acute esophagitis up to 3 months in childhood and adolescence
chronic esophagitis> 3 months proceeds cyclically according to the morphology of I st. - edema, hyperemia, a large amount of mucus II tbsp. - + the appearance of single erosions on the tops of folds of the III st. - many erosion against the background of severe edema and hyperemia of the IV century - erosion spread throughout the esophagus, contact bleeding, edema, hyperemia + viscous mucus in the form of a coating on the etiology
1) bacterial (dysentery, scarlet fever, flu, sepsis, flu, fungal infections)
3) physical (traumatic)
primary (diphtheria, scarlet fever, flu, sepsis.)
secondary (peptic ulcer, achalasia of the cardia, diverticulum of the esophagus, hiatal hernia)
1) acute esophagitis associated with infectious diseases, burns, poisoning, trauma, less often an allergic reaction
A number of infections (influenza, scarlet fever, diphtheria, inf. Mumps, fever typhoid) occur with symptoms of esophagitis. The reason is a decrease in immune activity + a hereditary predisposition. Patients with reduced immunological activity may have a necrotic course.
Severe esophagitis with chemical burns, while pieces of the mucosa are rejected with a cough (it is called exfoliative or membranous).
2) chronic esophagitis
The most common cause is gastroesophageal reflux (reflux of the contents of the stomach into the esophagus), normally in the lower part of the esophagus the esophageal sphincter is closed. Factors that reduce the tone of the sphincter of food-water:
fast food of copious amounts of food, together with a stream of swallowed air, quickly increases the pressure in the stomach and overcomes the tousus sphincter
food quality matters: fatty meat, flour products + alcohol cause food retention in the stomach and relax the food sphincter and lead to the development of esophagitis
smoking, drinking alcohol, chocolate
medicines: calcium antagonists, nitrates, analgesics (morphine), anticholinolytic drugs (atropine, metacin, platifillin), theophylline
the most important in the development of reflux esophagitis is a hiatal hernia.
In this case, there is a smoothing of the esophageal-gastric angle, pressure on the lower part of the esophagus in the thoracic cavity increases, in the absence of the supporting effect of the diaphragmatic legs.
contributes to the occurrence of reflux esophagitis peptic ulcer Conditions conducive to the occurrence of esophagitis in the presence of gastroesophageal reflux.
The main factor is the severity of gastroesophageal reflux. Along with this, the amount of food coming from the stomach into the esophagus, its quality and exposure time are important. Normally, the esophagus is cleansed while swallowing saliva (1.5 l / day). Cleansing occurs with the ingestion of food and fluid. Normally, the acid contents of the stomach are thrown into the esophagus for a total of 1 hour per day and this leads to “acidification” of the lower part of the esophagus, but esophagitis does not develop.
Irritation of the mucous membrane of the esophagus depends on:
the amount of stomach contents thrown in
from its chemical composition
development of an acidic environment in the esophagus (pH - 4 and below)
decrease in clearance rate (clarification)
Acid reflux esophagitis develops with peptic ulcer of the duodenum, when the pH of the gastric contents rises and conditions for the development of reflux esophagitis appear.
Alkaline reflux esophagitis is possible with both gastroesophageal and duodenogastric reflux with a decrease in gastric secretion. The most aggressive in relation to the food-water mucosa are bile acids, as well as pancreatic enzymes, such alkaline reflux esophagitis develops after gastric resection.
ACHALASIA OF CARDIA - 2 main phenomena are characteristic for it 1)
rhenium (lengthening) of the esophagus and 2) spasm of the ECG cardiac section. More precisely
it is not so much about spasm (cardiospasm), but about the absence
ability to relax the lower esophageal sphincter during the act of glo-
tania, which corresponds to the term "achalasia"
Allergy in the development of chronic esophagitis. It manifests itself in the form of hyperemia, edema, copious mucus and erosion. It can be combined with achalasia, while the enlarged upper part of the esophagus is a good reservoir for the reproduction of microbes and leads to sensitization of the body.
Specific lesions of the esophagus (tbc, luis) in the development of esophagitis are rare.
Traumatic lesions and foreign bodies of the esophagus can cause not only chronic, but also acute esophagitis.
The role of hereditary factors - acute esophagitis is not caused. Chronic esophagitis is more often associated with the presence of gastroduodenal reflux, and it is more often combined with a hiatal hernia. The occurrence of HPAI is closely related to hereditary predisposition. It can be congenital even with anomalies in the development of the musculoskeletal apparatus for cardia fixation. It contributes to the development of gastroduodenal reflux and peptic ulcer disease in the development of which hereditary factors play a role.
Diet is a risk factor for the development of gastroduodenal reflux (very cold, very hot, spicy seasonings, alcoholic beverages).
Anamnesis - with esophagitis, all unpleasant sensations of the patient can be divided into 2 groups: 1) related to the inflammatory process in the esophagus 2) to other diseases of the digestive tract with which esophagitis is associated.
Complaints of heartburn - a burning sensation that begins in the area of the reticular process behind the sternum and spreads upward. Heartburn is rarely on an empty stomach, often 1-2 hours after eating. Sometimes it appears after belching or after bending forward, with the horizontal position of the body. Heartburn is more common with chronic esophagitis.
Pain is not a specific symptom, pain associated with esophagitis does not appear after exercise
amplified by swallowing, localized in the lower third of the esophagus
may increase after eating acidic foods, spicy foods, when lying
sometimes accompanied by a feeling of longing
In acute esophagitis, pain can be aggravated by liquid food and spreads throughout the esophagus and is combined with burning.
In chronic esophagitis, the pain disappears after burping that occurs after taking alkalis. Pain with esophagitis is often associated with swallowing, which gives the patient the impression of dysphagia (food retention or violation of swallowing).
Less pathognomonic symptoms that occur with esophagitis
- belching or spitting up
Under the belching understand the involuntary release through the mouth of gases
from the stomach to the esophagus, and if it is food, then this is regurgitation, belching and regurgitation occur without nausea, without effort, as is the case with vomiting.
With esophagitis with gastroesophageal reflux, it is “acidic” after 15-20 minutes. after meal.
With esophagitis with duodenogastric reflux, it is "bitter."
Rarely, with esophagitis, rumination is a combination of pronounced
givany with repeated chewing of food and its swallowing - more often it is in children.
Bleeding from the esophagus is a rare occurrence with an erosive variant.
Hiccup - rarely, with chronic esophagitis, indicates
treatment in the process of the phrenic nerve, as manifestations of periphagitis.
Etiology and pathogenesis
Acute esophagitis usually develops as a result of a burn of the mucous membrane with very hot food or chemicals (concentrated acids and alkalis), injuries of the esophagus with sharp foreign bodies (metal needle, fish bones).
Chronic esophagitis develops mainly with gastrointestinal reflux (reflux esophagitis) - a retrograde entry of the contents of the stomach into the esophagus. Less commonly, chronic esophagitis is detected with regular dietary disorders (long-term intake of strong alcoholic drinks, exposure to spicy and very hot foods), organic lesions of the esophagus (stenosis, cancer, large diverticula).
Reflux esophagitis arises due to insufficiency of the lower esophageal sphincter or with an increase in intragastric pressure. Insufficiency of the lower esophageal sphincter is primary (cardia insufficiency, achalasia, hiatal hernia (UNDER), dysfunction of the sphincter, etc.) and secondary (scleroderma, pregnancy, smoking, relaxation of the smooth muscle wall of the esophagus when taking beta-blockers, nitrates, aminophylline, etc.). Reflux esophagitis develops with frequent reflux of the contents of the stomach into the esophagus with a decrease in the tone of the lower esophageal sphincter (below 5 mm Hg), gastric antiperistalsis, the presence of a hernia of AML, and increased intragastric pressure. Gastric contents (hydrochloric acid, pepsin, bile, pancreatic enzymes, etc.) damage the mucous membrane of the esophagus.
According to the morphological picture, acute esophagitis is subdivided into catarrhal, erosive, hemorrhagic, pseudomembranous, necrotic, and also abscess and phlegmon of the esophagus. Clinical manifestations depend on the severity of the inflammatory process.
Patients with acute catarrhal esophagitis complain of burning, a feeling of greasing, and pain behind the sternum when swallowed. In patients with hemorrhagic esophagitis, bloody vomiting is observed, pseudomembranous films are found in the vomit, consisting of fibrin and elements of the mucous membrane of the esophagus. With an abscess and phlegmon of the esophagus, a severe clinical picture of septic intoxication is characteristic.
The diagnosis of acute esophagitis is straightforward and is based on anamnesis and clinical presentation. Esophagoscopy in acute esophagitis is contraindicated. The course of severe forms of acute esophagitis can be complicated by mediastinitis. Patients with acute esophagitis must be hospitalized in the surgical department. Patients with mild forms of esophagitis are prescribed hunger and antacids (almagel, phosphalugel, etc.) for several days. With an abscess and phlegmon of the esophagus, antibiotics are prescribed, in the absence of effect, surgical treatment is performed.
In reflux esophagitis, the most characteristic symptom is heartburn with regurgitation of the gastric contents in the oral cavity or without it. Often there are pain when swallowing and dysphagia, especially with ulcerative stenosis of the esophagus. The diagnosis of reflux esophagitis is confirmed by x-ray examination, endoscopy, esophageal manometry, changes in pH dynamics and Bernstein breakdown. X-ray analysis of the esophagus with barium sulfate in reflux esophagitis is not informative, but with high reliability it allows to identify esophageal ulcers, ulcerative stenosis and severe gastroesophageal reflux with a sharply weakened lower esophageal sphincter.
Accurate diagnosis of esophagitis with or without hemorrhage is possible with esophagoscopy with a biopsy. The registration of pH in the esophagus after the introduction of 300 ml of 0.1 N hydrochloric acid into the stomach confirms the presence of reflux, but the invasive method requires the introduction of a pH meter electrode into the lower third of the esophagus. Bernstein's test is highly correlated with sternal pain in reflux esophagitis, i.e. symptoms are reproduced with the introduction of 0.1 N HCl into the lower esophagus and disappear after perfusion with saline. Esophageal manometry allows you to assess the condition of the lower esophageal sphincter. With severe reflux, pressure indicators are below the normal limit.
The course of reflux esophagitis can be complicated by a benign stricture of the esophagus, ulceration of the esophagus, accompanied by bleeding, aspiration pneumonia or asthma attacks, esophageal spasm with severe pain. Perhaps the development of Berrett metaplasia is the replacement of the stratified squamous epithelium of the esophagus with a single-layered cylindrical epithelium of the gastric type. This condition is considered precancerous.
Patients are advised to sleep with the head end of the bed raised by at least 15 cm, reduce obesity in case of obesity, do not lie down for 1.5 hours after eating, stop eating 3 hours before bedtime, stop smoking, limit fat and chocolate intake.
Prescribe drugs that increase the tone of the lower sphincter of the esophagus:
- domperidone (motilium and other analogues) or cisapride (coordinatex and other analogues) 10 mg 3 times a day after meals,
- antacids (maalox, almagel and other analogues) at the 1st dose 1 hour after eating 3 times a day and 4 times immediately before bedtime,
- histamine H2 receptor antagonists (ranitidine, zantac and other analogues) 150–300 mg 2 times a day or famotidine (gastrosidine, quamatel, ulfamide and other analogues) 20–40 mg 2 times a day, for each drug in the morning and in the evening with an obligatory interval of 12 hours,
- H +, K + -ATPase blockers: omeprazil (zerocide and other analogues) 20 mg 2 times a day in the morning and in the evening. The course of treatment is 4-6 weeks.
It is not recommended to take drugs that lower the tone of the lower esophageal sphincter (anticholinergics, beta-blockers, calcium channel blockers, nitrates, xanthine and its derivatives).
In the absence of the effect of conservative therapy of reflux esophagitis due to axial hernia of AML, and the occurrence of aspiration, bleeding and stricture of the esophagus that are not amenable to active therapy, surgical treatment is indicated.
Causes of superficial esophagitis
The disease can develop acutely or have a chronic course. In the first case, inflammation occurs after a single injury. The following reasons can be distinguished:
- Alimentary group (related to nutrition). Hot or cold food, spicy foods damage the mucous membrane. Mechanically coarse food leads to scratches, irritation of the esophagus.
- Traumatic injury. A small child may swallow a button or small inedible object. During gastroscopy, in some cases, the walls of the organ are damaged. Improper execution technique, muscle spasm, obstacles lead to a violation of the integrity of the esophagus.
- Burns with chemical compounds: alkali, acid, alcohol solutions.
- Infectious diseases (diphtheria, measles, scarlet fever) also cause changes in the distal esophagus.
Chronic esophagitis occurs due to prolonged exposure to the mucous membrane of damaging factors. Reflux (ingestion of the contents of the stomach into the esophagus) leads to catarrhal changes. If no further treatment is involved, hydrochloric acid corrodes the mucous membrane, the process can go into an erosive form. The presence of gastritis, gastroduodenitis only complicates the situation.
How to recognize a disease?
In the chronic form, there are no symptoms for a long time. The first signs of distal esophagitis are:
- Discomfort, pain behind the sternum while eating.
- Belching sour, heartburn indicates reflux.
- Frequent pneumonia, bronchitis due to ingestion of gastric contents into the respiratory system are observed.
- In the presence of gastritis or gastroduodenitis, the signs of the underlying disease come to the fore: epigastric pain, nausea, vomiting, loss of appetite.
- Thermal, chemical burns are manifested by severe, cutting pain, immediately after the action of a damaging factor. During gastroscopy, the distal esophagus is most often injured at the place of transition into the stomach.
A correctly collected medical history, the presence of symptoms of reflux, a connection with injuries, the use of chemicals, hot food simplifies the diagnosis. Based only on complaints, it is impossible to judge the disease, since other diseases have similar manifestations. To choose the right method of treatment, additional studies are carried out:
- FEGDS allows you to visually assess the condition of the mucosa, to eliminate the erosive process. If the surface is swollen, redness is observed in the distal esophagus, this indicates reflux.
- The state of the stomach and duodenum is also being studied. The presence of gastroduodenitis, gastritis makes adjustments to the treatment.
- X-ray of the esophagus.
- A general blood and urine test is necessary to control the degree of inflammation.
- The reflux of gastric juice into the esophagus (reflux) changes the acidity of the distal section. According to the pH data, acidification will be observed.
In case of catarrhal changes, drug treatment is preferred. For this, endoscopy data is needed to rule out an erosive process or more serious forms.
- Antacids (Almagel, Fosfalugel, Maaloks) will help to reduce the symptoms of reflux, heartburn.
- Motility of all departments of the gastrointestinal tract improves Motilium, Tserukal.
- Bismuth preparations, Solcoseryl promotes the speedy recovery of affected areas.
An important stage is the treatment of concomitant pathology. In the case of gastritis, gastroduodenitis, appropriate therapy is used, since these conditions provoke the development of reflux.
External and internal factors can provoke the development of esophagitis.
What is esophagitis and what causes superficial inflammation of the esophagus? Given the secondary development of pathology, the disease can occur due to a number of multiple factors. Usually this is a complex of various conditions that negatively affect the functionality of the digestive system.
With regular exposure to stimuli, chronic esophagitis develops with characteristic symptoms and a tendency to complications.
Lack of food discipline
Frequent snacks on the go, alcohol abuse, long breaks between meals, fasting along with overeating - all this can contribute to the development of esophageal disease, inflammation of the mucous membranes of the esophagus.
The use of aggressive foods (smoked products, pickles, pickles, preservation), accidental ingress of alkali, acids, iodine can provoke the development of superficial inflammation. Lack of a balanced diet in children under 7 years of age almost always leads to digestive disorders.
High abdominal pressure
An increase in intra-abdominal pressure is caused by internal or external factors, and is associated with natural or pathological processes. Normally, abdominal pressure is slightly higher than the pressure in the sternum.
The imbalance is caused by the following reasons:
- pregnancy, especially II and III trimesters,
- increased body weight
- cardiac sphincter dysfunction (decreased pulp tone),
- tumors in the peritoneum.
An increase in intra-abdominal pressure can occur with chronic digestive upset with severe flatulence, flatulence, bloating.
Many diseases of the digestive tract are accompanied by acidic heartburn with a reverse reflux of hydrochloric acid from the stomach to the esophagus.
Reflux can occur against the background of:
- gastroesophageal reflux disease of a multifactorial type,
- sliding hernial protrusions in the localization of the esophageal opening of the diaphragm,
- peptic ulcer disease
- insufficiency of peristalsis of the sphincters,
- development of pancreatitis.
The catarrhal form of esophagitis is also due to other factors. The reasons are long-term medical treatment (for example, hormonal and non-hormonal anti-inflammatory drugs, immunosuppressants, antitumor drugs), radiation and chemotherapy for cancer, frequent instrumental diagnostic methods, surgical procedures in the upper digestive system.
Superficial esophagitis also occurs against the background of frequent vomiting, chronic dysbiosis, and frequent inflammatory diseases of the digestive tract.
Diagnosis requires thoroughness to determine the underlying disease leading to esophagitis.
Symptoms and treatment of esophagitis are directly related. For a correct diagnosis, differential diagnosis is necessary. An initial examination for suspected inflammation of the esophagus canal is not particularly difficult.
For the final diagnosis, a number of the following activities are carried out:
- study of the life and clinical history of the patient,
- investigation of existing complaints,
- conducting esophageal pH measurement
- X-ray examination to detect tumors,
- esophageal manometry to assess esophageal motility.
Additionally, consult with an endoscopist for an esophagogastroscopy to obtain a biopsy of the altered mucous epithelium. Usually, endoscopic manipulations are resorted to when the diagnosis is unclear, and also in order to differentiate one pathology from another.
A biopsy and histological examination allow us to finally determine the nature of the pathology, as well as the degree of cancer risks.
Prevention and prognosis
There is no specific prophylaxis that would prevent the disease and its complications.
However, to reduce the risks of inflammation of the esophagus, it is recommended that a number of the following recommendations be observed:
- exclusion of bad habits (smoking, alcohol abuse),
- normalization of diet (several times a day in small portions),
- the use of easily digestible food,
- refusal of intense physical labor.
After eating, it is not recommended to immediately go to bed and drink water (only 30-40 minutes after eating). You can not regularly take antacids to stop attacks of heartburn. Such treatment is symptomatic, aimed at eliminating unpleasant manifestations. To clarify the treatment regimen, you should contact your doctor.
The prognosis for catarrhal esophagitis is generally favorable, due to the patient's timely response to the onset of symptoms and adequate therapy. Subject to a therapeutic diet, patients manage to achieve stable remission in relation to the underlying disease and minimize exacerbations of inflammation.
The prognosis is less favorable in case of non-compliance with medical recommendations, the absence of treatment. Often, the acute phase of catarrhal phenomena progresses rapidly, contributing to the development of the chronic process. Often complications develop, such as purulent lesions of the mucous membranes, perforation of the walls of the esophagus tube, stenosis of the esophagus. Complications are almost always treated surgically.