Mar 04, 2018
The disease manifests itself primarily by burning or pain along the esophagus;These sensations are greatly amplified when trying to swallow food;patients stop taking even medicines. They spit the saliva all the time, sometimes containing an admixture of blood and mucus, and in some cases even pieces of the esophageal mucosa that has escaped.
In all cases, urgent medical attention is required. When poisoning with chemical fluids should immediately carry out emergency measures. Treatment of severe cases of acute esophagitis is carried out in the hospital, the lungs - in the amount prescribed by the doctor's recommendations at home.
After discharge of the patient with acute esophagitis from the hospital, as well as with mild forms of the disease course, it is recommended to provide patients with mechanically, chemically and thermally sparing diet( diet No. 1) for at least 2 months. Immediately before meals, it is advisable to ingest 1 tablespoon of vegetable oil or fish oil.
Chronic esophagitis develops as a result of repeated or prolonged effects of various factors( including thermal, mechanical, chemical) damaging the mucosa of the esophagus. The causes of chronic esophagitis are often a poor state of teeth, insufficient chewing food, prolonged dietary restriction of protein( meat, fish, etc.), vitamin deficiency of food. The emergence of chronic esophagitis is also facilitated by diseases of other organs and systems, especially those with frequent exacerbations: chronic inflammatory diseases of the nasopharynx, maxillary cavities, lungs, bronchi, iron deficiency anemia, circulatory insufficiency, cirrhosis with esophageal varices, etc.
Especially often chronicesophagitis develops in patients with incomplete closure or yawning of pulp( sphincter) of the gastroesophageal junction. Chronic inflammation of the esophagus in these cases occurs when the acidic acid content in the esophagus is systematically thrown into the esophagus, which has a strong irritant and damaging effect on the mucosa. Chronic esophagitis in these patients is called reflux esophagitis.
Symptomatic of the disease in most cases is not clearly expressed. There is a burning sensation behind the sternum, little pain when passing food through the esophagus, belching, regurgitation, nausea, and easily vomiting.
The occurrence of the above described complaints should be an important reason for referring the patient to a district therapist or gastroenterologist. It should be borne in mind that the diagnosis of chronic esophagitis, or reflux esophagitis, delivered by a doctor after an appropriate examination, should not cause the patient to fear or feelings of doom, hopelessness. The prognosis( perspectives of course and cure) of the disease is usually favorable, good. However, this is possible only if the doctor's recommendations are strictly followed.
• general blood test;
• general urine analysis;
• blood and urine sugar;
• analysis of feces for occult blood;
• immunoassay and bacteriological methods for detecting a viral infection, candidiasis, etc.
If there are indications:
• hepatic complex;
• renal complex.
• EGDS with biopsy - on the background of general hyperemia, bleeding, eroded and ulcerated sections of the mucosa are visible, on the surface of which the mucous or hemorrhagic discharge is detected;
• esophageal chromoscopy;
• fluoroscopy of the esophagus - a decrease in the tone of the esophagus, thickening and swelling of the folds;
• intragastric pH-metry;
• intra-esophageal pH monitoring;
• Morphological examination of biopsy specimens;
• Ultrasound of the digestive system;
In the presence of indications:
• bronchoscopy and lung fluorography - to eliminate the organic pathology of the broncho-pulmonary system.
• Holter monitoring.
Consultations of specialists
• The dentist.
In the presence of indications:
• Surgeon - in the presence of complications: suspicion of esophageal cancer, perforation, bleeding.
Principles of treatment are as follows:
1. A diet is prescribed( in the acute period liquid or semi-liquid cooled food).
2. Antacids and astringents( histall, almagel, moalox, vikalin, preparations of bismuth, silver nitrate).
3. Means that regulate the motor functions of the upper digestive tract( cerulek, region, engonil).
4. Synthesis of substitutes( venter, sucralfate).
5. Acid blockers( H2-histamin blockers, H-cholinolytics).
6. Physiology( EHF and laser therapy, dyadic currents).
If chronic esophagitis has arisen as a result of diseases of other organs and systems, it should be correctly understood that the speed of getting rid of manifestations of esophageal inflammation depends on the persistence of treatment of the underlying pathological process. And this is the main condition, which lies in the complex of treatment of chronic esophagitis. Patients are shown for a long time therapeutic nutrition( diet number 1).In the dietary diet, it is necessary to provide products rich in vitamins, especially vitamins A, B, vegetable oils. When the disease worsens at home, the use of herbal decoctions should be used more widely. Very useful may be rose hip oil or sea buckthorn oil, prescribed 1 teaspoonful 5-6 times a day for 1.5 hours before meals. These oils have a good anti-inflammatory and analgesic effect, contain a wide range of vitamins necessary for the body, protect the mucous membrane of the esophagus from the adverse effects of saliva enzymes, food.
• avoiding smoking and alcohol;
• Where possible, restriction of drugs that cause drug-induced esophagitis( tetracycline, doxycycline, NSAIDs, cytostatics and steroid hormones);
• Restriction of products that relax the lower esophageal sphincter( tomatoes, coffee, strong tea, animal fats, mint), which irritate( onions, garlic, seasonings), gas-forming( peas, beans, champagne, beer);
It is recommended to use alkaline mineral water.
Esophagitis is an inflammatory disease of the esophagus mucosa. Two forms of esophagitis are known: acute and chronic( respectively acute and chronic inflammation of the esophagus).
As a rule, acute esophagitis develops as a result of direct traumatic action of different duration of thermal, mechanical or chemical factors on the mucosa of the esophagus. Acute esophagitis occurs: with mechanical damage to the esophagus( ingestion of fish bones, hard crusts, etc.);when receiving very hot food;when poisoning with acids, alkalis, technical liquids;occasionally as a manifestation of a common infection( scarlet fever, typhoid fever, other infectious diseases).Mechanical and chemical damage leads to esophagitis both by themselves and with the help of an infection falling into the damaged mucous membrane of the esophagus( from the oral cavity with food, etc.).
1) by origin: primary, secondary esophagitis;
2) downstream: acute, subacute, chronic;
3) by the nature of changes in the mucosa: catarrhal, erosive, ulcerative, hemorrhagic, necrotic;
4) for localization: diffuse( common), localized, reflux esophagitis;
5) by the degree of remission: mild, moderate, heavy;
6) complications: bleeding, perforation.
Characterized by pain syndrome with localization in the area of the xiphoid process;Dyspeptic syndrome( dysphagia, eructation, heartburn).
Instrumental research methods: fibroscopy - signs of inflammation activity, sphincter state of the apparatus;fluoroscopy: elimination of congenital pathology, diaphragmatic hernia;pH-metry: reflux diagnosis;sianometry: determination of the functional state of the sphincter apparatus.
Differential diagnosis is performed with esophageal-gastric hernia, varicose veins of the esophagus.