Diet should be less and more meals, not too full; Avoid smoking, drinking, coffee, chocolate, sour food and excessive fat; Avoid lying flat after meals; When lying flat, the head of the bed is raised by 20 ~ 30cm, and the belt should not be tied too tightly, so as to avoid all kinds of situations that cause excessive abdominal pressure. (2) promoting the emptying of esophagus and stomach
1. Dopamine antagonists These drugs can promote the emptying of esophagus and office and increase the tension of LES. These drugs include metoclopramide (metoclopramide, metoclopramide) and domperidone (domperidone, domperidone), both of which are 10 ~ 20 mg, and are taken 3 ~ 4 times a day before going to bed and meals. The former, if the dose is too large or taken for a long time, can lead to extrapyramidal nerve symptoms, so the elderly patients should use it with caution; Long-term use of the latter will also cause hyperprolactinemia, resulting in adverse reactions such as mammary gland hyperplasia, lactation and amenorrhea.
2. Cisapride promotes the peristalsis and emptying of esophagus and stomach by releasing acetylcholine from the postganglionic nerve of intestinal muscle plexus, thus reducing gastroesophageal reflux. 10 ~ 20 mg, 3 ~ 4 days a day, with few adverse reactions.
3. The cholinergic drug carbamoyl choline can increase the tension of LES, promote esophageal contraction, and accelerate the emptying of acidic food in esophagus to improve symptoms, 25mg each time, 3 ~ 4 times a day. This mouth can stimulate gastric acid secretion, so take it carefully for a long time. (3) reduce gastric acid
① Acidifier can neutralize gastric acid, thus reducing the activity of pepsin and reducing the damage of acidic gastric contents to esophageal mucosa. Alkaline drugs themselves can also increase the tension of LES. Aluminum hydroxide gel 10 ~ 30ml and magnesium oxide 0.3g, 3 ~ 4 times a day. Gariscon (alginate) contains alginic acid, sodium alginate and acidulant, which can float on the surface of stomach contents to prevent reflux of stomach contents.
② Histamine H2 receptor antagonists can be cimetidine, ranitidine and famotidine, with the dosage of 200mg, 3 ~ 4 times /d respectively. 150mg twice a day, 30mg a day. The course of treatment is 6-8 weeks. These drugs can strongly inhibit gastric acid secretion and improve gastroesophageal reflux. If the above symptoms cannot be improved, the dosage can be increased to 2 ~ 3 times.
(3) proton pump inhibitors. These drugs can block H-K-ATPase in parietal cells. Omeprazole and lansoprazole have been widely used in clinic. The former 20mg/d and the latter 30mg/d can improve its symptoms. (4) Combined medication
The combination of drugs promoting esophageal and gastric emptying and antacids has synergistic effect and can promote the healing of esophagitis. Dopamine antagonists or cisapride can also be used in combination with histamine H2 receptor antagonists or proton pump inhibitors.
After stopping taking the drug, about 80% of the cases relapsed within 6 months because LES tension could not be fundamentally improved. If histamine H2 receptor antagonists, proton pump inhibitors or dopamine are used to antagonize the anti-Japanese occupation, or drugs are taken in time when symptoms occur, better curative effects can be achieved. (5) Surgical treatment
It is mainly suitable for esophageal scar stenosis (feasible expansion or surgical correction), ineffective medical treatment, recurrent bleeding and recurrent pneumonia.