Reflux-esophagitis: symptoms and treatment, causes, symptoms

What it is? Reflux-esophagitis in modern medicine is called gastroesophageal reflux disease.

It is a chronic inflammatory reaction that develops in the wall of the esophagus against a background of constant or periodic casting of acidic gastric contents.

At the heart of this pathology is the impaired motor activity of the gastrointestinal tract. Reflux of gastric contents in the esophagus can be noted and normal. It is characterized by the following parameters:

1. 1) Occurs no more than 2 times during the day
   
2. 2) The duration of one episode is not more than 5 minutes.

Physiological reflux does not lead to the development of an inflammatory reaction in the esophageal wall, in contrast to the pathological.

Classification

Gastroesophageal reflux disease is classified according to different approaches:

1. 1) Depending on the presence of complications, a complicated and uncomplicated form is identified.
   
2. 2) This disease can occur both with and without esophagitis.
   
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3. 3) Endoscopically positive reflux esophagitis and endoscopically negative.
   
4. 4) In terms of severity, there are four forms. At the first degree, only the hyperemia of the mucosa of the esophagus is noted, while the second one - there are erosions, which already merge to the third degree, and the fourth degree is characterized by chronic ulcers and strictures.

Reasons for reflux esophagitis

The main etiopathogenetic factors of reflux esophagitis look as follows:

1. 1) Spontaneous relaxation of the lower esophageal sphincter
   
2. 2) Decreased activity of the neutralizing esophagus systems( normally it produces chemicals that convert acidic gastric contents to neutral, andalso decrease its peristalsis)
   
3. 3) Increased aggressiveness of gastric contents( high acidity of gastric juice, high content of bile and pancreatic ska in the stomach contents)
   
4. 4) Violation of the normal structure of the esophageal wall, which reduces its resistance( this is happening against the background of chronic esophagitis, microcirculation disorders, etc.).

It is customary to identify predisposing factors for the development of reflux esophagitis. If they are present, the probability of developing this disease increases. These include:

• congenital smooth muscle defect that forms the lower esophageal sphincter
  
• congenital impairment of its innervation( eg, aganglion)
  
• smoking
  
• increased coffee consumption
  
• alcoholism
  
• taking certain medications that have a relaxing effect on the musculature of the gastrointestinal tractcalcium channel blockers, nitrates, euphyllin group, benzodiazepines)
  
• pregnancy
  
• scleroderma
  
• hiatal hernia in the diaphragm
  
• ereedanie
  
• stagnation of food in the stomach
  
• obesity
  
• ascites
  
• long stay in a horizontal position.

Symptoms of reflux esophagitis

Reflux esophagitis can occur without symptoms, and can manifest itself in a variety of clinical manifestations:

1. 1) The most important symptom of reflux esophagitis is heartburn, as the gastric contents have an acidic environment uncommon to the esophagus
   
2. 2) Belchingby increasing the contents in the esophageal tube and stretching it
   
3. 3) Regurgitation, which occurs for the same reason as the eructation of
   
4. 4) Pain localized in the chest( they are very similar to angina pectoris, from whichthey need to be distinguished, since the treatment of these two pathological conditions is significantly different)
   
5. 5) The pain that occurs when swallowing.

Note, if you have a last symptom, it is likely that reflux esophagitis becomes more complex, which can lead to scarring and narrowing of the esophagus.

Diagnostic methods for

Diagnosis of gastroesophageal reflux disease should primarily be based on a clinical picture, as with endoscopy it is not always possible to detect inflammatory changes in the esophageal wall, especially at the initial stages of the disease.

Thus, according to statistical data, the symptoms of reflux esophagitis, which are observed daily, are observed in 10% of the world's population, 30% meet them weekly, and every month - 50% of people.

However, only 50% of patients can endoscopically confirm this disease. The rest recommend the conduct of the Berstein test, which consists in the introduction of hydrochloric acid and subsequent esophagoscopy.

The main endoscopic signs of reflux esophagitis are:

• inflammatory changes in the esophageal wall
  
• the presence of erosions and ulcers on the mucosa of the esophagus.

Earlier in the diagnosis of this disease, X-ray examination with X-ray contrast substances was used. However, it does not have sufficient informativeness. With its help, it was possible to detect either certain complications of reflux esophagitis, or some background conditions, namely:

• diaphragmatic hernia
  
• perforation of the esophageal wall
  
• cicatrical narrowing.

At present, the most valuable method for diagnosing gastroesophageal reflux disease, including its endoscopically negative forms, is the intraepithelial pH-metry. It is carried out throughout the day. With its help it is possible to evaluate:

• the number of refluxes generated during the reporting time
  
• their duration
  
• quality of thrown contents( acidic or alkaline)
  
• to reveal the relationship of refluxes with this or that factor( overeating, inclined body position, etc.)
  
• to pick up the individual timetaking medications taking into account the time of casting.

Treatment of reflux esophagitis

The main goals that should be achieved in the treatment of reflux esophagitis are:

• decrease in the amount of food thrown and reflux episodes
  
• decrease in aggressive properties of the thrown contents
  
• improve the activity of the esophageal neutralizing systems
  
• create protection of the esophageal mucosa.

General events that are recommended to be observed consistently are:

• Do not take the horizontal position immediately after eating
  
• Do not eat 2 hours before bedtime
  
• Raised head end of the bed
  
• Restrict fatty foods in the diet
  
• Quit smoking and drinking alcohol.

Sometimes it happens that general measures are sufficient for relief of the main symptoms of reflux esophagitis. However, if they prove to be ineffective, then a pharmacological correction is indicated.


In the second stage, which is transferred to the inefficiency of the former, prokinetics are used. These include Metoclopramide, or Cerucal. They help restore the reduced tone of the esophageal sphincter and normalize the motility of the gastrointestinal tract. They are used simultaneously with antacids( Almagel, Maalox) and antisecretory( Ranitidine, Omeprazole) agents.

Metoclopramide is recommended to be taken half an hour before a meal in order to achieve its maximum effectiveness. It is prescribed 3-4 times throughout the day, depending on the severity of clinical manifestations. The duration of the course of treatment is 1-1.5 months. The drug is excreted by the kidneys, so when renal insufficiency, its dose decreases and is selected individually.

Surgical treatment of reflux esophagitis, as a rule, is carried out at the stage of development of complications. The operation is performed urgently to save the patient's life, especially when it comes to esophageal bleeding.

Complications of reflux esophagitis

The presence of complications of gastroesophageal reflux disease determines the prognosis of this disease. The main complications that occur in 10-15% of patients are:

• peptic ulcer
  
• esophageal stricture
  
• bleeding
  
• perforation - violation of the integrity of the esophagus wall
  
• Barrett's esophagus, which is a precancerous condition. In this disease metaplasia of the esophageal epithelium is observed in the intestinal type, which is not adapted for existence in such an environment. Therefore, very often dysplasia develops, which increases the likelihood of esophageal cancer development.

The out-of-esophagus manifestations of reflux esophagitis began to speak only recently. Against the background of this disease, the probability of the following pathological processes increases significantly:

• recurrence of pneumonia
  
• chronic bronchitis
  
• bronchial obstruction
  
• reflux disease of the larynx and pharyngeal
  
• dental diseases
  
• cardiac arrhythmias in the form of extrasystole and conduction disorders.

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