This refers to inflammation of the mucous membrane of the lower esophagus. It often occurs due to frequent or prolonged reflux of aggressive juice from the stomach.
The erosive form is one of the most dangerous, because with it the mucous membrane begins to become covered with ulcers. If left untreated, they can bleed or lead to more serious consequences.
Erosive reflux esophagitis - what is it?
This is a disease that affects the entire lining of the esophagus or part of it. According to ICD-10, the disease belongs to group K20-K31. These are diseases of the stomach and duodenum.
The disease can occur without symptoms for a long time or have the same symptoms as gastritis. If left untreated, this disease can affect not only the upper cells of the esophagus, but also the deeper layers. Therefore, treatment is carried out under the strict supervision of a doctor.
The erosive form often occurs not only with the progression of the catarrhal type of the disease, but also in patients who have undergone gastrectomy or.
According to statistics, 2% of adults have reflux esophagitis. It is detected twice as often in men. The erosive form is a consequence of the progression of the catarrhal type of the disease.
Causes
Erosive esophagitis can appear for various reasons:
- overweight,
- excessive physical activity,
- errors in diet,
- emotional overstrain,
- wearing tight clothes,
Erosion may appear due to taking medications. Especially when it comes to anti-inflammatory and sedatives.
The erosive form can result from acute or chronic inflammation of the esophagus. Erosion is also formed after acids, alkalis and various technical liquids.
The prerequisite for the disease may be severe viral, bacterial or fungal infections, regular use of glucocorticosteroids and non-steroidal drugs.
Classification
There are several main forms of esophagitis:
- spicy,
- chronic,
- surface,
- ulcerative,
Spicy
This form is the most common. Accompanied by superficial or deeper inflammation of the mucous membrane. The disease develops gradually, so with timely treatment it can resolve without complications.
Chronic
Occurs when negative impact on the walls of the esophagus was constant. Develops over a long period of time. Therefore, it sometimes causes irreversible consequences that can affect all layers of the mucosa and other parts of the digestive tract.
Surface
Sometimes it is called catarrhal. This form is characterized by inflammation and swelling of the esophageal mucosa. Only the surface layers are affected by negative factors in this form. Therefore, the disease does not cause significant tissue destruction.
Ulcerative
This is a condition in which inflammation not only penetrates the lining of the esophagus, but also when it causes the formation of ulcers. This disease requires a serious approach to treatment.
The formation of lesions may begin both with prolonged contact with the irritating factor and with short-term contact.
Distal
The erosive form can be detected if only the lowermost part of the esophagus was affected by ulcers. It connects to the stomach.
Degrees
The erosive form has several forms:
- 1st degree. It is characterized by the manifestation separate type erosions. They don't touch each other. Sometimes erythema is detected at this stage. It is most often found in the distal esophagus.
- 2nd degree. An erosive lesion in which the erosions have a merging nature. Despite this fact, the lesion does not affect the entire mucous membrane.
- 3rd degree. Its peculiarity is that ulcers form in and in the lower part of the esophagus. It turns out that the entire mucous membrane is one large ulcer with a certain amount of healthy tissue.
- 4th degree. It includes not only the appearance of erosions, but is also accompanied by stenosis. This form usually has a chronic course.
Symptoms
Characteristic of the disease are pains that occur in different areas of the esophagus. They may appear while eating. Patients report frequent heartburn, a burning sensation in the chest, and regurgitation of food or mucus. Belching with blood may occur.
TO general symptoms This includes weakness, anemia, which occurs due to chronic blood loss or dizziness. If the pathological process is complemented by infection, this can lead to inflammation of neighboring organs.
Signs of the disease include:
- Pain of varying intensity. Mainly appears behind the sternum. May worsen with eating, at night, or with physical activity.
- Heartburn. Occurs when the acidic environment from the stomach affects the esophagus. The condition can occur when the body is in a horizontal position and during physical activity.
- Belching. It indicates insufficient functioning of the cardia. In some cases it is so strong that it resembles vomiting.
- Dysphagia. Appears in severe forms of esophagitis. A severe condition is characterized by sensations of food retention in the area of the xiphoid process.
Diagnostics
It is necessary to detect diseases in a timely manner. Based on the results of the study, it is possible to determine not only the severity of the pathology and its degree, but also the appropriateness of the treatment.
One of effective methods– fibrogastroduodenoscopy. During the procedure, the mucous membrane is examined using an endoscope. The method allows you to identify the presence of redness, the degree of motor dysfunction and the inflammatory process. If there are narrowings or scars, the method will help identify them.
Morphological assessment is given after studying the material under a microscope. Cells are taken in the same way as during the procedure. It allows you to exclude malignant degeneration and identify signs of pathology.
X-ray with contrast agent. Before using an x-ray, a barium suspension is injected. During the examination, erosions are revealed. The patient is viewed in both horizontal and vertical positions. This also makes it possible to determine the presence of reflux or diaphragmatic hernia.
How to treat erosive reflux esophagitis?
To cope with the disease, a person is advised to reconsider his lifestyle and make some adjustments to it.
You should definitely quit smoking and avoid serious physical activity associated with tilts. This will provoke the reflux of stomach contents into the esophagus.
Drugs
Two tactics are used for treatment. The first includes powerful ones. Over time, intensive medication use is reduced. The second principle is that drugs that have minimal effectiveness are prescribed first. As treatment progresses, the pharmacological effect increases.
One of the effective methods is taking secretolytics. These are drugs necessary to reduce gastric secrecy. Reducing acidity reduces the harmful effects on the delicate esophageal mucosa.
These medications include:
- proton pump inhibitors,
- H-blockers,
- M-anticholinergics.
The duration of taking medications depends on the degree of the disease and the number of erosions.
The minimum course is about a month. Among the soft medications, there are various antacids that neutralize the effect of hydrochloric acid. To increase the resistance of the esophageal mucosa, doctors may additionally prescribe medications for treatment.
Folk remedies
Patients with the erosive form are prescribed drugs that have wound-healing, anti-inflammatory and bactericidal effects. These include nettle, calendula, chamomile, mint and sage.
Among the popular recipes is a collection from chamomile flowers or flax seeds. Take two large spoons of these components. They add motherwort, licorice root and lemon balm leaves. The prepared mixture is infused for several hours after it is poured with boiling water. Drink ¼ glass three times a day.
To combat heartburn, freshly squeezed potato juice, dried raspberry or blackberry leaves can be used. The latter can simply be chewed.
Diet
With the erosive form, pain can occur even with an insignificant, at first glance, imbalance in food. should be gentle.
Products that enhance gas formation processes should be excluded. Cold and hot dishes are excluded. Foods that reduce the tone of the lower sphincter should be excluded from the menu. That is, you should not overuse chocolate, onions, garlic, pepper and coffee.
Before eating, drink a glass of still water. This will help protect your esophageal lining. During the day, you can eat a couple of pieces of raw potatoes. This will reduce the occurrence of gastric juice. Potatoes can be replaced with several nuts.
Prognosis and prevention
The erosive form requires more treatment. If there are no complications, then the prognosis is favorable, and life expectancy does not decrease. If the disease is not treated, then there is a high probability of developing precancerous and cancerous conditions.
Prevention of erosive reflux esophagitis consists of constant diet. It is important to sleep on an extra pillow so that your head is always higher than your feet. This will not allow the cardia to have a negative impact on the functioning of the digestive tract if the functioning of the cardia is disrupted.
Reflux esophagitis is one of the most common diseases affecting the esophagus. It occurs as a result of direct contact of the esophageal mucosa and intestinal contents. Due to the characteristic increased acidity, damage to the lower part of the esophagus occurs, due to which symptoms in the form of heartburn, pain and similar disorders of the digestive system are characteristic of the disease reflux esophagitis.
Features of the disease
Tracking the incidence rate based on real indicators is not possible, because reflux esophagitis occurs with mild symptoms, for which referral to specialists, as a rule, does not occur. Meanwhile, seeing a doctor is almost mandatory, even as a symptom or. The occurrence of reflux-esophagitis, moreover, can act as a symptom of the occurrence of a diaphragmatic septum. In this case, we are talking about a part of the stomach getting into the opening, which in its normal state should not be there in principle. There are also a number of specific types of foods that cause stomach contents to enter the esophagus. This particularly includes chocolate and citrus fruits, tomatoes and fatty foods. Additionally, for adults, coffee, alcohol, and smoking are the accompanying products that enter the esophagus.
Reflux esophagitis: symptoms
Each age category has its own characteristic signs of this disease. Thus, reflux esophagitis, the symptoms of which occur in children, manifests itself in the form of belching and frequent regurgitation, vomiting milk and belching air. When the child is raised in an upright position, a decrease in the isolated phenomena is observed, meanwhile, after the next feeding they appear again. As you continue to remain in a horizontal position, reflux esophagitis intensifies in its manifestations, and therefore the head end of the child’s sleeping place should be raised slightly or a pillow should be placed higher - this will relieve the characteristic symptoms.
For older children, a characteristic feature is the presence of complaints of frequent heartburn, sour belching, and often a burning sensation in the area behind the sternum. The listed symptoms are most often relevant after eating, when bending the body, and at night.
As for adults, painful sensations are most often noted in the area behind the sternum, and the most common symptom occurs, which has the character of a “coma” sensation in the throat. In addition, the symptoms characteristic of reflux esophagitis may also correspond to symptoms of a completely non-esophageal nature, expressed in a constant cough, hoarse voice, dental diseases, etc.
Increased reflux of stomach contents into the esophagus can be increased for a number of different reasons. So, this, first of all, may be associated with a disorder that occurs in the motility of the gastroduodenal zone, which is most often relevant in the presence of various types pathologies in the digestive organs. It is also associated with a slowdown in gastric emptying. It is noteworthy that delayed gastric emptying is observed in about 50% of the total number of patients diagnosed with reflux esophagitis. Due to the stretching of the stomach, the volume of contents in the stomach increases, which, in turn, contributes to the occurrence and development of reflux. Due to disturbances in pyloroduodenal motility, duodenogastric reflux is formed. In this case, we are talking not only about an increase in the volume of stomach contents, but also the formation of an additional factor that contributes to damage to the mucous membrane as a whole.
Degrees of reflux esophagitis
This disease has its own degrees that characterize it.
- I degree - manifestations consist of a separate type of erosion that does not merge with each other, as well as erythema that occurs in the distal esophagus;
- II degree - erosive lesions are merging in nature, but without covering the entire surface of the mucosa;
- III degree – manifestation of ulcerative lesions in the esophagus in the region of the lower third of its part. In this case, they merge when capturing the mucosal surface in a complex;
- IV degree – expressed in chronic ulcer of the esophagus and stenosis.
It is noteworthy that the average severity of reflux esophagitis is characterized by the manifestation of heartburn not only after eating. Thus, the pain becomes more intense and frequent, disturbing the patient even if he takes dietary food. Manifestations in the form of air belching, coated tongue and an unpleasant taste in the oral cavity are also more frequent.
Forms of reflux esophagitis
This disease has an acute and chronic manifestation.
- Acute reflux esophagitis manifests itself in inflammation of the walls of the esophagus with the simultaneous presence of painful sensations that are relevant when eating food, as well as liquids. It is characterized by an increase in temperature with general malaise; behind the sternum, the patient experiences unpleasant sensations along the esophagus. There is also a burning sensation and pain in the neck, excessive salivation, belching, and impaired swallowing function.
- Chronic reflux esophagitis manifests itself in chronic inflammation of the walls of the esophagus, which is accompanied by the occurrence of pain in the area behind the sternum. Often the chronic type of reflux is also accompanied by gastritis. Rawness behind the sternum can also occur when running; in addition, difficulty breathing, hiccups, heartburn and even vomiting may occur.
Esophagitis also occurs catarrhal, characterized by swelling that occurs in the esophageal mucosa and hyperemia, as well as erosive, the nature of whose development is determined by acute infections.
Biliary reflux esophagitis: symptoms
A disruption in the process of food digestion, in which the contents of the stomach end up in the intestines causing inflammation and irritation in it, as well as the flow of intestinal contents into the stomach, determines reflux. Accordingly, gastritis formed against the background of this process is defined as reflux gastritis. The reasons that provoked reflux determine its type, which can be duodenal or biliary.
Let us dwell on this type of biliary reflux esophagitis, the symptoms of which are expressed in a feeling of heaviness and fullness in the stomach, which is important during the process of eating, as well as immediately after it. Additionally, we note bitterness and belching, an unpleasant taste felt in the mouth, nausea, various types of stool disorders (alternating with diarrhea, as well as bloating). Predominantly biliary reflux gastritis is not expressed by pain symptoms. When pain occurs, it is aching and dull in nature, worsening after eating. It is noteworthy that this disease leads to disturbances in the body’s absorption of nutrients obtained through food. For this reason, there is significant weight loss, “stuck” formation on the lips, general weakness, and dry skin.
Causes of biliary reflux esophagitis
This type of disease is associated with the presence of disorders of the biliary system, as well as disturbances in motor skills (that is, dyskinesia), and lack of coherence in the functioning of the sphincters. Thus, disturbances provoke a failure in the sequence and force of pressure that occurs in the intestines and bile ducts. Further, at the reflex level, failures occur in the compression of the gastric and pancreatic ducts. Due to the occurrence of bilinary type of disorders, the contents from the duodenum, impregnated with bile and pancreatic enzymes, end up in the stomach, burning it and thereby forming gastritis. Often, biliary reflux esophagitis is combined with a diagnosis such as biliary duodenitis (or inflammation of the duodenum). This combination is explained by irritation produced by bile, which is secreted outside the process of normal digestion.
Erosive reflux esophagitis: symptoms
Esophagitis in its form, in which the mucous membrane of the esophagus is deeply damaged, is defined as erosive reflux esophagitis, the symptoms of which manifest themselves in the form of heartburn and belching, nausea (occasionally vomiting), pain in the area behind the sternum, painful swallowing and the presence of a “coma.” " in the throat. Despite the fact that these manifestations are generally characteristic of esophagitis, in this case they are more pronounced, accordingly, bringing more anxiety and discomfort to the patient.
The worsening of the disease is provoked by dietary errors, which include the consumption of various types of acidic foods, caffeine and alcohol. Often the course of the disease is aggravated by medications, even something so harmless, at first glance, as paracetamol, analgin, aspirin, etc.
Treatment of reflux esophagitis
To treat reflux esophagitis in any of its forms, it is natural that the root cause, that is, the disease that provoked its occurrence, should be eliminated. These include gastritis and neurosis, or peptic ulcer. By determining the correct therapy, the symptoms of reflux esophagitis may subsequently be less pronounced, and with its help it will be possible to reduce the harmful effects of gastric contents that enter the esophagus. Also, therapy in its correct form will increase the overall resistance of the esophageal mucosa, facilitating rapid cleansing of the stomach after eating.
The primary point of treatment for esophagitis is nothing more than a diet, in which spicy and fatty foods, chocolate, tomatoes, citrus fruits, caffeine and, if possible, smoking should be excluded.
Additionally, the specialist prescribes medications that reduce stomach acidity, in particular these include antacids. Peptic ulcer disease, as well as erosion, require the use of antisecretory drugs (proton pump inhibitors or H2 blockers). Due to this, intragastric pressure decreases, which ensures the overall resistance of the stomach to food intake. Additionally, due to this, intestinal motility is normalized, and all symptoms characteristic of reflux esophagitis are eliminated. To avoid an increase in the symptoms that occur when lying down, additional pillows are placed to elevate the upper body - this measure will help reduce heartburn, as well as pain that occurs in the sternum.
To diagnose reflux esophagitis, as well as diseases accompanying its occurrence, you should contact a gastroenterologist. Based on the patient's complaints, duration and severity of the disease, as well as morphological and endoscopic assessment of changes, appropriate treatment will be determined.
Reflux esophagitis is inflammatory disease tunicae mucosae (mucous membrane) of the distal esophagus, caused by exposure to gastric or duodenal peptic reflux. The distal section is the part of the esophagus that is adjacent to the stomach. Cm. .
Manifestations in adults include esophageal (heartburn, belching, dysphagia, retrosternal pain and burning), and extraesophageal (dry cough, hoarseness, pain in the tongue, bitterness in the mouth) symptoms.
Causes
In pathogenesis, there are 3 main causes of reflux esophagitis:
- Insufficiency of the lower esophageal sphincter (LES), which is divided into relative (the result of excessive gastric motility with a normally functioning LES) and absolute - the result of impaired functioning of the LES. This can be facilitated by:
- axial hernia;
- , duodenitis; ;
- hypertrophic, ;
- gastric and duodenal ulcerogenic lesions, especially with;
- conditions after gastrectomy;
- s , states s low acidity gastric juice;
- abuse of drugs that relax smooth muscles (nitrates, beta blockers, tranquilizers).
- alcohol and smoking abuse,
- stressful situations;
- starvation.
- Impaired rate of emptying and cleansing of the esophagus (esophageal clearance).
- Violation of the mechanisms that protect the mucosa from damage.
Based on the causes of the disease, it is clear that for effective drug treatment it is necessary not only to act on the symptoms caused by esophageal disease, but also to cure the diseases that caused this condition.
Classification
RE has two main forms – acute and chronic.
The causes of acute reflux esophagitis can be:
- allergic diseases;
- exacerbation of chronic stomach diseases (condition after gastrectomy, hiatal hernia, subatrophic gastritis, gastric ulcer);
- infection (, septic esophagitis).
Acute reflux esophagitis is manifested by the following symptoms:
- general malaise;
- increased temperature;
- dysphagia;
- heartburn;
- belching;
- pain along the esophagus while eating.
Chronic reflux esophagitis can develop as an outcome of a poorly treated acute form, or as a primary chronic disease. This form of the disease is often accompanied by gastrointestinal diseases; it is characterized by both esophageal and extraesophageal symptoms of EC.
- Depending on the prevalence of the pathological process, there are:
- focal reflux esophagitis - the pathological process occupies one or more lesions on the posterior or lateral wall of the organ in the distal (adjacent to the stomach) section;
- diffuse RE - the pathological process occupies all or most of the organ.
Depending on the depth of the damage to the walls, they are distinguished: non-erosive reflux esophagitis (superficial) and.
Non-erosive forms of pathology
Non-erosive forms are divided into catarrhal and edematous. Distal nonerosive reflux esophagitis is a mild superficial form of the disease. Symptoms are usually mild, patients complain of small belching in the retrosternal area, at times (usually after overeating or sudden bending of the body). Sometimes pathological condition proceeds without heartburn at all.
Treatment mainly includes:
- diet;
- herbal medicine (various herbal decoctions and tinctures);
- physiotherapy.
Signs of erosive reflux esophagitis are:
- heartburn;
- belching;
- chest pain.
The uncomplicated form is treated conservatively: diet therapy, drug therapy, methods traditional medicine. If complications occur, surgical treatment is possible.
Rarely, the disease occurs with moderate symptoms or is completely asymptomatic. More often, the symptoms of reflux esophagitis in adults are pronounced. Symptoms from the esophagus and symptoms from neighboring organs are distinguished.
Symptoms from the esophagus:
- heartburn;
- belching
- pain in the retrosternal region (“tightens behind the sternum”), often radiating to the neck and back, relieved with antacids;
- dysphagia, of varying severity, of a transient nature;
- with a severe illness, vomiting with blood is possible.
Symptoms from other systems and organs:
- from the cardiac system: extrasystoles, conduction disturbances, cardialgia;
- from the pulmonary system: dry cough (sputum appears when a secondary infection is attached), shortness of breath, difficulty breathing, sleep apnea;
- from the otorhinolaryngological organs: symptoms of pharyngitis (pain and mucus in the throat, possible redness of the throat), the appearance of symptoms of acute laryngitis due to reflux disease (hoarseness, severe pain when swallowing, sore throat);
- from the dental organs: phenomena of glossitis (feeling that the tongue is burning, pain in the tongue), damage to tooth enamel, stomatitis;
- from the blood: symptoms of anemia.
Cough
The cough with reflux esophagitis is dry, often painful. Drip infections that occur against this background are severe and can be complicated by the development of bronchial asthma.
There are two mechanisms for the development of cough syndrome:
- Reflux particles, with severe damage to the esophagus, enter the pharynx, and from there into the nasopharynx and trachea, where they irritate the cough receptors of the mucous membrane.
- If the reflux rate is low, and the process is localized only in the distal esophagus, irritation of the vagal centers located in the lower part of the esophagus, which activate the cough center of the brain, is possible.
In order to properly treat cough with reflux esophagitis, it is necessary, first of all, to increase the pH of gastric juice in order to remove the cause that causes it (antacids, IGRs, PPIs). Frequent aspiration pneumonia requires surgical treatment. To make it easier to endure attacks, you can take cough remedies recommended by alternative medicine (honey, aloe, propolis). Breathing exercises are often used.
Extrasystoles
Extrasystole (extraordinary contractions of the heart muscle) is a common complaint in diseases of the stomach and gastrointestinal tract in general. Extrasystoles arise as a result of viscerocardial reflexes and are functional in nature. Special antiarrhythmic treatment is not required, especially with moderately severe extrasystole.
Another reason for the occurrence of extrasystole is the long-term effect of reflux on the vagal centers located in the lower part of the esophagus. The consequence is the development of vegetative-vascular dystonia with psychosomatic manifestations.
Treatment should be aimed at eliminating the pathology that caused the extrasystole.
When patients do not tolerate extrasystole well, especially if it is accompanied by increased excitability (fear, insomnia), of course, correction of the condition is required. But before treating extrasystole, consultation with a neuropsychiatrist is necessary, since substances usually prescribed for neuroses (antidepressants, tranquilizers, antipsychotics) can worsen the condition of the lower esophageal sphincter.
Symptoms of chronic forms of reflux esophagitis
Clinical manifestations of RE depending on the morphological form of the process.
Table 1. Symptoms of chronic reflux esophagitis
| Types of reflux esophagitis | Symptoms |
| Catarrhal and edematous | The mildest forms of the disease, accompanied by inflammation of the mucous membrane. The clinical picture is moderate or weak. Patients complain of slight discomfort in the retrosternal region and epigastrium, occasional heartburn, and belching. All symptoms worsen with overeating and physical activity. The course is usually benign and, with proper treatment, ends in complete recovery. |
| The general condition is not disturbed. In patients over 60 years of age, endoscopic examination often reveals whitish spots in the thoracic esophagus - this is intracellular glycogen deposition (acanthosis of the esophagus). Complaints of retrosternal burning pain that occurs both during and outside of meals, heartburn, provoked by constant consumption of soda, belching, hypersalivation. The disease is often accompanied by extraesophageal symptoms. In severe cases, complications are possible. |
|
| Fibrinous | Complaints of difficulty swallowing, heartburn, belching, sharp chest pain radiating to the back and pericardial region, the appearance of gray films in the mouth. |
| Erythematous | The general condition is disturbed. Patients complain of dysphagia, vomiting, regurgitation of mucus, heartburn, a burning sensation in the chest, and retrosternal pain. The clinic is dominated by regurgitation of bloody mucus, vomiting mixed with blood, severe dysphagia, odynophagia - a feeling of pain during the passage of food through the esophagus, pain in the chest, melena - stool mixed with blood. |
| Necrotic | Develops against the background of severe diseases (uremia, agranulocytosis, sepsis); the disease is manifested by dysphagia, odynophagia, repeated vomiting, sharp retrosternal pain, aggravated by swallowing. |
Degrees of reflux esophagitis
During the pathology, 4 degrees of severity are distinguished.
Table 2. Reflux esophagitis and severity
| Reflux esophagitis | Symptoms | Treatment |
| 1st degree | Heartburn that occurs when the diet is violated and when overeating, discomfort in the retrosternal area, belching. | Drug treatment is usually not required. |
| 2nd degree | Heartburn dominates the clinic. The burning sensation intensifies during physical activity, especially when bending over. Patients complain of: belching, retrosternal pain, bad breath, white coating on the tongue, a feeling of a lump in the throat. |
Strict adherence to the diet. Taking medications that reduce the concentration of H+ ions in refluxate (antacids, IGRs, PPIs), prokinetics. |
| 3rd degree | Heartburn, belching, retrosternal pain bother me almost constantly. Extraesophageal signs of the disease appear: dry, hysterical cough, palpitations, arrhythmias, pain in the mouth, hoarseness. |
This degree requires massive therapy lasting at least 8 weeks. PPIs, antacids, prokinetics, and reparants are used. |
| 4th degree | This is the stage of complications:
|
Drug treatment, as in grade 3 + treatment of complications. Possible surgery. |
Diagnostic methods
ER is diagnosed using endoscopy (with biopsy), x-ray examination of the esophagus and stomach, intra-esophageal pH-metry and manometry.
- Esophagoscopy allows you to carefully examine the esophageal mucosa, determine the degree of damage to the organ according to the Los Angeles classification (a, b, c, d), and take a biopsy specimen for histological examination.
- allows you to identify the lesion, the degree of narrowing of the organ lumen.
- Long-term measurement of esophageal acidity allows us to determine the presence of gastroesophageal reflux.
- Manometry of the esophagus - allows you to evaluate the motility of the organ and determine the clearance of the esophagus.
After the examination, a diagnosis is made and a prescription is prescribed. drug treatment medications.
Reflux esophagitis and drug treatment with drugs
For rational treatment of the disease it is necessary:
- change your lifestyle to eliminate the negative influences that led to the disease;
- take all medications prescribed by your doctor;
- if necessary, supplement drug therapy with traditional medicine.
Drug therapy is prescribed in accordance with the severity of the inflammatory process and the severity of the pathological process. The doctor determines how long and in what dosage to take the tablets.
Pathogenetic drugs are:
- antacids and alginates - drugs increase the pH of gastric juice, thereby reducing acid aggression on the esophageal mucosa, in addition, they envelop the mucosa, providing cytoprotection (cell protection).
- antisecretory agents (IGR, PPI) – reduce the concentration of H+ ions in gastric juice;
- Prokinetics are drugs that accelerate the movement of food from the stomach into the intestines, thereby eliminating congestion in the stomach and increasing the tone of the lower sphincter.
Table 3. The most effective drugs for the treatment of reflux esophagitis in adults
| A drug | How to use |
|
Antacids |
|
| Phosphalugel | The dose of the drug is prescribed individually. The drug is prescribed immediately after meals and at night |
| Almagel | 5-10 ml (1-2 scoops) 3-4 times a day after meals |
| Maalox | 1-2 packets an hour after meals or if heartburn occurs |
|
Prokinetics |
|
| Trimedat | The daily dose for oral administration is 300 mg, rectally 100-200 mg, parenterally 50 mg. The duration of use depends on the clinical situation. |
| Domperidone (Motilium) |
1 tablet (10 mg) three times a day. Max dose 30 mg |
| Ganaton | Take 50 mg 3 times a day |
| Itomed | 1 tablet (50 mg) three times a day |
| Iberogast | 20 drops 3 times a day before meals with a little water |
| Cerucal | 5-10 mg three times a day |
|
H2 histaminolytics |
|
| Ranitidine | 150 mg twice daily |
|
Proton pump inhibitors |
|
| Lansoprazole | 1 capsule per day |
|
Omeprazole |
20 mg twice daily |
|
Rabeprazole |
20 mg per day (1 tablet) |
|
Pantoprazole (Nolpaza) |
1 tab. (40 mg) per day |
| Antiulcer agents with bactericidal activity against Helicobacter pylori | |
| 1 tab. 2-3 times a day half an hour before meals | |
|
Reparants |
|
| Ursosan | 1 capsule 1 time at night |
| Venter | 1 gr. in the morning and before bed |
|
Hepatoprotectors |
|
| Ursofalk | The dose is prescribed individually |
|
Choleretic agents |
|
| Hofitol | 2 tablets each. three times a day before meals |
| Allohol | 2 tablets each. three times a day |
| Odeston | 1-2 tab. (200-400 mg) three times a day |
|
Antispasmodics |
|
| Duspatalin | 135 mg 3 times a day |
|
Enzymatic preparations |
|
| Creon | 1-2 capsules with meals |
|
Antipsychotics |
|
| Eglonil | 50-150 mg per day |
Attention! Patients should know what medications to take at night for severe nocturnal heartburn - the so-called “nighttime acid reflux.” These are Phosphalugel (antacid), Omez Insta (a special form of PPI), chamomile tea(1 glass).
But even the most effective drugs will not help if the patient does not change his lifestyle, eliminate the causes of the disease, and do not follow a diet.
What to do if the disease does not go away? First of all, you should know that treatment of reflux esophagitis is a long process. How long treatment will require depends on the severity of the disease, in any case at least 6-8 months. You need to tune in emotionally. If the disease is really difficult to treat, a re-examination is prescribed, especially if there are complaints (yellow coating on the tongue, constant bitterness in the mouth) to exclude biliary reflux esophagitis, pancreatic pathology. If the examination reveals nothing, the question of surgery arises.
Lifestyle with reflux esophagitis
Before starting treatment for reflux esophagitis, it is necessary to get rid of those addictions and habits that led to cardia insufficiency. This means that you need to listen to simple recommendations and strictly follow all medical advice:
- Diet therapy is one of the main components in the treatment of gastrointestinal patients. Patients must strictly adhere to the recommended diet, excluding all prohibited foods from the menu. Food should be warm, boiled (or steamed), soft. You need to eat regularly, often, in small portions.
- A patient with EC must avoid physical and mental stress and stressful situations in every possible way. However, you cannot completely give up physical activity (you can visit the pool, go for walks).
- It is necessary to ensure a full 8 hours of sleep at night. It is better to sleep on a special wedge-shaped pillow for GERD, one end of which is raised twenty centimeters above the level of the bed, which prevents the backflow of gastric contents and allows you to sleep correctly.
- Quit alcohol and smoking.
All these tips must be followed even after the clinical manifestations have subsided, so they are a prevention of repeated exacerbations.
Surgical treatment
Surgery for reflux esophagitis is a last resort. It is resorted to only if the consequences of refusing the operation are much more severe than the operation itself and the risks of its complications.
Indications for surgical treatment:
- complex drug therapy prescribed in maximum doses, carried out for more than six months, did not produce results;
- the patient has frequent aspiration pneumonia, threatening severe pulmonary pathology;
- severe complications of chronic reflux esophagitis have developed (scarring, severe ulcerative pathology, Barrett's esophagus, bleeding);
- The patient has a hiatal hernia.
Is reflux esophagitis dangerous?
Symptoms of an uncomplicated course of the disease can be very unpleasant. But what is dangerous about reflux esophagitis is its complications. The most dangerous consequences include:
- Esophageal stenosis, which occurs with long-term chronic inflammation. The normal mucosa is replaced by scar tissue, narrowing the lumen of the organ.
- . If inflammation exists for a long time, then not only the superficial, but also the deep layers of the esophageal wall are affected. Ulcers are often complicated by bleeding, requiring emergency surgical treatment.
- . This . With this pathology, the likelihood of development is very high.
Effective traditional medicine for the treatment of reflux esophagitis
Table 3. Traditional medicine
| Means | Action | Recipe (and how to take it) |
| Sea buckthorn oil | Normalizes the production of digestive juices. Antitumor effect Strengthens regenerative processes |
Buy at the pharmacy A dessert spoon after meals 3 times a day (2 weeks) |
| Potato juice | Has an enveloping effect, reduces symptoms - heartburn and retrosternal pain | Squeeze the juice from 1 potato tuber. Freshly squeezed juice is drunk before meals 3 times a day (for 2 weeks) |
| Honey | Anti-inflammatory effect | 25 grams 2 times a day 1 hour after meals |
| Linseed oil | Accelerates the regeneration of damaged mucosa, which is important for the treatment of reflux esophagitis | Drink a teaspoon 2 times a day an hour before meals (10 days) |
| Flax seeds | Has an enveloping property, reduces the concentration of H+ ions | Pour boiling water over the flax seed overnight in a ratio of 1:5, take it in the morning before meals. Drink in weekly courses with a 10-day break |
| Herbs | Decrease in the concentration of H+ ions in the refluxate. Acceleration of mucosal regeneration. Strengthening gastric motility and LES tone. Reduced fermentation processes in the intestines, reduced flatulence |
Collection: chamomile flowers, flax seeds, licorice rhizomes, lemon balm leaves, taken in a ratio of 2:2:1:1. The ingredients are crushed and 1000 ml of boiling water is poured. The mixture of herbs is boiled in a water bath. Leave for 2 hours, strain the broth. You should drink the drink four times a day in an amount of 50 ml. |
| Chamomile | Anti-inflammatory | 1 sachet of chamomile is brewed with boiling water. Drink as tea 2 times a day after meals |
| Aloe | The juice has regenerative and anti-inflammatory properties, helps reduce the concentration of H+ ions | Freshly squeezed aloe vera juice is diluted with water (0.060–0.030), drink aloe before meals |
| Oatmeal jelly | Used as a component of dietary nutrition for reflux esophagitis and gastritis | Hercules flakes pour cold water in a ratio of 1:3. Leave it overnight. In the morning, strain and simmer until the liquid thickens. Eat as breakfast |
| Mint | Menthol oil has an antispasmodic, prokinetic effect. Reduces the activity of Helicobacter pylori. An incorrectly prepared mint solution can cause an aggravation of |
Pour 3 fresh mint leaves into 0.25 liters of boiling water. Drink once a day 0.5 hours before meals |
| Rose hip | Has an anti-inflammatory effect. Accelerates regeneration. Normalizes the functioning of the gastrointestinal tract, reduces the concentration of H+ ions in gastric juice |
60 grams of dry berries are poured into 1000 ml of boiling water and left for 6 hours. Drink instead of tea 3 times a day |
| Chicory | Blocks attacks of nausea, heartburn and discomfort after eating | Brew like coffee, take after meals |
| Goat milk | A symptomatic remedy that allows you to quickly relieve inflammation and unpleasant symptoms such as heartburn and belching | 1 glass per day in the morning before meals |
| plantain herb | Relieves pain, reduces the severity of symptoms, the inflammatory reaction, reduces the concentration of H+ ions | Squeeze juice from plantain leaves, dilute in 250 ml of water, drink throughout the day |
| Calendula | Has analgesic, anti-inflammatory, antiseptic and antispasmodic properties | 5 grams of dried flowers are brewed with 1 cup of boiling water. Drink like tea after meals |
| Dandelion | The drug reduces the severity of the inflammatory reaction and the severity of the main symptoms | The container is tightly filled with dandelion flowers, sprinkled with sugar. A teaspoon of the resulting syrup is dissolved in a glass of water. Drink before every meal |
Mineral waters for reflux esophagitis
Alkaline mineral waters are used for reflux esophagitis and gastritis during remission. Low-mineralized medicinal table waters are used. They normalize the motor and secretory functions of the stomach. They have a beneficial effect on the function of the esophageal sphincters.
"Borjomi"
Course treatment of RE mineral water"Borjomi" against the background of diet therapy significantly reduces the number of complaints, significantly reduces the acidity of gastric juice, improves its enzymatic properties, and cleanses the walls of the esophagus. The course of treatment is 21 days (drink 150 ml without gas three times a day 40 minutes before meals).
Borjomi resort "Essentuki No. 4"
Mineral water “Essentuki No. 4” reduces the secretion of H+ ions in the stomach and improves the functioning of the LES. For hyperacid gastritis and reflux esophagitis, drink water an hour before meals in a heated state, quickly, in large sips. Start taking Essentuki No. 4 with 100 ml, gradually increasing the dose.
Is it possible to cure reflux esophagitis forever?
It all depends on the severity of the disease. With grade 1 reflux esophagitis, for complete remission it is often enough to eliminate the causes of the disease, follow a diet, and use alternative medicine that has an anti-inflammatory, enveloping effect.
If the course is severe, then complex drug treatment is necessary to prevent complications.
If complications do arise, it is likely that surgical treatment will be required.
Reflux is the reverse flow of the contents of hollow organs in comparison with its normal movement.
This may be a natural phenomenon for a given physiological process or a consequence of the development of various pathologies. Often the cause is dysfunction of the sphincters that separate the hollow organs. A substance that moves in the opposite direction from the natural direction is called refluxate or refluxate.
Typically, two organs (divisions) are involved in reflux. The first will be where the reflux comes from, the second will be where the refluxate comes from. For example, it can be gastroesophageal, duodenogastric, vesicoureteral.
In some cases, reflux denotes not only the moment of reflux of the contents of one organ into another, but also a pathology, the cause of which is this physiological process. This is typical for vesicoureteral and pharyngolaryngeal reflux. It is important to understand the difference between gastroesophageal reflux (GER), which is considered a physiological act that is not always a pathology, and gastroesophageal reflux disease (GERD).
Common types of reflux
- Gastroesophageal or gastroesophageal - in this case, the contents of the stomach enter the esophagus.
- Duodenogastric - when contents from the duodenum enter the stomach.
- Duodenogastroesophageal or duodenogastric, in which intestinal contents reach the esophagus. It is a pathological disease.
- Duodenogastroesophageal or duodenogastric, in which the contents of the duodenum reach the mouth.
- Pharyngolaryngeal - stomach contents enter the pharynx. It is always a pathological form. Occurs due to a disorder of the upper esophageal sphincter.
That's what reflux is. Let's take a closer look at some of its forms.
Reflux esophagitis
This disease is one of the most common pathologies characteristic of the esophagus. Due to the fact that the mucous membrane of this organ does not have protection against various aggressive substances, contact with them can significantly damage the epithelium. The resulting inflammatory process in the esophagus provokes painful sensations.
Alas, it is simply impossible to track the actual frequency of this pathology, since the disease passes with mild symptoms, and patients do not even seek help from doctors. There is also a category of patients who have constant severe signs of the disease and require outpatient treatment. The most dangerous are refluxes with complications such as ulcers and various bleedings. This requires mandatory hospitalization and thorough treatment.
Let's look at what reflux esophagitis is in more detail.
Reflux esophagitis often occurs against the background of pathologies in the gastrointestinal tract (gastritis, ulcers, erosion). It may also be a sign of the formation of a hernia in the area of the esophageal opening of the septum of the diaphragm. How does this disease manifest itself? The symptoms of reflux are presented below.
Signs of pathology
Each age category has its own signs of this disease. Thus, reflux esophagitis in infants manifests itself in the form of belching and frequent regurgitation, sometimes accompanied by vomiting milk. While raising the baby to an upright position, you can observe a decrease in the mentioned symptoms, and immediately after the next feeding they may appear again. As you continue to remain horizontal, reflux may intensify. For this reason, after feeding, mothers carry their babies in a column, that is, vertically, for some time until the baby burps.
Symptoms of reflux may vary among different age groups. For older children, an important feature is the presence of complaints of disturbing frequent heartburn and belching of sour liquid. In addition, there is often a burning sensation in the area behind the sternum. The listed types of symptoms are most noticeable after eating, as well as when bending over and at night. Reflux in a child should not be ignored.
It is noteworthy that delayed gastric emptying occurs in 50% of all patients diagnosed with esophageal reflux. Due to the expansion of the volume of the stomach, the amount of contents in it also increases. This, in turn, is a prerequisite for the formation and development of the disease.
When a child has reflux, the reflux of substances that were the contents of the stomach into the esophagus occurs for a number of reasons. It is noteworthy that it is considered to be the norm, which can be present even in completely healthy infants and older children. In infants it occurs in the form of brief episodes. They often spit up milk or formula. If the disease is uncomplicated, then therapy is not required. The frequency of reflux in babies will decrease over time, because the angle between the stomach and esophagus will increase.
In a child, you can most often detect the presence of:
- refusal to eat;
- severe vomiting;
- hiccups;
- arching of the back and neck;
- frequent cough;
- changes in voice timbre;
- aspiration during regurgitation;
- ear inflammation;
- swallowing disorders;
- poor weight gain.
As for adults, it should be said that here most often one can notice painful sensations in the area behind the sternum, a lump in the throat, and heartburn. Some patients also experience extra-esophageal signs of the disease. These include manifestations such as sinusitis, caries, damage to tooth enamel, pharyngitis and inflammation of the larynx. The disease may also be similar to bronchial asthma- a person suffers from a severe cough and shortness of breath. By looking at the symptoms, you can better understand what reflux is.
Stages
The disease, as already noted, affects many people. But it can happen in different ways. It depends on the stage of the disease. The following degrees of reflux are distinguished:
- The initial stage of the development of the disease is considered to be gastroesophageal reflux disease, that is, reflux without esophagitis. It is often called non-erosive reflux disease. Main characteristics initial stage- during examination of the esophagus, no ulcerative changes in the mucous membrane are detected.
- 1st degree. The presence of individual areas with point-sized erosions is noted. There is swelling of the mucous membrane and hyperemia. There may be no obvious signs, which makes diagnosis difficult.
- 2nd degree. It has an erosive form. The size of erosions is 5 mm, they are merging and multiple.
- 3rd degree. The examination reveals large areas with ulcers on the mucous membrane. Signs of the disease cause concern regardless of food intake.
- 4th degree. Characterized by the presence of gastroesophageal reflux. That is, an extensive ulcerative lesion of the esophagus, covering an area of more than 75% of the entire surface. It is poorly treated and often develops into cancer.
When discomfort If you experience frequent heartburn during or immediately after meals, you should immediately consult a doctor. He will conduct an examination and prescribe comprehensive treatment that will prevent complications and serious consequences.
Forms
This disease can be acute or chronic:
- The acute type of gastroesophageal reflux is expressed in inflammation of the esophageal walls and painful sensations that are relevant when eating. Typical symptoms include fever accompanied by general malaise, as well as pain in the chest. In addition, there is a burning sensation and pain in the neck area along with excessive salivation and belching, and there is also a disturbance in the proper function of swallowing.
- Chronic reflux is expressed by corresponding inflammation of the walls of the esophagus, which is simultaneously accompanied by the appearance of pain in the chest. This can often be accompanied by gastritis. Unpleasant symptoms can make themselves felt when running; in addition, hiccups, difficulty swallowing and heartburn accompanied by vomiting may also occur.
Symptoms of biliary reflux gastritis
Reflux gastritis can be biliary. The reason for this pathology is the reflux of bile moving along the bile ducts back into the stomach.
With the biliary type of gastric reflux, symptoms manifest themselves in a feeling of heaviness. As well as fullness in the stomach, which is important during a meal or immediately after it. Additionally, there is the presence of bitterness and belching, an unpleasant taste in the mouth, nausea, and various bowel disorders, such as constipation, which alternate with diarrhea and bloating. Mostly reflux of the biliary type is not expressed by pain. If it occurs, it is dull and aching in nature, which worsens after eating. It should be noted that the described disease leads to a pathology in the body’s absorption of essential nutrients. In this regard, there is significant weight loss, general weakness, swelling on the lips, and dry skin.
Causes of biliary reflux
This type of disease is associated with disorders of the biliary system, with problems in its motility, that is, with dyskinesia and poor functioning of the sphincters.
Due to the formation of such disorders, which arise due to bile enzymes, as well as the pancreas, the contents that are in the duodenum enter the stomach and significantly burn it, thereby forming the well-known gastritis. Very often, biliary reflux can be combined with the diagnosis of duodenitis, in other words, inflammation of the duodenum. Doctors explain this combination by irritation produced by bile secreted outside the process of healthy digestion.
Symptoms of erosive reflux
With this form of the disease, the esophageal mucosa can be deeply damaged. Symptoms include heartburn, nausea, and occasionally vomiting, as well as belching. There is pain behind the sternum, it becomes difficult to swallow and a lump is felt in the larynx. Despite the fact that these symptoms are generally characteristic of esophagitis, in this situation they are more likely to be more pronounced, and therefore bring more anxiety and discomfort to the patient.
The development of the disease can be provoked by dietary errors, which include the consumption of all kinds of acidic foods, caffeine and alcohol. Often the course of the disease can be aggravated by medications, even such harmless ones as the usual paracetamol, aspirin, analgin.
How to get rid of the disease
In order to treat reflux, regardless of its form, the root cause must be eliminated first. These include gastritis, neurosis, peptic ulcer or gastroduodenitis. With proper treatment, reflux symptoms will subsequently become less severe. At the same time, it will be possible to reduce the harmful effects of gastric contents entering the esophagus.
The first step in treatment is nothing more than proper diet for reflux, during which you need to exclude tomatoes, caffeine, spicy, fatty foods, chocolate, citrus fruits. It is also important to refuse bad habits- stop smoking and drinking alcohol.
The last meal should be no later than three hours before bedtime. Overeating has a very negative effect on the digestive tract. You need to eat in small portions, but quite often - up to six times a day.
When diagnosed with reflux esophagitis, the patient should reduce dairy and other foods that cause bloating in the diet:
- fresh or sauerkraut;
- black bread;
- green peas and beans;
- mushrooms;
- fresh berries, fruits;
- carbonated drinks.
In this case, it is allowed to include in food:
- eggs, but soft-boiled;
- cottage cheese;
- cereal products;
- crackers and stale bread;
- meat or fish soufflé;
- steamed meatballs from lean meat;
- baked apples;
- compote.
Additionally, in such cases, the doctor prescribes medications, the effects of which significantly reduce the amount of acidity in the stomach (antacids). Due to this, intestinal motility is normalized. You also need to add extra pillows while sleeping. This measure helps reduce heartburn, as well as pain that may appear in the sternum. A diet for reflux must be followed.
Thus, in order to diagnose the disease, it is recommended to consult a gastroenterologist. Based on the patient’s complaints, severity of pathology and duration, as well as endoscopic and morphological assessment of changes, appropriate treatment is prescribed.
Treatment of reflux with folk remedies
Dandelion effectively helps in the fight against reflux. Rinse the yellow inflorescences of the plant thoroughly and place in a 3-liter jar. Fill the container to the top. Sprinkle the flowers with sugar and leave until the juice appears. Dandelion syrup is diluted with water and drunk daily before meals.
To prevent and cure this disease, you should drink celery juice. It is better to do this on an empty stomach, 1 tbsp. l. half an hour before meals.
You can relieve symptoms and eliminate inflammation with dill infusion. To prepare it, grind 2 tsp. seeds and pour boiling water over them. The container is covered and kept for three hours. Take 1 tbsp four times a day. l.
Herbal decoctions can relieve inflammation and relieve pain by normalizing the acidity of gastric juice. The most useful are:
- motherwort grass;
- licorice;
- Melissa;
- flax-seed.
You can combine these components with each other. All ingredients are ground to a powder state. You need to take 1 tablespoon of each plant and pour boiling water over it. Heat in a water bath for 10 minutes. For esophagitis you need to take 60 ml 4 times a day.
For heartburn and belching, a different recipe should be used. To do this, calamus, rose hips, valerian and dandelion flowers are mixed in equal parts and poured with boiling water. The mixture is infused for fifteen minutes. Take a teaspoon of infusion on the first day. Add 30 ml to it clean water. Take 3 times a day before meals. On the second day, add a large spoonful of water. On other days, the dosage is increased to 2 tbsp. l. The course of therapy in this way is sixty days.
You can use plantain juice. It has a powerful healing effect. People with high stomach acidity should not drink it. The juice is easy to prepare. To do this, you need to take well-washed leaves and grind them in a blender. Then squeeze through cheesecloth. Drink 1 tablespoon of juice during meals. Do not use more than four times a day.
Products based on flax seed have enveloping properties.
For reflux esophagitis, take honey. It is better to do this an hour or two before meals. Doctors advise diluting it with water, so it is more gentle on the stomach. The course of therapy is about 2 months.
We looked at what reflux is and how to treat it correctly.
Many people, when they hear the diagnosis, think: erosive reflux esophagitis - what is it. This is a disease in which the mucous layers in the lower region of the esophagus become inflamed. This disease develops due to the fact that food coma and other substances from the stomach are often and aggressively thrown into this part of the tubular organ.
Causes of the disease
This disease is considered one of the stages of gastroesophageal reflux disease. The gastric contents are food lump, hydrochloric acid, mucus, enzymes for digestive processes, and sometimes also pancreatic juice and bile acid. The reflux of stomach contents into the esophagus is gastroesophageal reflux. This problem can occur even in a relatively healthy person. But usually this happens no more than 2 times during the day. Duration is up to 5 minutes. In the daytime, due to food intake, this phenomenon is observed more often. Most reflux is not even felt by a person.
To prevent such reversals, a healthy body has several protective mechanisms. This applies to the following phenomena:
- the tone of the esophageal sphincters is at a sufficient level, both at the lower and at the top (these are muscle valves that are located at the transition of the organ, at the top - into the pharynx and at the bottom - into the stomach);
- self-cleaning of the esophagus (in this case, the reflux fluid entering the esophagus is neutralized);
- the integrity of the mucous membrane of the esophagus, it is quite strong and, most importantly, intact (in this case there must be normal blood circulation so that the glands produce a sufficient amount of mucus, as well as substances such as prostaglandins and bicarbonates, the cells of the mucosa must be constantly renewed);
- rapid removal of gastric contents that have entered the esophagus;
- regulation and control of acid formation in the stomach.
The causes of reflux esophagitis are very diverse. This pathology can be caused by various factors that will reduce the effect of protective factors or completely suppress them. For example, it could be smoking. The reason may also be overweight. Excessive loads also have an adverse effect, especially when it comes to the abdominal muscles. So if you are prone to this pathology, you should not carry heavy objects. Often the problem lies in the diet, or rather its improper use. Under no circumstances should you eat sour foods. It is very harmful to overeat before bed. Often the problem lies in addiction to alcoholic beverages. Stress and emotional tension also harm the human body. You cannot wear tight clothes - corsets, bandages, etc. They put pressure on the body and internal organs and harm blood flow.
Erosive reflux esophagitis can also be caused by the consequences of surgery or bougienage. Also common cause is a hernia in the opening of the esophagus. Due to the too wide lumen, the contents of the stomach exit back through the sphincter. In addition, this pathology is often provoked by medications that the patient took for too long and without the supervision of a doctor. This usually applies to drugs with anti-inflammatory properties, a group of medications - calcium antagonists, antibiotics, nitrates, antidepressants, beta-blockers, theophyllines, quinidine, hormonal, sedatives and narcotic drugs.
Reflux esophagitis often appears in pregnant women, but then, after childbirth, it disappears. In addition, children also develop this pathology if there are abnormalities in the development of the muscular system and nervous system. It is also necessary to take into account constipation, which gradually becomes chronic. Another cause is scleroderma.
At first, stomach enzymes, lysolecithin and bile acid simply irritate the walls of the esophagus when thrown into it. As a result, the first symptoms appear. Then the inflammatory process develops. If reflux regularly comes into contact with the mucous membrane, erosions appear. They subsequently become the cause of strictures (these are scar-type deformities). The organ often bleeds. Besides, inflammatory processes, which are not controlled, can cause changes of a precancerous type (Barrett's syndrome), and then they degenerate into malignant tumors. As a result, adenocarcinoma develops.
Symptoms of the disease
If a patient has reflux esophagitis, the symptoms will differ depending on the form of this disease. There are non-erosive and erosive forms. With a non-erosive type of disease, only swelling and redness of the walls will be detected during an endoscopic examination. In the erosive form, erosions of varying lengths will be detected. In this case, the degree is indicated - from first to fourth or a-d. The doctor determines it depending on the degree of organ damage and the prevalence of defects. In addition, it is necessary to determine the presence of complications - ulcers, Barrett's syndrome, stricture, shortening of a tubular organ.
Signs of reflux esophagitis will differ depending on the degree of organ damage. The disease can occur in a latent form, so that symptoms do not appear at all. But most often erosive esophagitis greatly disturbs a person. All clinical manifestations conditionally divided into extraesophageal and esophageal.
As a rule, symptoms of the esophageal type occur after overeating, eating dinner late, dietary errors, drinking alcohol or carbonated drinks, stress and physical strain. Symptoms usually appear when a person is lying down or lifting heavy objects. Symptoms of the esophageal type are as follows:
- in 75% of all cases heartburn occurs;
- sometimes the intensity of salivation increases;
- nausea and vomiting attacks;
- belching – bitter or sour;
- in the morning there is an unpleasant taste in the mouth - sour or bitter;
- sometimes there are problems with swallowing food (this occurs due to the fact that the esophagus contracts);
- You may feel discomfort or even pain when swallowing.
A burning pain is felt in the epigastric region. A person can easily confuse it with heart pain, heart attack and angina pectoris. Then these sensations spread to the neck, chest, and the area between the shoulder blades.
All of these esophageal symptoms are considered classic. They can appear all together, or only part of them appears.
As for extra-esophageal symptoms, they are more difficult to associate with reflux esophagitis. For example, the voice becomes hoarse and there is a lump in the throat for a long time. Ulcers and granulomas appear on the vocal cords. A person coughs for a long time, producing sputum and mucus. Sometimes suffocation occurs. The gums may become inflamed. Damage to tooth enamel rarely occurs. Sometimes a person feels pain in the lower part of the mouth. My neck hurts from time to time. Laryngeal papillomatosis rarely appears. The mouth smells unpleasant. In some cases, the heart rhythm is disrupted.
Therapeutic measures
For erosive reflux esophagitis, it is necessary to begin treatment as early as possible. It is recommended to make lifestyle adjustments and eat right. Medicines are usually prescribed. In severe cases it is required surgical intervention. Treatment is usually carried out on an outpatient basis. Hospitalization is required only if severe complications are detected.
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Erosive esophagitis appears due to an incorrect lifestyle, so it is recommended to change it for the better. It is required to stop smoking and drinking alcohol. It's better not to indulge in carbonated drinks. You definitely need to monitor your own weight and get rid of extra pounds. The part of the bed where the head is located needs to be raised by 15 cm. Moreover, pillows cannot be placed - because of them, the pressure inside increases abdominal cavity. You cannot lie down for 3 hours after eating. It is prohibited to wear tight clothing, especially belts, elastic bands, girdles, bandages and corsets. You can't lift weights. You definitely need to play sports and walk in the fresh air.
A diet for erosive reflux esophagitis is mandatory. It will help prevent the development of complications. A gentle diet is prescribed. You can’t overeat, but it’s also forbidden to starve yourself. Do not rely on full-fat milk, cocoa, coffee, egg yolks, butter, margarine, pepper, garlic and onions, tomatoes, chocolate, mint, citrus fruits. All these products reduce the tone of the esophageal sphincters.
Drug therapy
Erosive esophagitis must be treated with medications. This treatment involves the use of two directions. First you need to use powerful drugs, and then intensity medicines decreases. Then the second strategy should increase the pharmacological effect.
Antisecretory drugs must be prescribed. They reduce the intensity of secretion in the stomach. Since the acidity level in the organ drops, the contents of the stomach do not affect the esophageal mucosa. These drugs include proton pump inhibitors. H2-blockers and M-anticholinergics are also required. The duration of the course will be determined by the doctor, but it lasts at least a month.
In the erosive form, prokinetics are required. For example, domperidone, metoclopramide, etc. They will be able to improve their motor skills. Alginates and antacids will be needed. They neutralize the effect of hydrochloric acid.
Erosive-ulcerative esophagitis is a fairly common disease. With this disease, the mucous membranes of the esophagus in its lower part become inflamed. This occurs because stomach contents flow back out of the organ. As a result, hydrochloric acid and enzymes damage the walls of the organ. If the disease is not treated, then erosions and ulcers will appear in the areas of inflammation.
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The symptoms and treatment of this disease are determined by the doctor; you should not self-medicate.
But in addition to medications, you need to pay attention to normalizing your lifestyle, proper nutrition, therapeutic exercises.
