说医论药11：胃酸反流的自我救助

胃酸，并非一种特殊的化学物质。胃酸实际上就是化学工业上常见的盐酸，因在人体胃中产生和发挥作用而被称为胃酸。可以想象胃酸具有强腐蚀破坏作用。正常情况下，胃壁细胞同时分泌粘液和碱性物质，保护人体胃壁细胞组织本身不被胃酸破坏。胃酸对于消化系统的功能是必不可少的。人体肠胃道消化有三种形式：物理消化，例如咀嚼和胃肠道蠕动；化学消化和生物消化。胃酸可以破坏食物细胞壁和大分子的完整性，是化学消化的主要组成。同时，胃酸提供的酸性环境对于胃蛋白酶原的激活是必不可少的，可以帮助蛋白酶的生物消化。

虽然胃壁具有对抗胃酸腐蚀破坏的能力，消化系统的其他部分，包括位于胃上游的食道和胃下游的肠道，并没有胃壁特有的保护能力，如果胃酸进入食道和肠道都会造成破坏。控制胃酸反流进入食道管腔的是位于食道与胃接口处的是食道下括约肌。食道下括约肌在进食时开放，允许食物从食道进入胃；而在其它时候，食道下括约肌处于关闭状态，防止胃酸和胃内容物倒流进入食道。胃酸反流病，就是多种原因造成食道下括约肌松懈，胃酸返流进入食道，造成食道组织的慢性炎症和破坏。

胃酸反流最常见的症状就是“烧心”。但是胃酸反流本身与心脏没有直接联系。由于食道位于心脏后面，烧心的感觉其实来自于胃酸对于食道组织的烧烁。烧心的感觉经常起始于上腹部，可以一直延伸到喉咙。胃酸反流其它常见症状包括睡眠时苦酸反流至喉咙； 口中有苦味； 持续干咳; 喉咙发紧的感觉，好像有一块食物粘在那里； 吞咽麻烦等。胃酸反流除了造成诸多不适之外，胃酸对于食道组织的破坏，诱发食道癌。根据癌变细胞（组成食道管壁的细胞）不同，食道癌有两种主要类型。一种类型是鳞状细胞癌，另一种类型称为腺癌。食道癌早期可能没有任何症状。在更晚期的癌症中，食道癌的症状包括：吞咽困难或疼痛；不明原因体重下降；胸骨后疼痛；咳嗽；嘶哑；消化不良和胃灼热。

影响胃酸反流的因素很多，包括生活方式，饮食习惯，超重，怀孕，药物，以及其它健康问题引发的并发症等。但是，引发胃酸反流的因素可以归纳为三个方面：食物不洁引发的感染和炎症，胃排空不及时，以及胃酸产生过多。目前用于缓解和防止胃酸反流带来的并发症的药物很多。但是，所有的药物都是强制性减少胃酸分泌，并不能从根本上解决引起问题的根源。而且，很多药物长期使用可能会造成不同程度的不良作用。那么，有哪些事情是自己可以做并且可以缓解胃酸反流问题的？下面是有关专家推荐的关于如何控制饮食和改变生活方式来预防和治疗胃酸反流的措施：

1. 不要暴饮暴食。如果已经有胃酸过多问题，可以尝试少量多餐。胃容积扩张刺激胃酸分泌增加，也会加大胃酸反流的压力；
2. 改变饮食，避免高脂肪难以消化的食物（增加胃排空需要的时间），避免辛辣刺激性食物，避免过多甜食（包括太甜的水果）；
3. 避免任何碳酸饮料（如可乐类），因为饮料中的气体会增加胃酸反流。同时，尽量不要饮用其它含糖饮料，以白水为主；
4. 饭后尽量保持坐立。睡觉前三小时之内不要进食，包括零食；
5. 饭后避免剧烈运动。饭后慢走有好处，但是两个小时内不要从事需要弯腰倒立的运动；
6. 睡觉时尽量保持头高于脚，必要时考虑半躺着；
7. 如果体重超标要减重，超重会导致食道下括约肌松懈；
8. 戒烟，尼古丁会引起食道下括约肌松懈；
9. 如果您在使用其它药物，如激素，消炎药等等，请咨询您的医生。有些药物会增加胃酸反流，因该尽量避免；
10. 改变生活方式，避免久坐不动。经常锻炼，不仅改善你的肌肉能力，对于消化系统，心血管系统，免疫系统的正常运作非常重要。

消化系统的正常运作是健康的的基础，对于生长发育和精彩人生都至关重要。你的消化系统，在昼夜不息的为你工作，提供构建身体的细胞组织所需的原料，提供身体正常运作所需要消耗的能量和其它营养物质。所以，你应该好好爱护自己。不良饮食和生活习惯会给身体带来不可逆转的损害，而这种损害经常是难以医治的。永远牢记，自己的身体，自己的人生，自己负责。

Gastroesophageal reflux disease (GERD) is a medical condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach into the esophagus tube. Normally, a ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter, prevents backing up of stomach contents, this sphincter relaxes during swallowing to allow food to pass, and then tightens to prevent flow in the opposite direction. In people with GERD, the sphincter relaxes between swallows, resulting1 stomach contents and corrosive acid to go up and damage the lining of the esophagus.

The stomach produces hydrochloric acid, which is critical for the digestive functions of stomach. Stomach acid helps break down the food and provide an acidic environment in which the digestive enzymes can perform their functions. The inner lining of the stomach can resist damage by this acid, as the cells lining the stomach wall secrete large amounts of protective mucus and alkalic chemicals. The lining of the esophagus does not share these resistant features and stomach acid can damage it. GERD is common and affects about 20% of the US population.

Persistent heartburn is the most common symptom of GERD. However, GERD has nothing to do with your heart. The esophagus lies just behind the heart, so heartburn is actually the sensation of acid burning the esophagus near where the heart is located. Heartburn usually starts in the upper abdomen and spreads up into the neck or throat. The pain can last as long as 2 hours, and usually get worse after eating, lying down or bending over. Other symptoms of GERD include: regurgitation of bitter acid up into the throat while sleeping; bitter taste in the mouth; persistent dry cough; feeling of tightness in the throat, as if a piece of food is stuck there; trouble swallowing.

胃酸反流可能造成食道组织的破坏，诱发食道癌。根据癌变细胞（组成食道管壁的细胞）不同，食道癌有两种主要类型。一种类型是鳞状细胞癌，另一种类型称为腺癌。食道癌早期可能没有任何症状。在更晚期的癌症中，食道癌的症状包括：吞咽困难或疼痛；不明原因体重下降；胸骨后疼痛；咳嗽；嘶哑；消化不良和胃灼热。

Acid reflux can be aggravated by many different things, including lifestyle, medication, diet, pregnancy, weight gain, and certain medical conditions. However, there are three main conditions which can contribute to acid reflux: poor clearance of food, too much acid in the stomach, and delayed stomach emptying. Home remedies for acid reflux include changes in lifestyle, diet, and habits. Here are few things recommended by experts:

1. Eat sparingly and slowly. When the stomach is very full, the pressure may push more reflux into the esophagus. If possible, you may want to try to eat small meals more frequently rather than three large meals daily.
2.  Avoid certain foods. People with acid reflux should limit or eliminate foods that are more likely to trigger reflux, including mint, fatty foods, whole milk, cheese, ice cream, spicy foods, pineapple and citrus fruits such as lemons, grapefruit, oranges, tomatoes, onions, garlic, coffee, tea, chocolate, and alcohol.
3.  Don't drink carbonated beverages. Those drinks make you burp, which sends acid into the esophagus. Drink flat water instead of sparkling water.
4.  Stay up after eating. When you're standing or sitting, gravity helps keeps acid in the stomach. You should try to finish eating three hours before you go to bed. This means no naps after lunch, and no late suppers or midnight snacks.
5.  Don't move too fast after eating. You should avoid vigorous exercise for a couple of hours after eating. An after-dinner stroll is fine, but a more strenuous workout, especially if it involves bending over, can send acid into your esophagus.
6.  Sleep on an incline or stake up your pillows. Ideally, your head should be 6 to 8 inches higher than your feet.
7.  Lose weight if it's advised. Increased weight spreads the muscular structure that supports the lower esophageal sphincter, decreasing the pressure that holds the sphincter closed.
8.  If you smoke, quit. Nicotine may relax the lower esophageal sphincter.
9.  Check your medications. Drugs like postmenopausal estrogen, tricyclic antidepressants, and anti-inflammatory painkillers, alendronate (Fosamax), ibandronate (Boniva), or risedronate (Actonel), may increase acid reflux and you should consider change them if possible.
10.  Be active and exercise regularly. Exercise not only makes your muscles stronger; it also helps maintain proper functions of your internal organs, including those in your digestive system, your cardiovascular system, and your immune system. You don't have to be a pro-athlete and perform professional spots regularly, just change your habits and be active will help tremendously.

The proper functioning of the digestive system is one of the foundations of health, and it is critical for your development, growth, and having a productive life. Your digestive system works tirelessly to supply your body with all nutrients needed to build the cell tissues and make sure they have adequate energy and materials for their functions. You owe to yourself to take care of it properly and poor lifestyle and bad habits can lead to irreversibl damage to the physiological functions of your body. Remember, your body，your life, your responsibility.