Esophagitis is an inflammation on the walls of the esophagus, and the disease can be of various forms, on which the manifestation of symptoms depends. Erosive-ulcerative esophagitis is characterized by severe damage to the mucous membrane. Experts say that at the same time, ulcers are formed on the surface that require immediate treatment.
If the reflux of the contents has become permanent, the disease will be able to deeply affect the lining of the esophagus. The causes of esophagitis can be not only emissions, but also surgeries, HPAI, infection, duodenal ulcer, chemical burn.
Such esophagitis is characterized by several stages of formation:
- The appearance of single ulcers on the surface of the mucosa in the lower part of the organ,
- An increase in the number of ulcers that makes itself felt by certain symptoms
- Transition to a chronic form.
Of course, early detection of the disease allows for easier treatment.
What signs of ulcerative esophagitis should I see a doctor with?
Erosive and ulcerative esophagitis, the symptoms of which may resemble the symptoms of other ailments of internal organs, require immediate treatment.
To understand if you really have heartburn, which is considered the main sign of ulcerative esophagitis, you need to pay attention to the following points:
- The pain should be felt in the sternum,
- Severe burning in the chest around the esophagus,
- The appearance of heartburn is noticed after eating and in a horizontal position.
Specialists are able to diagnose the disease through the use of the following types of examination:
- Endoscope examination,
- Registration of organ motility changes using esophagomanometry,
- pH-metry involving observation over a long period of time in various places of the digestive tract.
How is the treatment of erosive and ulcerative esophagitis?
The non-drug methods of therapy include:
- Sleep on a high pillow
- Walking after eating for about an hour,
- The prohibition of the use of tight belts,
- Exclusion of exercises for training the abdominals,
- Balanced diet.
Drug methods are:
- The use of drugs that lower the acidity of the stomach, which is an important principle in the treatment of the disease,
- The use of inhibitors that reduce the amount of hydrochloric acid produced that adversely affects the lining of the esophagus,
- The use of drugs that stimulate the motor activity of the digestive tract.
If the therapy of erosive and ulcerative esophagitis did not give the desired result and the symptoms continue to manifest, specialists resort to the appointment of surgical intervention.
- Surgical correction of decreased tonus of the cardia,
- Correction of a hernia of the esophageal diaphragmatic opening, which provokes the penetration of acid from the stomach.
Prevention of ulcerative esophagitis
In order for ulcerative esophagitis not to repeat, it is necessary to observe some rules:
- Medicines must be washed down with a large volume of water in order to reduce irritation of the mucous membrane,
- Stop drinking and smoking,
- Exclude tomatoes, citrus fruits, chocolate and fatty foods from the diet,
- Try to wear loose-fitting clothing,
- Sleep on a raised headboard
- If the signs of the disease are severe, visit the clinic.
What causes the disease?
As a rule, the emergence of erosion contributes to the long course of the inflammatory process in the mucous membranes of the esophagus. They can also occur against the background of a chemical or thermal burn. However, erosive esophagitis can be a complication of viral, bacterial or fungal infections, as well as prolonged use of NSAIDs.
Gastritis esophagitis is an inflammation that occurs when the acidic gastric contents are regularly thrown into the distal esophagus. The cause of its occurrence is considered cardiac insufficiency - the weakness of the muscle ring, located on the border of the two sections of the digestive system. This pathological condition occurs when there is a sliding hernia of the diaphragm, scarring of the upper stomach, persistent vomiting and shortening of the esophagus.
By the nature of the course, erosive esophagitis can be chronic, subacute and acute. In the latter case, a slight or deep lesion of the mucous membranes of the organ is observed. Symptoms of the disease arise suddenly, with timely treatment, they quickly disappear, not contributing to the development of complications.
Chronic erosive esophagitis is characterized by a gradual development of the clinical picture. Healing of ulcers may be accompanied by scarring of the tissues that impairs the function of the esophagus. A peptic form of inflammation occurs when gastric juice enters the distal organ.
With the superficial form of the disease, significant tissue destruction is not observed, erosion penetrate to a depth of not more than 0.5 mm. Erosive ulcerative esophagitis is an inflammatory process characterized by the appearance of deep defects. A distal type of disease is detected with inflammation of the esophagus closest to the stomach.
Esophagitis - inflammation of the mucous membrane of the esophagus
Esophagitis is an inflammation of the mucous membrane of the esophagus, most often in its lower parts. This is a fairly common disease that occurs in acute or chronic form. It is often combined with other diseases of the digestive tract - gastritis, impaired bile secretion, and liver disease.
The clinical picture of esophagitis
The main manifestation of the disease is pain, spreading throughout the esophagus. Most often, this symptom occurs after eating. In addition, there is a burning sensation behind the sternum, sour belching, food regurgitation, vomiting with impurities of blood. The general condition of the body worsens - the temperature rises, general weakness develops, and appetite decreases.
Anemia that occurs against a background of chronic bleeding manifests itself in the form of pallor of the skin and dizziness. Infection of erosion leads to the development of life-threatening complications - mediastinitis, phlegmon, perforation of the walls of the esophagus with massive bleeding.
The most severe consequence of erosive inflammation is hemorrhagic esophagitis, in which large vessels are affected. Barrett's esophagus develops against the background of a long course of the inflammatory process. This condition is precancerous, it is characterized by the replacement of epithelial cells of the esophagus by intestines. Ulcerative esophagitis proceeds in 4 stages, each of which has its own symptoms.
- The first degree of the disease leads to redness and swelling of the mucous membranes.
- If fibrous fibers and shallow ulcers are detected, second-stage esophagitis is diagnosed.
- With a disease of the third degree, a change in the length of the esophagus, the appearance of deep ulcers and areas of fibrosis are observed.
- The fourth stage of the disease is characterized by stenosis and shortening of the organ, progressive fibrosis and the formation of through holes in the walls.
Distal reflux esophagitis is manifested by pains of various intensities, localized in the xiphoid process. As a rule, they increase in the evening and after physical activity.
Heartburn is a typical sign of a disease associated with the ingress of acidic gastric juice into the mucous membranes. Overeating, lying down, and leaning can contribute to a burning sensation. Belching is considered one of the manifestations of cardiac failure. In some cases, it is accompanied by the casting of food into the oral cavity.
The most severe sign of inflammation is dysphagia, in which there is a delay in contents in the lower esophagus. With a narrowing of the organ, this symptom becomes permanent. Examination of the patient begins with the collection of anamnesis and conducting FGDS with targeted biopsy.
During the examination of the mucous membranes, erosions of varying severity, redness and swelling of the tissues are detected. An X-ray examination reveals cardiac insufficiency and increased motility. Histological analysis of the material obtained by biopsy can detect dysplasia or metaplasia. Mandatory is a biochemical blood test. Helicobacter pylori can be detected in the gastric contents.
Methods of treating a disease
With erosive esophagitis, the same therapeutic schemes are used as with other forms of inflammation. Treatment should be directed to the cause of erosion. Mandatory is a special diet. From the diet, it is necessary to exclude fatty, fried and spicy foods, chocolate, coffee and sour fruits.
You need to eat in small portions, 4-5 times a day. It is recommended to permanently stop smoking and drinking alcohol. Antacids, histamine receptor blockers and alginates normalize the acidity of gastric juice, contribute to more rapid healing of erosion.
Drug therapy may include the use of anti-inflammatory and protective agents. In cardiac insufficiency, prokinetics are used that increase the tone of the esophagus sphincter and prevent the reflux of gastric contents.
With erosive reflux esophagitis, it is not recommended to go to bed immediately after eating. You need to sleep on a bed with a raised headboard. This helps to get rid of heartburn and pain in the sternum.
Additionally, alternative methods of treatment can be used. Decoctions of medicinal plants have wound healing, antibacterial and hemostatic effects. 1 tbsp. l nettle, chamomile flowers or oak bark pour 200 ml of boiling water, insist for an hour and take 3 times a day before meals.
Flax seeds have a wound healing and enveloping effect. 2 tbsp. l raw materials pour 0.5 liters of boiling water, leave overnight. The resulting liquid is drunk before meals 3-4 times a day. The course of treatment lasts 30-45 days. With erosive esophagitis, potato juice is also used.
Acute esophagitis occurs in the following cases
- With mechanical damage to the esophagus, for example, rough food (swallowing of stale, not moistened with saliva, - bread crusts, injuries of the esophagus with fish bone),
- Chemical damage - in contact with acids, alkalis and other substances that irritate the mucous membrane (strong alcohol),
- Reception of very hot food (thermal burn),
- For infectious diseases such as scarlet fever, diphtheria, flu,
- Esophagitis can be the result of an allergic process, most often the patient has other signs of allergy.
Mechanical, thermal and chemical damage not only lead to inflammation of the mucous membrane of the esophagus, but also provide access to microbial agents that penetrate from the oral cavity with food.
Causes of Chronic Esophagitis
- Metabolic disorders - with vitamin-mineral deficiency, prolonged tissue hypoxia, chronic intoxication of the body,
- The impact of occupational hazards,
- With swallowing disorders, narrowing of the lumen, food does not reach the stomach and accumulates in the lower segment of the esophagus, which leads to congestive esophagitis,
- Nonspecific ulcerogenic esophagitis develops for unknown reasons, morphologically changes in the mucosa are similar to those that occur with ulcerative colitis,
- The allergic nature of esophagitis is more commonly observed in childhood.
Separately isolated reflux esophagitis occurs when throwing the acidic contents of the stomach into the esophagus. The reason is the failure of the cardiac sphincter of the esophagus, as well as protrusion through the diaphragmatic opening of a part of the stomach. Such esophagitis is also called reflux disease.
The disease can be in a mild form, when the symptoms are practically absent, and proceed with severe symptoms (phlegmonous, necrotic esophagitis). According to the morphological picture, the following forms of esophagitis are distinguished:
- erosive (indicates the 2nd degree of the process),
If there are superficial changes in the mucosa, patients may not complain. Symptoms appear with 2 degrees of esophagitis.
- Difficulty swallowing (doctors call this condition dysphagia) is one of the early signs of esophagitis. Patients complain that food is stuck somewhere in the middle of the chest. This makes them chew food thoroughly, drink plenty of it with drinks.
- Pain along the esophagus, burning behind the sternum depends on the degree of damage to the esophagus. Usually these symptoms are aggravated when trying to swallow food, in severe cases, patients refuse to even take medication.
- With erosion of the mucous membrane of the esophagus (2nd, 3rd and 4th degree), there may be bloody vomiting,
- If the cause is a sliding hernia of the diaphragm, belching and heartburn occur, and the symptoms resemble an ulcer or gastritis. In the chronic form of esophagitis, swallowing, regurgitation occurs after heavy meals, alcohol abuse, and smoking. In a horizontal position, the symptoms intensify and quickly disappear after taking antacids.
Esophagitis in children
Esophagitis often develops in childhood. In infants, the disease is due to failure of the neuromuscular system or due to congenital strictures of the esophagus. More often, babies who have had intrauterine hypoxia and have damage to the cervical spine during childbirth are sick.
Esophagitis in a newborn can be identified by abundant regurgitation, prolonged hiccups or vomiting after eating, the baby's rapidly developing hypotrophy. In the morning, parents find a yellow spot on the pillow, which is a sign of regurgitation of food.
In older children, esophagitis is a consequence of the mismatch between the growth rate of the esophagus in length and the growth of the body, it is caused by hormonal disorders in the teenage period.
As already stated above, esophagitis is an inflammation of the esophagus with an additional lesion of its mucous membrane. The development of the disease is associated with internal and external injuries of the body: poisoning (including hazardous chemicals), mechanical damage to the abdominal organs, gastroesophageal terminal reflux (with reflux, the contents of the stomach move back through the lower esophageal sphincter, a substance that due to terminal reflux moving in the opposite direction called reflux), HIV / AIDS, herpes virus infection.
A complication of which of these diseases is erosive and ulcerative esophagitis? It can become both a complication and an accompanying pathology that worsens the patient's condition. Specialists distinguish several conditional classifications of the disease:
- intensity of development: chronic / acute / subacute,
- according to the degree of damage to internal tissues: total / distotal / proximal,
- according to the degree of damage to the whole organism: minor (without significant damage to the mucosa) / with significant mucosal defects / lesion with necrosis of the mucous membranes and tissues of the esophagus.
The most common is a chronic form of pathology. The time frame for the formation and development of the disease can reach several years (in the absence of the required medical intervention, such a pathogenic effect becomes irreversible). In some cases, the infection can "pass" from one organ to another: there are the appearance of adverse symptoms in different parts of the body, inflammation of adjacent (with a newly damaged organ) parts of the esophagus. For example, with the development of terminal reflux esophagitis, the patient feels a burning sensation, discomfort in the chest area (closer to the heart). Terminal reflux is characterized by the appearance of heartburn, difficulties with the swallowing process and so on.
Treatment of erosive esophagitis at an early stage of development of atherinfection is not difficult and is most often limited to standard therapeutic procedures. In the absence of the required treatment (+ therapy of concomitant diseases and manifestations, such as terminal reflux), the likelihood of the formation of a tumor, peptic ulcer.
Reasons for development
- The presence of a hernia / ulcer of the esophagus.
- Acute inflammatory processes caused by an infectious or bacteriological pathogen in the abdominal organs.
- Damage to the esophagus after probing (a special method for diagnosing the abdominal cavity using a special rod - probe).
- Uncontrolled intake of “heavy” medications for the body.
- Ingestion of alkali, acid, any technical fluid.
- Excessive consumption of alcoholic beverages.
- An unbalanced diet. The predominance of fatty, carbohydrate, spicy foods in the patient's daily menu.
Stages of the disease
- 1st stage. Infection of internal tissues begins. Most often, the affected areas are as distant as possible from each other. The appearance of the first signs of discomfort, severity in the body.
- 2nd stage. The connection of the affected areas. Most of the mucous membrane of the esophagus is infected.
- 3rd stage. All mucous membranes are infected. A third of the esophagus is covered with ulcers.
- 4th stage. Narrowing the lumen of the esophagus (acute pain develops). The disease takes a chronic form.
Symptoms of erosive esophagitis of the esophagus
Symptoms of esophagitis vary depending on the individual characteristics of the body, the degree of organ damage, the cause of the infection. Experts point to cases of complete absence of symptoms and vice versa. pronounced clinical picture of the disease:
- prolonged ongoing heartburn (diet will help reduce discomfort from this symptom),
- pain behind the chest
- general exhaustion of the body, severe headaches, acute pain radiating to different parts of the body,
- nausea / vomiting immediately after ingestion of food. Possible release of vomit with blood clots,
- discomfort in the stomach, a feeling of heaviness and fullness,
- difficulty swallowing,
- dry cough,
- deformation of the voice (becomes more hoarse).
After a thorough diagnosis (diverse analyzes / X-ray / biopsy), the specialist determines what and how to treat the patient. With a diagnosis of erosive esophagitis, treatment consists of several blocks:
- conservative therapy
- diet (the menu should be made by a specialist, based on the indicators of the body and the individual preferences of the patient),
- rationalization of activity (physical exercise, outdoor activities, hardening).
The therapeutic course lasts more than 2 months. For the duration of therapy (and further) it is recommended to stop the consumption of alcoholic beverages and tobacco products.
The diet is based on several rules:
- Minimal heat treatment of food products, which boils down to cooking and cooking food for a couple. It is forbidden to eat baked or fried food.
- Ban on seasoning / carbonated drinks / coffee / cocoa.
- Enter fractional power. Reception of portions should be carried out daily with a break of 2-3 hours (food should be taken immediately after the feeling of hunger). The maximum allowable number of servings per day is 7.
- The last meal should be carried out 4 hours before going to bed.
- The use of vitamin complexes and dietary supplements.
- Taking medicinal decoctions to strengthen the nervous system.
The standards of drug therapy suggest the use of several groups of tablets for:
- normalization of internal microflora (since one of the consequences of the disease is dysbiosis),
- strengthening the protective function of the immune system,
- regeneration of affected tissues, their speedy healing and functioning,
- reduce the pathogenic effects of infection,
- providing antiseptic and anti-inflammatory effects.
A conservative course of treatment includes taking vitamin complexes and biologically active substances. Experts recommend physiotherapy, in the case of terminal reflux - amplipulse therapy (exposure to current). Also, with reflux, it is recommended to take antihistamines, antacids and alginates.
To reduce the pain threshold, they take any pain-relieving pills that are suitable for the patient (such as No-shpa, Nurofen and others). Before buying medicines, pay attention to their composition, certificates and quality standards, date of manufacture. To normalize the psycho-emotional state, it is recommended to consult a therapist.
If conservative treatment is ineffective, the doctor should resort to surgery.
Experts recommend that you carefully approach the means of alternative therapy, and if possible, abandon them altogether. In medical practice, there are cases of aggravation of the situation, relapses, the development of additional pathologies due to self-treatment.
Some folk remedies are recommended by the doctors themselves, based on the therapeutic experience and the needs of the patient's body. It is permissible to use an extract of aloe, potato juice or flaxseed. Products have a beneficial effect on the body, which is why they must be present in the diet during the diet.
In order to avoid the development of esophagitis, several rules should be followed:
The main rule of a healthy esophagus is to prevent its re-infection.
- Strengthening the protective function of the immune system by taking appropriate medications, hardening, and more.
- Introducing the rules of healthy eating into a familiar diet. It is recommended to calculate the required amount of protein-fat-carbohydrates (calculated per unit weight) and calculate nutrition based on individual indicators. Begin to eat fractionally, stop eating excessively carbohydrate foods. Changes will affect the internal state (rapid improvement of well-being, increased stamina, normalization of sleep) and the external (the skin will become more toned and clean, problems with hair and nail growth will partially disappear).
- Introduce optimal physical activity.
- Perform routine diagnostics 1-2 times a year. Thus, the specialist will be able to track any changes in the patient’s condition and provide timely assistance (without bringing the situation to surgery).
- The ban on self-medication and excessive adherence to the advice of traditional medicine. Before treating a certain organ yourself, you should seek the help of a specialist, coordinate subsequent manipulations, control and feel your own body. If the condition worsens, you should immediately stop taking all medical and folk remedies.
- Maximum protection from mechanical damage to the integrity of the abdominal cavity. Prevention of ingress of foreign objects that can provoke poisoning or damage to organs.
- Timely treatment of diseases (such as reflux) before undergoing a therapeutic complex and after it.
Reasons and stages of development
Esophagitis with erosion of the mucous membrane of the esophagus goes through several stages of development:
- the first stage is characterized by the appearance of separate areas affected by erosion, not merging with each other, and erythema,
- the second stage - the affected areas are merged into one, but do not cover the entire surface of the mucous membrane,
- the third stage - the appearance of ulcerative lesions in the lower third of the esophagus with fusion and coverage of the entire surface of the mucosa,
- the fourth stage is stenosis and chronic peptic ulcer.
The main causes of the onset of the disease:
- damage to the mucous membrane of the esophagus occurs against the background of acute inflammation of the esophagus and the resulting hernias, ulcers,
- sometimes the disease becomes a consequence or occurs simultaneously with bacterial and viral infections,
- in some patients, cases of the formation of erosion of the esophagus after sounding were detected,
- identified individual cases when erosive reflux esophagitis affected patients uncontrolled taking anti-inflammatory drugs,
- in case of accidental penetration of acids, alkalis or technical fluids into the body, damage to the esophagus is guaranteed,
- often people who abuse alcohol and spicy foods are affected.
The sooner the disease is detected, the easier and faster the treatment will be. Erosive esophagitis can be recognized and accurately diagnosed by its characteristic signs.
Degrees of esophagitis
The endoscopic picture allows you to assess the degree of mucosal damage in esophagitis.
- Esophagitis of the 1st degree: the folds are smoothed, friability and redness of the mucous membrane are noted. With 1 degree of erosion or ulcers are absent.
- Grade 2: One or more erosions in the lower segment of the esophagus can be determined. At 2 degrees, mucosal damage takes no more than 1/10 of the part.
- 3 degree: there are several erosions, they merge with each other, are covered with exudate or necrotic masses. Mucosal defects at 3 degrees occupy no more than half the area of the lower third of the esophagus.
- 4 degree: numerous erosion merged together, located in a circular. The affected area is more than 5 cm above the entry site of the esophagus into the stomach.
Symptoms of the disease
But not always the symptoms of esophagitis are pronounced. Sometimes the patient does not feel anything until the time of the preventive examination using one of the methods of hardware diagnostics or a comprehensive examination of the body. But nevertheless, in the vast majority of cases, this disease loudly declares itself already in the early stages.
Symptoms of all types of esophagitis are similar to each other, and with damage to the mucous membrane, they become pronounced.
- Severe and often occurring heartburn should be the reason for contacting a gastroenterologist, especially if this unpleasant sensation intensifies after eating too oily or spicy foods. Esophagitis pain is localized in the chest, directly behind the sternum, but not in the abdomen. If at the same time there is weakness, dizziness, shortness of breath, most likely these are signs of some kind of concomitant disease (for example, angina may cause a burning sensation in the chest after physical exertion).
- Nausea that occurs immediately after eating.
- Soreness when swallowing, feeling of heaviness, pressure in the stomach.
- Belching or vomiting with an admixture of blood, impaired breathing.
- Dry painful cough at night.
Some of these symptoms can occur with other diseases of the internal organs. In any case, they all require you to see a doctor for a comprehensive examination.
Erosive (ulcerative) esophagitis: diagnosis and treatment
To diagnose damage to the mucous membrane of the esophagus, a blood test, x-ray examination and biopsy are prescribed. X-rays help to see erosion and inflammation, biopsy - changes in cells (dysplasia, metaplasia).
With the timely appointment of treatment, the prognosis of complete recovery is quite favorable. Most often, gastroenterologists treat esophagitis with conservative methods. Since this disease is often accompanied by intestinal dysbiosis, therapy, as a rule, begins with the restoration of microflora. Special preparations (lactobacilli, bifidobacteria) and fermented milk products, as well as taking a complex of vitamins and microelements, help in this.
Treatment of ulcerative esophagitis includes taking the following drugs:
- antacids (rennie, almagel) two hours after eating and at bedtime,
- prokinetics (domperidone, motilium) - contribute to the normalization of the flow of hydrochloric acid through the esophagus into the intestine, taken four times a day,
- inhibitors (rabeprozole, soars),
- enveloping and anti-inflammatory drugs (bismuth subcitrate, venter),
- H + receptor blockers for healing erosion.
The duration of treatment is at least two months. For general protection and strengthening the body, it is necessary to take drugs that increase immunity.
What nutritional rules should be followed for esophagitis?
To completely get rid of erosive esophagitis, it is important to follow a diet and at least temporarily give up smoking and alcohol, as this irritates the mucous membrane of the esophagus even more.
The diet for esophagitis should be observed constantly, until complete recovery, while the patient must take into account a number of requirements.
- Minimal culinary processing of products. All dishes must be prepared by steaming, boiling or stewing. The use of baked and fried foods is prohibited.
- Exception from the diet of raw fruits and vegetables, nuts, seeds.
- Exclusion of coffee, cocoa, carbonated drinks.
- The exception of seasonings, smoked meats, spicy dishes.
- Compliance with the general principles of nutrition in diseases of the gastrointestinal tract: eat often in small portions, relax after each meal, eat dinner 3-4 hours before bedtime.
- Discontinuation of sedatives, tranquilizers, prostaglandins, which worsen the condition of the esophageal sphincters. Replacement of sedatives with decoctions of mint, lemon balm, tincture of calendula, chamomile, valerian or other herbs. In addition, traditional medicine recommends special fees for the treatment of the digestive system. They usually include anise, cinnamon, marjoram, marigold, dandelion, fireweed. Practice has shown that almost all types of esophagitis respond well to folk remedies.
- Recommended dishes with a soft consistency, mashed, blended - boiled eggs, soups, milk porridges, pastes, jelly, kefir, vegetables, steamed meat.
Failure to follow a diet or refusal to treat esophagitis can very quickly lead to the development of esophageal stenosis - its narrowing, in which it is impossible to eat normally, perforation of the esophagus wall, phlegmon, purulent abscesses. In order to avoid such complications, follow the doctor's instructions, avoid eating dry and hot food, visit a gastroenterologist for a routine examination, even after complete recovery.
We will examine in more detail what erosive esophagitis is, and because of what it appears. Most often this is due to the release of the contents of the stomach into the esophagus. Digestive enzymes, hydrochloric acid, bile acids, pancreatic juice are ejected from the stomach, and, of course, their presence in the esophagus is undesirable. If the disease develops precisely because of frequent releases of the contents of the stomach into the esophagus, then it is called erosive reflux esophagitis (reflux - discharge).
Emissions of gastric contents into the esophagus occur in healthy people, but they are relatively rare - as a rule, no more than twice a day, and are short - about five minutes. This usually occurs after eating. In a healthy body, mechanisms work through which emissions remain episodic cases and do not lead to erosion in the esophagus.First of all, these are the esophagus sphincters that separate it from the pharynx and stomach. Also in the esophagus there is a mechanism for cleansing of the reflux fluid that is still in it.
There are several factors that make defense mechanisms not effective enough. The first of these is overweight, as well as smoking, alcohol, great physical exertion, primarily on the abdominal area, the use of acidic, salty, fatty foods, bedtime, stress, tight clothing.
In addition to external factors, there are also diseases and physical defects that can lead to the development of erosive esophagitis: a hernia in the esophagus of the diaphragm, scleroderma, abnormal development of the muscular system, constipation. May occur due to pregnancy. It is also possible erosion in the esophagus due to the use of anti-inflammatory, sedatives, drugs, hormones, adrenergic blockers, calcium antagonists, antidepressants, antibiotics.
Esophagitis is divided into two types:
- Non-erosive - the course of the pathology is easier, swelling and redness are noted.
- Erosive - mucosal defects are noted. Erosive reflux esophagitis is divided into four degrees of severity, that is, the number and size of defects in the mucosa, as well as the presence of complications.
We are interested in the second of these types. It, in turn, is divided by the nature of the current into the following categories:
- Acute - the most widespread. It is accompanied by inflammation of the mucous membrane of the esophagus. It develops suddenly.
- Chronic - prolonged inflammation of the esophagus. Because of it, irreversible changes can occur in the structure and work of the esophagus.
- Catarrhal - inflammation of the surface layer without penetration into the tissue.
- Ulcerative - esophagitis penetrates into the deeper layers of the mucosa, ulcers appear in it, as a result of which erosive-ulcerative esophagitis develops.
Some of these categories may overlap.
Finally, according to localization, they distinguish:
- erosive distal esophagitis - inflammation of the lower end of the esophagus near the connection with the stomach,
- proximal - inflammation of the upper sections,
- total - inflammation of the esophagus along its entire length.
Course of the disease
In terms of severity, four degrees of erosive esophagitis are distinguished.
If gastric enzymes and acids only irritate the mucous membrane of the esophagus, then this reflux esophagitis 1 degree. Gradually, symptoms of pathology begin to appear, inflammation develops. Due to prolonged contact of the mucosa with irritating substances, the situation worsens.
Esophagitis 2 degrees It is diagnosed when fibrous deposits and superficial ulcers are found on the mucous membrane of the esophagus.
If you do not carry out a therapeutic effect, the inflammation will turn into ulcerative erosive esophagitis, scarring and bleeding, and shortening of the esophagus will appear.
Third degree the development of the disease is characterized by inflammation of a large part of the esophagus.
At fourth foci of inflammation cover three quarters of its mucosa or more. There is progressive fibrosis, narrowing of the esophagus, penetrating ulcers are formed. Complications such as mediastinitis, phlegmon, perforation of erosion with profuse bleeding, non-healing ulcers and perforation of the esophagus wall are possible. If it continues for a long time without treatment, precancerous changes (Barrett's disease) may occur in the esophagus.
Some of the symptoms are hidden, others are pronounced. All symptoms are divided into two groups: esophageal and extraesophageal. The second is more difficult to associate with esophagitis, and many tests have to be done before it is reliably detected.
Esophageal symptoms usually occur when taking a horizontal position, at night, while tilting or lifting heavy objects. This: heartburn (in most patients), pain in the epigastric region, as well as behind the sternum, increased salivation, sour or bitter belching, sometimes nausea and vomiting. Heartburn with erosive esophagitis is stronger than in most other cases. The patient constantly experiences burning pains, often they arise even due to the use of conventional products that are not very high in fat or severity.
Swallowing with erosion of the esophagus is painful or unpleasant due to spastic contractions, and after swallowing painful sensations arise in the upper abdomen. An attack of pain provokes even a couple of sips of tea, and if the patient wants to eat a sandwich, then he will have very strong cramps. In the mornings, the mouth has a very unpleasant aftertaste, pains in the epigastric and sternal zones, protruding between the shoulder blades, in the neck, from the left side of the sternum. Sometimes they are confused with heart pain.
Other symptoms include the following: weakness and dizziness, feeling like a lump is stuck in the throat, or just a long discomfort in it, a hoarse voice, suffocation, problems with ligaments, cough without sputum, gum disease and damage to tooth enamel, pilomato-throat, pain in neck, periodic heart rhythm disturbances, pain in the lower jaw, bad breath.
The severity of symptoms with esophagitis of the esophagus does not always clearly indicate how much the mucous membrane is actually affected, so your doctor will need to conduct an examination to determine the stage of the disease.
The diagnostic procedure is called fibrogastroduodenoscopy. What is it and what is it for? In its course, the mucous membrane of the esophagus is examined using an endoscopic apparatus, and its condition is assessed. It is revealed whether there are redness, inflammation, narrowing, scarring, ulcers. Tissue can also be taken from the affected area for analysis. Under the microscope, its morphological assessment is done, necessary to explore the possibility of malignant transformation. With its help, the general condition is also clarified: how strong the degree of inflammation, edema, whether there are microbleeds.
An X-ray study with a suspension of barium is also carried out. It reveals inflammation, ulcers, narrowing. During the study, the patient will have to take both horizontal and vertical position. Thus, the esophagus will be checked for duodenogastric and gastroesophageal refluxes, diaphragm hernia. A pH test of the esophagus and manometry can be performed (checking contractility). It is extremely important to identify erosive esophagitis on time, because if the case is already running, treating it is much more difficult and longer.
If the esophagus is affected due to the constant release of hydrochloric acid from the stomach, the stomach should be treated. But in addition to this, the treatment of the esophagus itself will also need to be addressed. And here in different cases different methods can be used.
Drug treatment for erosive esophagitis.
First of all, it should be aimed at eliminating the root cause, which led to the development of the disease. At the same time, antacids are used to regulate the acidity of the stomach, alginators, histamine receptor blockers for healing erosion, anti-inflammatory and enveloping, painkillers and healing drugs. Prokinetics will prevent relaxation of the esophageal sphincter and the release of gastric contents. To heal wounds, you can take a course of laser therapy.
Lifestyle change, diet.
Do not smoke or drink alcohol. It is absolutely impossible to overeat. Food should be taken four to five times a day in small portions, you can not eat late in the evening. Spicy and fatty dishes should be completely eliminated, and also not to eat too cold and hot. Steamed dishes are preferred.
You will also have to abandon the products, due to which the tone of the sphincter of the esophagus can be weakened, because it is because of the relaxation of the sphincter that the gastric juice enters the esophagus. These are: chocolate, margarine, red fish, tomatoes, citrus fruits, any fried dishes. From drinks coffee, skim milk and cream, sour juices, all carbonated drinks. Use should be herbal teas and sweet juices.
It is necessary to avoid the use of indigestible fruits and vegetables, as well as those due to which gases are formed. Carrots, potatoes, zucchini, pumpkin, and sweet fruits will be useful. Meat should be eaten only lean; when preparing it, use seasonings that will not irritate the mucous membrane. Skim milk is only allowed to consume yogurt and cheese.
If a complication of the disease is detected, hospitalization should be carried out with subsequent surgical intervention. It is also advisable if, after long therapy, large erosive foci could not be healed. The main type of surgery now is endoscopic resection of the ulcer surface. Injuries with it are minimal and the recovery period is short.
With an ulcerative or phlegmonous process, its perforation of the walls can occur, which leads to inflammation of the mediastinum or peritoneum. Erosive esophagitis (2nd degree) can be complicated by bleeding. Both acute and chronic processes often lead to narrowing of the lumen of the esophagus and the formation of scars. If the cause of esophagitis is damage to the walls by a foreign body, phlegmon or abscess of the esophagus may occur.
In the early days, patients are advised to refrain from eating. With esophagitis, enveloping drugs, antacids are prescribed. Severe inflammation of the esophagus requires the appointment of antibiotics.