Reflux esophagitis is an inflammation of the lower part of the esophagus, which is caused due to the damage of its walls by the contents thrown from the stomach or intestines. This inflammation is an independent disease, most often it is a symptom of ulcerative lesions of the digestive tract or a complication of gastroesophageal reflux disease.
Reflux esophagitis has no specific symptoms. His first symptom is heartburn. It also manifests itself in such digestive disorders as dysphagia, belching sour, especially after eating. There is pain in the epigastrium, which gives to the area between the shoulder blades, neck, lower jaw, left side of the chest. There are also extraesophageal manifestations of the disease, which include coughing, shortness of breath in a horizontal position, hoarseness, dry throat, inflammation of the tonsils or paranasal sinuses, white tongue on the tongue, bloating, nausea, vomiting, rapid food saturation.
The medical classification of reflux esophagitis divides it into degrees (A, B, C, D), they are also called stages (1, 2, 3, 4). Also, depending on the prevalence of certain changes, catarrhal, exfoliative, edematous, erosive, pseudomembranous, necrotic, and phlegmonous reflux esophagitis are isolated.
Causes and problem diagnosis
The reasons for the development of pathology can be:
- weakness of the muscular system of the lower esophageal sphincter,
- spontaneous relaxation of the gastroesophageal sphincter,
- hiatal (diaphragmatic) hernia,
- the use of sedatives and antispasmodics,
- reducing the ability of the body to self-purification,
- strengthening the damaging properties of the contents thrown from the stomach or intestines,
- reduction in the resistance of the mucous membrane to the damaging effects of throwing back food,
- upset stomach emptying
- intraperitoneal hypertension (that is, increased pressure), often developing with obesity, ascites, overeating, marked distention of the intestine.
To diagnose the disease you need to contact a gastroenterologist. He will give direction to the study of the esophagus, after which the whole picture will become clear.
The study is conducted using an endoscope. At the first stage of the disease, slightly smoothed, in places loose, walls of the esophagus are seen. Also appointed to be examined on x-rays, it determines the change in the contours of the mucous membrane and the volume of mucus.
If the esophagitis has several severe symptoms, and there are painful sensations, then it will be easy to diagnose with a routine examination. Treatment in this case will be short and effective.
The first step in treatment should be the removal of the underlying cause. It should promptly identify the inflammatory process that provoked the occurrence of reflux esophagitis. These include diseases such as gastritis, ulcers, or even neurosis.
It is also important to choose the right drugs, which will not only alleviate the symptoms, but also eliminate third-party inflammatory processes.
Diet - an important point in the treatment of esophagitis. Its erosive type tends to "obey" food. Prohibited foods may aggravate the situation and increase the appearance of symptoms. Coffee, spirits, chocolate and citrus fruits should be excluded from the diet.
Take medication every two hours. The main components of the composition - magnesium and aluminum. Antacids with these ingredients are not recommended for people with renal insufficiency. In this case, prescribed medications containing only aluminum. Treatment with antacids is long, but quite effective.
Lesion of the respiratory system
Reflux esophagitis 1 degree may manifest as hoarseness, persistent cough, laryngitis, bronchitis, etc. At the same time, characteristic symptoms for reflux may not occur at all.
For accurate diagnosis spend daily pH-metry. It is used to determine the presence of problems in the respiratory organs. Note that bronchial asthma often appears together with reflux esophagitis. If this fact is ignored, asthma exacerbation may occur, which will provoke pneumonia. Then the treatment will be long.
The treatment is carefully chosen to eliminate the symptoms of two diseases at once. The active course of taking medications along with diet therapy has a positive effect on the further prognosis. Also, patients suffering from esophagitis and reflux of asthma should stop smoking and alcohol forever.
Recommendations for mild esophagitis
Using these recommendations, you can cope with reflux esophagitis even at the initial stage of the disease:
- For one approach to food, try not to eat too much. Overeating provokes the release of acid into the esophagus, which causes an attack of esophagitis.
- Before bedtime it is undesirable to take heavy food. It is recommended to limit light sandwich.
- Do not drink milk fatty varieties. Eat low-fat, low-fat dairy drinks. It may seem that relief comes after drinking a cup of milk. Short remission - a new surge of esophagitis.
If you drink full-fat milk with antacids, the risk of developing a syndrome of the milk-alkaline type is high.
- Eat only those products that you allowed the doctor. He knows better what is safe.
- Eliminate at least for the time consumption of fresh berries. You can eat fruit (limited amount).
- Enter in your usual menu products containing a high content of fiber and carbohydrates. They eliminate the increased acidity, in addition, the body is easier to take such food.
- Alas, but you should completely remove fatty and spicy foods from the menu. After several days without fat and spicy, the patient is already beginning to feel better, because these dishes are poorly digested in the stomach.
- During treatment, nicotine should be discarded. Also, do not take alcohol. These factors only increase the production, and then the release of gastric juice.
- Going to bed should be no earlier than 3 hours after the last meal.
- Do not prescribe treatment yourself, it should do a specialist.
The initial form of esophagitis in children and pregnant women
Toddlers who have not yet learned how to talk cannot explain their condition. But the phenomena unpleasant to the child can be recognized during and after feeding. The child begins to evade the spoon with food, often crying and coughing at night. The symptoms of the little ones vary slightly with the usual symptoms:
- Increased body temperature.
- Restlessness in the evening.
- Prolonged crying
- Night cough.
- Burping, nausea and gagging.
With two signs from the above list, the child should be shown to the pediatrician.
In addition, a baby who has a reflux esophagitis requires some care. Since the baby has a spherical stomach, feeding should be carried out in a semi-vertical position. After eating, do not let the child fall asleep for about 2 hours. The pillow on the bed should be higher than usual (10-15 cm).
Treatment of esophagitis in young children is quite specific, since it is difficult to choose a drug because of its possible toxic effect on the child’s body.
In newborns, regurgitation in the first three months is considered normal.
In pregnant women, you can also observe symptoms of reflux esophagitis. This is due to increased intrauterine pressure. Symptoms are usually observed in late gestation. As a rule, the state improves after childbirth.
About the features and causes of reflux esophagitis, you can learn from this video:
Classification of reflux esophagitis
Disease of the esophagus has such unexpressed symptoms in the initial stages (1-2 degrees), that patients very rarely seek medical help during the first three years of the disease and do not carry out any treatment. Therefore, the real cause of the disease, and how it proceeded, no one in fact can not recover.
- Grade 1 (Art. A) - an esophagus area of approximately 5 mm is affected, and the lesion has the appearance of folds,
- Grade 2 (B) - it is possible to detect from one to several defective mucosal changes over an area with a diameter of more than 5 mm, also in the form of folds,
- 3 (C) - the lesion may already be up to 75% of the circumference of the esophagus from two folds or more,
- 4 (D) - more than 75% of the esophagus circumferentially exposed to defects.
The disease may be acute or chronic.
The most important note of reflux esophagitis at 1 tbsp. Then the treatment is completely simple, short and can take place even without medication.
How to recognize reflux esophagitis grade 1?
Symptoms of this disease are found in about half of the population. The very first of these is heartburn. Often, no one takes this sign seriously and does not take any measures for examination. The actions of most patients are aimed at eliminating this symptom, they do not even try to find out its cause and begin treatment of the underlying disease that caused heartburn.
After 1-2 degrees of reflux esophagitis, pain in the sternum can appear, giving way to the back, nausea, vomiting. Even at a later stage - this is difficulty swallowing, which leads to a decrease in food intake, weight loss, dry skin and anemia.
In the supine position, the symptoms increase, especially if you go to bed immediately after eating. Better to wait at least an hour.
Treatment of reflux esophagitis Art. BUT
The treatment of 1 degree of reflux esophagitis is nutrition. First, in order to avoid overeating and overflowing of the stomach, one should eat food in large portions 5-6 times a day in the form of basic techniques, slightly larger in volume, and snacking. Always important, but on 1st. especially, to prevent stagnation of food in the stomach and intestines. Eating less than 3-4 hours before bedtime is not worth it.
If you do not go to bed within an hour after eating, then she will have time to leave the stomach and move into the intestines. Consequently, there will be no release of food masses into the esophagus, the inflammatory process will be stopped by 1-2 degrees.
Another aspect is dieting. If the disease is defined at grade A, then the exclusion of irritating mucous products will prevent the further development of reflux esophagitis grade 1 to a more serious condition and reduce inflammation.
Having got rid of the habit of transmitting at the beginning, you can forget about overcrowding in the stomach and meteorism, which increases the pressure in the abdominal cavity, weakens the sphincter and increases the likelihood of reflux. Therefore, they are excluded from food: beans, sauerkraut, mushrooms, soda, black bread, dried apricots, spicy dishes, alcohol and spices. After eating for some time you should not bend over and lie down. If there are any individual products that cause reflux esophagitis, para. 1., which can be recognized by heartburn, they should also be excluded.
Observing all these simple rules, it is possible to confine them in the treatment of reflux esophagitis of 1 degree and prevent the development of more complex forms.
Causes of pathological changes
The esophagus is a hollow, dense tube designed to transport chopped food to the stomach. Both organs have special sphincters that prevent the rise of aggressive hydrochloric acid to the top. However, this sometimes happens. Several factors provoke a violation, which can be divided into 3 large groups.
Anatomical causes of gastroesophageal disease (GERD):
- Pregnancy. During pregnancy, women often develop grade 1 reflux esophagitis due to fetal pressure on the stomach.
- In children, inflammation of the esophagus occurs due to the weakness of food sphincters.
- excess weight,
- passion for alcohol,
- food (junk food or too much of it),
- tight clothing.
GERD can occur in children and adults who are too active.
The disease is caused by diseases and infections of the digestive system, such as:
- hernia of diaphragm,
- stenosis or gastric spasm,
- superficial gastritis,
- duodenal ulcer and stomach,
- diseases of the respiratory system, accompanied by cough,
- autoimmune disorders.
Pathology also provoke frequent stress and emotional stress.
Methods for the diagnosis of reflux esophagitis:
- For the diagnosis of reflux esophagitis prescribed instrumental examination of the esophagus with an endoscope. As a result, it reveals the presence of inflammation, erosive changes, ulcerative lesions, and the replacement of squamous epithelium with a cylindrical epithelium.
- Another type of diagnosis of throwing food into the esophagus is the daily pH-metry of the esophagus. A decrease in pH (i.e., pH) less than 4, or, conversely, an increase of more than 7, indicates the presence of reflux. At the same time, the decrease in the pH value reveals the reflux of gastric contents, and the increase - the intestinal one. Normally, the pH is 6.0. This type of study determines the number and duration of reflux episodes in the lower esophageal section. It is the daily pH-metry that makes it possible to select individual treatment and monitor the effectiveness of prescribed drugs.
- The manometry of the esophageal sphincters allows you to determine the change in the tone of the valves.
- pH-metry combined with impedance measurement. The study is called impedance pH meter. This method allows the evaluation of esophageal peristalsis and gastroesophageal refluxes.
Easy version of the disease
The disease begins with stage 1 - reflux esophagitis 1 (A) degree. What is this will help to understand the fact that stage 1 is characterized only by intense reddening of the esophageal mucosa and the formation of pinpoint erosion.
To eliminate reflux esophagitis stage 1, you must:
- Do not abuse the food, eat in small portions and only warm food,
- eat every 2-3 hours
- do not eat fried, pickled, spicy and sour foods and dishes,
- stop drinking alcohol and smoking
- eat at least two hours before bedtime
- bring weight back to normal
- wear comfortable clothes, abandon tight belts,
- eliminate inclinations after eating,
- stop taking medicines that can trigger the relaxation of the gastroesophageal sphincter.
As therapy with folk methods, you can take dandelion flower syrup. To obtain it you need to cut the flowers of a dandelion and, putting layers in a jar, pour them with sugar. The resulting mixture is well suppress and insist before the formation of juice. After that, dilute 1 teaspoon of juice in half a glass of water and take before meals 3 times a day. You can also brew a mixture of marigold, lemon balm, oregano and plantain in the form of tea. Before use, dilute 1 tablespoon of the concentrate in 200 ml of water. Take 1/3 cup before meals.
Reflux esophagitis grade 2 is characterized by the development of erosions and ulcerative changes on the esophageal mucosa, which tend to merge into a single whole, thus increasing the area of the lesion. The percentage of damage is at least 40% of the whole body.
On examination, erosions of scarlet color with numerous bruises, swelling and thickening are visible. On the upper layer of the mucous membrane, there is a discharge of purulent, serous and bloody character.When vomiting, exfoliated mucous may come out with emetic masses. This stage should be treated with medication:
- Prokinetics is a group of drugs (Dimelium, Motilium, Domstal, etc.), which is aimed at stimulating the motor function of the digestive tract. As a result of their use, the tone of the lower esophageal sphincter is stimulated, fast passage of the food lump through the esophagus, accelerated emptying of the stomach from digested food.
- Antacid agents (Almagel, Agiflux, Maalox) are used to neutralize excess hydrochloric acid in the stomach, normalize the acidity of the gastric juice and protect the stomach walls due to the enveloping effect.
- Antiulcer drugs such as Ranitidine, Omeprazole, Lansoprozole and others, reduce the formation of hydrochloric acid and have a bactericidal effect against Helicobacter pylori.
With the progression of the disease to reflux esophagitis 3-4 degrees, one or several esophageal folds are affected. The mucous membrane is affected up to 75% around the circumference. Symptoms and disorders of the functioning of the body are aggravated. Because of this, there is a disturbance in the work of the neighboring organs involved in digestion (intestines, stomach, gallbladder, liver).
In the absence of adequate treatment, the process of transforming the cells of an organ into necrotic fibers is started, rotting is observed, and oncopathology is formed.
At these stages, complex therapy of the condition is necessary, which includes diet, compliance with the recommended rules, taking the above medicines, as well as the use of drugs from the group of gastroprotectors and reparants. These include: Venter, Solkoseril, Actovegin and others.
At the first symptoms of the disease it is necessary to consult a specialist. All means and dosages are selected individually by the attending physician according to the results of tests and studies. In the case of a running form, surgical treatment of the disease is possible.
Types of intestinal and gastric diseases
Gastroenterologists believe that the pain and characteristic features of digestive disorders do not yet give grounds for self-diagnosis.
The most frequently diagnosed diseases of the stomach and intestines are:
- Duodenogastric reflux esophagitis,
- Stomach ulcer,
- Irritable bowel syndrome,
- Gastric and intestinal polyps.
Some of these diseases are quite dangerous and are even considered precancerous: that is, professional and systemic therapy for these diseases is obligatory.
Reflux esophagitis 1 degree is a rather difficult disease caused by dysfunction of the switching functions of the esophageal lower sphincter, after which inflammation of the mucous membrane of the organ occurs. Pathology begins because of obesity or wearing tight clothing that squeezes the esophagus.
The main provocateur of the disease is the weakening of the neuromuscular esophageal part. Most of all, children suffer from pathology. Also the reasons are:
- Strong internal pressure of the stomach inhibits the functioning of the gastrointestinal tract. Because of this, gastritis or peptic ulcer disease occurs.
- Stressful situations inhibit intestinal motility.
- Poor nutrition provokes pathology. Abuse of sweets leads to esophageal diseases.
- Uncontrolled medication with prostaglandins or nitrites as ingredients.
- Smoking is an essential provocateur for esophagitis reflux.
The classification of GERD is as follows:
- At grade 1, the area of damage to the mucous membrane of the esophagus is small, it is limited by folds.
- Reflux esophagitis grade 2 is characterized by the presence of several defects or one, but more than 5 mm in diameter. They are all limited to folds.
- The third degree of pathology is characterized by the presence of several lesions, with up to 75% of the esophagus being affected.
- In the fourth degree of the disease, the prevalence of defects exceeds 75% of the esophageal circumference of the esophagus.
- 5 degrees of reflux esophagitis was not detected.
At the first stage of reflux esophagitis, the following clinical symptoms occur:
- The entire esophagus is susceptible to burning.
- A person often regurgitates gastric contents or air. There is acid in the belching.
Signs of chronic gastroesophageal disease:
- Hacking cough. This cough rarely causes expectoration of the sputum.
- The voice becomes hoarse.
- In the throat constantly felt lump.
- Headache concentrates on the surface of the face.
- The nose is often stuffy.
The severity of symptoms is not always comparable to the stages that the disease has.
Symptoms of the disease
Signs of a disease depend on its stage. At the first there is a periodic heartburn or belching, which appears after eating, in a horizontal position or physical exertion.
In general, the following manifestations are characteristic of pathology, the intensity of which increases as it develops:
- burning in the chest,
- sore throat,
- belching with a sour or bitter taste,
- bad breath,
- periodic cough
- change voice timbre.
It is very important to identify the disease in the first stage.
Dynamics of the disease
In children and adults, there are 4 stages of development of reflux esophagitis, differing in the degree of damage to the esophagus and symptoms:
- First degree (type A). At this stage, changes affect only the lower esophagus (esophagitis n3). Small ulcers are formed, their size is about 5 mm. Symptoms are very mild.
- Esophagitis 2 degrees (type B). Erosive areas increase, in some places merge. The affected area reaches 10%. Symptoms of reflux esophagitis grade 2: heartburn after eating and belching during physical exertion.
- Grade 3 - GERD type. Erosive and ulcerative areas merge, their area may be about 75%. Symptoms of reflux esophagitis grade 3 is not associated with food intake.
- GERD C type or Barrett's esophagus. Erosive and ulcerative changes make up more than 80% of the esophagus. In children and adults pronounced pain during swallowing and at rest. At this stage there is a high risk of perforation and malignancy.
GERD is most often diagnosed by the attending physician in the second stage, when the symptoms of the disease cause discomfort to the person.
Forms of the disease
Let us give a classification of the disease reflux esophagitis according to the form of its course. Esophagitis species:
- Acute. Appears on the background of pathologies of the digestive tract, infectious diseases, beriberi. His symptoms are: discomfort while eating, pain in the center of the sternum after eating.
- Chronic. The disease can be caused by bad habits, overeating and develop as a result of acute complications. Chronic pathology is often accompanied by pronounced symptoms.
Varieties of the disease
Gastroenterologists distinguish several different types of morphological changes on the walls of the esophagus.
- Catarrhal Changes are superficial, only mucous membrane suffers.
- Hydropic. Tissues inflame and swell, the lumen of the esophagus decreases.
- Erosive esophagitis. Fabrics become loose, ulcers appear on them. For erosive esophagitis characterized by 2 forms: acute and chronic.
- Hemorrhagic esophagitis. In this form, there are violations in the vessels of the esophagus, periodic hemorrhages are possible. Such changes are due to typhoid, influenza, so the second name of this pathology is infectious esophagitis.
- Pseudomembranous. A film appears on the mucous membranes, which is rejected when coughing and vomiting.
- Exfoliated. The mucosa departs with deeper layers of tissue.
- Necrotic, or Barrett's disease. At this stage, tissue death occurs, it is called precancerous.
- Phlegmonous and diffuse esophagitis. Mucosa is inflamed, pustules form on it.
Another type of pathology, which stands alone, is corrosive esophagitis. Its occurrence is associated with thermal and chemical burns of the mucous.
Recently, the diagnosis of "eosinophilic esophagitis" is increasingly being made. It usually develops in children due to allergic irritation of the esophagus. Eosinophilic esophagitis derives its name from the white blood cells of the same name, which appear in it under the influence of a stimulus. The causes of the disease have not yet been clarified. Eosinophilic esophagitis is manifested already in the infancy of regurgitation, vomiting, refusal of breast or nipples due to discomfort when swallowing.
Any patient with grade 1 reflux esophagitis is required to adhere to the following prescriptions:
- Do not eat large portions of food and prevent overeating, in particular before going to bed. It is necessary to observe split meals with the consumption of small portions. Reduce the amount of fatty, spicy, sweet, use which serves as a provoking factor in pathology. Be wary of using medications that contribute to the reflux of gastric contents into the esophagus (sedatives, theophylline, nitrates, verapamil, and other calcium channel inhibitors).
- Reduce the amount of physical activity that is associated with weight lifting and tension of the abdominal muscles.
- Sleep with your head up.
- Eliminate addiction (smoking and alcohol abuse).
- Reduce weight when it is in excess.
For the treatment of the disease under consideration, a long time is used by means that promote and reduce the acidity of pancreatic juice, as well as accelerate the movement of food masses through the esophagus:
- Medications that reduce the acidity of pancreatic juice. Such treatment is aimed at increasing the pH of the gastric juice and lowering its ability to affect the mucosa of the esophagus. The most effective in this case will be proton pump inhibitors (omeprazole, rabeprazole, etc.), inhibiting the production of hydrochloric acid and promote an increase in pH. Less commonly used blockers are H2-histamine receptors (Ranitidine, Famotidine), which reduce acidity, but with less efficacy.
- Means that accelerate the passage of food masses through the esophagus and prevent the reflux of gastric contents into the esophagus. These medications include Domperidone, Zerukal and others. Also used as the only drug in combination with lifestyle changes for the pathology in question.
This disease is characterized by mild symptoms (heartburn, belching). Often it does not provoke anxiety in patients.
But, the progression of pathology without proper therapy can cause the formation of dangerous consequences, including cancer.
If the initial manifestations of the disease appear, it is necessary to immediately seek medical advice in order to implement timely diagnosis and appropriate therapy.
Drugs must be consumed under the supervision of a specialist, since it is necessary to make an optimal set of medicines for each patient, taking into account the provoking factor of the pathology in question.
When a patient adheres to a diet in parallel and has no diseases of the chronic digestive organs, it will be possible to completely get rid of the disease and prevent its progression.
In order to prevent the pathological process and its recurrence, it is required to remove all factors that provoke the occurrence of the disease:
- to normalize the quality, quantity, caloric intake,
- control weight
- train the abdominal muscles
- eliminate addiction,
- adhere to the frequency of power,
- adjust sleep patterns.
Reflux esophagitis at the initial stage is a reversible condition. Therefore, it is necessary to consult a doctor in a timely manner for diagnosis and the initiation of appropriate treatment.
Reflux esophagitis grade 1 is rarely an independent disease. It is often provoked by the pathology of the digestive system.
In this state, it is imperative to follow a diet and use the prescribed medication.
With the treatment started on time, it will be possible to fully restore the esophageal mucosa and eliminate pain, heartburn and intestinal disorders.