Esophagitis

Chronic reflux esophagitis: a characteristic of the disease

Before proceeding to the description of the chronic form of the disease, you should understand what constitutes a reflux. Under this term, we understand the deviation in which the contents of the stomach is thrown into the esophagus. Inflammation of the walls of the lower part of the latter, resulting from this, is called reflux esophagitis. The disease may be acute or chronic.

The second is a prolonged irritation of the walls of the esophagus with gastric acid. The inflammatory process at the same time goes on constantly, although it makes itself felt periodically. During remission, the symptoms disappear, but then reappear. As a rule, exacerbations occur in the offseason - in spring or autumn.

Causes of illness

There are many reasons why pathology can develop. The main ones include:

  • hernia of the esophagus,
  • gastric or duodenal ulcer,
  • cardia deficiency,
  • sphincter dysfunction, delimiting the esophagus, as well as the stomach,
  • gastritis,
  • pancreatic inflammation,
  • gallbladder disease
  • regular intake of certain medications.

Less commonly, the occurrence of chronic reflux esophagitis can provoke:

  • excessive drinking alcohol, chocolate, coffee,
  • pregnancy,
  • regular weight lifting
  • obesity,
  • lesion of the vagus nerve
  • high intragastric or intra-abdominal pressure.

Stages and symptoms

Symptoms of chronic reflux esophagitis may not appear for a very long time or be barely noticeable and depend on the stages of the course of the disease, which are distinguished by five:

  • When the first degree of illness symptoms are absent or almost imperceptible. Occasionally, mild heartburn may occur, resembling a tingling throat. A little later, there is a burning sensation in the chest, which occurs after eating - especially acute and acidic, and also after drinking soda, alcohol or coffee. Profusely eating, a person may feel a sharp pain when bending forward. Hoarseness and discomfort (even mild pain) are sometimes observed during swallowing. At this stage, the mucosa of the esophagus is practically not broken - at least, it is almost impossible to reveal the foci of inflammation during the research. There may be only red dots on the walls.
  • The second stage is characterized by more serious mucosal lesions. Erosion develops. Their total area reaches 20%. All the above symptoms become more pronounced, they burp after a meal, especially during physical activity or, on the contrary, while resting in a horizontal position.
  • If treatment is not carried out, erosive reflux esophagitis progresses. The third degree of pathology is diagnosed. The affected areas of the esophageal mucosa already account for 50% of the total tissue area. When swallowing a person experiences severe pain. Pestered with heartburn, belching, discomfort behind the sternum. Quality of life is seriously reduced. The patient is afraid of eating, begins to lose weight.
  • In the fourth stage, the entire mucosa of the esophagus is damaged. The pain in it does not subside almost never - even at rest. Saliva has an unpleasant taste. A dry cough appears - sometimes masses with blood streaks expectorant. The patient is constantly nauseous, he can no longer eat. Weight loss reaches frightening sizes.
  • At the last stage of the disease, serious complications of reflux esophagitis are diagnosed. These can be bleeding, narrowing of the lumen of the tubular organ, or the so-called Barrett's esophagus.

Diagnostics

To identify chronic reflux esophagitis in the first stage is difficult even during hardware research. But an experienced diagnostician is still able to notice the disease even at the very beginning of its course.

Also, as a rule, the following studies are conducted:

  • endoscopy
  • bilimetry,
  • measurements of the acidity of gastric juice.

Treatment of the disease

Treatment of reflux esophagitis predominantly conservative. Operations are resorted to only in the last stages, when the disease is neglected and threatens with degeneration into oncology. It is best to treat the illness during exacerbations - the organs at this moment are more susceptible to therapy.

Of the medications, patients usually prescribe drugs that block the proton pump, which are taken for a long time. Also relevant are the following medications:

  • antacids that reduce acidity and protect the mucous membrane of the esophagus and stomach from the aggressive effects of irritants ("Maalox", "Almagel"),
  • antisecretory, reducing the secretion of gastric juice ("Omeprazole"),
  • prokinetas that increase the sphincter tone ("Motilak"),
  • antispasmodics,
  • antiemetic,
  • immune system stimulants.

Folk remedies in the treatment of reflux esophagitis are considered only as ancillary and are not always prescribed - mainly when the patient is allergic to any medications. A positive effect can be obtained from decoctions and tinctures from herbs that have a sedative, antispasmodic, anti-inflammatory, analgesic and immunity enhancing effect (calamus, althea, hawthorn, mint, plantain, chamomile, dill, horsetail).

The use of enveloping substances (for example, potato juice) is also recommended. If there are lesions of the esophagus, it is helpful for the patient to make enemas from herbal decoctions.

  • Collect a three-liter jar of dandelion flowers. Rinse them thoroughly and add two glasses of sugar. Then you need to thoroughly grind everything until the juice appears. Liter of water is added to a half-glass of water. the resulting juice. Need to drink every day before eating.
  • 1 tsp chamomile, 2 tsp. mint and 2 tsp. wormwood - everything is mixed and filled with liter of boiling water. Two hours infused and filtered. Need to drink 100 grams for half an hour before eating.
  • Art. l melissa, art. l licorice, art. l plantain, 2 tbsp. l chamomile and as much flax seed. Everything is mixed up. 2 tbsp. l collection poured 0.5 liters of boiling water. The composition must be boiled for 15 minutes, strain and leave alone for two hours. You need to drink 100 grams four times a day before eating.

Patient's lifestyle and diet

For the treatment to be as effective as possible, the patient must adhere to the following rules:

  • refuse to wear tight, tight clothes,
  • quit smoking if this habit is present
  • do not drink alcohol
  • in the presence of excess weight to start a fight with him,
  • try to lean less and strain the press,
  • sleep in a position where the head is above the stomach.

Diet involves the rejection of spicy, farinaceous (except white stale bread), sour, salty, smoked, fruit juices, soups in fatty meat broths, chocolate, coffee, strong tea, soda, cabbage, legumes, fresh milk, etc.

It is recommended to eat mashed low-fat soups and porridges, lean meat and fish, dairy products, soft-boiled eggs and other products that do not cause an increase in acidity and the amount of gastric juice secreted, as well as not injuring the walls of the esophagus.

You need to eat at least 6 times a day in small portions, chewing food thoroughly.

Prevention

The main preventive measures in the case of reflux esophagitis consist in the timely treatment of diseases that can provoke the throwing of stomach contents into the esophagus. In addition, it is important to eat right, not to lie down after a meal, not to abuse alcohol, do not smoke, and avoid nerve surges.

As noted above, the chronic form of reflux esophagitis is not completely cured. The maximum that can be achieved is to delay the next aggravation for many years and even decades. If nothing is done, the disease will progress and will face serious complications - including malignant neoplasms. Therefore, in no case should one ignore the disturbing symptoms and the doctor should be consulted as soon as possible.

Stages and symptoms

Chronic zophagitis is accompanied by dysfunction of the esophagus. The severity of clinical symptoms depends on the area of ​​mucosal lesions. Depending on the specified criterion, the following stages of the pathological process are distinguished:

  1. The problem is accompanied by limited damage to the mucous membrane without obvious dystrophic changes. An endoscopic examination of an organ does not always reveal the affected area. The diagnosis is more often established clinically based on the relevant symptoms.
  2. The corresponding stage is characterized by the appearance of erosion - areas of the active inflammatory process. The key feature is the prevalence of damage occupying up to 20% of the entire surface of the mucous membrane of the organ.
  3. The pathological process extends to 50% of the inner surface of the esophagus. The growing clinical picture. The patient requires complete treatment to minimize the manifestations of the inflammatory process. There are areas of ulceration of the mucous membrane with the addition of a secondary infection.
  4. The fourth stage of chronic reflux esophagitis is accompanied by a total lesion of the mucous membrane. Pain and symptoms occur at rest. To stabilize the patient's well-being, complex therapy is used, which does not always ensure the rapid achievement of the desired result.
  5. The fifth stage is accompanied by the progression of complications of the disease with the development of cardia stenosis, a violation of the passage of food into the stomach. Pre-cancerous changes occur in the mucosa.

  • Pain and discomfort in the chest.
  • Heartburn.
  • Weakness.
  • Nausea.
  • Vomiting.
  • Pain when swallowing.
  • A feeling of a lump in the throat.


The severity of symptoms depends on the stage of the pathological process.

Which doctor treats reflux esophagitis?

The treatment of chronic reflux esophagitis can be practiced by several specialists. In mild and moderate forms of the disease, recovery is allowed from the family doctor or the district physician. If it is impossible to stabilize the well-being of the patient, he is sent to the gastroenterologist for the selection of specific therapy.

The progression of complications in the form of bleeding from ulcers or malignant degeneration of the esophageal mucosa requires the involvement of surgeons or oncologists, respectively, in the treatment process.

Complications

Chronic esophagitis - a disease with which the patient must put up all his life. It is impossible to completely get rid of GERD, but it is realistic to reduce the number of relapses. In the absence of adequate treatment, the pathology progresses.

  • Ulcerative mucosa.
  • Bleeding.
  • Malignant degeneration of the esophageal mucosa with the progression of cancer.

These conditions require treatment by narrow specialists. Oncological pathology significantly reduces the quality and duration of the patient's life.

What is reflux esophagitis?

This name is derived from two Greek roots - “gastro” (stomach), “esophagos” (esophagus), and the Latin word “reflux”, which means “return back." In this way, gastrophageal reflux disease is the return of food from the stomach back to the esophagus. If the surface of the esophagus is inflamed, but during treatment it heals without scar formation - this is an erosive reflux esophagitis. If the symptoms are observed for a long time, it means that the disease has passed into the chronic stage.

In a normal digestive process, when a food product, previously crushed and covered with saliva, approaches the lower esophageal sphincter, it passes it and immediately closes in so that the delicate tissues of the esophagus do not damage the caustic gastric juice. Reflux esophagitis occurs when the lower esophageal sphincter is weakened, due to which the acid content of the stomach enters the esophagus. The severity of the disease depends on the level of dysfunction of the sphincter, as well as the type and amount of fluid that has entered the stomach, and on the possibility of saliva to neutralize the action of the acid.

Factors affecting the occurrence of reflux esophagitis

Improper diet and unhealthy lifestyle can contribute to the development of gastroesophageal reflux disease, especially the heavy consumption of chocolate, fried and fatty foods, coffee and alcoholic beverages. Studies have shown that smoking can also adversely affect the tone of the lower esophageal valve.

Heartburn is one of the most common symptoms of the disease. It usually feels like a burning sensation in the chest, starting somewhere at the diaphragm and ending at the neck or throat. Sometimes in the mouth there is a sour or bitter taste. Pain, burning, pressure can last up to two hours and are especially unpleasant after eating. Often, people are forced to spend time standing, because tilting or trying to lie down leads to heartburn.

Sometimes the pain of heartburn is confused with the pain of a heart attack or heart disease. However, if heart pain is also associated with physical activity (it may increase or weaken depending on the exercise), then the pain from heartburn usually occurs after eating. However, in any cases of chest pain, it is recommended to consult a doctor.

Does the presence of hiatal hernia affect the onset of reflux esophagitis?

A hiatus hernia, or hiatus hernia, occurs when the upper part of the stomach swells into the chest cavity through a small hole in the diaphragm - the muscle that separates the abdominal cavity from the chest cavity. However, recent studies have shown that this opening, on the contrary, helps to support the lower part of the esophagus. Many people with hernia of the esophagus have no problems with heartburn or, especially, with reflux esophagitis.

Severe coughing, excessive vomiting or physical exertion can cause increased pressure in the abdominal cavity, which leads to a hernia of the esophageal opening. Obesity and pregnancy can also affect its occurrence. Many relatively healthy people older than 50 years or more have a small hernia of the esophagus. She usually does not require treatment. However, if the hernia is complicated by a severe case of reflux esophagitis, surgery may be necessary to reduce its size.

Frequency of heartburn and reflux esophagitis

Symptoms of the disease, especially heartburn, are regularly felt by 20% to 50% of the population, and many pregnant women suffer from them almost every day. Recent studies have shown that both infants and children of preschool age are more likely to suffer from heartburn and reflux esophagitis than previously thought. Digestion problems can lead to coughing and other problems of the respiratory system.

How to treat reflux esophagitis?

Most people who have complained of reflux esophagitis of people, doctors recommend a change of diet and lifestyle. The goal of treatment is to reduce the amount of contents entering the esophagus from the stomach and reduce the damage to the inner surface of the esophagus.

One of the most frequent recommendations is to avoid eating foods and beverages that may adversely affect the tone of the lower esophageal valve. Such products include chocolate, peppermint, fatty and fried foods, coffee, alcoholic beverages. All this can irritate the damaged surface of the esophagus. If after eating citrus fruits, tomatoes, spices (pepper), symptoms of reflux esophagitis occur, it is worth refusing them too.Smoking also negatively affects the lower esophageal valve, therefore, with reflux esophagitis, it is recommended to minimize it or stop it altogether.

Also, a reduction in portions leads to relief of the patient's condition, dinner no later than 2-3 hours before bedtime, so that the level of acid in the stomach decreases, and the stomach itself has already gotten rid of some of its contents. Some people suffering from obesity, weight loss has helped to stop the symptoms of the disease.

Patients are advised to sleep on a cushion 15-16 cm high. Inclining the body reduces heartburn, allowing gravity to reduce the penetration of stomach contents into the esophagus.

Along with lifestyle changes, the doctor may recommend medications. Antacids neutralize the acid, trapped in the esophagus, thereby stopping heartburn. Some drugs, such as Gaviscon, along with an acid neutralizer form a protective gel barrier that prevents stomach contents from entering the esophagus or, if this could not be avoided, protects the inner surface of the esophagus.

However, long-term use of antacids can lead to side effects, such as diarrhea and impaired calcium-magnesium balance. The latter can be a serious danger for patients with kidney disease. If the patient takes antacids for more than two weeks, you should consult with your doctor.

Chronic reflux esophagitis requires medical treatment. The doctor usually recommends taking drugs that reduce the level of acid in the stomach. These include H blockers2 receptors that affect the level of gastric secretion. Of these, at present, famotidine is mainly used in Russia. The drugs that contain it: Kvamatel, Ulfamid, Pepsid, and so on.

Another type of medical drugs used in the treatment of reflux esophagitis is proton pump inhibitors. They inhibit the protein responsible for the secretion of acid in the stomach. These include omeprazole (Gastrozol, Zerocide, Omez), pantoprazole (Kontrolok, Nolpaza), rabeprazole (Pariet, Zulbex, Noflux) and others.

What medical examinations may be needed for reflux esophagitis?

If symptoms of reflux esophagitis persist, the patient will need a full diagnostic examination. It usually involves endoscopy — when a small tube with a tiny video camera at the end is placed in the esophagus. Thus, the doctor can see exactly where the tissue is inflamed or irritated. If the results of endoscopy were unsatisfactory, it is useful to take a small sample of tissue from the inner surface of the esophagus for further investigation (biopsy).

Although X-rays of the upper gastrointestinal tract are of little use in reflux esophagitis itself, it is usually used to help rule out other diagnoses — for example, gastric ulcer and duodenal ulcer.

Another doctor may offer the patient to measure the acidity of gastric juice. This method allows you to check the level of acidity in different parts of the digestive system for a long time, during meals, physical activity, sleep.

Is surgery required for reflux esophagitis?

Surgical intervention is required only if reflux esophagitis has become chronic, incapable of conventional treatment, or has complications such as Barrett's esophagus, ulcers, and esophageal strictures. Usually applied so-called. fundoplication. This is a laparoscopic operation, during which part of the stomach wraps around the esophagus, creating a kind of clutch that prevents the penetration of gastric acids into the esophagus. As a result, the pressure in the lower part of the esophagus increases, the sphincter function and gastric emptying improve.

Possible complications of reflux esophagitis

Sometimes reflux esophagitis leads to serious complications. Too much acid in the esophagus can cause bleeding or ulcers. In turn, scars from ulcers lead to a narrowing or stricture of the esophagus. Some people develop so-called. “Barrett's esophagus” - the usual flat stratified epithelium of the esophagus is replaced with a cylindrical one. This condition may increase the risk of cancer.

Although gastroesophageal reflux disease can limit daily human activities, it is rarely life threatening. Subject to the observance of diet, healthy lifestyle and, if necessary, timely admission of medications on the recommendation of a doctor, you can successfully stop all her symptoms and enjoy life.

Watch the video: Heartburn, Acid Reflux, GERD-Mayo Clinic (February 2020).