Chronic distal reflux esophagitis of the 1st degree. Causes and treatment of distal esophagitis. Extraesophageal symptoms of inflammatory processes on the esophageal mucosa differ not only in the nature of severity, but also in localization

Regardless of the etiology, inflammation of the esophagus is defined by the general term "esophagitis". What is this pathological condition? What symptoms may indicate the presence of an ailment? How to deal with it? We will discuss all this in the article.

Types of esophagitis

All cases of inflammation of the esophagus in medicine are systematized, which helps, focusing on the duration of the disease, its severity and the place of the pathological process, to make an accurate diagnosis. So, depending on the nature of the disease, esophagitis is divided into acute and chronic. According to the severity of the disease, catarrhal (that is, superficial) and erosive (in this case, the deep layers of the mucous membrane are affected) esophagitis are distinguished. Depending on the location of the inflamed area in the esophageal mucosa, the disease can be total (if the entire esophagus is affected), proximal (the upper section is inflamed) and distal reflux esophagitis (pathology in the lower esophagus).

Acute, subacute and chronic disease

The most common is the acute form of esophagitis. Inflammation in this case can be both superficial and deep, but it is always distinguished by the suddenness and speed of development of manifestations. Such inflammation develops as a result of a mucosal burn caused by ingestion of hot food, drink or chemicals, past infectious diseases (for example, diphtheria), foreign body injuries, or radiation damage. Acute esophagitis usually resolves without serious consequences or complications for the patient.

Prolonged inflammation of the walls of the esophagus has a subacute or chronic form. The first can develop with the systematic use of too spicy food, strong alcohol or its surrogate, and the like. A chronic disease is most often caused by reflux (that is, the reverse movement of food from the stomach into the esophagus). Usually this disease accompanies a person for many years, gradually leading to serious changes in the work and structure of the esophagus.

Chronic reflux esophagitis

This is a burn that occurs due to the constantly repeated release or leakage of gastric juice or intestinal contents into the esophagus. Peptic esophagitis is caused by a relative and sometimes absolute failure of the obturator capabilities of the cardiac sphincter that separates the esophagus from the stomach. A rather serious role in the development of this chronic disease is played by the ever-increasing intragastric pressure and impaired motility of the gastrointestinal tract. Often this pathology is combined with a hernia of the food opening in the diaphragm, peptic ulcer or gallstone disease and pancreatitis.

Esophagitis: insufficiency of the cardia

Separately, I would like to dwell on the concept of "insufficiency of the cardia." The upper portion of the stomach is called the cardia. Here is the sphincter that closes the gap between the esophagus and stomach. During normal operation, it passes the food bolus only in one direction, reliably blocking its passage back. In this case, there is no special valve blocking the movement in the esophagus. Anatomically, the mechanism of the obturator function of the cardia is supported by the following structures:

esophageal sphincter;
diaphragmatic-esophageal ligament;
"mucous rosette" (folds of the mucous membrane of the esophagus, which descend into the lumen of the stomach, playing the role of an additional valve);
normal location of the esophagus in relation to the diaphragm;
ring muscles of the upper part of the stomach.

If any of these structures does not work well, then cardia insufficiency occurs. And this is one of the serious aspects for the development of esophagitis. Due to the fact that the pressure in the stomach is normally always higher than in the chest cavity, a weakened or deformed sphincter for some reason allows the contents to return back and burn the unprotected esophageal mucosa. And repeated repetition of such a process causes serious pathological changes in this part of the gastrointestinal tract.

Causes of ulcerative esophagitis

If the emissions of acidic contents have become chronic, then the disease can penetrate deep into the mucous membrane of the esophagus, and erosion or ulcers form on it over time. True, the causes that cause ulcerative esophagitis are not only emissions, but also surgical interventions, holes, ulcers of the duodenum and stomach, infectious diseases, chemical burns, excessive intake of spicy food and damage resulting from the introduction of a probe or during radiation therapy.

This disease has several degrees characterizing it:

The first degree is manifested by the appearance of separate, non-merging erosions in the lower part of the esophagus.
Erosive and ulcerative esophagitis of the 2nd degree is expressed by the appearance of confluent erosions, which do not capture the entire mucosa.
The third degree is accompanied by ulcerative lesions in the lower third of the esophagus;
The fourth degree is a condition of chronic ulcer and stenosis (narrowing of the lumen of the esophagus).

Causes and consequences of candidal esophagitis

The disease occurs not only due to functional disorders in the gastrointestinal tract. It can be caused by infections that have penetrated from the outside, or even by “native” bacteria that, for some reason, have begun to grow rapidly. If the causative agent of the inflammatory process in the esophagus is candida, candidal esophagitis is diagnosed. This is the same thrush, but located on the walls of the esophagus. Candida fungi take root on human tissues very easily and, if the microflora of the digestive tract is disturbed, they begin to develop rapidly. Alcohol, hormonal (including contraceptives) or antibacterial drugs can cause changes in the microflora and, accordingly, the development of a fungal infection.

Candidiasis esophagitis is usually not life threatening, but it can cause a lot of trouble. Due to fungal inflammation, scarring can develop and, as a result, shortening of the esophagus. And this situation greatly increases the risk of axial hernia in the esophageal opening of the diaphragm. Candidal inflammation can cause ulceration, internal bleeding, and perforation of the described part of the gastrointestinal tract.

How dangerous is esophagitis?

I would like to emphasize: in no case should you underestimate esophagitis (that this is a serious disease, we hope you have already understood). It cannot be “tolerated” or drowned out by taking some kind of potion. The described condition is considered in medicine to be the most massive pathology of the esophagus, which leads to serious complications, such as, for example, it later causes the patient difficulty in swallowing and, accordingly, requires a reconstructive operation. Another life-threatening complication also needs surgical intervention - perforation (perforation) of the esophageal wall. Statistics claim that ten percent of patients with esophagitis develop the so-called which is characterized by the degeneration of the cells of its mucous membrane into cells characteristic of the intestinal mucosa. Such a condition in medicine is considered precancerous.

How to determine if you have esophagitis

All the types of disease described above have common signs that should make the patient suspect esophagitis. The symptoms and treatment of this pathology will be discussed below. Therapy should be carried out only under the supervision of a gastroenterologist.

All of these symptoms may be aggravated, for example, after a cup of coffee, smoking a cigarette, hot, hard or spicy food. There are frequent complaints of increased manifestations of the disease in stressful situations. It is clear that the set of symptoms in different patients may differ. It depends on the severity of disorders in the esophagus, and on the localization of the inflammatory process, and on concomitant diseases.

How to distinguish esophagitis from other diseases

Taking into account that the symptoms characteristic of the described disease can also be observed in some other pathologies of the internal organs that are not related to esophagitis and require a completely different treatment, it is necessary to clarify some of the nuances.

Pain with esophagitis is not felt in the abdomen, but immediately behind the sternum, in the chest.
Heartburn is usually the main symptom of the described disease. If, along with a burning sensation in the chest, you develop severe weakness, dizziness and shortness of breath, then it is more accurate to assume that there is no esophagitis.
If a burning sensation in the chest appears from physical exertion, then this may be a sign of angina pectoris.

When is it necessary to visit a gastroenterologist?

We hope that esophagitis, the symptoms and treatment of which are discussed in this article, will not lead to serious consequences for you. To do this, you need to see a doctor in time! Do not delay visiting a specialist if heartburn has become permanent and is difficult to eliminate with drugs; her seizures are not always explicable; you have difficulty swallowing; your voice has changed, and the weight is noticeably reduced; blood appeared in the vomit; the temperature rose to 38 ° C and above; you have long persistent hiccups; the feces became liquid and turned black.

What diseases can be accompanied by inflammation of the esophagus

By the way, it should be mentioned, speaking about esophagitis, that this disease often appears in patients who already have some problems with the gastrointestinal tract. As a rule, we are talking about ailments that stimulate the increased aggressiveness of gastric juice or are accompanied by its excessive formation. The same applies to impaired motility of the gastroduodenal region (stomach and duodenum), slowing down its emptying. All this contributes to the distension of the stomach and, as a result, causes reflux.

Diseases that contribute to the development of esophagitis include gastroduodenitis, peptic ulcer of the stomach or duodenum, hernia of the diaphragmatic esophagus, cholecystitis and other pathologies. By the way, in pregnant women in the later stages of fetal development, the risk of developing reflux esophagitis is also high. This is due to an increase in intra-abdominal pressure in women.

What to do if you have combined esophagitis

It has already been mentioned above that esophagitis is often a complex disease that manifests itself against the background of other problems of the gastrointestinal tract. Therefore, if you have a combined diagnosis of gastritis-esophagitis, then the treatment should be comprehensive. Preparations are selected in accordance with the cause of gastritis and the level of acidity associated with this disease. Therapy also includes drugs that relieve heartburn, stabilize the motility of the esophagus and stomach, as well as substances that accelerate the healing of the mucosa. The same advice applies to treatment for a diagnosis of gastroduodenitis-esophagitis. It is important in the treatment of these diseases to follow diet No. 1, which involves sparing fractional nutrition. At the same time, overeating is strictly prohibited, and the last meal should be taken no later than two hours before bedtime.

How is esophagitis diagnosed?

Esophagitis, the symptoms and treatment of which we cover in the article, usually does not present difficulties in diagnosis. After the doctor listens to your complaints and examines your medical history, he should conduct some research. These include endoscopy of the esophagus, which will show changes in the mucosa, and x-rays using a contrast agent (barium). During the last procedure, a picture is taken, in which disturbances in the esophagus are clearly visible: its swelling and the presence of a large amount of mucus. And with the development of an ulcer, flowing of a contrast agent into its crater is visible.

How to treat acute esophagitis

The main task is to eliminate the causes of the disease, and in the future the patient must follow a strict diet. We are talking about the use of soft pureed food, which should have room temperature. All foods that irritate the mucous membrane of the esophagus are excluded from the diet, including those containing a large amount of fiber, as well as fried foods, soda and alcohol. Smoking for those suffering from this disease is dangerous! Patients diagnosed with "esophagitis" drugs that affect the tone of the esophageal sphincter are prescribed by prior agreement with the attending physician. These can be sedatives or tranquilizers, prostaglandins, and so on. It is advisable for patients to sleep on a bed with a high headboard, do not wear tight clothes, try not to lie down after eating and bend over less often.

Treatment of chronic esophagitis

In the absence of stenosis, perforation, bleeding, and the like, the prognosis for the treatment of the chronic form of the disease is favorable. As a rule, drugs that block the production of acid, antifungal or antiviral drugs, antibiotics are taken. Painkillers are also prescribed. Corticosteroids are recommended to reduce inflammation. If swallowing is difficult, the patient is given intravenous nutrition. In cases where the disease is due to the presence of a hole in the diaphragm, an operation is performed. Surgical intervention is also justified in case of unsuccessful conservative treatment, the presence of complications in the form of bleeding or stricture, and the development of such a dangerous pathology as Barrett's esophagus. It is good to combine conservative therapy with folk recipes that help alleviate the patient's condition.

Treatment with folk remedies

Alternative treatment of esophagitis is, as a rule, recipes aimed at relieving inflammation, alleviating painful manifestations and eliminating heartburn. So, to restore the mucosa of the esophagus, healers recommend taking a decoction of oregano, walnut leaves and oak bark. They are mixed in equal proportions and carefully crushed. One dessert spoon of the mixture should be poured with boiling water and held for fifteen minutes in a water bath. Take this decoction warm, two tablespoons before or immediately after meals.

In order to relieve swelling caused by the inflammatory process, take a mixture of oregano, alder and Ivan da Marya. They are mixed in equal quantities and crushed. Just like in the previous recipe, a spoonful of the mixture, filled with hot water, is kept in a water bath and taken up to seven times a day.

Perfectly removes inflammation and aloe. It is consumed by mixing with or without honey, simply by sucking on a piece of the peeled leaf. And although it will not be very tasty, but this tool will help very effectively.

The root will save from pain in the stomach. One teaspoon of crushed root is poured into a glass of boiling water and allowed to cool. After straining, take half a glass still warm half an hour before meals. And remember that during the day you need to drink at least two glasses of this infusion.

In addition to the treatment options described above, to alleviate the condition, some more prescriptions can be recommended:

food should be soft, not spicy and not sour;
eliminate juices from the diet, replacing them with fruit drinks containing vitamin C;
bite off food in small pieces and carefully chew;
with difficulty swallowing, tilt your head back, then the food will pass along the back of the throat, facilitating swallowing;
drink liquid through a straw.

From the article, you learned about such a disease as esophagitis, what it is, what are the causes, symptoms and ways to eliminate the disease. Remember: healing requires discipline. In addition to taking the drugs and traditional medicine prescribed by the specialist, the patient must follow the prescribed diet and give up smoking and alcohol. Only in this way will the disease that prevents you from living a full life will recede. Good luck and good health!

Reflux esophagitis is a pathological condition in which the mucous membrane of the esophagus becomes inflamed due to the reflux of stomach contents into the organ. Most often, this condition progresses in case of insufficiency of the cardia - the sphincter, anatomically located between the esophageal tube and the stomach, does not completely close, and because of this, hydrochloric acid and particles of undigested food enter the esophagus. The distal part of this organ is usually affected. The disease itself has several degrees of development, and each of them has its own clinical picture. It is important to know the symptoms of such a pathology, so that when they are first expressed, immediately consult a doctor and carry out treatment.

Reflux esophagitis can begin to progress in humans due to such etiological factors:

regular consumption of large quantities of alcoholic beverages;
carrying out an operable intervention on the esophageal opening of the diaphragm;
pylorospasm;
smoking;
the formation of a hernia of the esophageal opening, localized in the diaphragm;
scleroderma;
progression of peptic ulcer of the duodenum and stomach;
pregnancy (reflux esophagitis of the 1st degree is often noted in this condition, since the growing fetus begins to put pressure on the bottom of the stomach, provoking the reflux of its contents into the esophagus);
taking for the purpose of treating pharmaceuticals that have a relaxing effect on the lower esophageal sphincter;
defective work of the sphincter due to obesity;
gastritis caused by Helicobacter pylori.

Degrees of pathology

In total, there are four degrees of progression of distal reflux esophagitis. The main criterion for separation is the severity of the lesion, as well as the intensity of the manifestation of symptoms. Diagnosis and treatment must be started as soon as the symptoms of the first stage appear, until the clinic of the disease worsens and complications begin to develop.

Stages of distal reflux esophagitis:

first or A stage. In this case, one or more erosions are formed in the distal esophagus, the dimensions of which do not exceed five millimeters. Between themselves, these inflamed areas do not merge. Erosive reflux esophagitis of the first degree responds best to conservative therapy;
second or B stage. Distal erosive reflux esophagitis of the 2nd degree is characterized by the fact that about 50 percent of the circumference of the esophageal tube is already affected by erosion. In diameter, the inflamed areas exceed five millimeters, and can merge with each other;
third or C stage. Extensive areas of erosion are revealed on the mucosa. About 75% of the area of the distal esophagus is affected. Not only conservative, but also surgical treatment may be required;
fourth or D stage. In this case, a chronic ulcer of the esophagus is already formed. At this stage, various complications are already beginning to progress, in particular, narrowing of the esophagus, perforation of its walls, and so on. Treatment is usually surgical.

Diagnostics

The most informative diagnostic method is endoscopy. With the help of an endoscope with a camera at the end, the doctor has the opportunity to assess the condition of the mucosa, identify the presence of erosions or ulcers, identify areas of pathological narrowing, and so on. In addition, such a disease can be diagnosed by radiography of the esophagus using a contrast agent. Treatment is prescribed only after all the results of the examination are received.

Therapeutic measures

Treatment of the disease can be both conservative and surgical. Usually, doctors resort to operable intervention with 3-4 degrees of progression of reflux esophagitis, as well as in the presence of complications. Most often, drug therapy is prescribed. Proton pump blockers, antacids, enveloping drugs, and others are prescribed. In addition, it is very important that the patient follow a sparing diet during and after treatment. It excludes the use of alcohol, caffeinated drinks, solid foods, smoked meats, too spicy dishes. It is allowed to eat dishes cooked in a steam or in the oven. The diet includes lean meat, skim milk, mashed bananas, mousses, soups (not in fatty broth). It is best if the menu is compiled by a competent nutritionist.

The prevalence of the disease in the population

The prevalence of reflux esophagitis in Russia is unknown, since a holistic record of the incidence is not kept. However, according to a recent social medical survey in Moscow, the main symptom of this disease, namely heartburn, is observed in 35% of women and 15% of men. Such figures indicate the occurrence of reflux esophagitis in every 8 people, which makes doctors sound a certain alarm. At the same time, no more than 10% of people with this symptom seek medical help.

A more complete picture of the prevalence of reflux esophagitis can be obtained by studying the statistics of the disease abroad. According to the US medical services, symptoms of reflux esophagitis are found in 30-50% of adults, and about 20% of people experience heartburn on a weekly basis. As in Russia, people with symptoms of the disease do not rush for medical help - only one in three people go to see their doctor.

GERD is a very common disease

Causes of reflux esophagitis

All causes of the disease can be divided into four large groups:

Associated with a congenital or acquired decrease in the activity of the antireflux mechanism, which prevents the entry of gastric juice into the esophagus.
Decrease in the rate of passage of food through the esophagus, which leads to its overstretching and disruption of the sphincters, which normally close the place where the esophagus passes into the stomach.
Increased sensitivity of the inner lining of the esophagus to irritants, in particular, to gastric juice.
Hypersecretion of hydrochloric acid and active enzymes in the stomach, which leads to an increase in the aggressiveness of gastric juice.

In most cases, in patients with reflux esophagitis of any stage, there is a combination of several factors leading to constant irritation of the esophageal mucosa and the appearance of symptoms of the disease. It should be noted that some of them may be congenital in nature (the nature of the antireflux mechanism, the sensitivity of the esophageal wall, and others).

Clinical manifestations of reflux esophagitis

Reflux esophagitis is often characterized by painful symptoms

The clinical symptoms of reflux esophagitis are varied. It should be noted that the severity of all symptoms does not depend on the nature and severity of changes in the inner lining of the esophagus, which makes it difficult to set the correct severity.

The manifestations of reflux esophagitis are divided into two large groups:

Associated with damage to the esophagus, which includes heartburn, swallowing disorders, belching, retrosternal pain and regurgitation.
Not related to the esophagus: cough, dry throat, hoarseness, shortness of breath, increased salivation, caries and others.

According to patient surveys, the most common symptoms are heartburn and belching of sour foods, most often occurring either during sleep or when leaning forward. The second most common symptom of reflux esophagitis is chest pain that mimics angina pectoris. The rest of these symptoms are not as common.

Heartburn and belching

The most common complaints in patients with reflux esophagitis. Heartburn is a burning sensation of varying strength behind the sternum (corresponding to the lower third of the esophagus) or in the region of the shoulder blades. It occurs in nine out of ten patients with the disease. The reason for the appearance is the effect of the contents of the stomach with a very low pH on the mucous membrane of the lower esophagus. Both the doctor and the patient must remember that the severity of heartburn does not reflect the severity of the esophageal lesion. At the same time, heartburn attacks occur more often when the diet is violated, the use of various carbonated and alcoholic beverages, during exercise and during sleep.

Chronic heartburn is the most common symptom of GERD.

Very often, heartburn is the first symptom of a disease that requires attention from a person and seeking medical help.

Belching and regurgitation of food are observed in half of the patients. The most typical occurrence of these symptoms after eating. Most often, regurgitation of acidic contents occurs.

Pain behind the sternum

Pain sensations are localized behind the sternum, between the shoulder blades and can move to the neck, lower jaw, left half of the chest. Very often similar to angina attacks, but not stopped by taking nitroglycerin. In this regard, in order to exclude angina pectoris, myocardial infarction and other diseases, it is necessary to pay attention to the factors that caused the pain syndrome. Retrosternal pain is often associated with a poor prognosis for the patient, especially when combined with rapid weight loss and impaired swallowing.

Swallowing disorder

Swallowing disorder, or dysphagia, is less common than other symptoms, and is associated with impaired progression of the food bolus through the esophagus. One of the rare signs of the disease, along with extraesophageal symptoms.

Feeling of food stuck in the esophagus

Diagnosis of reflux esophagitis

The following methods can be used to make a correct diagnosis:

An X-ray examination using a contrast agent allows assessing the motor function of the esophagus, identifying a diverticulum of the organ wall, various strictures and narrowing of the lumen of the esophagus, as well as indirect signs of an inflammatory process in the wall (its thickening, changes in the nature of folding, unevenness of the contour).
Endoscopy with or without 24-hour esophageal pH monitoring is considered the gold standard for diagnosis. In addition, it is endoscopic examination that allows you to correctly set the severity of reflux esophagitis. Daily monitoring of pH in the esophagus allows you to identify its changes and detect the strength and frequency of reflux of gastric contents.
Evaluation of the motor activity of the esophagus allows you to evaluate the evacuation function of the organ and the work of antireflux mechanisms.
Morphological examination of the esophageal wall plays an important role in the diagnosis of Barrett's esophagus and esophageal adenocarcinoma. Barrett's esophagus is a precancerous condition characterized by changes in the wall of the organ with the replacement of the esophageal type of the mucosa with the gastric type.

It is important to remember that all these diagnostic methods should be supplemented by the history of the patient's illness and life, as well as his complaints. None of the diagnostic methods guarantees 100% accuracy of the result.

Treatment of the disease

In the treatment of reflux esophagitis of the first degree, non-drug and drug therapies play an important role. Remember that the appointment of treatment should be carried out by the attending physician after a complete examination of the patient, taking into account all indications and contraindications.

Non-drug methods

Any patient with a diagnosis should follow a number of recommendations:

Do not eat large portions of food and do not overeat, especially before bedtime. It is important to adhere to fractional nutrition with the use of small portions. Reduce the amount of fatty, spicy, sweet foods, which in themselves can serve as an irritant. Carefully use drugs that promote the reflux of stomach contents into the esophagus (sedatives, theophylline, nitrates, verapamil and other calcium channel inhibitors).
Reduce the amount of physical activity associated with lifting heavy weights and tension in the abdominal muscles.
Raise the head of the bed and sleep with your head elevated.
Give up bad habits (smoking and drinking alcohol).
Reduce body weight in case of its excess.

Medical methods

For the treatment of reflux esophagitis of the first degree, drugs are used for a long time that help reduce the acidity of gastric juice and accelerate the movement of food through the esophagus:

Drugs that reduce the acidity of gastric juice. This therapy is aimed at increasing the pH of the gastric juice and, thereby, at reducing its ability to damage the mucosa of the esophagus. The most effective in this respect are proton pump inhibitors (omeprazole, rabeprazole and others), which inhibit the production of hydrochloric acid and increase the pH level. Less often, blockers of H2-histamine receptors (Ranitidine, Famotidine) are used, which also reduce acidity, but are less effective.

proton pump inhibitor

Drugs that speed up the passage of food through the esophagus and prevent the reflux of stomach contents into the esophagus. This group of medicines includes Domperidone, Cerucal and others. Can be used as the sole drug in combination with lifestyle changes for grade 1 reflux esophagitis.

Reflux esophagitis of the first degree is characterized by mild symptoms (heartburn, belching) and most often does not cause concern in patients. However, the progression of the disease without appropriate treatment can lead to the development of severe complications, up to oncopathology.

In the event of the first symptoms of the disease, it is necessary to immediately seek medical help for timely diagnostic measures and the appointment of the necessary treatment.

Inflammatory lesion of the mucous membrane of the esophagus. Manifestations of esophagitis can be burning pain behind the sternum, swallowing disorders, heartburn, increased salivation. A complication of esophagitis can be a peptic ulcer, stenosis, perforation of the esophagus, Barrett's disease. The diagnostic minimum consists of esophagoscopy, endoscopic biopsy and radiography of the esophagus. Treatment is prescribed taking into account the etiology of esophagitis; includes diet, drug therapy, physiotherapy; if necessary, surgical treatment of narrowing of the esophagus (bougienage, dissection of cicatricial strictures, etc.).

General information

Esophagitis is an inflammatory disease of the esophageal wall of an acute or chronic course. With esophagitis, the inflammatory process develops in the inner, mucous membrane of the esophagus and, with progression, can affect deeper layers. Among diseases of the esophagus, esophagitis is the most common, in 30-40% of cases the disease can occur without severe symptoms.

Esophagitis can be the result of various kinds of damage to the esophageal mucosa or develop as a result of an infectious lesion, gastritis, reflux of gastric juice (sometimes with bile) from the stomach. Esophagitis due to reflux (reflux) of gastric contents is distinguished as a separate disease - gastroesophageal reflux disease.

Esophagitis classification

Esophagitis downstream can be acute, subacute and chronic. According to the nature of the inflammatory process and its severity in gastroenterology, catarrhal, edematous, erosive, pseudomembranous, hemorrhagic, exfoliative, necrotic and phlegmonous esophagitis are distinguished.

Catarrhal and edematous esophagitis (the most common forms) are limited to hyperemia of the mucosa and its edema. With an acute infectious process, as well as chemical and thermal burns of the esophagus, the development of erosions of the mucous membrane (erosive esophagitis) is possible. In severe infections, the development of a necrotic form often occurs. Hemorrhagic esophagitis is accompanied by hemorrhages in the wall of the esophagus. In the pseudomembranous form, the fibrous exudate is not adherent to the submucosal tissue, in contrast to exfoliative esophagitis. Phlegmon of the esophagus, as a rule, develops when the wall of the esophagus is damaged by a foreign body.

According to the localization and prevalence of the inflammatory process, distal, proximal and total esophagitis are distinguished.

The classification of esophagitis according to the degree of damage has differences for the acute and chronic course of the disease. Acute esophagitis and burns of the esophagus are divided into three degrees:

superficial lesion without erosive and ulcerative defects;
defeat of the entire thickness of the mucosa with ulcerative defects and necrosis;
the lesion extends to the submucosal layers, deep defects are formed with the possibility of perforation of the esophageal wall, bleeding. After healing, the formation of cicatricial strictures is possible.

Chronic esophagitis according to the severity of wall damage is divided into 4 degrees according to the Savary and Miller classification (classification of endoscopic signs of chronic esophagitis):

hyperemia without erosive defects in the distal sections;
scattered small erosive defects of the mucosa;
mucosal erosion merge with each other;
ulcerative lesions of the mucosa, stenosis.

Etiology and pathogenesis

Acute esophagitis develops as a result of a short-term damaging factor:

acute infectious processes (influenza, fungal infection, diphtheria, etc.);
physical damage (burn, trauma during the introduction of the probe, damage by foreign bodies);
chemical burn (damage by caustic chemicals);
an allergic reaction to food (usually combined with other signs of allergy).

The most severe damage to the esophagus after burns.

In the pathogenesis of infectious esophagitis, the main factor in the development of inflammation is a decrease in the immune properties of the body.

The reasons for the development of chronic esophagitis are also diverse:

alimentary esophagitis (eating very hot, spicy food, strong alcohol);
occupational esophagitis (work associated with the inhalation of vapors of caustic chemicals);
congestive esophagitis (irritation of the mucosa by the remnants of accumulated food with various kinds of difficulties in the evacuation function of the esophagus);
allergic esophagitis (develops in connection with food allergies);
dysmetabolic esophagitis (associated with metabolic disorders - hypovitaminosis, microelement deficiency and tissue hypoxia, prolonged intoxication of the body, etc.);
idiopathic ulcerous esophagitis (a special form of chronic inflammation of the esophagus of unclear etiology, morphologically similar to ulcerative colitis and granulomatosis of the esophagus (nonspecific regional stenosing esophagitis).

As a separate disease, peptic, or reflux esophagitis, is isolated. It develops as a result of gastroesophageal reflux (reflux of gastric contents into the esophagus). Sometimes combined with duodeno-gastric reflux. Reflux from the stomach into the esophagus can occur for the following reasons: insufficiency of the cardia (lower esophageal sphincter); hiatal hernia (hiatal hernia); insufficient length of the esophagus.

Symptoms of acute esophagitis

The severity of symptoms in acute esophagitis is directly dependent on the severity of the inflammatory process in the esophageal mucosa. In the catarrhal form, esophagitis can occur without clinical symptoms, only sometimes manifested by increased sensitivity of the esophagus to hot or cold food. Severe forms of esophagitis are manifested by a pronounced pain symptom (acute, severe, burning pain in the chest, radiating to the neck and back), swallowing disorder (dysphagia) due to severe pain, heartburn, increased salivation.

In extremely severe cases - hematemesis up to a state of shock. Severely flowing esophagitis after a week can be replaced by a period of imaginary well-being (a sharp decrease in symptoms, perhaps even eating solid food), but without adequate treatment, after a few weeks (up to 3 months), the healing of severe defects in the esophageal wall can lead to the formation of rough scars and stenosis, which will lead to the progression of dysphagia and food regurgitation.

Symptoms of chronic esophagitis

With reflux esophagitis, the main clinical manifestation is heartburn (burning in the epigastric region and behind the sternum). As a rule, heartburn increases after taking fatty, spicy foods, coffee, carbonated drinks. Overeating also contributes to the development of symptoms. Other likely symptoms may be: eructation (airy, sour, bitter with an admixture of bile); regurgitation may appear at night. Frequent accession of respiratory disorders, laryngospasm, bronchial asthma, frequent pneumonia. Symptoms of respiratory failure occur, as a rule, at night, in a horizontal position of the body.

Chronic esophagitis can occur with pain behind the sternum in the region of the xiphoid process, radiating to the back and neck. Chronic esophagitis is characterized by a moderate severity of the pain symptom.

In children of the first year of life, insufficiency of the esophageal sphincter can be diagnosed by repeated moderate regurgitation immediately after feeding in a horizontal position. With persistent regurgitation, symptoms of malnutrition may develop.

Complications of esophagitis

The following diseases and conditions can become complications of esophagitis:

peptic ulcer of the esophagus (often develops in Barrett's disease), characterized by the formation of a deep defect in the wall of the esophagus, can lead to rough scarring and shortening of the esophagus;
narrowing (stenosis) of the lumen of the esophagus (leads to disruption of the passage of food into the stomach, weight loss);
perforation of the esophageal wall (perforation) - a life-threatening complication that requires urgent surgical intervention;
purulent complications of esophagitis - abscess, phlegmon (as a rule, are the result of damage to the esophagus by a foreign body);
Barrett's disease (with prolonged reflux esophagitis without adequate treatment, degeneration of the epithelium of the esophagus develops - metaplasia). Barrett's esophagus is a precancerous condition.

Diagnosis of esophagitis

If acute esophagitis is manifested by clinical symptoms, then the diagnosis of this disease, as a rule, is not a problem - the localization of the pain symptom is very specific and characteristic. The survey allows you to identify the likely cause of the development of esophagitis. To confirm the diagnosis, an endoscopic examination of the esophagus (esophagoscopy) is used, which shows changes in the mucosa, their severity. An endoscopic examination of the esophagus is carried out no earlier than on the sixth day after the manifestation of a pronounced clinical picture. Indications for endoscopic examination are determined individually. If necessary, an endoscopic mucosal biopsy is taken and examined histologically.

Disturbances in the motor function of the esophagus are detected using esophagomanometry. X-ray of the esophagus reveals changes in the contours of the esophagus, ulceration, swelling of the wall and accumulation of mucus.

Treatment of acute esophagitis

Acute esophagitis due to a chemical burn requires urgent gastric lavage to remove the chemical agent. For the treatment of mild forms of acute esophagitis, patients are recommended to refrain from eating for 1-2 days, drug treatment consists in taking antacids and drugs of the famotidine group. After the start of nutrition, exclude foods that can damage the mucous membrane (alcohol, coffee, hot, spicy, rough foods) and foods that activate the production of gastric juice (chocolate, fatty foods). Smoking cessation is recommended for all patients with esophagitis.

With a severe course of the disease - careful nutrition up to the refusal of enteral nutrition, enveloping and gel antacid preparations. With severe intoxication - infusion therapy with the help of detoxification solutions. To suppress the infectious process - antibiotic therapy.

In ulcerative esophagitis with a pronounced pain symptom, anesthesia is prescribed and gastric lavage is contraindicated. With the failure of massive antibiotic treatment of foci of purulent inflammation (cellulitis, abscess) - surgical sanitation. Also an indication for the surgical treatment of esophagitis is the development of severe stricture of the esophagus, not amenable to dilatation.

Treatment of chronic esophagitis

In the treatment of acute esophagitis, the elimination of the factor of its occurrence is of primary importance. The most important component of treatment is strict adherence to diet and diet and lifestyle. Recommendations for diet in the period of acute clinical manifestations: the use of a moderate amount of soft pureed food at room temperature. Exclusion from the diet of foods that irritate the mucous membrane - spicy, fatty, fried, carbonated, alcohol-containing foods. Also avoid foods that are high in fiber.

Patients with esophagitis should stop smoking and taking medications that affect the tone of the esophageal sphincter (sedatives, tranquilizers, theophylline, prostaglandins, etc.).

You should also refuse to eat at least one and a half to two hours before bedtime, do not take a horizontal position after eating, do not spend a lot of time bending over. It is recommended to sleep on a raised headboard. Do not tighten at the waist.

Drug therapy for chronic esophagitis:

drugs that reduce the acidity of gastric juice (antacids - gel antacids with anesthetics, proton pump inhibitors, H2-histamine receptor blockers are the best choice);
drugs that increase the tone of the cardia (lower esophageal sphincter and accelerate the movement of the food bolus from the stomach into the duodenum (dopa receptor blockers and cholinomimetics).

Prevention of esophagitis involves avoiding the causes of its development - burns with hot food, chemicals, damage by foreign bodies, etc. Prevention of chronic esophagitis - regular dispensary examination by a gastroenterologist and, if necessary, treatment. Patients with chronic esophagitis as a prophylaxis of exacerbations are shown sanatorium-and-spa treatment.

Reflux esophagitis is a disease in which inflammation of the lining of the esophagus occurs. The cause of the inflammatory process is the pathological reflux of the contents of the stomach into the esophagus.

After the food is swallowed, it moves through a long narrow esophagus and enters the gastric sac, the entrance to which is closed by a special cardiac sphincter. Thus, everything that enters the stomach from the outside should not normally flow back into the esophagus.

When the work of the cardiac sphincter is disturbed, the fluid from the stomach freely penetrates back into the esophageal tube, burning its mucous membranes.

A variety of factors can provoke the appearance of this disorder, such as, for example, pregnancy, gastritis, alcohol abuse and smoking, stress, medication, weight lifting, infections. The key point here is a decrease in the tone of the sphincter, combined with an increase in intra-abdominal pressure, due to which the gastric contents literally splash out into the esophagus.

The danger of reflux esophagitis lies in the long-term effect of a mixture of gastric acid, enzymes and bile on the esophageal walls, which leads to ongoing inflammatory processes in them.

In the mucosa of the esophagus, the acid-base environment is closer to neutral, so when gastric juice enters the esophagus, it acts irritatingly and injures delicate tissue, as it contains acid to break down and digest food.

Stages of reflux esophagitis

During the course of the disease, depending on the severity of the process, the main stages are distinguished. There are four of them.

Reflux esophagitis grade 1: what is it

For reflux disease, esophagitis of the 1st degree, the symptoms and treatment of which is important to know for each patient. It is characterized by mild symptoms, since the lesion of the esophagus is still insignificant. May be observed:

These unpleasant symptoms appear after a hearty meal or after prolonged physical work in an inclined position.

Important! Due to the resulting shift in the acid-base balance in the esophagus, saliva also changes ph, which creates a favorable environment for the occurrence of caries in the oral cavity and subsequent destruction of tooth enamel.

Reflux esophagitis grade 1 can be detected using esophagogastroscopy: a thin tube is inserted into the stomach, at the end of which there is an optical device that allows you to see inflammation in the digestive organ. The initial stage of reflux esophagitis will give out intense redness of the mucous membrane lining the esophagus and the presence of minor point erosions on its surface, in the form of scratches or cracks. If timely treatment is not started at this stage, the disease will progress.

Treatment of the first stage of gastroesophageal reflux disease is complex. The main emphasis is on a diet that implies a healthy diet, as well as on therapeutic exercises. Regular "casts" of gastric masses into the esophagus provoke burns of the walls of the esophagus, which is fraught with an increase in erosions and ulcers, and worsening of the clinical picture of the disease.

Patients may face diagnoses such as distal reflux esophagitis grade 1 and erosive reflux esophagitis grade 1.

Reflux esophagitis grade 2: what is it

The second stage of reflux esophagitis, according to doctors, is the most diagnosed, since most patients begin to notice specific symptoms of the disease, which is the reason for their appeal to specialists. The main difference of this stage is heartburn and burning sensation after eating. In addition, heartburn is provoked by any load, as well as the recumbent position of a person.

Due attention should be paid to treatment in the diagnosis of erosive reflux esophagitis of the 2nd degree.

Reflux esophagitis grade 3

IN third stage the appearance of unpleasant symptoms does not depend on food intake, which means the presence of an extensive lesion in the walls of the esophagus.

Reflux esophagitis grade 4

And the fourth stage, the most severe and dangerous, in terms of the occurrence of various complications, such as esophageal stenosis, or even cancer.

IN fourth stage symptoms become constant companions of the patient: there is almost always a sour taste in the mouth, swallowing is difficult and painful, the stomach often hurts and burns in the chest area. At this stage, the lower esophagus is completely covered with chronic non-healing ulcers.

Los Angeles Classification

Subdivided according to severity:

reflux esophagitis A grade: damage to the inner lining of the esophagus looks like one or two small lesions, up to 5 mm in size; the inflammatory process affects only one fold of the esophagus.
Grade B: damage to the walls of the esophagus reaches more than 5 mm in length.
Grade C: the area of the esophagus within two folds is subject to the inflammatory process, the lesion is less than 75% of the circumference of the esophagus.
Grade D: The mucosa of the esophagus is affected by more than 75% of its circumference.

There is also a classification of reflux esophagitis by Savary And Miller, according to which there are 4 degrees of severity:

I- on the mucosa there are erosions, redness, exudate (inflammatory fluid), the area of the lesion is less than 10%;

II- hit by 10 before 50% the circumference of the esophagus, the surface of the mucosa is covered with erosions that merge with each other;