophagus are impaired, the formation of pro- inflammatory cytokines, free oxygen radicals, and the formation of prostaglandins are impaired. In such situations, doctors use drugs from the rebamipide group ( rebagit ), which can enhance protection and reduce mucosal permeability, therefore, more effectively eliminates the symptoms of GERD.
Sometimes gastroprotectors work well on their own. In addition, their inclusion in the treatment regimen allows you to get a result even in those patients who do not feel improvement after taking proton pump inhibitors. Finally, rebamipide can reduce the dosage of PPIs, and thereby minimize the likelihood of side effects in long-term treatment.
Why reduce mucosal permeability?
The development of GERD is based on a violation of the mechanism of cytoprotection (protection) of the esophagus. It has three defense mechanisms. The first is mucus, bicarbonates of saliva and mucin. The second is epithelial cells and tight intercellular contacts that close like gates and do not let anything superfluous through. They play a major role in protecting against hydrochloric acid and bile acids. Finally, at the third level, there are alkaline bicarbonates that come here from the blood: they neutralize the acid.
In GERD, there is an expansion of intercellular spaces in the stratified epithelium. Bottom line: protection weakens, there is a burning sensation in the esophagus, pain, erosion, and possibly ulcers, bleeding, scars. With a long-term course of the disease – Barrett’s esophagus, and then – cancer of the esophagus.
Numerous studies, most of which were conducted in Japan, have shown that in GERD it is important not only to reduce acid, but also to protect the cells of the esophagus from destruction. It is the Japanese, along with other peoples of Asia, who most often suffer from stomach problems. Therefore, in this country, most of the drugs, methods for diagnosing and treating this group of diseases are being developed.
Including the Japanese created drugs to protect the mucous membrane: gastroprotectors , and actively use them in the treatment of GERD, dyspepsia, ulcers, intestinal inflammation and other diseases. The effectiveness of this approach has been scientifically proven.
Studies in 2016 showed that the additional inclusion of gastroprotectors in the GERD treatment regimen more effectively eliminates such symptoms: heartburn, pain and heaviness in the abdomen, and vomiting.
A study by N. Yoshida showed that when using PPIs alone, GERD symptoms persist in more than half of patients. If cytoprotectors are included in the scheme , then 80% of patients have no symptoms.
Thus, the treatment of GERD and dyspepsia should be comprehensive. It includes agents to reduce acid production, improve motility and protect the mucosa. In this case, you can count on good long-term results of therapy.