Esophagitis - Causes, Symptoms and Treatment .MF .
often uncomfortable symptoms, such as heartburn, pain in the upper abdomen, violation of swallowing when eating, associated with diseases of the stomach.However, a similar clinical picture manifests itself and inflammation in the esophagus, or otherwise, esophagitis.
Esophagitis - esophagus is a disease that occurs as a result of adverse factors on its mucosa is acute or chronic, and severe lesions of the esophagus which can lead to complications.
In terms of mucosal lesions emit catarrh, edema, erosive, hemorrhagic, necrotizing, pseudomembranous, exfoliative esophagitis and abscess.By the nature of the esophagus lesions it may be proximal (in primary sections) distal (closest to the stomach) and total when activated throughout the mucosa of the esophagus.
Causes of esophagitis
Gastroesophageal reflux is the most common cause of inflammation of the esophagus, also known as reflux esophagitis.The disease develops due to incomplete closure cardia of the stomach, resulting in gastric contents, hav
Chemical factors.The second most common cause of injury of the esophagus - is poisoning by chemicals, such as a suicide attempt or by mistake.Develops chemical burn mucous, which in most cases leads to cicatricial fusion of the walls of the esophagus, called strictures.This could cause burns alkalis, acids (most acetic acid), solvents (gasoline) is less common esophageal damage surrogate alcohol.Esophagitis with constant use of ethanol occurs in individuals suffering from alcoholism.
esophagus Foreign bodies are found almost as often as the chemical damage.Most often such a situation arises when a person swallows the fish or chicken bone, and she wedged into the esophageal lumen.In this case, not only will develop acute esophagitis, and possibly perforation of the wall of the bone through.It is fraught with the development of abscess (pus) esophagitis and leaking pus in the mediastinum - a cavity in which is located the heart, trachea and major blood vessels.In addition, often a foreign body is found in small children if swallowed various items of medium and large size, such as coins, batteries, parts of toys, and so on. D.
The foreign body of the esophagus in a child with X-ray
Thermal factors, basically is an increase in the temperature of food intake, for example, if a person is quickly swallowed the very hot food or regularly takes food hot.
Infectious agents , such as fungi of the genus Candida, influenza viruses, measles, cytomegalovirus, micro-organisms that cause diphtheria, scarlet fever, typhoid fever, can trigger acute or chronic esophagitis in patients with reduced immunity, such as HIV - infected patients.In such cases, it is developing a hemorrhagic (bleeding in the formation of esophageal wall in viral infections) or exfoliative (with the formation of deep-soldered with mucosal inflammatory fibrin films in diphtheria or scarlet fever) esophagitis.
nutritional factors have a direct impact on the mucosa of the esophagus when we eat foods that cause allergic reactions in the patient, or the products containing spices and preservatives, as well as fatty, spicy, fried foods and smoked.
esophageal endoscope damage is extremely rare as a result of a gastroscopy.
Symptoms of esophagitis
clinical picture of acute and chronic esophagitis consists of the following syndromes:
- Pain syndrome is characterized by heartburn, sharp or constant burning pain in the sternum and upper abdomen radiating to the back and neck.When poisoning by chemicals or swallowed foreign body pain is sharp, intense.In addition to pain in the chest and neck, burns characterized by pain in the oral mucosa with appropriate signs defeat chemical mouth and pronounced swelling of the face, neck and larynx, causing hoarseness and asthma.
- Syndrome dysphagia - violation of swallowing food, especially the solid look.While receiving solid food the patient is forced to drink their drink of water.In severe esophageal lesions occur difficulty swallowing soft food and liquids.
- Regurgitation or regurgitation - throw swallowed food from the esophagus back into the throat.It occurs immediately after a meal or after a few hours, can disturb the patient during the night.It is also characterized by frequent belching with a sour or bitter taste.
- breathing disorders are manifested in the form of hacking dry cough often at night, and reflex laryngospasm (closure of the glottis in the larynx with the inability of the air for a few seconds or minutes) due to inhalation of food particles thrown into the oral cavity.In patients with a 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 chair.In hemorrhagic esophagitis may cause vomiting blood dark color.
- The shock possible with severe acute esophagitis, cause chemical burns of the esophagus, when the defeat covers all layers of its wall and spread to nearby organs.Here, in fact, there is a painful shock.The infectious - toxic shock syndrome with associated symptoms occurs when the esophagus wall perforation with the development of a purulent inflammation of nearby organs mediastinum.
In acute inflammation of the esophagus, as opposed to chronic, symptoms appear suddenly, they are pronounced and cause significant discomfort to the patient, urging him to see a doctor.When catarrhal symptoms and edematous form of esophagitis may be less pronounced.In chronic esophagitis symptoms somewhat erased and not so booming, so the patient as it accustomed to the discomfort, doing self-treatment, for example, are constantly taking Rennie almagel and other drugs for heartburn.Such patient approach to their own health is fundamentally wrong, as inflammation in the esophagus should be treated only by a doctor after the test and determine the cause of esophagitis.Otherwise, long-term existing esophagitis can lead to cicatricial adhesions in the wall of the esophagus and other complications.
disease when symptoms similar to symptoms of esophagitis, you should contact a physician, gastroenterologist, or call an ambulance, for example, in case of poisoning or chemical substance ingested foreign body.In addition to questioning and examination of the patient, the doctor prescribes any of the other diagnostic methods.Depending on whether an acute or chronic esophagitis in a given patient, the survey may be carried out urgently on admission or scheduled in the clinic.They can be assigned:
- General blood and urine tests.
- Specific blood tests in suspected infectious diseases (determination of antibodies to cytomegalovirus titer, the causative agent of typhoid fever, diphtheria, blood test for HIV, etc.).
- esophagography - the introduction of a radiopaque substance through the mouth and radiography.It allows you to define a foreign body, to assess the patency of the esophagus.It may be assigned at a chemical burn of the esophagus in a day after the poisoning, when the patient is removed from the state of shock.
- esophageal motility study - the definition of the pressure inside the esophagus and its contractile activity using a special catheter introduced through the mouth, also allows for the measurement of pH (reaction medium) in the lumen of the esophagus and determine its emptying rate (clearance of the esophagus).
- Esophagoscopy - examination of the esophagus from the inside with the help of input through the mouth esophagoscopy.It allows you to define attributes specific to a particular form of the disease (redness and mucous discharge, ulcers and erosion, hemorrhage, fibrinous film, etc.), as well as to determine the degree of damage to the esophagus sections.Perhaps biopsy (biopsy specimens) tissue with subsequent histological examination.
The need for such a method for acute esophagitis determined by careful history of the patient during the examination.For example, if there is a danger of perforation of the esophagus and the wedging wall sharp foreign body, the patient is immediately ready for operation without an esophagoscopy or it is performed under general anesthesia.When chemical burns and acute esophagitis examination can be carried out only a few days (8-10 days) in order to prevent further injury to the mucous membrane.Diagnosis and treatment here will depend entirely on the patient's medical history, or rather, from what has been drunk and eaten on the eve of the disease.
In chronic esophagitis esophagoscopy performed routinely after the general clinical examination of the patient.
reflux esophagitis during esophagoscopy
Treatment of esophagitis
Treatment of acute esophagitis boils down to the following activities:
- refusal of food intake during the first two days, but in severe chemical lesions of the esophagus - parenteral nutrition,when nutrient solutions are administered intravenously,
- proton pump inhibitors to reduce the formation of hydrochloric acid in the stomach - omeprazole, pantoprazole, and others,
- blockers histamine receptors with the same purpose - famotidine, ranitidine, and others,
- antacids to neutralize the existing saltacid in the stomach - almagel, Aluminium phosphate gel, Rennie and others,
- antifungal, antiviral or antimicrobial therapy for infections of the esophagus,
- use of antibiotics in the wall of the esophagus is damaged by a foreign body.
Treatment of chronic esophagitis:
- diet except annoying (hot, greasy, spicy) food, compliance with diet,
- omeprazole, famotidine, antacids,
- drugs that improve the promotion of the food bolus in 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 chemical burns of the esophagus is performed only in a hospital. as emergency prehospital not recommended gastric lavage independent of the fact that the poison gets back into the esophagus vomiting and inflict additional damage and possible injury of the esophagus wall when his muscles spasm due to vomiting.It is enough to give the victim a drink a couple of glasses of a weak solution of citric acid with alkali burns and weak soda solution for burns acid.If the fluid type is not installed, you can drink two cups of warm milk.These measures to neutralize the toxic substances are effective only during the first 4-6 hours, so it should be as soon as possible to call an ambulance.A doctor at a hospital may consider necessary gastric lavage, but only using a thin probe.
The hospital used drugs such as Promedolum for analgesia, relanium to eliminate the agitation, atropine for the relief of spasm of the esophageal muscles, glucocorticoid hormones (prednisolone, dexamethasone) in the state of shock, and to prevent the formation of scar adhesions walls of the esophagus, broad-spectrum antibiotics forprevention of infectious complications.In the first two - three days excluded reception of liquid and solid food.A week after the poisoning begin to conduct probing the esophagus.This sequential administration of probes of different diameters to prevent the formation of scar stricture of the esophagus.
Surgical treatment may be indicated in the following cases:
- Complicated for gastroesophageal reflux disease.The operation is to fix the fundus of the stomach to the lower esophagus from the outside to improve the function of esophageal sphincter.
- Complications of acute esophagitis in the form of scar stricture and obstruction of the esophagus.Conducted plastic and resection (removal of a portion) of the esophagus.
- Perforation of the esophagus wall with the development of purulent inflammation.Held esophageal dissection (esophagotomy) with the installation of drains in periesophageal space.
Lifestyle with esophagitis
crucial for the prevention of exacerbations of chronic esophagitis and for the prevention of acute complications of esophagitis is diet and nutrition.Key recommendations:
- Centauri food and frequent smaller meals at least 4 - 6 times a day, the food should be consumed in a shabby, steam, boiled or stewed with a gentle temperature regime, the last meal should be no later than four - fivehours before bedtime,
- complete cessation of smoking,
- after a meal is not recommended to lie down or sleep, it is better to take a short walk on foot,
- in the acute phase excluded fresh juices, fruits and vegetables, cabbage, beans, brown bread,
-excludes products of fried, sharp, spicy, savory, soft drinks, alcohol, coffee and chocolate, fast food,
- welcomed the use of low-fat milk and sour cream, cottage cheese, cereals and grain products, eggs, steamed vegetables and baked fruits, low-fatmeats, poultry and fish, white bread or crackers.
addition of a balanced diet, you need to fully relax, avoid stress, spend enough time outdoors.When reflux - esophagitis should not wear tight clothes and stretch the abdominal muscles, as these factors contribute to the increase in intra-abdominal pressure and reflux of gastric contents into the esophagus.Sleep should be raised with headboard.
For the prevention of acute esophagitis chemical nature should be stored vinegar or household solvents signed packaging, but if a family has young children, remove all chemicals from reach.
probability of complications of esophagitis determined by the nature and timing of treatment.For example, in the form of edema or bluetongue complications are rare, while in severe chemical esophagitis - frequently.Complications of esophagitis include:
- peptic esophageal ulcers, bleeding and perforation (perforation) ulcers,
- Barrett's esophagus - a precancerous condition due to constant irritation of the cells of the mucous membrane of hydrochloric acid at reflux esophagitis,
- cicatricial narrowing of the esophagus,
- aspiration pneumoniain the first two days after a chemical burn of the esophagus - the most frequent complication of it,
- perforation of the esophagus wall when probing (extremely rare),
- purulent mediastinitis (inflammation of the mediastinum) after perforation, chemical burns or esophageal foreign body.
esophagitis prognosis of mild to moderate severity favorable if treatment is started on time, keep to a diet, and there is no risk of complications.
As if there were complications, but they are timely identified and subjected to treatment, the prognosis for a favorable life, but quality of life is deteriorating significantly.
In severe esophageal lesions, such as burns, severe adverse prognosis, and the mortality rate is 50-60%.
therapists Sazykina OJ