Ezofagit - Causes, symptoms and treatment. MF.

Often unpleasant symptoms such as heartburn, upper abdominal pain, impaired swallowing while eating, are associated with stomach diseases. However, a similar clinical picture manifests itself and the inflammatory process in the esophagus, or in another way, esophagitis.

Esophagitis is a disease of the esophagus that occurs as a result of the action of adverse factors on its mucous membrane, flowing acutely or chronically, and with severe lesions of the esophagus that can lead to complications.

By the degree of involvement of the mucous membrane, catarrhal, edematic, erosive, hemorrhagic, necrotic, pseudomembranous, exfoliative and phlegmonous esophagitis are distinguished. According to the nature of the esophagus, it can be proximal( in the initial sections), distal( closer to the stomach) and total, when the mucosa is involved throughout the esophagus.

Causes of esophagitis

Gastroesophageal reflux is the most common cause of inflammation of the esophagus, also called reflux esophagitis. The disease develops due to incomplete closure of the cardiac part of the stomach, as a result of which the gastric content, which has an acidic reaction, is thrown back into the esophagus. Normally, this should not be, because the cells of the mucosa of the esophagus and stomach differ, and if in the stomach hydrochloric acid does not exert a destructive effect on the mucosa, then in the esophagus this leads to constant irritation and the appearance of edema, and the idea and erosion of mucosal defectsand submucosal structures. The casting of gastric contents can occur with diaphragmatic hernia, obesity, pregnancy, frequent use of alcohol and smoking, abuse of fatty foods.

Chemical factors .The second most frequent cause of esophageal damage is poisoning with chemicals, for example, when attempting suicide or by mistake. A chemical burn of the mucosa develops, which in most cases leads to a cicatrical fusion of the walls of the esophagus, called strictures. Possible burns with alkali, acids( most often acetic acid), solvents( gasoline), there is less often a lesion of the esophagus by surrogates of alcohol. Ezofagit with the constant use of ethyl alcohol develops in people with alcoholism.

Foreign bodies of the esophagus occur almost as often as chemical damage. Most often there is a situation where a person swallows a fish or a chicken bone, and it wedges in the lumen of the esophagus. In this case, not only acute esophagitis will develop, but perforation of the bone through the wall is possible. This is fraught with the development of phlegmonous( purulent) esophagitis and the flow of pus into the mediastinum - a cavity in which the heart, trachea and large vessels are located. In addition, a foreign body is often found in young children when swallowed by various medium and large items, such as coins, batteries, toy parts, etc.

Foreign body of the esophagus in a child when radiographing

Thermal factors , basically there is an increasethe temperature of the food intake, for example, if a person quickly swallows a very hot meal or systematically takes food hot.

Infectious agents of , such as Candida fungi, influenza viruses, measles, cytomegalovirus, microorganisms that cause diphtheria, scarlet fever, typhoid fever, can provoke acute or chronic esophagitis in persons with reduced immunity, for example, in HIV-infected patients. In such cases, hemorrhagic( with the formation of hemorrhages in the wall of the esophagus in case of viral infections) or exfoliative( with the formation of deeply coagulated fibrin inflammatory films with diphtheria or scarlet fever) esophagitis develops.

Alimentary factors have a direct effect on the esophageal mucosa in the use of products that cause allergies in this patient, or products containing spices and preservatives, as well as fatty, sharp, fried foods and smoked products.

endoscope injury is extremely rare as a result of gastroscopy.

Symptoms of esophagitis

The clinical picture of acute and chronic esophagitis consists of the following syndromes:

- Pain syndrome is characterized by heartburn, acute or persistent burning pain in the sternum and upper abdomen, giving back and neck. When poisoning with chemicals or swallowing a foreign body, the pain is sharp, intense. In addition to pain behind the breastbone and neck, burns are characterized by pain on the mucous membrane of the mouth with the corresponding signs of damage to the chemical substance of the mouth, as well as pronounced edema of the face, neck and larynx, causing hoarseness and suffocation.

- Dysphagia syndrome is a violation of ingestion of food, especially a hard find. During the reception of solid foods, the patient is forced to drink them with a sip of water. With severe lesions of the esophagus, difficulty occurs when swallowing soft food and liquids.

- Regurgitation, or regurgitation of - throwing swallowed food back from the esophagus into the pharynx. Occurs immediately after meals or after several hours, may disturb the patient at night. A frequent eructation with a sour or bitter aftertaste is also characteristic.

- Respiratory disorders appear as a dry dry cough more often at night and reflex laryngospasm( closing the glottis in the larynx with the inability to hold air for a few seconds or minutes) due to inhalation of food particles thrown into the mouth. In patients with constant irritation of the pharynx and larynx, acidic gastric contents often develop bronchitis.

- Dyspepsia syndrome may occur with concomitant gastritis or gastric ulcer and is characterized by nausea, vomiting, unstable stools. With hemorrhagic esophagitis, vomiting can occur with blood of a dark color.

- The shock state of is possible with a severe degree of acute esophagitis caused by a chemical burn of the esophagus, when the lesion covers all layers of its wall and spreads to nearby organs. Here, in fact, there is a pain shock. Infectious - toxic shock with the corresponding symptoms appears with perforation of the esophageal wall with the development of purulent inflammation of the nearby mediastinal organs.
In acute inflammation of the esophagus, unlike the chronic, all the symptoms appear suddenly, they are pronounced and cause considerable discomfort to the patient, prompting him to consult a doctor. With catarrhal and edematous forms, the symptoms of esophagitis may be less pronounced. With chronic esophagitis, the symptomatology is somewhat erased, and not so rapidly develops, so the patient, as it were, gets used to unpleasant sensations, practicing self-medication, for example, constantly taking renni, almagel and other drugs for heartburn. Such a patient's approach to his health is fundamentally wrong, since the inflammatory process in the esophagus should be treated only by a doctor after examination and establishing the cause of esophagitis. Otherwise, long-term esophagitis can lead to scarring in the esophagus wall and other complications.

Diagnosis of the disease

If symptoms similar to those of esophagitis appear, you should consult a therapist, a gastroenterologist, or call an ambulance, for example, for poisoning with a chemical substance or ingesting a foreign body. In addition to interviewing and examining the patient, the doctor prescribes any of the additional diagnostic methods. Depending on the acute or chronic course of esophagitis in a given patient, the examination can be carried out urgently upon admission to the hospital or planned in a polyclinic. Can be assigned:

- General blood and urine tests.
- Specific blood tests for suspected infectious diseases( detection of titer of antibodies to cytomegalovirus, causative agent of typhoid, diphtheria, blood test for HIV, etc.).
- Esophagography - introduction of a radiopaque substance through the mouth and carrying out radiography. Allows you to determine the foreign body, assess the patency of the esophagus. It can be prescribed for a chemical burn of the esophagus just the day after the poisoning, when the patient is removed from the shock state.
- Esophagomanometry - the determination of pressure inside the esophagus and its contractile activity with a special oral catheter can also measure the pH of the esophagus and determine the rate of its evacuation( esophageal clearance).
- Esophagoscopy - examination of the esophagus from the inside with the help of an esophagoscope inserted through the mouth. It allows to determine the signs characteristic of a particular form of the disease( reddening and mucous discharge, ulcers and erosions, hemorrhages, fibrinous films, etc.), and also to determine the degree of lesion of the esophagus. It is possible to conduct a biopsy( tissue sampling) of tissue with further histological examination.

The need for such a method for acute esophagitis is determined by careful collection of anamnesis when examining the patient. For example, if there is a danger of wedging and perforation of the esophageal wall with a sharp foreign body, the patient is immediately prepared for surgery without esophagoscopy or is under general anesthesia. In case of chemical burns and acute esophagitis, the examination can be carried out only after a few days( on days 8-10) in order to avoid even more trauma to the mucous membrane. The diagnosis and treatment here will depend entirely on the patient's medical history, or rather, on what was drunk and eaten on the eve of the disease.

In chronic esophagitis esophagoscopy is performed in a planned manner after a general clinical examination of the patient.

Reflux esophagitis with esophagoscopy

Treatment of esophagitis

Therapy of acute esophagitis is reduced to the following measures:

- refusal to eat during the first two days, and in case of severe chemical damage to the esophagus - parenteral nutrition, when nutrient solutions are administered intravenously,
- inhibitorsproton pump to reduce the formation of hydrochloric acid in the stomach - omeprazole, pantoprazole, etc.,
- blockers of histamine receptors with the same purpose - famotidine, ranitidine, etc.,
- antacidReparate already available to neutralize the hydrochloric acid in the stomach - almagel, Aluminum phosphate gel, Rennie et al,
- antifungal, antiviral or antimicrobial therapy for infections of the esophagus,
- antibiotics esophageal wall is damaged by a foreign body.

Treatment of chronic esophagitis:

- diet with exclusion of irritating( hot, fatty, acute) food, adherence to diet,
- omeprazole, famotidine, antacids,
- drugs that improve the progression of the alimentary tract through the digestive tract - motilium, ganaton.

Treatment of reflux esophagitis is described in detail in the article Gastroesophageal reflux disease.

Treatment of acute esophagitis due to a chemical burn of the esophagus is carried out only in a hospital. As an emergency aid in the pre-hospital stage, self-washing of the stomach is not recommended due to the fact that the toxic agent will get back into the esophagus during vomiting and cause additional damage, and the esophageal wall may be injured by spasm of its muscles due to vomiting. It is enough to give the victim to drink a couple of glasses of a weak solution of citric acid for burns with alkali and a weak solution of soda with burns with acid. If the type of liquid is not installed, you can drink two glasses of warm milk. These measures to neutralize the poisonous substance are effective only during the first 4-6 hours, therefore it is necessary to call an ambulance as soon as possible. A doctor in a hospital may find it necessary to rinse the stomach, but only using a thin probe.

In hospital, such drugs as promedol for pain relief, relanium for the removal of psychomotor agitation, atropine for arresting spasm of esophageal muscles, glucocorticoid hormones( prednisolone, dexamethasone) in case of shock and to prevent scarring of esophageal walls, broad-spectrum antibiotics for prophylaxisinfectious complications. In the first two to three days, the intake of liquid and solid food is excluded. A week after the poisoning, they begin to conduct bougie of the esophagus. This is the sequential introduction of probes of different diameters to prevent the formation of cicatrical strictures of the esophagus.

Surgical treatment of can be indicated in the following cases:

- Complicated course of gastroesophageal reflux disease. The operation consists in fixing the bottom of the stomach to the lower part of the esophagus from the outside to improve the function of the esophageal sphincter.
- Complications of acute esophagitis in the form of cicatricial strictures and obstruction of the esophagus. Plastic and resection( removal of part) of the esophagus are carried out.
- Perforation of the esophagus wall with development of purulent inflammation. A dissection of the esophagus( esophagothia) is carried out with the installation of drains in the near-esophagogastric space.

Lifestyle with esophagitis

Diet and diet are critical for preventing exacerbations of chronic esophagitis and for preventing complications of acute esophagitis. The main recommendations:

- food intake in frequent fractional portions at least 4-6 times a day, the food should be eaten in a wipe, steam, boiled or stewed with a gentle temperature regime, the last meal should be no later than four to five hoursup to sleep,
- full quit smoking,
- after eating it is not recommended to lie or sleep, it's better to take a short walk,
- in the acute period, fresh juices, fruits and vegetables, cabbage, beans, black bread,
are excludedproducts in friedspicy, salty foods, carbonated drinks, alcohol, coffee and chocolate, fast food,
- welcome the use of low-fat milk and sour cream, cottage cheese, cereals and cereals, scrambled eggs, stewed vegetables and baked fruit, low-fat meat, poultryand fish, white bread or crackers.

In addition to rational nutrition, you need to fully rest, avoid stress, enough time to spend in the fresh air. With reflux esophagitis, one should not wear tight clothes and strain the abdominal muscles, as these factors help increase intra-abdominal pressure and reflux of gastric contents into the esophagus. Sleep should be with a raised head.

To prevent acute chemical esophagitis, vinegar or household solvents should be stored in a signed container, and if there are small children in the house, remove all chemicals from the reach zone.

Complications of

The likelihood of complications is determined by the nature of the esophagitis and the timeliness of the treatment. So, for example, with catarrhal or edematous form complications develop rarely, while in severe chemical esophagitis - quite often. The complications of esophagitis include:

- peptic ulcer of the esophagus, bleeding and perforation of the ulcer,
- barrette esophagus - precancerous state due to constant irritation of the cells of the mucous membrane with hydrochloric acid in reflux-esophagitis,
- cicatrical narrowing of the esophagus,
- aspiration pneumonia inthe first two days after the chemical burn of the esophagus - its most frequent complication,
- perforation of the esophagus wall during its bougie( it is extremely rare),
- purulent mediastinitisOsten) after punching, chemical burns or foreign body esophagus.

Forecast

The prognosis for mild to moderate esophagitis is favorable, if the treatment is started on time, the diet is observed, and there is no risk of complications.

In case of complications, but they are timely identified and treated, the prognosis for life is favorable, but the quality of life is significantly deteriorating.

In severe lesions of the esophagus, for example, with severe burns, the forecast is unfavorable, and the mortality rate reaches 50-60%.

Doctor therapist Sazykina O.Yu.