MEDICAL

By the most conservative estimates, every tenth inhabitant of the Earth is experiencing pain from cholelithiasis. This is one of the most common diseases, participation over recent years in all regions, among both sexes, all age groups. On the one hand this is due to improved diagnostic methods, on the other hand – the changing nature of power and an increase of nervous and mental stress.

Currently expanded opportunities as a tool, ultrasound, and laboratory (biochemical, bacteriological) studies bile-excreting system. Perfected skill as a physician in the diagnosis and treatment. In addition to surgical and nonsurgical treatment appeared. 

But before you start treatment, the physician must understand the cause of stones in the gallbladder.

Gall bladder in humans has a length of 5 to 10 mm per day over such a small body of distinguished 1000 ml of bile. Overheating and physical activity help to reduce allocations bile. Biliary excretion is reduced in the evening, but does not stop at night.

In the risk group includes those whose relatives suffer from this disease, people with overweight and leading sedentary lifestyles. Very important role played by nutrition. Eating high-calorie and refined foods promotes the formation of gallstones and violation of the coordinated work of the special zhomov-sphincter of biliary tract. They open at the right time and allow the bile to the intestine, where digestion is carried out. Doctors call this condition dyskinesia – a violation of the motor function of biliary tract. Disruption of synchrony of the gall bladder and sphincter can lead to stagnation of bile in the bladder, its condensation.

This "stone formation" in the gall bladder is the correlation between cholesterol and bile acids. In violation of the acid-alkaline balance of the unrelated cholesterol precipitates out and the process of forming stones. This process is lengthy and may take several years.

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Chronic duodenitis - a disease 12-duodenum, the main manifestation of which are changes in the form of mucosal inflammation, atrophy, erosions. It may be an independent disease, as well as concomitant peptic ulcer, chronic pancreatitis, cholecystitis, gastritis, food allergies, liver disease.

Symptoms and course of chronic duodenitis. Typical pit of the stomach pain of varying intensity, at different times of day, including the "hungry", the night may be permanent in the form of bursting open and severity, nausea and a tendency to constipation, heartburn, burping air. The course of the disease for many years. Exacerbations often in spring or autumn, after the error in the food, last from 2 weeks to 1.5 months. Symptoms of exacerbations in some patients with se resemble peptic ulcer 12-duodenum. Most gastric acidity is normal or increased, reduced case with gastritis associated with atrophy of the mucous membrane. Duodenitis may be complicated by bleeding from erosion.

Recognition of chronic duodenitis. When ostroduodenoskopii detect mucosal inflammatory changes (swelling, redness) and the presence of erosions, yazvopodobpye superficial mucosal damage. X-ray data have very little.

Treatment of chronic duodenitis. During exacerbation diet number 1. Outside exacerbation advised to observe diet 4 times a day, excluding canned goods, meats, spices, alcohol. Spa treatment only in remission.

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Most dystrophy develops in early childhood.

Dystrophy in children - a chronic disorder of food, accompanied by a violation of assimilation by the body of nutrients from food, metabolic organism, its growth and development.

Causes of malnutrition

The causes of malnutrition are long-term starvation, overfeeding, high-quality violations of food predominance of products containing large amounts of carbohydrates, various infectious diseases (eg, dysentery, pneumonia), the error in the care of a child. Dystrophy also occurs due to insufficient food absorption in the gastrointestinal tract. It can develop in malformation of the gastrointestinal tract (eg, narrowing the place of transition of the esophagus to the stomach).

Symptoms dystrophy

The main clinical signs of malnutrition: weight change and growth, reduced resistance to various infections, disorders of the gastrointestinal tract.

Dystrophy, characterized by reduction in body weight of the child, called hypotrophy, with the degree of weight loss may be different, up to a sharp catch. In this type of dystrophy, allocate dystrophy with normal or increased weight. This type of dystrophy is rare and is caused, as a rule, monotonous feeding: mostly flour or dairy products. Children sluggish, inactive, they have noted a tendency to infections (ulcers on the skin, acute respiratory diseases, etc.). Children though and it looks full, but not their tissue elastic to the touch, and loose, testovatye, skin pale.When a uniform milk feeding and delayed introduction of complementary foods are often caused constipation. Feces are yellow, with a grayish tinge, dry, fetid. With monotonous flour-fed feces brown, watery, sweet, with a sour smell.

Treatment dystrophy

Treatment of malnutrition being a physician with the reasons that caused it. For example, in cases of dystrophy-related quantitative underfeeding, the appointment of the required amount of food by introducing a lactation aid can be sufficient to cure. Dystrophy, evolved as a result of malformation of the gastrointestinal tract, requires prompt treatment.

Prevention dystrophy

The prevention of malnutrition should begin even before birth. Expectant mother should observe the regime of the day, variously eat. After the birth of the child should consult a doctor as his nurse, when to start to introduce solid foods, in what quantity and composition, how to arrange proper care for the child and prevent acute and chronic diseases. Valuable means of preventing malnutrition is to correct physical education.

Muscular dystrophy, a group of chronic, inherited disease of skeletal (arbitrary) muscle man. Muscular dystrophy manifested progressive weakness and degeneration of muscles.

There are several forms of muscular dystrophy. They differ in characteristics such as age, in which the disease begins, the localization of affected muscles, the severity of muscle weakness, the rate of progression of dystrophy and type of inheritance. Most occur in two forms: Duchenne muscular dystrophy and myotonic muscular dystrophy.

Treatment of muscular dystrophy

There are ways to prevent or slow the progression of muscle weakness in muscular dystrophy. Therapy is aimed primarily at combating complications, such as spinal deformity, growing as a result of the weakness of the back muscles, or susceptibility to pneumonia caused by weakness of respiratory muscles. In this direction with some success, and quality of life of patients with muscular dystrophy has improved. Now many patients, despite their illness can lead full and productive lives.

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Dyspepsia - is a collective term. He refers to impairment of the function of digestion, which occurs when an insufficient allocation of digestive enzymes or poor diet.

Distinguish fermentation, putrefactive and fatty dyspepsia. Fermentation dyspepsia associated with excessive consumption of carbohydrates (sugar, honey, flour products, fruits, grapes, peas, beans, cabbage, etc.), and fermenting beverages (kvass), resulting in the gut microbes multiply.

Symptoms of dyspepsia

Heartburn - a burning sensation behind the breastbone or in the epigastrium, extending from the bottom up.

Nausea - familiar to all the painful sensation of approaching vomiting, sometimes with a feeling of pressure in the epigastrium.

Belching often occurs at elevated anxiety. The immediate cause of burping – intake air (or pneumophagia). People who eat very quickly, experiencing pneumophagia. Belching may be accompanied by increased salivation.

Unpleasant sensations (and even pain), upper abdominal and lower regions of the thorax.

Feeling overflow in the stomach or heaviness in the epigastrium.

Flatulence - this feeling of bursting open the abdomen, caused by excessive gas formation.

Treatment of dyspepsia

Treatment of toxic dyspepsia should be started as soon as possible. Its main purpose is to combat toxicosis, prevention of severe metabolic disturbances, rapid and complete recovery of all body functions.

Start at the "hungry pause" while the introduction of large quantities of liquid. The duration of this period is determined depending on the child’s age and condition to the disease and ranges from 6-8 hours (children’s first months of life, premature, weak, underweight) to 12 hours (in children older and stronger). Deprivation of food during the day allowed only in cases when the disease develops in eyrotrofikov.

Upon expiration of "starving pause" the baby is fed expressed breast milk 10 ml every 2 hours (10 times a day) is cooled. Replace artificial breast milk mixture should be only in cases of total inability to get it in the right quantity. From artificial mixtures of preference should be given yogurt.

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Dyskinesia of the intestines (irritable bowel syndrome, spastic colitis) - violation of the motor function of the colon and to a lesser extent, small intestine, not caused by organic lesions, characterized by pain, change in the administration of the intestine, and sometimes increased secretion of mucus. Is found in half of patients seeking about intestinal disorders.

Reasons dyskinesia intestine are neurotic disorders, dystonia of the autonomic nervous system, conflict and stressful situations, diencephalic disorders, genetic predisposition, endocrine disturbances. When dyskinesia in different parts of the intestine occur hyperkinetic (spastic) or hypokinetic (atonic) changes, and more often – a combination of both types of disorders.

Clinical picture

Concerned about the abdominal pain without clear localization and disorders of the chair, often accompanied by increased production of mucus. They arise from time to time, ranging from feelings of pressure in the lower abdomen to intense colic, the duration of their – from several minutes to several days. These pains are often mistaken for an attack of appendicitis and resort to surgery. There may be constipation alternating with diarrhea. The latter are usually in the morning or after a meal. Most of feces mixed with mucus.

The diagnosis can be made only after excluding organic diseases with similar symptoms. When endoscopy revealed hyperemia of the mucous membrane of the colon. Last places covered with slime, some of its parts spastic reduced. Microscopy of stool, biochemical studies did not reveal his change. In contrast to the habitual constipation with intestinal dyskinesia often alternating with constipation, diarrhea, a significant admixture of mucus in feces, sometimes it is removed in the form of membranes, expressed pain syndrome (up to the attacks of intestinal colic), spastic bowel loops and reduced morbidity at a palpation, haustration their reinforced uneven, there is no significant accumulation of feces in the rectum.

Treatment

When choosing a diet considered intolerance of any products should be avoided major restrictions in the diet and monotonous food. Medicines are appointed with great care – mainly sedatives and tranquilizers (valerian, motherwort, bromides, elenium, trioxazine, diazepam, melipramin, etc.). Recommended warm on his stomach, baths (coniferous, oxygen), wet pack, galvanic collar, diathermy, paraffin and ozokerite appliques on the lower abdomen. Good effect give electrosleep, acupuncture.

Prevention

Svoeremennoe treatment of neurosis, the organization of rest after work, weekends, during vacation, sufficient physical activity, sports.

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Dyskinesia biliary tract - a complex disorder bile-excreting system, due to violations of motor function of the gallbladder and bile ducts in the absence of organic changes. In patients with marked or excessive or insufficient reduction of the gall bladder. As practice shows, dyskinesias are more common in women. Bile-excreting system disorders can be identified by its increased contractile activity (hyperkinetic dyskinesia) or low (hypokinetic dyskinesia). Hyperkinetic dyskinesia is more common in younger age, hypokinetic – people with unstable mentality, and after 40 years.

What are the causes of dyskinesias?

Dyskinesia of the gall bladder is seen as a psychosomatic illness, when the trigger is stressful situations, the underlying personality conflicts. The fact is that negative emotions and stressful situations affect the motor activity of the gall bladder. Reduced, in particular, the development of bile, it stagnates in the gall bladder. In a patient in a large percentage of cases to identify the different kinds of family, sexual and professional difficulties.

Significant role in the development of the disease also play a violation of the nervous regulation of the gall bladder, changes in the level of internal hormones of the gastrointestinal tract, menopause, lack of function of the ovaries, adrenal glands and other endocrine glands.

When severe asthenia, sedentary lifestyle, poor diet with very long intervals between meals fairly frequently revealed hypokinetic form of dyskinesia (reduced contractile activity).

In addition to psychogenic disorders as etiological factors known food allergies.

In addition, dyskinesia can join cholecystitis and cholelithiasis. Hyperkinetic form (increased contractile activity) occurs reflexively in ulcer disease, colitis, appendicitis, and some other diseases.

Frequent, but irregular diet, excessive enthusiasm acute dishes, the systematic use of food seasonings, irritate the mucous membrane of the digestive tract predispose to the appearance of hyperkinetic dyskinesias.

Parasitic, helminth infections of the digestive tract often occur with pronounced symptoms of dyskinesia of the gallbladder and bile ducts.

What are the symptoms of dyskinesia of the biliary tract

Patients primarily complain of pain in the right hypochondrium. They are of indeterminate nature, dull, aching, sometimes "give" in the right shoulder, right shoulder, lasted from several hours to several days. Such pains are characteristic hypokinetic dyskinesia of the gallbladder. When hyperkinetic diskinenzii pains are sharp, cramping, usually short-lived. They may grow after a heavy meal, especially oily, spicy. Often there bitterness in the mouth, especially in the mornings. On the part of the psyche in patients with dyskinesia predominant symptoms of depression, emotional and physical weakness. Patients complain of constant fatigue, bad mood, sleep disturbances and appetite, often in men decreased libido, women experience menstrual problems. Sometimes an attack of biliary colic accompanied by a sense of cardiac arrest or, conversely, tachycardia, numbness in hands and feet, anxiety, etc.

How to observe doctors, patients often hypothesize about its "very serious" condition and is actively urging doctors to their cause.

The course of the disease is usually long with periods of exacerbation (often provoked by emotional stress, elimentarnymi violations) and temporary improvements. With the passage of time in the gall bladder and ducts may be an inflammatory process or formed gallstones.

Diagnosis

In the presence of one or more of the above symptoms, you should as soon as possible to see a doctor and get tested. What is included in diagnosis of dyskinesias?

Usually spend an ultrasound of the abdominal cavity, a blood test. To clarify the nature of the biliary tract dysfunction (elevated or reduced contractile activity) perform duodenal sounding or ultrasound with choleretic breakfast.

Is there a cure dyskinesia?

To a large extent determined by the treatment of the reasons that prompted dyskinesia biliary tract. Given the fact that the primary dyskinesia of the gallbladder related to psychosomatic diseases, attaches great importance to psychotherapeutic interventions. It should, however, say that to provide such treatment must be a qualified therapist, and patients are extremely reluctant to apply to such physicians, because they believe that they have a purely somatic disease. Psychotropic medications should be appointed by the doctor, taking into account violations of the psychological state of patients, form and structure of these violations. Antidepressants for depression shows, daytime tranquilizers, antipsychotics lungs.

Further treatment depends on the type of dyskinesia. Patients hypokinetic dyskinesia recommended products with choleretic action, enriched with magnesium, which include sorbitol, xylitol.

Used mineral water of high mineralization type; water prescribed in the cold or slightly heated by a 200-250 ml 2-3 times a day for 30-60 minutes before eating. An effective therapeutic exercises, massage, diadynamic currents. In hyperkinetic dyskinesia in the diet are limited to mechanical and chemical stimuli, fats, must be appointed antispasmodics, it is desirable to have a selective effect on the gall bladder and ducts, low mineral water. Surgical treatment is not shown.

In order to prevent biliary tract dyskinesia requires timely treatment of neurotic disorders, the normalization of work and rest regime, the elimination of conflict situations, adequate sleep, regular meals at the same hour at least 3-4 times a day.

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Dysbacteriosis colon - a disease associated with the development of pathogenic (harmful to the body) of microflora in the gastrointestinal tract, which displaces healthy. As a result, food is dropped, stagnant, poorly evacuated and are absorbed into the blood degradation products. All this is accompanied by increased formation of gases and unstable chair, while patients do not receive a number of nutrients, vitamins, trace elements.

Tract of newborns in the first hours of life is sterile. During the first days, he settled by random microflora. Microbes "colonize" the intestinal mucosa, forming a dense "bacterial turf.

Later in the gut of infants (fed with breast milk) establishes a specific bacterial flora consisting of lactic acid bacteria, which persists up to a year, and after the cessation of breastfeeding is replaced by the microflora of adults, in which the highest percentage (90%) accounted for bifidobacteria. These microorganisms have a major role in the regulation of digestion, absorption of vitamins and essential amino acids, as well as a number of biologically active compounds, without which no man can do. At normal levels (quantitative and qualitative) useful intestinal microflora inhibit growth and reproduction of pathogenic (pathogenic) micro and protects the body from the development of intestinal infections. The significant role of bifidobacteria in the process of digestion. They are able to enhance the hydrolysis (splitting) of proteins, fermented sugar, fats break down, dissolve cellulose, stimulate the intestinal peristalsis and to ensure proper evacuation of its contents. Biologically active substances (BAS), which distinguish bifidobacteria, are actively involved in the metabolism, reduce the toxic load on the liver.

Under their influence normal blood composition (increased hemoglobin and reduced erythrocyte sedimentation rate). With the deterioration of environmental conditions, the number of microflora change until the complete disappearance (elimination), this leads to the rapid development of pathogenic flora, fungi and yeast fungi of the genus Candida (Candida), which indicates the occurrence of acute intestinal dysbacteriosis.

There are several groups of causes leading to dysbacteriosis:

Dysbacteriosis bowel symptoms are: flatulence, abdominal pain (sometimes cramping because the gut is trying to get free, drop stagnant mass of undigested food), diarrhea alternating with constipation. As well as weakness, sweating, irritability (as a result of the lack of B vitamins), hair loss, rash on the face (due to malabsorption of vitamins A and E groups).

Modern methods of examination can determine the cause of dysbacteriosis, identify pathogens and to find adequate treatment. There are modern pharmacological tools to teach the intestines work, eliminate constipation and restore the normal microflora.

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Diverticulosis of the colon - a condition in which a wall of the intestine are small in size to one or two centimeters in the base saclike diverticulum (diverticula). Diverticula of intestine develops mainly in elderly people in countries with high living standards.

Main role in a wide spread of the disease is reducing the number of plant foods in the diet and the prevalence in the diet of meat and flour dishes, which leads to constipation. In addition to constipation, promote the development of diverticula obesity, flatulence (excessive gas formation), transferred intestinal infections (eg, dysentery), a long and messy reception laxative medicines.

What’s happening?

With age, the elasticity of the walls of intestines is greatly reduced. Increasing the pressure in the intestine (as a result of constipation, bloating, etc.) leads to the protrusion of some of its sections, formed diverticulum.

How to tell?

For diverticulosis is characterized by:

Diverticulitis

As a result of stagnation in the digestive diverticulum of stool, there is inflammation of the diverticula – diverticulitis. When inflammation develops a fever, worsening pain in the abdomen, found in the stool mucus and blood, expressed concern flatulence. It is inflammation of the diverticula often causes ill-treatment of diverticulosis to the doctor.

How dangerous?

Inflammation of the diverticula leads to the development of serious complications:

Diagnosis of

Diagnosis of diverticulosis of the colon involved in the doctor-gastroenterologist. To identify the disease in addition to the inspection, analysis of blood and stool analysis to conduct a minimum of two studies:

Treatment

Inflammatory disorders and complications of diverticula disease are treated in hospital, uncomplicated diverticulosis – at home. The main objective in the treatment of uncomplicated diverticulosis of the colon – to normalize the chair. This will prevent the formation of new protrusion and prevent the inflammation of the diverticula. First of all, a diet rich in plant foods, it is recommended acceptance of wheat bran. To reduce abdominal pain prescribe antispasmodic drugs (no-spa, etc.) In the development of diverticulitis prescribe antibiotics. Treatment of bleeding depends on its intensity. The most common use of special drugs that contribute to stop bleeding. At other complications of diverticulosis (diverticulum perforation or narrowing of the lumen of the intestine), as well as the ineffectiveness of therapeutic use of surgical intervention. Most often during surgery to remove affected bowel area.

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Diarrhea (diarrhea) - frequent bowel movements or one-time allocation of liquid faeces (usually more than 200-300 g per day).

At the heart of diarrhea may be based on an increase in active secretion of intestinal sodium and water retention, increased osmotic pressure in the oral ulcers (decreased absorption of water and eletrolitov), violations of peristalsis, increased exudation of water and electrolytes into the lumen of the intestine. Excess secretion in the small intestine develops in its colonization of pathogenic microorganisms (eg, cholera vibrios, ente-ropatogennymi viruses), with tumors that produce peptide hormones, syndrome Zollinger-Ellison (due to increased production of gastrin). Excess secretion in the colon is possible with malabsorption in the small intestine of fatty acids with long chains of bile acids (for example, dysbacteriosis). Hyperosmotic diarrhea develops with malabsorption (eg celiac disease), deficiency of pancreatic enzymes (in chronic pancreatitis, pancreatic cancer) and bile salts (with obstructive jaundice), under the action of osmotic laxatives (magnesium sulfate, lacto-vine).

Violations peristalsis possible with irritable bowel syndrome, under the influence of some laxatives (senna extract, Bisacodyl, castor oil). Increased exudation of water and electrolytes is accompanied by exudation of protein into the lumen through the gut mucosal damage – with Crohn’s disease, ulcerative colitis, intestinal tuberculosis, intestinal infections (dysentery, salmonellosis), malignant tumors and ischemic bowel disease.

Symptoms, diarrhea (diarrhea)

Frequency of stool varies, feces – watery or mushy. When gipersekretornoy diarrhea stools copious and watery, with hyperosmotic – prevails polifekaliya (increase in the number of faeces from undigested residues), with motor diarrhea occurs slim frequent loose stools, with stools giperekssudativnoy fluid, sometimes mixed with pus and blood. The nature of defecation depends on the disease.

Thus, the presence of fresh or altered blood in the stool indicates pathology of the colon, the appearance of pus and mucus – in the inflammatory process. In particular, when dysentery stool has a dense consistency first, then becomes a liquid, scanty, it appears mucus and blood in amoebiasis – contains a glassy mucus and blood and sometimes mucus and blood pervades feces become kind of raspberry jelly.

In diseases of the pancreas indicated "fat" calories (after rinsing faeces on the toilet are drops of fat).

There are acute diarrhea (lasting less than 2-3 weeks) and chronic (lasting more than 3 weeks). The causes of acute diarrhea usually are infectious (dysentery, salmonellosis, etc.) and other inflammatory bowel disease (ulcerative colitis, Crohn’s disease), intake of medicines (laxatives, antibiotics, antacids containing magnesium salts, etc.).

For acute infectious diarrhea are typical signs of intoxication, fever, anorexia, sometimes – vomiting. The cause of diarrhea, continuing after acute gastroenteritis, can be persistent infection (giardiasis, iersenioz) acquired lactase deficiency, irritable bowel syndrome, as well as previously unrecognized disease (eg, celiac disease, ulcerative colitis).

Chronic diarrhea may be a manifestation of functional disorders or organic bowel disease, including irritable bowel syndrome, colon cancer, ulcerative colitis, Crohn’s disease, malabsorption syndrome, etc. Pain in gipogastrii may accompany diarrhea in diseases of the colon (diverticulosis, Crohn’s disease, irritable colon tumors of the colon), in the upper half of the stomach – with pancreatitis, Zollinger-Ellison syndrome. Ulcerative colitis, and dysbiosis often manifested by diarrhea without pain. Fetid smell faeces, presence of undigested residues, feeling rumbling, transfusion, abdominal distension – nonspecific symptoms, occurring in many diseases.

Lightweight and non-durable diarrhea little effect on the general condition of patients, severe and chronic lead to dehydration, loss of electrolytes (potassium, sodium, magnesium), exhaustion, hypovitaminosis, pronounced changes in the organs. To determine the cause of diarrhea spend scatological and bacteriological study.

Treatment of diarrhea (diarrhea)

Treatment is directed primarily at addressing the causes of the diarrhea. For example, with pancreatic insufficiency shows enzymatic preparations – Creon, Festal, mezim forte and others have shown mechanically and chemically light diet with the exception of products that enhance motor evakuatornuyu and secretory function. In order to restore eubioza use of antibacterials, preference is given to drugs which do not disturb the equilibrium of the microbial flora in the intestines – Intetriks, nifuroxazide (ersefu-Rila), etc. Uses bacterial preparations – Bifidumbacterin, bifikol, laktobakterin, Bacto-SUB-T, lineks, enterol, flonivin BS and others, as well as hilak forte. As symptomatic treatment using calcium carbonate, bismuth preparations, tanalbin; decoctions of oak bark, grasses, hypericum, serpentine root, bloodroot, or burnet, wild cherry fruit, the infusion of blueberries, alder aggregate fruits, flowers, daisies, belladonna tincture, etc. Apply adsorb, binders, enveloping means (smectic, Tanna, PC, etc.). To slow intestinal peristalsis use spasmodicals (No-Spa, papaverine, bkus-Copan). Antidiarrheal destviem has loperamide (Imodium), lowering the tone and motility of the intestine through effects on opiate receptors. The drug is used in acute gastroenteritis, motor disorders, appointed in a dose of 4 mg by mouth after the first loose stool, then 2 mg after each bowel movement. In the development of dehydration is conducted infusion therapy or rehydration solutions (tsitroglyukosolan, Rehydron, tours) are appointed for oral administration.

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Hiatal hernia - a result of displacement of the diaphragm through the esophageal opening into the chest cavity of an organ of the abdominal cavity, usually the stomach. It occurs in almost 50% of older persons, accompanied by a peptic ulcer, chronic cholecystitis. For the formation of hiatal hernia enough to develop with age and muscle weakness of the connective tissue of the diaphragm, which would expand the hole through which the esophagus passes from the thoracic cavity in the abdomen, or part of the increase in abdominal pressure caused by heavy physical exertion, coughing, constipation, overeating.

Symptoms and flow. Often hernia does not manifest itself and is defined as "discovery" in the study of the stomach to treat other problems. The classic syndrome presented reflyuksezofagita: spontaneous or tilted forward of pain in the lower third of the sternum, or her, give up or back, of varying intensity heartburn in the position of a patient lying down, which is taking place, if he shall sit or get up, hiccups, belching air. The most serious complications are hernia incarceration and bleeding from the resulting esophagus or stomach ulcers.

Treatment. Diet number 1, cream, fermented baked, whipped egg whites, use before eating vegetable oils, it is better with vitamin A – sea buckthorn or hips, almagel. When pain – papaverine, platifillin, atropine. Operative treatment – only when complications.

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