Exercises for gerb. Warsaw gymnastics with gerb: rules of execution and contraindications

How are therapeutic exercises performed for reflux esophagitis, what are the main exercises used for gastroesophageal reflux disease (GERD) along with medications and diet?

Heartburn is an unpleasant and often painful burning sensation in the chest, found in almost every inhabitant of our planet.

This condition appears due to the periodic reflux of acidic stomach contents into the esophagus when the lower esophageal sphincter is not completely closed. If such situations are regularly repeated, we can talk about the development of reflux esophagitis (currently the term “gastroesophageal reflux disease” is more common).

Typically, the main treatment for this disease is long-term, months-long use of medications such as omeprazole, famotidine, as well as periodic use of antacids, herbal decoctions, and adherence to a certain regimen. In the initial stages of GERD, good positive results are achieved by using acupressure. The problem is that drugs and folk remedies do not act on the cause of the disease, but only remove its symptoms, primarily heartburn. But the weakness of the esophageal sphincter remains. Therapeutic exercises for reflux esophagitis are precisely aimed at strengthening the muscles of the diaphragm and esophagus, which helps prevent the reflux of acidic stomach contents into the esophagus and significantly improve the condition of the patient with GERD.

Exercise therapy helps reduce the frequency of exacerbations and reduce the symptoms of the disease (heartburn, chest pain, sleep disturbances due to repeated episodes of regurgitation, that is, the reflux of food and gastric juice into the esophagus and oral cavity).

Basic exercises for reflux esophagitis

Diaphragmatic breathing

It is necessary to restore the natural type of breathing that is present in infants and then lost. To put it simply, you need to learn to breathe with your stomach, not your chest. This will strengthen the muscles of the diaphragm - the partition between the chest and abdominal cavities, as well as the lower esophageal sphincter.

Starting position – lying on your back, legs bent at the knees. Place the palm of the left hand on the chest, palm right hand- on the stomach. We take a deep breath through our nose (slowly, leisurely), while rib cage remains in place, and the stomach rises (protrudes) as much as possible. When you exhale, the stomach returns to its original position. We perform 20-30 inhalations and exhalations, then rest for 2-3 minutes and repeat (another 20-30 breathing movements). Repeat this exercise for reflux esophagitis, it is necessary 3-4 times during the day (2 approaches each).
I.p. - sitting on a chair. We carry out diaphragmatic breathing, described above (but the hands are on the knees). After a week of doing the exercise, when you inhale, the stomach protrudes and tenses, and when you exhale, it moderately retracts. Repeat 20-30 times.
I.p. - Same. Inhalation is performed through a loosely closed mouth (a narrow gap remains), while the stomach protrudes, and exhalation is made with jerking movements through a narrow hole in the mouth (in the form of a tube) - in 10-20 short exhalations (“fu-fu-fu”) on a retracted stomach. Then again take a deep breath and then jerky exhale through the “tube”

Exercises with difficulty and holding your breath with reflux

We inhale through our nose while simultaneously protruding our abdomen, then hold our breath for 2-3 seconds. We exhale through the left nostril (the right nostril is closed) for the longest possible time (at the rate of inhaling for 4-5 seconds, holding the breath for 2-3 seconds, then exhaling for 8-10 seconds). After inhaling again, exhale through the right nostril while the left one is closed. We perform 20-30 exercises.
Inhale through the nose and exhale through the mouth through a thin tube, which is lowered into a container of water (you can use straws for cocktails). We carry out 20-30 repetitions.

Breathing exercises by Strelnikova for reflux esophagitis

We begin after 3-4 weeks of performing the above exercises. The essence of breathing movements is short breaths through the nose while limiting the excursion of the chest (that is, we breathe, in fact, with the stomach). 20-30 breaths are taken and only then – one noisy, long exhalation through the mouth. When inhaling, movements of the arms (“hug the shoulders”) are carried out simultaneously in a lying and sitting position, a half-squat in a standing position, turns with the head or torso, etc. In the first 3-4 days of classes, 300-400 breaths are taken per class. Then gradually the number of respiratory movements with GERD increases to 600-800-1000. In the future, a thousand breaths per day becomes the average standard per day.

Aerobic training for GERD

Along with breathing exercises for reflux esophagitis, it is necessary to perform dynamic aerobic exercises daily or every other day. This can be moderate and brisk walking for 40-60 minutes a day (including Nordic walking), jogging for 15-20 minutes every other day, swimming.

If possible, avoid strong bending of the body, lifting heavy objects with severe tension in the abdominal wall, and other activities associated with stress on the abdominal muscles. During training, there should be no heartburn, severe drooling, or regurgitation.

Regular exercise therapy according to the scheme described above, taking into account initial fitness and exercise tolerance, will help strengthen the lower esophageal sphincter and reduce the manifestations of reflux esophagitis. An integrated approach to the treatment of GERD, including taking medications prescribed by a doctor, following a work and rest schedule, diet and a set of exercises for reflux esophagitis, in most cases allows you to get rid of the symptoms of the disease and prevent exacerbations.

GERD - gastroesophageal reflux - is a disease characterized by heartburn, which occurs due to the reflux of part of the stomach contents along with hydrochloric acid into the esophagus. In this case, the patient feels a burning sensation behind the sternum or in the throat, a sour taste in the mouth, belching, and sometimes pain. The condition is aggravated in a lying position, while bending, during physical activity immediately after eating. GERD is most often caused by weakening of the sphincter muscle between the stomach and esophagus. If the disease is not treated or only periodically gets rid of symptoms, then there may be complications and serious problems with the gastrointestinal tract. Complex treatment works best: a combination of diet, medications and physical therapy prescribed by a doctor.

Exercise therapy for esophagitis

GERD requires therapeutic exercises, without weights, excessive dynamism, bending or abdominal exercises. It is recommended to conduct the first lessons with experienced trainer Exercise therapy with the appropriate certificate. Universal therapeutic exercises can not be. Exercises are selected individually by the instructor, depending on the patient’s health, preparedness, and well-being.

All exercises should be aimed at strengthening the diaphragm for GERD. The quality of work depends on its condition. Exercise therapy complex performed on an empty stomach or at least 2-3 hours after meals. At the same time, food should be easily digestible and not cause heartburn. For example, fatty or protein foods take a long time to digest; it is better to eat something containing carbohydrates; drinking water before training is not recommended.

The role of physical therapy is to strengthen health, the immune system, muscles, improve blood circulation, enrich the blood with oxygen, and activate metabolic processes in the body. Exercises to strengthen the esophageal sphincter are aimed at preventing GERD, because frequent heartburn due to dysfunction of its function can lead to complications, including ulcers or esophageal cancer.

Aerobic exercise in the form of vigorous or nordic walking, jogging, cycling or an exercise bike should be included in the set of exercises for reflux esophagitis. Exercises on the horizontal bar or parallel bars, without inversions, and swimming are encouraged.

The starting position of most exercises in the gym, at home, on fresh air must be sitting or standing. It is necessary to avoid lying on your back; you can lie, but at an angle, with your head above your feet or on your side, to avoid reflux.

Tilts are allowed only to the left or right, but not forward - down, smoothly, without jerking, the arm is lowered and moves along the body. You should not get carried away with Pilates, jumping, or intense aerobics. From yoga, you can only use breathing and stretching; inverted asanas are prohibited. Self-massage or massage of the abdominal wall is recommended. This can be done while performing breathing exercises, helping the abdomen in the hypochondrium area with your hands.

Breathing exercises for GERD

Breathing exercises are useful and effective. It is very important to reduce intra-abdominal pressure during exercise. Correct specific breathing copes with this task and gradually strengthens the diaphragm, as well as the lower esophageal sphincter. It is recommended to do breathing exercises in the following sequence:

diaphragmatic or abdominal breathing - on a slow deep inhalation, the stomach protrudes strongly, on exhalation it relaxes, but does not retract. The exercise lasts 10 minutes, with a 20-second rest every minute;
on next stage as you exhale, the stomach gradually retracts;
the exercise must be repeated while sitting, then while walking, gradually combining with exercises, while the exhalation becomes twice as long as the inhalation, only the stomach works, the chest remains motionless.

Such breathing exercises for reflux esophagitis, it must be performed twice a day for 15-20 minutes. At correct technique When performed, diaphragmatic breathing strengthens the muscles of the diaphragm itself, saturates the blood with oxygen, cleanses the lungs of those who smoke a lot from tar and nicotine, promotes weight loss, reduces flatulence, and relieves constipation.

At the beginning of exercises, breathing exercises for GERD may cause dizziness due to a possible increase in blood pressure. In this case, you need to take less deep breaths. In a normal state, a person does not track breathing patterns. During breathing exercises, it is recommended to carefully monitor the behavior of the organs during them, the duration of inhalation and exhalation, and your condition. If you feel unpleasant, you need to relax and breathe calmly. In the future, the technique of such breathing will become clearer and easier, will benefit the body, including improving the functioning of the esophageal sphincter and the gastrointestinal tract as a whole.

Diaphragmatic breathing in combination with physical exercise is the basis of the “bodyflex” weight loss system. This effective method fight against overweight. It can also be used by patients with GERD, excluding some exercises. In addition to inhaling and exhaling using the abdominal muscles, bodyflex involves holding your breath for 10 seconds after exhaling completely. Patients with high blood pressure or arrhythmia should perform the complex with caution after consulting a doctor. The value of the method is that it strengthens the diaphragm muscles and reduces weight, which has a beneficial effect on getting rid of GERD and its symptoms.

A course of gastroesophageal exercise therapy usually takes about 3 months. Breaks will have to be taken in case of exacerbation or complications that need to be eliminated by other means. For those who are not lazy to do gymnastics, and also combine it with diet and medications, the symptoms of GERD may completely disappear and not appear for a long time.

If the disease is advanced and proceeds with complications, then therapeutic exercises will have to be done later. First, it is necessary to relieve the exacerbation, severe symptoms in the form of bowel dysfunction, constant heartburn, and vomiting with the help of medications and nutrition. with esophagitis includes dishes that do not provoke increased secretion of gastric juice during digestion and the reflux of hydrochloric acid into the esophagus.

Proper nutrition, excluding heavy, poorly digestible or irritating gastrointestinal foods, helps the patient cope with GERD, eliminating heartburn and the severe discomfort associated with it. Proper drinking regime is also necessary. Water improves the digestion process, quenches thirst, improves well-being, and regulates metabolic processes.

Strength training, like deep bending, is prohibited for reflux symptoms due to increased intra-abdominal pressure and stress on the muscles abdominals. Complex physical therapy exercises should be developed by an experienced physician instructor. You should not do this on your own, so as not to harm your health if you select it incorrectly.

Gymnastic exercises will not save you from GERD alone. The disease is treated in a complex that includes drug therapy, a special diet and physical therapy. Breathing exercises must be combined with light physical exercise. Intense sports for people with diagnosed GERD, especially complicated or during an exacerbation, are prohibited. Diaphragmatic breathing exercises are undesirable during respiratory diseases; they are not suitable for hypertensive patients or people with diseases of the cardiovascular system.

Self-massage of the abdomen or abdominal wall should be performed with extreme caution, without using excessive force, preferably under the supervision of a doctor. It is most convenient to entrust the massage of this area to an experienced specialist, because this effective method improving the functioning of the digestive organs. But in the absence of knowledge and experience, massage can cause harm to health, including exacerbation of chronic gastrointestinal diseases.

Strengthening the lower esophageal sphincter, as the main means of combating esophageal reflux, is impossible without therapeutic exercises, a special diet, and drug support. If a patient with GERD has a great desire and desire to get rid of extremely unpleasant symptoms in the form of heartburn and other manifestations listed above, then it is necessary to persistently and diligently carry out this entire complex of treatment. Then the quality of life will be much higher.

The information on our website is provided by qualified doctors and is for informational purposes only. Don't self-medicate! Be sure to consult a specialist!

Gastroenterologist, professor, doctor of medical sciences. Prescribes diagnostics and carries out treatment. Expert of the group for the study of inflammatory diseases. Author of more than 300 scientific papers.

Sports will help on the path to curing GERD. Physical exercise will not only speed up recovery, but will also have a beneficial effect on the body. When taking on this or that physical complex, you need to understand that you should not expect a therapeutic effect from the loads; they are not able to eliminate heartburn - the main symptom of the disease. But they may well speed up the time of recovery. But gymnastic exercises will not bring any effect if you do not follow a diet and take medications.

Physical exercise can improve your overall health digestive system.

Be careful with exercise for GERD

Physical activity with functional abnormalities of the digestive organs is often prohibited. There are no strict restrictions for reflux, but you need to remember the basic rules that will help make the sport completely safe for your health and bring maximum benefits.

It is forbidden to exercise immediately after eating. This is because the lower esophageal sphincter is weak, which means activity after eating will cause stomach contents to regurgitate up into the esophagus. This will lead to severe heartburn. In view of these circumstances, you need to wait at least an hour after eating and start sports activities. You should not eat for an hour after activity. There is no need to talk about prohibiting snacking during exercise.

When eating food, you should not bend or twist forward, and you should not lift heavy objects. This will cause the same reaction as exercising after eating. In addition, bending over compresses the stomach, which increases the load on the gastrointestinal tract.

You need to carefully monitor the breaks between food and exercise, and then it will not cause harm. In addition, you need to adhere to a healthy lifestyle.

What loads are contraindicated?

There are certain prohibitions on playing sports with reflux esophagitis. Some doctors recommend avoiding abdominal exercises only, as they increase the pressure inside the abdominal cavity, which can aggravate the disease.

It is recommended to limit the weight you use during training. This rule is suitable for those who have previously worked with heavy weights. Those patients with GERD who have not exercised with weights should not do so.

In general, no sports are prohibited. You need to follow the recommendations of your doctor and not put too much strain on yourself. Then there will be no harm to health. Sports will go only beneficial, as it allows you to release negative energy, which will reduce the likelihood of relapse of reflux esophagitis due to stress.

Yoga classes: benefit or harm?

Yoga, like any sport, can bring both benefits and harm. Doctors do not recommend asanas that place pressure or strain on the abdominal muscles, as this will cause an increase in internal pressure. Therefore, yoga asanas such as bhujansana, salabhasana and others are prohibited. Yoga exercises that do not load the abs (for example, nauli, udiyana), on the contrary, are indicated for patients with GERD.

Yoga is rich in breathing asanas, which are useful for patients.

Is it possible to cure exercise therapy disease?

It is impossible to cure reflux esophagitis with exercise alone, since no sport will affect the root of the problem. In order to relieve symptoms and get rid of causes, treatment with pharmaceutical drugs is necessary. Sometimes therapy for reflux cannot be done without surgery.

Physical therapy will benefit the patient, as it helps strengthen the diaphragm. Thanks to this, the esophageal sphincter better retains the contents of the stomach in it, without passing upward.

Gymnastics and exercise therapy

Benefits of physical therapy

Exercise therapy should be prescribed by a doctor, since such activity is differentiated depending on the degree of the disease and the physical capabilities of each individual patient. If a patient has complicated or advanced reflux esophagitis, physical activity is completely contraindicated for him. The advantages of physical therapy are the following factors:

such exercises improve muscle tone, which improves metabolic processes and promotes tissue regeneration;
Exercise therapy improves the functioning of the human immune system;
proper activity helps strengthen the diaphragm, which improves the functioning of the esophageal sphincter;
Exercise therapy is used as a preventive measure against GERD;
The right exercises can help get rid of night pain and burning.

Exercise therapy refers to physiotherapeutic treatment, so the complex is different for each patient. It is aimed at achieving specific goals:

strengthen the immune system;
develop the muscle layer, which will improve metabolic processes;
heartburn prevention;
improved absorption of medications.

Breathing exercises

In order for physical therapy for reflux esophagitis to bring maximum benefit, you need to learn how to breathe correctly. To do this you need to do breathing exercises. Before class, you need to find the most comfortable body position, it is best to stand or sit. You need to inhale deeply and exhale slowly. Repeat 4 times. You need to train on an empty stomach. If the patient has a severe degree of illness, he should refuse the procedures.

Such training should be done with breaks for rest, as physical exercise can cause fainting or weakness. You need to train for preventive purposes three times a week. In addition, you need to engage in other activities. Swimming and cardio exercises are useful for reflux esophagitis.

But they may well speed up the time of recovery. But gymnastic exercises will not bring any effect if you do not follow a diet and take medications.

Physical exercise can strengthen the condition of the entire digestive system.

Be careful with exercise for GERD

It is forbidden to exercise immediately after eating. This is because the lower esophageal sphincter is weak, which means activity after eating will cause stomach contents to regurgitate up into the esophagus. This will lead to severe heartburn. In view of these circumstances, you need to wait at least an hour after eating and begin sports activities. You should not eat for an hour after activity. There is no need to talk about prohibiting snacking during exercise.

You need to carefully monitor the breaks between food and exercise, and then it will not cause harm. In addition, you need to adhere to a healthy lifestyle.

What loads are contraindicated?

In general, no sports are prohibited. You need to follow the recommendations of your doctor and not put too much strain on yourself. Then there will be no harm to health. Sports will only be beneficial, as it allows you to release negative energy, which will reduce the likelihood of relapse of reflux esophagitis due to stress.

Yoga classes: benefit or harm?

Yoga, like any sport, can bring both benefits and harm. Doctors do not recommend asanas that place pressure or stress on the abdominal muscles, as this will cause an increase in internal pressure. Therefore, yoga asanas such as bhujansana, salabhasana and others are prohibited. Yoga exercises that do not load the abs (for example, nauli, udiyana), on the contrary, are indicated for patients with GERD.

Yoga is rich in breathing asanas, which are useful for patients.

Is it possible to cure exercise therapy disease?

Physical therapy will benefit the patient, as it helps strengthen the diaphragm. Thanks to this, the esophageal sphincter better retains the contents of the stomach in it, without passing upward.

Gymnastics and exercise therapy

Benefits of physical therapy

such exercises improve muscle tone, which improves metabolic processes and promotes tissue regeneration;
Exercise therapy improves the functioning of the human immune system;
proper activity helps strengthen the diaphragm, which improves the functioning of the esophageal sphincter;
Exercise therapy is used as a preventive measure against GERD;
The right exercises can help get rid of night pain and burning.

Exercise therapy refers to physiotherapeutic treatment, so the complex is different for each patient. It is aimed at achieving specific goals:

strengthen the immune system;
develop the muscle layer, which will improve metabolic processes;
heartburn prevention;
improved absorption of medications.

Breathing exercises

At the beginning of the course, everything should be done lying on your back or on your right side on a plane slightly raised to your head. First you need to inhale, sticking your stomach forward and hold it for a few seconds. As you exhale, the abdominal wall relaxes; there is no need to pull in your stomach. The duration of the workout is 10 minutes with breaks of 20 seconds every minute.

Then, after a couple of workouts, you can begin to draw in your stomach as you exhale. After a few more sessions, leg movement is added to breathing. After which you can move on to exercises in a sitting or standing position. A course of physical therapy, which is used to treat GERD, takes approximately 3 months.

Prohibitions and warnings

Each sport has certain caveats, especially if the person playing it is sick. Exercise therapy and breathing exercises are no exception. With esophagitis, you need to remember the following requirements:

You can’t exercise after eating, even if it’s a snack (you can’t exercise after taking a sip of water);
It is better not to do gymnastics during exacerbation of GERD;
everything needs to be done calmly, in moderate pace without putting too much strain on the body.

Esophagitis usually recurs 2 times every 12 months, so courses of physical therapy and gymnastics are aimed at prevention. The minimum number of workouts per week is 2 times. Exercises should be selected by the attending physician who is competent in such matters.

Gymnastics is not the only treatment. The patient needs a course of drug therapy. In addition, the patient needs to engage in other sports, exercise healthy image life.

It is important not only to exercise, but to change your lifestyle to one that will have a beneficial effect on the body. This will help prevent relapses of the disease and improve well-being, because sports, proper nutrition and the absence of destructive habits are the basis of health.

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Training with gastroesophageal reflux.

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I have had heartburn and reflux since childhood, and I can’t even brush my teeth calmly (because of the “call signs”). I had terrible gastritis at the age of 9, I was scared of an ulcer, I was treated by gastroenterologists, BUT at the same time I was seriously involved in dancing (hip-hop, aerobics) training was 6 hours 3 times a week. danced for 12 years, became bronze medalist Ukraine. Now I’m “retired”)))) my stomach problems have started to return, but thanks to DiOn I haven’t had heartburn for a month now.

heartburn is rather secondary and unpleasant - you can just stupidly swallow 2 times)) so as not to scare people during workouts and skip or replace incline exercises.

In general, it’s difficult to imagine how one can train with this, but somehow people live and train.

or late in the evening right before bed?

I have a healthy gastrointestinal tract, but here it is.

City: Sinegorye village

City: Moscow Golden Domed

but I need to eat before exercise so that the break is no more than 1.5 hours - otherwise I have time to get hungry (((

City: By the White Sea

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30 g uncrushed rolled oats, 200 g water, 130 g milk, salt

Rules for playing sports with reflux esophagitis

In the process of treating many diseases of the gastrointestinal tract, patients are often interested in whether exercise is indicated for them, and if so, what kind of sports and with what intensity. Physical exercise is an important part of therapy for reflux esophagitis.

Of course, on their own they will not cure a diseased organ, but in tandem with a therapeutic diet and medication support, they can greatly speed up recovery and contribute to the overall strengthening of the body.

Nuances of training for GERD

Gastroesophageal reflux disease forces you to draw up a special training plan, taking into account the severity of the disease and general physical training patient.

It is a scientifically proven fact that people who regularly exercised suffered much less from the specific symptoms of reflux disease than physically inactive people with a sedentary lifestyle, and especially those who were overweight.

Excess weight greatly increases your chances of developing GERD. People with a body mass index over 30 are more than 2 times more likely to become gastroenterologist patients than people with normal BMI within 18.5–25.

However, the patient should not forget that excessive load it is contraindicated. In addition, in order not to worsen your condition, you need to follow the recommendations of your doctor and trainer, and also do not forget about the following rules:

Digestion takes some time. In itself, a stomach filled with food is a load on the esophageal sphincter, and when shaking and physical stress are added to this, deterioration is inevitable. To prevent this, you need to train only on an empty stomach.
When planning your diet, you need to focus on your training schedule. Certain foods, especially fatty foods and legumes (by the way, the diet for reflux esophagitis prohibits such foods) take an extremely long time to digest. If the workout should take place 2-3 hours after eating, preference should be given to easily digestible carbohydrate foods, with a minimum content of fat and protein. Before training, you need to avoid consuming foods that cause heartburn and belching.
Avoid overly intense exercise such as fast run, crossfit, aerobics. With such a load, the contents of the stomach shake, resulting in discomfort. It is worth giving preference to exercises that keep the body in an “even” position: yoga, moderate jogging, skating, cycling (you can use an exercise bike or a stepper).
There is no need to get carried away with exercises in a lying position (bench press, Pilates), which provokes the reflux of stomach contents into the esophagus.
Throughout the training session, it is worth monitoring the fluid balance in the body. In addition to quenching thirst, water stimulates digestion and stabilizes the functional state of all organs.

Benefits of Exercise for GERD

The advantages of exercise therapy for reflux esophagitis include:

strengthening the lower esophageal sphincter;
reducing the intensity of reflux of stomach contents into the esophagus and mitigating the occurrence of night reflux;
increasing the body's immune defense;
stimulation of metabolic processes.

Breathing exercises for GERD

The key to effective training for reflux esophagitis is correct, even breathing. Before giving yourself an active load, you need to take a comfortable position (most importantly, without lying down). After this, the patient will have to perform the following tasks one by one:

Take a deep breath and slowly release the air. Repeat the exercise at least 5 times. When exhaling, you need to involve the abdominal organs as much as possible, strongly straining and “blowing out” your stomach.
Slowly inhale air and release it in several short exhalations.
Next task: take a slow, deep breath and a sharp, rapid exhalation, actively engaging the peritoneum. Repeat the exercise 8–12 times.
Take a deep breath and hold your breath for 5–7 seconds. Slowly release the air, tensing your abdominal muscles as much as possible. Do several approaches, gradually increasing the period of holding your breath to 17 seconds.
We must not forget about proper rest between approaches. Such breathing exercises can cause dizziness, and an unprepared, physically weak person can even faint.

Breathing exercises for reflux esophagitis reduce the pain of symptoms, reduce intra-abdominal pressure and stimulate the functioning of the stomach. Any exercise should be done by tensing the abdominal muscles as much as possible and as if exhaling through the stomach.

Exercises prohibited for GERD:

any abdominal exercises, especially those related to raising legs while lying down;
bending the torso forward and all similar exercises;
lifting sports equipment weighing over 10–12 kilograms.

The therapeutic training plan for GERD excludes exercises in a horizontal position, as they intensify the reflux of stomach contents into the esophagus and increase discomfort: heartburn, burning, pain.

It is better to perform any exercise in a sitting or standing position. Moderate-intensity exercise is great for stimulating digestive function, and drinking enough water will further aid this.

In addition to moderate-intensity aerobics, if you have reflux esophagitis, you can do exercises to strengthen your legs, arms and core muscles:

swing your legs and arms;
any training combinations in the knee-elbow position;
various lifts of dumbbells (total weight should not exceed 15 kilograms) and bodybar in a sitting and standing position.

By following all of the above recommendations, gaining endurance and patience, and also enlisting the support of a trainer specializing in exercise therapy, you can not only reduce the unpleasant symptoms of GERD, but also strengthen and improve the health of the body. In tandem with proper nutrition and medication support (exclusively on the recommendation of the attending physician), recovery is progressing by leaps and bounds.

attending physician. Copying of materials is permitted only with an active link to the source.

GERD AND SPORTS

City Clinical Hospital No. 68; Moscow, Shkuleva st., 4

Department of Emergency Surgical Gastroenterology
Department of Acute Surgical Diseases of the Liver and Pancreas
Department of Ultrasound Diagnostics

Topics of consultations:

ultrasound diagnostics;
all types of minimally invasive surgical interventions under ultrasound control;
surgical gastroenterology;
organization of treatment in Moscow and abroad in all areas;

Write down the complaints, duration of the disease, previously used treatment and its effectiveness, results of FGDS and X-ray of the esophagus.

Once you receive your answer, don’t forget to rate it (“rate the answer”). I am grateful to everyone who considered it possible and necessary to evaluate the answer!

They prescribed pariet once a day.

Among the symptoms, the stomach is full, there is no heartburn, and there is difficulty breathing (sometimes) as if there is not enough air.

Exercise for gastrointestinal reflux

People who suffer from gastro-food reflux also do not refuse to exercise. But with such a disease, any training must have a special approach. Gastroesophageal reflux disease, as it is called “scientifically,” brings a lot of trouble to a person, and sports in this case can become a source of relief and bring a lot of benefits to the body. This is also proven by studies that were conducted back in 2004. Then it was noted that all the people who played sports experienced much less symptoms of GERD than all those patients who never became friends with sports. Relieves the symptoms of GERD and the ability to maintain a healthy weight, which is also possible with exercise. With weight gain, the symptoms of the disease noticeably increase and worsen.

It has even been noted that all overweight people suffer from the symptoms of this disease 2.5 times more than people with normal weight. There was a greater likelihood of developing digestive tract cancer in fat people than in people who are not overweight.

In any case, physical exercise has a beneficial effect on the body. They help improve its health in many aspects and reduce the symptoms of GERD. But there is still a risk of aggravating such symptoms, so you should be careful with sports. Although, this does not mean at all that you should put aside your sneakers and immediately put on slippers to sit on the sofa in inactivity. There are more benefits from sports than from inactivity. In this regard, there is no need to give up training at all. It is only important to study a few recommendations and then follow them carefully in order to keep the disease under control, improve your well-being and enjoy the results of sports training.

Rules of conduct for reflux

1. In order for the digestion process to proceed properly, it takes a little time. The weight of a filled stomach itself is a rather serious test for the sphincter. If you add to all this the concussions that occur during sports, it is clear that the symptoms can quickly worsen. Therefore, it is very important to control your food intake and exercise. It is advisable that at least two hours pass between them. Although, it all also depends on the person, as well as on the type of food. If you ate something very light for lunch, then it may take a little less time to digest. If the diet was heavier, then more time will be required before training.

2. Be very careful about what you eat. Food should be quickly digested and quickly absorbed. Fatty foods will take a long time to digest, just like protein foods. Before training, it is better to give preference to a diet rich in carbohydrates. It is also advisable to avoid foods that may cause heartburn. But, in any case, no matter what foods you choose, remember that it will take time to digest them.

3. Carry a bottle of water with you, as it tends to raise your energy level. After all, it is water that will help prevent dehydration, which often becomes a consequence of too intense training. In addition, water is an excellent aid for digesting food.

4. There is no need to pay too much attention to intense exercise, which includes jogging or, for example, intensive classes aerobics. These movements can only aggravate the condition, because during such training the contents of the stomach are actively shaken. It is best to choose more “even” sports that will not contribute to aggravation. Exercises such as yoga, walking, cycling or rollerblading are suitable. There are people for whom exacerbations begin when they take a “lying down” position. In this case, it is important to try to avoid such exercises.

Be prepared to consult a doctor

If none of the recommendations help, you need to consult a doctor. After a little research, your doctor will tell you what you absolutely need to do in order to relieve discomfort from physical activity. You may need to undergo an additional course of treatment.

GEBE has symptoms such as chest pain and heartburn. But they can occur not only with BBB, but also become a consequence of other diseases. This especially applies to chest pain, because this symptom may indicate some kind of heart disease. Therefore, if chest pain intensifies, doctors recommend not to ignore it, but to immediately seek advice from a clinic.

Each person has his own characteristics. And the body of each of us is individual. We experience diseases differently, feel symptoms, and everyone has their own level of sensations. Therefore, what is useful for one person can become a big and serious problem for another. And everyone is looking for their own path in sports on their own. This also applies to people who suffer from gastrointestinal reflux. Each of them must find their own preferences in sports. But this is not easy to do; you often have to use trial and error.

Lifestyle changes for GERD

It is a little unusual to hear recommendations from doctors about the need to change something in your life in order to successfully treat gastroesophageal reflux disease. Accept that it will take a long time to accept medicinal substances, it’s still possible, but not everyone is ready to change their habits.

It is clear that any disease of the digestive system requires a special diet. But why make changes to lifestyle with GERD is difficult to understand.

Lifestyle changes are part of the treatment plan

Why do doctors focus their attention on the importance of this point in treatment? How can adjusting your work schedule or wearing certain clothes help in the fight against an unpleasant illness?

At first glance, such “appointments” look ridiculous. But in fact, this is the only way to finally or permanently get rid of the burning annoying problem. What will have to be changed?

You should avoid lifting heavy objects after eating, and reduce physical activity after any, even light, snack.
Find time for a calm and measured meal (change your diet culture - you need to eat at least five times a day).
You'll have to take care of yourself thoroughly: quit smoking and lose weight!
Down with tight-fitting clothes that restrict movement - they only worsen the course of the disease.
Do not be nervous. If you are a very vulnerable type of person who always takes all negativity to heart, sign up for a course with a psychologist.

So, in short, you will need to change something, in more detail the work on yourself looks like this.

Be careful with physical activity

Living well with GERD is like studying science. If you organize everything from the very beginning, then it will be much easier and clearer. For those who like to play sports, it is important to plan it correctly. For what? This disease is compatible with physical activity, but under certain circumstances.

Due to the weakness of the lower esophageal sphincter (the round muscle that closes the return passage of food from the stomach to the esophagus), any exercise immediately after eating will lead to a burning sensation due to the reflux of acid or a bolus of food into the upper parts of the digestive system. Therefore, the first rule is to eat food an hour or an hour after active physical exercise.
The second rule is: you cannot eat while playing sports, for the same reason.
The third point concerns not intensive physical activity, and behavior: do not lift weights or bend over while eating. This promotes backward movement of food, which causes burning and pain. In addition, when bending over, the stomach is compressed, which creates additional stress on the digestive organs.

In case of reflux disease, it is necessary to clearly distinguish between periods for nutrition and active rest.

Nutrition for GERD

To help your body cope with the disease, it is important to organize nutrition for GERD. We are talking not only about frequent meals, it is necessary that food enters the body in small portions and is properly cooked. For what? - everything is very simple if you consider the features of the course of the disease.

Gastroesophagitis is an inflammatory process of the mucous membrane and esophagus. During the period of exacerbation of the disease, the load on these organs is maximum and the body does not always cope with its functions. If you eat a lot, consuming large quantities of fatty, spicy and fried food, it will not be fully digested, which a person feels in the form of heaviness, heartburn, and abdominal pain.
With fractional meals, the food supply is evenly distributed; due to the small volume, it is processed faster and better.
Boiled, stewed and baked food does not contain irritants and carcinogens (which are formed if foods are fried), which is easier for the stomach and does not “scratch” the inflamed esophagus.
And lastly, eat slowly! The process of processing food is also a burden on the body, do not complicate the work gastrointestinal tract.

Self-care

Another important reason to lose weight is GERD. You will have to change your lifestyle, but this will only be for the good. All overweight- harmful not only to the heart and joints, but also to the digestive organs. The abdomen, enlarged in volume due to fat deposits, props up the stomach. This leads to frequent reflux of hydrochloric acid into the esophagus and inflammation of its lower section. Lose weight gradually and your body will feel much better.

Smoking and drinking coffee on an empty stomach are the first enemies of the esophagus and gastrointestinal tract. All harmful substances contained in cigarette smoke cause inflammation of the mucous membrane of the digestive organs and disrupt local protection. To recover, it is better to give up these habits.

Peace of mind

Stress at work, problems in the family - these are unnecessary constant nervous strains. It is important to protect your nervous system. Its excessive stimulation causes deep damage to internal organs, including the digestive system. In gastroesophageal disease, nervous disorders aggravate the process. What to do? You need to act:

during difficult emotional periods, drink tea with herbs that normalize the functioning of the nervous system;
take medications to improve adaptation to stress;
work with specialists - take auto-training courses from a psychologist.

Small adjustments in lifestyle and nutrition for GERD are not a violation of one’s freedom, but a necessity and important points in the treatment of the disease. Treat such prescriptions with understanding and patience, and the period of taking the medications may be shortened.

Really not a word about alcohol? Incredible)) Did you just forget to mention or is this not the main trigger?

Igor, can you imagine how many people will take your advice and harm themselves? Try medicine.

This is exactly what Omez is doing wrong, try it (deleted).

I have been suffering from heartburn for 5 years now, I swallowed an umbrella, the doctor said it was reflux esophagitis. I took Omez, but it washes away.

Copying of materials is permitted if an active link to our website is installed.

All information on the site is provided for informational purposes; on all questions of treatment, consultation with a doctor is required.

Warshavskaya gymnastics for GERD: rules of execution and contraindications

Warsaw gymnastics for GERD is prescribed quite often. Therapeutic exercise only speeds up recovery, keeps the condition stable for a long time, and reduces the amount of medications consumed. However, it will not be possible to cure gastroesophageal disease with gymnastics alone, although the time of recovery will come closer.

The benefits of physical education and the rules for doing it

Exercise therapy for pathologies such as esophagitis and cardia insufficiency is carried out in accordance with the recommendations of specialists, so as not to cause further harm. Gymnastic exercises are characterized by the following advantages:

stimulate the immune system;
develop the muscles of the human body, which contributes to good nutrition tissues, rapid healing of wounds on the mucous membranes of the gastrointestinal tract;
breathing exercises, as well as yoga, strengthen the sphincter of the lower esophagus, which does not allow the contents of the stomach to be thrown back;

reduces reflux disease (its manifestations) at night;
each exercise also helps to avoid the development of reflux esophagitis, as well as pathology such as cardia failure.

Warsaw gymnastics for GERD must be performed in compliance with certain rules. A specialist should select the complex based on the degree of development of the pathology, general condition patient. Exercise must be combined with diet and other forms of treatment.

Features of breathing exercises

If a person has cardial failure or esophageal disease, there is no need for intensive physical training. Correct breathing is needed. The following actions will be useful:

Gymnastics must be performed in a comfortable position: sitting. Once the patient has decided, he should slowly take a deep breath and exhale. At the second stage, the process involves internal organs abdominal cavity. The exercise should be repeated 4 times.
The next movement involves inhaling slowly (deeply). At the same time, you need to release the air quickly. This is done through the abdominal cavity. Number of repetitions - 10.
Take a deep, slow breath and hold the air inside for 5 seconds. While simultaneously tensing the abdominal muscles, a gradual exhalation is made. Air retention can be increased over time to 15 seconds.
The last exercise is also not difficult. The patient just needs to take a deep breath and then release the air, but in stages. You can even watch a video of exactly how this is done.

Too much oxygen, which comes from doing gymnastics, causes dizziness and even fainting. Therefore, you should be careful.

Except breathing exercises, such a disorder requires performing aerobic exercises: fast walking, jogging, cycling. If a person plays sports, then he needs to take into account that manipulations that strongly strain the abdominal muscles are prohibited.

Cautions and Indications

To find out whether it is possible to play sports with GERD, it is better to contact a specialist who will conduct an examination and determine the degree of development of the pathology. It is also important to know whether cardia insufficiency has been diagnosed. Changing your lifestyle for GERD can help you recover.

People with this disease must exercise carefully, as there are certain contraindications:

You cannot do physical exercise if the inflammation associated with esophagitis is severe.
Gymnastics is performed on an empty stomach; you should not even drink water.
If there is cardia deficiency, then a person should do gymnastics in a position that will allow him to completely relax and calm down.

If the cardiac sphincter is too weak, it must be strengthened, since it will not prevent the release of stomach contents back into the esophagus. Exercise should be performed to prevent GERD. At the same time, the difficulty level gradually increases. However, too intense training is contraindicated.

WORKOUT

For people suffering from gastroesophageal reflux or, scientifically, gastroesophageal reflux disease (GERD), exercise requires a special approach. For some, moderate exercise can relieve symptoms of GERD, providing great benefits to the body in all ways. A 2004 study reported that people who exercised regularly experienced significantly less symptoms of GERD compared to those who did not exercise. Not to mention, regular exercise is the best way to maintain a healthy weight, which can also help relieve GERD symptoms. Overweight increases the likelihood of GERD symptoms. Obese people(those with a body mass index of more than 30) suffer from reflux or esophageal erosion 2.5 times more often than people with a normal BMI (from 18.5 to 24.9). They are also three times more likely to develop esophageal cancer than people of normal weight.

Digestion takes time. The weight of a full stomach is in itself a serious test for the esophageal sphincter. If you add to this the concussions that occur during sports, then you will have problems. Make sure that at least two hours pass between meals and training (more time may be required for a specific person and type of food).

Symptoms of GERD such as heartburn and chest pain are often indistinguishable from similar signs of serious heart disease because the same nerves are involved. Doctors urge us not to ignore any chest pain. If you feel chest pain, whether you are exercising or not, be sure to consult a doctor!

Gastroesophageal reflux disease (GERD) - Conservative treatment

The success of therapy lies not only in adequately carried out drug correction, but also in changing the patient’s lifestyle and dietary habits.

changes in body position during sleep;
dietary changes;
abstinence from smoking;
abstinence from alcohol abuse;
if necessary, weight loss;
refusal of medications that induce the occurrence of GERD;
avoiding loads that increase intra-abdominal pressure, wearing corsets, bandages and tight belts, lifting weights of more than 8-10 kg on both arms, work involving bending the body forward, physical exercises associated with overstraining the abdominal muscles.

Recovery muscle tone apertures recommended special exercises, not associated with torso tilt.

Exception strictly horizontal position during sleep allows you to reduce the number of reflux episodes and their duration, as esophageal cleansing increases due to the action of gravity. The patient is recommended to raise the head end of the bed by 15 cm.

it is necessary to exclude overeating and “snacking” at night;
lying down after eating;
after eating, avoid bending forward and horizontal position;
foods rich in fat (whole milk, cream, fatty fish, goose, duck, pork, fatty beef, lamb, cakes, pastries), drinks containing caffeine (coffee, strong tea or cola), chocolate, foods containing peppermint and pepper (all of them reduce the tone of the lower esophageal sphincter);
citrus fruits and tomatoes, fried foods, onions and garlic, since they have a direct irritating effect on the sensitive mucous membrane of the esophagus;
consumption of butter and margarine is limited;
3-4 meals a day are recommended, a diet with a high protein content, since protein foods increase the tone of the lower esophageal sphincter;
last meal - at least 3 hours before bedtime, after meals - 30-minute walks.
sleep with the head of the bed raised; eliminate loads that increase intra-abdominal pressure: do not wear tight clothes and tight belts, corsets, do not lift weights of more than 8-10 kg on both hands, avoid physical activity associated with abdominal strain; to give up smoking; maintaining normal body weight;

For preventive purposes, it is necessary to prescribe the cocktails proposed by G.V. for 2-3 weeks. Dibizhevoi: cream or fermented baked milk 0.5 liters + beaten white of one egg + 75 ml. 3% tannin. Apply 8-10 times a day, a few sips through a straw before and after meals.

Avoid taking medications that reduce the tone of the lower esophageal sphincter (anticholinergics, tricyclic antidepressants, sedatives, tranquilizers, calcium antagonists, beta-agonists, drugs containing L-dopamine, narcotics, prostaglandins, progesterone, theophylline).

Treatment in most cases should be carried out on an outpatient basis. Treatment should include general measures and specific drug therapy.

Indications for hospitalization

Antireflux treatment for complicated disease, as well as in case of ineffectiveness of adequate drug therapy. Carrying out endoscopic or surgical intervention (fundoplication) in case of ineffectiveness of drug therapy, in the presence of complications of esophagitis: stricture of Barrett's esophagus, bleeding.

Includes the appointment of prokinetics, antisecretory agents and antacids.

Brief characteristics of drugs used in the treatment of gastroesophageal reflux disease:

1. Antacids

Mechanism of action: neutralize hydrochloric acid, inactivate pepsin, adsorb bile acids and lysolycetin, stimulate the secretion of bicarbonates, have a cytoprotective effect, improve esophageal cleansing and alkalization of the stomach, which helps increase the tone of the lower esophageal sphincter.

For the treatment of gastroesophageal reflux disease, it is better to use liquid forms of antacids. It is better to use conditionally insoluble (non-systemic) antacid drugs, such as those containing non-absorbable aluminum and magnesium, antacids (Maalox, Phosphalugel, Gastal, Rennie), as well as antacid drugs that contain substances that eliminate symptoms of flatulence (Protab, Daijin, Gestid).

Of the huge variety of antacid drugs, one of the most effective is Maalox. It is distinguished by a variety of forms, the highest acid-neutralizing ability, as well as the presence of a cytoprotective effect due to the binding of bile acids, cytotoxins, lysolecithin and activation of the synthesis of prostaglandins and glycoproteins, stimulation of the secretion of bicarbonates and protective mucopolysaccharide mucus, an almost complete absence of side effects and a pleasant taste.

Preference should be given to third generation antacid drugs such as Topalcan, Gaviscon. They contain: colloidal aluminum oxide, magnesium bicarbonate, hydrated silicic anhydrite and alginic acid. When dissolved, Topalkan forms a foamy antacid suspension, which not only adsorbs HCI, but also, accumulating above the layer of food and liquid and entering the esophagus in the case of gastroesophageal reflux, has a therapeutic effect, protecting the esophageal mucosa from aggressive gastric contents. Topalcan is prescribed 2 tablets 3 times a day 40 minutes after meals and at night.

The pharmacological effect of these drugs is to enhance antropyloric motility, which leads to accelerated evacuation of gastric contents and increased tone of the lower esophageal sphincter, reducing the number of gastroesophageal refluxes and the time of contact of gastric contents with the esophageal mucosa, improving esophageal cleansing and eliminating slow gastric evacuation.

One of the first drugs in this group is the central dopamine receptor blocker Metoclopramide (Cerucal, Reglan). It enhances the release of acetylcholine in the gastrointestinal tract (stimulates the motility of the stomach, small intestine and esophagus), blocks central dopamine receptors (impact on the vomiting center and the center for regulating gastrointestinal motility). Metoclopramide increases the tone of the lower esophageal sphincter, accelerates gastric emptying, has a positive effect on esophageal clearance and reduces gastroesophageal reflux.

The disadvantage of Metoclopramide is its undesirable central effect ( headache, insomnia, weakness, impotence, gynecomastia, increased extrapyramidal disorders). Therefore, it cannot be used for a long time.

A more successful drug from this group is Motilium (Domperidone), which is an antagonist of peripheral dopamine receptors. The effectiveness of Motilium as a prokinetic agent does not exceed that of Metoclopramide, but the drug does not penetrate the blood-brain barrier and has virtually no effect side effects. Motilium is prescribed 1 tablet (10 mg) 3 times a day before meals. As monotherapy, it can be used in patients with degrees I-II of GERD. It is important to note that taking Motilium cannot be combined in time with taking antacids, since its absorption requires an acidic environment, and with anticholinergic drugs that neutralize the effect of Motilium. The most effective treatment for GERD is Prepulsid (Cisapride, Coordinax, Peristil). It is a gastrointestinal prokinetic agent without antidopaminergic properties. Its mechanism of action is based on an indirect cholinergic effect on the neuromuscular apparatus of the gastrointestinal tract. Prepulsid increases the tone of the LES, increases the amplitude of contractions of the esophagus and accelerates the evacuation of gastric contents. At the same time, the drug does not affect gastric secretion, so Prepulsid for reflux esophagitis is best combined with antisecretory drugs.

The prokinetic potential of a number of other drugs is being studied: Sandostatin, Leuprolide, Botox, as well as drugs acting through serotonin receptors 5-HT 3 and 5-HT 4.

3. Antisecretory drugs

The goal of antisecretory therapy for GERD is to reduce the damaging effect of acidic gastric contents on the esophageal mucosa. Histamine H2 receptor blockers and proton pump inhibitors are used in the treatment of GERD.

4. Histamine H2 receptor blockers

There are currently 5 classes of H2 blockers available: Cimetidine (I generation), Ranitidine (II generation), Famotidine (III generation), Nizatidine (Axid) (IV generation) and Roxatidine (V generation).

The most widely used drugs are from the Ranitidine (Ranisan, Zantac, Ranitin) and Famotidine (Kvamatel, Ulfamid, Famosan, Gastrosidine) groups. These drugs effectively reduce basal, nocturnal, food- and drug-stimulated secretion of hydrochloric acid in the stomach, and inhibit the secretion of pepsins. If a choice is possible, preference should be given to Famotidine, which, due to greater selectivity and lower dosage, acts longer and does not cause side effects, inherent in Ranitidine. Famotidine is 40 times more effective than cimitidine and 8 times more effective than ranitidine. In a single dose of 40 mg, it reduces nocturnal secretion by 94% and basal secretion by 95%. In addition, Famotidine stimulates the protective properties of the mucous membrane by increasing blood flow, bicarbonate production, prostaglandin synthesis, and enhancing epithelial repair. The duration of action of 20 mg Famotidine is 12 hours, 40 mg - 18 hours. Recommended dose for GERD treatment mg per day.

5. Proton pump blockers

Proton pump blockers are currently considered the most powerful antisecretory drugs. Drugs in this group are practically free of side effects, since they exist in active form only in the parietal cell. The action of these drugs is to inhibit the activity of Na + /K + -ATPase in the parietal cells of the stomach and block the final stage of HCI secretion, while almost 100% inhibition of the production of hydrochloric acid in the stomach occurs. Currently, 4 chemical varieties of this group of drugs are known: Omeprazole, Pantoprazole, Lanzoprazole, Rabeprazole. The ancestor of proton pump inhibitors is Omeprazole, first registered as the drug Losek by Astra (Sweden). A single dose of 40 mg of Omeprazole completely blocks the formation of HCI for 24 hours. Pantoprazole and Lanzoprazole are used in dosages of 30 and 40 mg, respectively. The drug from the Rabiprazole group, Pariet, has not yet been registered in our country; clinical trials are underway.

Omeprazole (Losec, Losek-maps, Mopral, Zoltum, etc.) at a dose of 40 mg allows achieving healing of esophageal erosions in 85-90% of patients, including patients who do not respond to therapy with histamine H 2 receptor blockers. Omeprazole is especially indicated for patients with stage II-IV GERD. In control studies with Omeprazole, earlier subsidence of GERD symptoms and more frequent cures were noted in comparison with conventional or double doses of H 2 blockers, which is associated with a greater degree of suppression of acid production.

Recently, a new improved form of the drug Losek, produced by Astra, Losek-maps, has appeared on the drug market. Its advantage is that it does not contain allergen fillers (lactose and gelatin), is smaller in size than a capsule, and is coated with a special coating to make it easier to swallow. This drug can be dissolved in water and, if necessary, used in patients with a nasopharyngeal tube.

Currently, a new class of antisecretory drugs is being developed that do not inhibit the proton pump, but only interfere with the movement of Na + /K + -ATPase. A representative of this new group of drugs is ME.

Misoprostol (Cytotec, Cytotec) is a synthetic analogue of PG E2. It has a broad protective effect on the gastrointestinal mucosa:

reduces the acidity of gastric juice (suppresses the release of hydrochloric acid and pepsin, reduces the reverse diffusion of hydrogen ions through the gastric mucosa;
increases the secretion of mucus and bicarbonates;
increases the protective properties of mucus;
improve blood flow to the esophageal mucosa.

Misoprostol is prescribed 0.2 mg 4 times a day, usually for stage III gastroesophageal reflux disease.

Venter (Sucralfate) is the ammonium salt of sulfated sucrose (a disaccharide). Accelerates the healing of erosive and ulcerative defects of the esophagogastroduodenal mucosa by forming a chemical complex - a protective barrier on the surface of erosions and ulcers and prevents the action of pepsin, acid and bile. Has astringent properties. Prescribe 1 g 4 times a day between meals. The administration of Sucralfate and antacid drugs must be separated by time.

For gastroesophageal reflux caused by reflux of duodenal contents into the esophagus (alkaline, bile variant of reflux), usually observed with cholelithiasis, a good effect is achieved by taking non-toxic ursodeoxycholic bile acid (Ursofalk) 250 mg at night, which in this case is combined with Coordinax. The use of Cholestyramine is also justified (ammonium anion exchange resin, a non-absorbable polymer, binds to bile acids, forming a strong complex with them that is excreted in the feces). Accepted g/day.

Dynamic observation of detected secretory, morphological and microcirculatory disorders in GERD is confirmed by the currently proposed various schemes for drug correction of gastroesophageal reflux disease.

The most common are (A.A. Sheptulin):

a “step-by-step” therapy scheme, which involves prescribing drugs and combinations of different strengths at different stages of the disease. So, at the first stage, the main place in treatment is given to lifestyle changes and, if necessary, taking antacid medications. If clinical symptoms persist, prokinetics or H2-histamine receptor blockers are prescribed at the second stage of treatment. If such therapy is ineffective, then at the 3rd stage, proton pump inhibitors or a combination of H 2 blockers and prokinetics are used (in especially severe cases, a combination of proton pump blockers and prokinetics);
The “step down” therapy scheme involves prescribing proton pump inhibitors from the very beginning, followed by a transition to taking H2 blockers or prokinetics after achieving a clinical effect. The use of such a regimen is justified in patients with severe disease and severe erosive and ulcerative changes in the mucous membrane of the esophagus.

Options for drug therapy taking into account the stage of development of GERD (P.Ya. Grigoriev):

For gastroesophageal reflux without esophagitis, Motilium or Cisapride 10 mg 3 times a day is prescribed orally for 10 days in combination with antacids 15 ml 1 hour after meals, 3 times a day and 4 times before bedtime.
For reflux esophagitis 1st degree severity - H 2 blockers are prescribed orally: for 6 weeks - Ranitidine 150 mg 2 times a day or Famotidine 20 mg 2 times a day (for each drug taken in the morning and evening with an interval of 12 hours). After 6 weeks, if remission occurs, drug treatment is stopped.
For reflux esophagitis of the second degree of severity, Ranitidine 300 mg 2 times a day or Famotidine 40 mg 2 times a day or Omeprazole 20 mg after lunch (hours) is prescribed for 6 weeks. After six weeks, drug treatment is stopped if remission occurs.
For reflux esophagitis of the third degree of severity, Omeprazole 20 mg is prescribed orally for 4 weeks, 2 times a day, morning and evening with a mandatory interval of 12 hours, and then, in the absence of symptoms, continue taking Omeprazole 20 mg per day or another proton pump inhibitor 30 mg 2 times a day for up to 8 weeks, after which they switch to taking histamine H2 receptor blockers in a maintenance half dose for a year.
For reflux esophagitis of the fourth degree of severity, Omeprazole 20 mg 2 times a day is prescribed orally for 8 weeks, morning and evening with a mandatory interval of 12 hours, or another proton pump inhibitor 30 mg 2 times a day and when remission occurs, switch to constant use of H2-histamine blockers. TO additional funds Treatment of refractory forms of GERD includes Sucralfate (Venter, Sukratgel) 1 g 4 times a day 30 minutes before meals for 1 month.

mild disease (grade 0-1 reflux esophagitis) requires a special lifestyle and, if necessary, taking antacids or H2 receptor blockers;
with moderate severity (grade II reflux esophagitis), along with constant adherence to a special lifestyle and diet, long-term use of H 2 receptor blockers in combination with prokinetics or proton pump inhibitors is necessary;
in case of severe illness (grade III reflux esophagitis), a combination of H2 receptor blockers and proton pump inhibitors or high doses of H2 receptor blockers and prokinetics are prescribed;
the lack of effect of conservative treatment or complicated forms of reflux esophagitis are an indication for surgical treatment.

Considering that one of the main reasons leading to an increase in spontaneous relaxations of the lower esophageal sphincter is an increase in the level of neuroticism in patients suffering from GERD, testing to assess the personality profile and correct the identified disorders seems extremely relevant. To assess the personality profile of patients with pathological gastroesophageal reflux identified by pH-metry, we conduct psychological testing using a computer modification of the Eysenck, Schmishek, MMPI, Spielberger questionnaires, and the Luscher color test, which allows us to identify the dependence of the nature and severity of gastroesophageal reflux on individual personality characteristics and accordingly, taking this into account, develop effective schemes treatment. Thus, it is possible to achieve not only a reduction in treatment time, but also significantly improve the quality of life of patients. Along with standard therapy, depending on the identified anxious or depressive personality type, patients are prescribed Eglonil 50 mg 3 times a day or Grandaxin 50 mg 2 times a day, Teralen 25 mg 2 times a day, which improves the prognosis of the disease.

Treatment of gastroesophageal reflux disease in pregnant women

It has been established that the main symptom of GERD - heartburn - occurs in 30-50% of pregnant women. The majority (52%) of pregnant women experience heartburn in the first trimester. The pathogenesis of GERD is associated with hypotension of the LES under basal conditions, increased intra-abdominal pressure and slow gastric evacuation function. Diagnosis of the disease is based on clinical data. Carrying out (if necessary) endoscopic examination is considered safe. Lifestyle changes are especially important in treatment. At the next stage, “non-absorbable” antacid drugs (Maalox, Phosphalugel, Sucralfate, etc.) are added. Considering that Sucralfate (Venter) can cause constipation, the use of Maalox is more justified. In case of treatment refractoriness, H2 blockers such as Ranitidine or Famotidine can be used.

The use of Nizatidine during pregnancy is not indicated, since in the experiment the drug showed teratogenic properties. Taking into account experimental data, the use of Omeprazole, Metoclopramide and Cisapride is also undesirable, although there are isolated reports of their successful use during pregnancy.

Anti-relapse treatment of gastroesophageal reflux disease

Currently, there are several options for anti-relapse treatment of GERD (permanent therapy):

H 2 blockers in a full daily dose twice a day (ranitidine 150 mg 2 times a day, famotidine 20 mg 2 times a day, nizatidine 150 mg 2 times a day).
Treatment with proton pump inhibitors: Omeprazole (Losec) 20 mg in the morning on an empty stomach.
Taking prokinetics: Cisapride (Coordinax) or Motilium at half the dose compared to the dose used during an exacerbation.
Long-term treatment with non-absorbable antacids (Maalox, Phosphalugel, etc.).

The most effective anti-relapse drug is omeprazole 20 mg in the morning on an empty stomach (88% of patients remain in remission for 6 months of treatment). When comparing Ranitidine and placebo, this figure is 13 and 11%, respectively, which casts doubt on the advisability of long-term use of Ranitidine for the anti-relapse treatment of GERD.

A retrospective analysis of prolonged permanent use of small doses of Maalox suspension 10 ml 4 times a day (acid neutralizing ability 108 mEq) in 196 patients with stage II GERD showed a fairly high anti-relapse effect of this regimen. After 6 months of permanent therapy, remission remained in 82% of patients. None of the patients experienced side effects that forced them to stop prolonged treatment. No data have been obtained on the presence of phosphorus deficiency in the body.

American experts estimate that five years of full-fledged antireflux therapy costs patients more than $6,000. However, when you stop taking even the most effective drugs and their combinations do not experience long-term remission. According to foreign authors, relapse of GERD symptoms occurs in 50% of patients 6 months after stopping antireflux therapy, and in 87-90% after 12 months. There is an opinion among surgeons that adequately performed surgical treatment of GERD is effective and cost-effective.

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kyiv National Medical University them. A.A. Bogomolets, specialty - “General Medicine”

The benefits of physical education and the rules for doing it

stimulate the immune system;
develop the muscles of the human body, which promotes good tissue nutrition and rapid healing of wounds on the mucous membranes of the gastrointestinal tract;
breathing exercises, as well as yoga, strengthen the sphincter of the lower esophagus, which does not allow the contents of the stomach to be thrown back;

reduces reflux disease (its manifestations) at night;
each exercise also helps to avoid the development of reflux esophagitis, as well as pathology such as cardia failure.

Warsaw gymnastics for GERD must be performed in compliance with certain rules. A specialist should select the complex based on the degree of development of the pathology and the general condition of the patient. Exercise must be combined with diet and other forms of treatment.

Features of breathing exercises

If a person has cardia insufficiency or esophageal disease, there is no need for intense physical training. Correct breathing is needed. The following actions will be useful:

Gymnastics must be performed in a comfortable position: sitting. Once the patient has decided, he should slowly take a deep breath and exhale. At the second stage, the internal organs of the abdominal cavity are involved in the process. The exercise should be repeated 4 times.
The next movement involves inhaling slowly (deeply). At the same time, you need to release the air quickly. This is done through the abdominal cavity. Number of repetitions - 10.
Take a deep, slow breath and hold the air inside for 5 seconds. While simultaneously tensing the abdominal muscles, a gradual exhalation is made. Air retention can be increased over time to 15 seconds.
The last exercise is also not difficult. The patient just needs to take a deep breath and then release the air, but in stages. You can even watch a video of exactly how this is done.

Too much oxygen, which comes from doing gymnastics, causes dizziness and even fainting. Therefore, you should be careful.

In addition to breathing exercises, this disorder requires performing aerobic exercises: fast walking, jogging, cycling. If a person plays sports, then he needs to take into account that manipulations that strongly strain the abdominal muscles are prohibited.

Cautions and Indications

People with this disease must perform exercises carefully, as there are certain contraindications:

You cannot do physical exercise if the inflammation associated with esophagitis is severe.
Gymnastics is performed on an empty stomach; you should not even drink water.
If there is cardia deficiency, then a person should do gymnastics in a position that will allow him to completely relax and calm down.