Erosive gastritis reflux esophagitis. Erosive reflux esophagitis: ideas about causes, manifestations and treatment

Reflux esophagitis is a disease of a chronic nature, which consists in the pathological reflux of gastric contents into the esophagus.

Since there is no protection against such aggressive substances in the mucous membrane, epithelial damage occurs due to contact with them, with further inflammation and, accordingly, painful sensations.

When reflux esophagitis occurs, the acidity level of the esophagus drops markedly due to the mixing of the contents of the esophagus with acidic gastric reflux and digestive enzymes. The result of prolonged contact of the mucous membrane of the esophagus with such an irritant is its inflammation and trauma.

In this article, we will look at reflux esophagitis, its first symptoms and the basic principles of treatment, including at home.

The reasons

Why does reflux esophagitis occur, and what is it? The cause of reflux esophagitis lies, as a rule, in the excessive relaxation of the esophageal sphincter at the entrance to the stomach. This muscle should be in a compressed state most of the time. A healthy esophagus only relaxes for 6-10 seconds to allow food or liquid to pass through. If the sphincter remains relaxed for longer (up to a minute for patients after each swallow), this causes a regression of the acidic contents of the stomach into the esophagus.

Often reflux esophagitis accompanies diseases of the gastrointestinal tract, such as:

• or stomach cancer;
• vagus nerve damage;
• violation of duodenal patency of the esophagus;
• pyloroduodenal stenosis;

It is not uncommon for reflux esophagitis to occur after stomach surgery. Also, the disease can be the result of smoking, drinking alcohol and drinking a lot of coffee. In some cases, sphincter relaxation occurs in people suffering from a hernia of the esophagus or from penetration of part of the stomach into the chest. This is seen in obese people, as a large belly increases pressure on the diaphragm.

Erosive reflux esophagitis

A complicated form of the disease, in which small ulcers (erosion) form on the esophageal mucosa. With erosive reflux esophagitis, all of the above symptoms become more pronounced, bringing tangible discomfort to the patient. Manifestations of the disease are aggravated after eating, as well as certain drugs, such as aspirin.

Degrees

The course of the disease is characterized by several stages, and the symptoms gradually increase, and the erosive lesion of the esophagus becomes more pronounced.

1. degree - manifested by separate non-merging erosions and erythema of the distal esophagus;
2. degree - merging, but not capturing the entire surface of the mucosal erosive lesions;
3. degree - manifested by ulcerative lesions of the lower third of the esophagus, which merge and cover the entire surface of the mucosa;
4. degree - chronic ulcer of the esophagus, as well as stenosis.

Symptoms of reflux esophagitis

If reflux esophagitis occurs, the symptoms of this disease may be pain behind the sternum, extending closer to the heart and even to the left shoulder, and can also suck in the pit of the stomach. Very often, the patient does not even associate these symptoms with problems with the esophagus at all, they are mistaken for an angina attack.

So, the main signs of reflux-esophagitis in adults are:

• belching air or food;
• heartburn;
• nausea;
• regurgitation;
• sour taste in the mouth;
• incessant hiccups.

Symptoms of reflux esophagitis often worsen when lying down (especially after eating) and disappear when sitting.

Chronic reflux esophagitis

Esophagitis in a chronic form, with a characteristic change in periods of exacerbation with periods of remission, can either be the result of acute undertreated reflux esophagitis, or develop against the background of alcoholism and the intake of coarse poor-quality food.

According to the types of changes, reflux esophagitis can be:

• superficial (distal);
• erosive;
• hemorrhagic;
• pseudomembranous, etc.

Signs of reflux esophagitis in the chronic stage, with a medical examination using X-rays, may be a violation of the mucous membranes of the esophagus, the appearance of ulcers and erosions.

Diagnostics

Today, quite different methods are used to detect gastroesophageal reflux. Thanks to the x-ray of the esophagus, it is possible to fix the ingress of contrast from the stomach into the esophagus or to find a hernia of the esophageal opening of the diaphragm.

A more reliable method is long-term pH-metry of the esophagus (measurement of acidity in the lumen of the esophagus using a probe). This allows you to set the frequency, duration and severity of reflux. And yet the main method for diagnosing reflux esophagitis is endoscopic. With it, you can get confirmation of the presence of the disease, and determine the degree of its severity.

In general, the symptoms and treatment of reflux esophagitis depend on the severity of the disease, the age of the patient, and comorbidities. Some forms require no therapy, while others require surgery.

How to treat reflux esophagitis

When symptoms of reflux esophagitis appear, treatment consists in eliminating the disease that caused it (gastritis, neurosis, peptic ulcer or gastroduodenitis). Proper therapy will reduce the symptoms of reflux in adults, help reduce the harmful effects of gastric contents thrown into the esophagus, increase the resistance of the esophageal mucosa, and quickly clear the stomach after eating.

Conservative treatment shown to patients with uncomplicated disease. It includes general recommendations:

• after eating, avoid bending forward and do not lie down for 1.5 hours
• sleep with the head end of the bed raised by at least 15 cm,
• do not wear tight clothing and tight belts,
• limit the consumption of foods that are aggressive to the esophageal mucosa (fats, alcohol, coffee, chocolate, citrus fruits, etc.),
• give up smoking.

drug therapy with reflux esophagitis, at least 8-12 weeks are carried out, followed by maintenance therapy for 6-12 months. Appoint:

• proton pump inhibitors (omeprazole, lansoprazole, rabeprazole) in regular or double dosage,
• antacids (almagel, phosphalugel, maalox, gelusil-lacquer, etc.) are usually prescribed 1.5-2 hours after meals and at night,
• prokinetics - domperidone, metoclopramide.

To reduce the manifestation of symptoms such as heartburn and chest pain in the supine position, you should adopt the correct posture - the upper body should be slightly elevated, for which several pillows can be used.

Operation

This treatment is rarely used. Main indications for surgery:

• Ineffectiveness of long-term drug treatment.
• Development of Barrett's esophagus with the risk of malignancy (development of cancer of the esophagus).
• Esophageal strictures.
• Frequent esophageal bleeding.
• Frequent aspiration pneumonia.

The main method of surgical treatment is the Nissen fundoplication, which restores the normal functioning of the cardiac sphincter.

Diet

With reflux esophagitis, the diet is quite strict and prohibits eating a certain amount of food. Among them:

• alcoholic drinks, natural fruit juices, carbonated drinks;
• pickled and smoked foods, pickles;
• strong broths and soups cooked on them;
• fatty and fried foods;
• fruits (especially citrus fruits);
• spices, sauces;
• chewing gum;
• products that increase gas formation (cabbage, black bread, milk, legumes, etc.);
• products that relax the lower gastric sphincter and provoke stagnation of food masses in the stomach (sweets, strong tea, chocolate, etc.).

The diet of a person suffering from reflux should include the following foods:

• soft-boiled eggs,
• low-fat milk and mashed low-fat cottage cheese,
• dairy products,
• porridge,
• meat and fish soufflé,
• steamed cutlets and meatballs,
• crackers soaked in water or stale bread,
• baked apples.

• nutrition of patients suffering from reflux disease should be fractional and include five to six meals a day, the last - four hours before bedtime.
• portions should be small so that the stomach is filled with only a third of its volume.
• Afternoon sleep is better to replace with a quiet walk. This contributes to the fact that food quickly gets from the stomach to the intestines, and the reflux of acidic contents into the esophagus will not occur.

To reduce gastroesophageal reflux, you must:

• lose weight
• sleep on a bed with a high headboard,
• observe time intervals between meals and sleep,
• stop smoking,
• stop drinking alcohol, fatty foods, coffee, chocolate, citrus fruits,
• break the habit of drinking water.

Folk remedies

Treatment of reflux esophagitis with folk remedies can only be carried out as an auxiliary procedure. Alternative treatment of reflux esophagitis is based on taking decoctions that soothe the mucous membrane of the esophagus, products that stimulate the tone of the sphincter, reduce acidity and fight heartburn.

Forecast

Reflux esophagitis has, as a rule, a favorable prognosis for working capacity and life. If there are no complications, then it does not reduce its duration. But with inadequate treatment and non-compliance with the recommendations given by doctors, new relapses of esophagitis and its progression are possible.

At the present time, there are active discussions between scientists from different countries about the described disease. The thing is that, on the one hand, this disease is considered as an independent pathology, and on the other hand, as a complication or one of the forms of the course.

This is a disease of the esophagus, which has a chronic course and is manifested by degenerative changes in the wall of this organ in the form of erosive lesions.

So why do many doctors tend to believe that this is not an independent nosology, but a form of manifestation of GERD. This is explained by the fact that the most common cause of the disease is the reflux of acidic contents from the stomach cavity into the esophagus.

And this is directly related to reflux pathology. In addition, both of these concepts usually accompany each other.

Causes of the disease

The very first group of causes includes those that directly cause gastroesophageal reflux. These include:

1. Conditions under which the closing work of the muscular apparatus of the sphincter between the esophagus and stomach is damaged. As a rule, this is a pathological breakdown at the level of the nervous and hormonal systems. These conditions are:

• dysregulation of the central nervous system, with various injuries, bruises, poisoning with poisons and chemicals;
• hormonal imbalance, pathological changes in the endocrine system;
• muscle ataxia, paralysis, paresis of sphincters, including the esophageal.

As a result of these pathologies, the sequence of passage of food through the gastric tract is disrupted. Due to incomplete closure of the sphincter valves, the contents of the stomach flow back into the esophagus and cause a destructive effect on its wall.

2. Intermittent failure of the sphincter. Violation of its work is not systematic, regular, but occurs under certain conditions. These conditions are:

• irrational food intake, periods of fasting are replaced by periods of overeating;
• the use of hard foods in the diet that can injure the internal membranes of organs;
• drinking plenty of fluids in a short period of time.

3. "Non-reflux" causes. Among them, changes from other digestive organs are most often distinguished:

• mechanical defects or formations in the stomach cavity: stenosis, postoperative scars, tumors, polyps, diverticula, hernial protrusions, malformations.
• bad habits: smoking, drinking alcohol or psychotropic substances;
• eating raw fish or raw meat;
• thermally poorly processed food;
• prolonged fasting;
• prolonged stressful situations, shocks, depressions;
• taking certain drugs: antibiotics, NSAIDs, hormones and others;
• other concomitant chronic diseases: oncological processes, hepatitis, chronic pancreatitis, cholecystitis, food poisoning.

The disease is classified into stages depending on the spread of the erosive process:

1. Stage I - single shallow erosion without signs of confluence and complications.
2. Stage II - erosive lesions with a tendency to unite and merge. At the bottom of the erosions, full-blooded vessels are visible, their edges are edematous, swelling.
3. Stage III - extensive damage by erosive elements, up to ulcerative defects, with signs of complications in the form of bleeding, perforation, malignancy.

According to the severity are distinguished:

• Mild degree - mild symptoms and clinical manifestations. The patient practically does not complain.
• Medium degree - the general condition suffers moderately, performance is impaired, the patient is concerned about the main complaints.
• Severe degree - a pronounced violation of the organ, poor general condition of the patient, painful symptoms, damage to other organs and systems, the presence of complications in the form of bleeding, perforation, perforation.

How to identify a disease

You can't do it without the help of a qualified specialist. The doctor must collect all the necessary information about the complaints, detail them and prescribe the necessary medical examination methods.

• The most informative way to learn about pathology is to conduct an endoscopic examination -. It will reveal the presence of erosions, their characteristics, complications or their absence. In addition, the degree and extent of the lesion is assessed. The endoscopist describes the visual picture, and the doctor, taking into account all complaints and examinations, makes a diagnosis.
• If necessary, resort to the method of pH-metry. This must be done to assess the acid-base composition of the esophagus and to prevent aggressive effects on its wall by an acidic environment.
• To exclude other diseases or to confirm concomitant diseases that could cause esophagitis, an ultrasound examination of the abdominal organs is prescribed.
• X-ray diagnostics of the esophagus with a contrast agent. Deep erosions can be visualized by this method.
• The use of high technologies - computed tomography and magnetic resonance imaging. With the help of these studies, it is possible to examine in a volumetric version the wall of the organ and its damage.

Symptoms and treatment of erosive reflux esophagitis

The symptoms of the disease are somewhat similar to those of gastroesophageal reflux disease, they are varied and can manifest in different combinations. But some signs have their own significant difference, which helps to identify this form of the disease.

• Pain and discomfort in the upper abdomen. Patients may report chest pain. Sometimes such signs can be masked as diseases of the heart, lungs, mediastinum.
• A very characteristic sign is the sensation of the passage and movement of food through the esophagus and stomach. Due to the fact that the erosion surface contains a large number of pain and sensory receptors, this phenomenon occurs.
• Difficulty swallowing food bolus. The process occurs in severe forms with damage to the uppermost parts of the esophagus.
• Heartburn. The symptom in this disease is more pronounced and painful than in GERD. It is permanent, regardless of what the patient ate when it was. Heartburn attacks can occur even at night. Any physical labor exacerbates the course of the symptom.
• The taste of blood in the mouth. A very important distinguishing feature. Appears with bleeding erosions. It is a formidable symptom, after which you should definitely consult a doctor.
• Belching of gas or undigested food. Among other things, there may be an eructation of acidic contents mixed with bile or hydrochloric acid.
• Indomitable hiccup. Usually, few people pay attention to this symptom. However, do not forget about it. With the described pathology, this phenomenon may be the only sign of the disease.
• Increased production of salivary glands. A person notices an increase in the amount of saliva in the oral cavity.
• Sensation of a lump in the throat. This symptom may masquerade as a sore throat.
• Dry cough.
• Decrease in the timbre of the voice.

If you notice one of these symptoms in yourself, you do not need to immediately become sure that you have esophagitis. Only a set of signs and a complete diagnostic examination by a doctor will give you reliable information about your health.

Treatment of the disease

When treating this type of esophagitis, it is important to take into account that the pathologies that contributed to its formation should also be treated. Usually therapy is carried out on an outpatient basis.

In the hospital, severe forms requiring surgical interventions are treated. When prescribing treatment, the doctor must comply with the following criteria:

• therapy should be complex;
• complete;
• correspond to the state, severity and course of the disease;
• there should be a minimum number of side effects;
• aimed at recovery, prevention of complications.

First of all, it is important for the patient to explain that he should change his lifestyle and nutrition in a more correct direction.

The regime of the day, rational nutrition, protective regime of work and rest must be observed. It's important to watch your weight. If there are excess kilograms, you need to gradually get rid of them.

If, on the contrary, the weight is not enough, it must be reached with a balanced diet to the norm. Clothing should be comfortable, loose, and pinching in the abdominal cavity should be avoided. Tight clothing should not be worn.

After eating for 40 minutes, be in a sitting or standing position, do not engage in physical activity during this time. Daily walks in nature should be included in the daily routine.

The diet should be balanced, rich in easily digestible components, correspond to the energy and plastic costs of the body.

We exclude from the diet alcohol, tobacco, bad habits, spicy, fried, raw meat, canned food, chocolate, coffee, soda, concentrated juices.

We add cereals, sour-milk products, boiled, steamed dishes, fish, chicken breast, fresh vegetables, fruits, except citrus fruits, compote, jelly, tea to the diet.

Meals should be divided into 6 time intervals in small portions. The last dose should be 2 hours before bedtime. When expressed, you need to sleep with a raised head end.

Medical therapy

antacid group. The drugs neutralize the acidic contents in the esophagus, reduce the risk of damage to the mucosa, prevent the appearance of new erosions, and promote the healing of the old ones. Most often prescribed maalox, phosphalugel.

Antisecretory drugs. Here the choice is between proton pump inhibitors and H-histamine receptor blockers. Blockers include omeprazole, emanera, lansoprazole and others.

Therapy is carried out for a long time. The course is at least three months. They help reduce acidity. Contribute to the prevention of complications and relapses.

The main group are prokinetics. They have an anti-reflective effect. Cerucal, metoclopramide, domperidone can be used.

They operate at the central level. Eliminate heartburn, nausea, vomiting, bitterness in the mouth. A group of drugs is especially effective when combined with gastroesophageal reflux disease.

In addition, if there are other pathologies from the gastrointestinal tract, it is necessary to treat them as well. Enzymes can be prescribed: mezim, pancreatin; probiotics: linex, normobact, adsorbents: activated carbon, hepatoprotectors: phosphaglyph and others.

Surgical treatment is indicated for severe forms and the course of the disease with complications.

Treatment with folk remedies

Patients do not always believe in the healing effect of medicinal herbs. However, when combined with drug therapy, herbs prove to be a very important helper. They enhance the effect of medicines and have their own therapeutic properties.

From this pathology, decoctions of chamomile and dill have an effect.

Ordinary pharmacy chamomile is very good. You can buy ready-made packaged fees or use the loose option. In any case, it is necessary to fill the phytocollection with hot boiled water, let it brew for two hours.

Drink 250 ml daily for at least two weeks. This simple recipe will help relieve pain and heal erosions.

Dill solution is prepared in a similar way. It is best to brew dry.

Sea buckthorn, nettle leaves, aloe, propolis have healing properties.

Many sources describe the healing effect of celery, or rather its juice. Freshly squeezed juice drink 1 tablespoon before meals.

At home, you can independently prepare a collection of chamomile, mint, lemon balm and flax seeds. In equal proportions, tea is brewed from these herbs. Insist in a teapot or thermos and use before going to bed.

Potato juice is effective in mild pathology. The potatoes are thoroughly washed, peeled, rubbed on a grater, squeezed and filtered through cheesecloth. If you get a thick consistency, you can dilute a little with boiled water. Take 1 tablespoon 3 times a day.

Problems with the digestive organs are the scourge of modern society. First of all, this is due to gastronomic habits (fried foods, fast food, etc.) and a disturbed diet, frequent stress and bad habits.

One of the most common diseases of the gastrointestinal tract - reflux esophagitis, is recorded in almost half of the population. However, patients often hesitate to contact a doctor when symptoms of reflux esophagitis appear, and treatment is delayed or requires more radical measures due to total damage to the esophagus and the occurrence of complications.

Reflux esophagitis - what is it?

Reflux esophagitis is an inflammatory process that affects the mucosa of the esophagus as a result of regular throwing of the contents of the stomach and duodenum 12 into the esophagus. Let's take a closer look at what it is.

Reflux esophagitis, medically called gastroesophageal reflux disease (GERD), develops in the distal esophagus. Starting with catarrhal inflammation, the disease passes into an erosive stage, followed by scarring. A more severe variant of the course of GERD is necrosis and perforation of ulcerative foci.

Reflux disease is chronic and is caused by the following disorders: impaired evacuation of food from the stomach and increased intra-abdominal pressure. However, the following conditions are necessary for the development of the disease:

• decreased tone of the circular muscle (lower sphincter) of the esophagus;
• aggressive properties of the contents of the stomach thrown into the esophagus;
• reduced regenerative capacity of the esophageal mucosa as a result of circulatory disorders.

The causes that provoke reflux esophagitis include both organic pathology and external factors:

• diaphragmatic hernia of the esophagus;
• congenital pyloric stenosis and acquired pylorospasm;
• ulcerative lesions of the stomach and duodenum;
• gastritis (especially with reproduction in the stomach of Helicobacter pylori);
• systemic scleroderma;
• operations on the esophagus and stomach;
• smoking, alcohol abuse;
• long-term use of medications that reduce the tone of the esophageal sphincter (Metoprolol, Nitroglycerin).

The risk of developing reflux esophagitis is significantly increased by obesity and pregnancy, the consumption of spicy foods, coffee and undiluted fruit juices.

Stages of reflux disease

Symptoms of GERD - their severity and impact on the general condition of the patient - directly depend on the degree of damage to the esophageal mucosa.

There are the following stages of reflux esophagitis:

1. stage 1 - minimal damage to the mucosa of the esophagus, the diameter of the focus of inflammation is less than 5 mm, limited to one fold;
2. stage 2 - single or multiple foci larger than 5 mm;
3. stage 3 - the spread of inflammation to 2 or more folds, in total, less than 75% of the circumference of the esophagus is damaged;
4. Stage 4 - large, merging foci, the circumference of the lesion is more than 75%.

Symptoms of reflux esophagitis according to the forms of the disease

Symptoms of reflux esophagitis are manifested not only by signs characteristic of damage to the gastrointestinal tract, but also, at first glance, not associated with damage to the esophagus. Typical flowing reflux disease can be suspected by the following regularly recurring symptoms:

• Heartburn and burning soreness behind the sternum - the patient often indicates their occurrence after eating, especially after coffee, fatty / hot food, alcohol;
• Belching of sour or air, nausea;
• Lump in throat and difficulty swallowing food;
• Pain after eating - occur 1-1.5 hours after eating, indicate a pronounced inflammatory process.

Symptoms of reflux esophagitis are especially aggravated if the patient lies down in bed (takes a horizontal position) after eating.

Often the disease proceeds in an erased form. In typical signs, the severity of which can vary significantly (possibly asymptomatic course, the disease is detected during EGD), symptoms uncharacteristic of reflux esophagitis are added.

• Pulmonary GERD

It combines dyspeptic symptoms (belching, heartburn) and signs of bronchial obstruction: a long-lasting cough, shortness of breath, asthma attacks at night.

The process of throwing acidic contents from the esophagus into the bronchi is often diagnosed as bronchitis, but its treatment does not bring the desired recovery. Also, reflux esophagitis in the pulmonary form can provoke bronchial asthma.

• Cardiac form of reflux disease

The anatomically close location of the nerve plexuses causes the frequent occurrence of symptoms that mimic angina pectoris. However, pain attacks always occur after a nutritional error: overeating, eating spicy and sour foods, fatty and fried foods.

• Otolaryngological form of reflux esophagitis

Often, against the background of heartburn and belching, the patient notes a sore throat and sore throat (simulation of pharyngitis), the appearance of nasal congestion and the release of clear mucus (rhinitis due to irritation with acid reflux into the nasal passages and swelling of the nasal mucosa).

• Dental form of reflux inflammation of the esophagus

The acidic contents of the stomach, bypassing the esophagus and entering the oral cavity, destroy tooth enamel. The patient may note total caries.

Reflux esophagitis without timely treatment lasts for years with a gradual increase in symptoms and can lead to irreversible changes in the esophageal mucosa - scarring.

The treatment regimen for reflux disease includes a complex effect aimed at eliminating its cause and symptoms. For a complete cure, long-term adherence to all points of the treatment regimen is necessary:

Drug therapy

Treatment of reflux esophagitis with drugs is prescribed only by a qualified gastroenterologist and includes:

• Substances that reduce acidity - antacids (Almagel, Maalox, Phosphalugel, Rennie), antisecretory PPIs (Omeprazole, Rabeprazole, Pantoprazole);
• Means for healing erosion - Solcoseryl, Actovegin, Drotaverin, Pantothenic acid, sea buckthorn oil;
• Medicines that eliminate nausea and belching by increasing gastrointestinal motility - Motilium, Cerucal, Raglan.

Regime events

A strict regimen will not only speed up recovery, but also prevent the occurrence of exacerbations. The habit should be:

• Education of stress resistance.
• Sleep 7-8 hours. The head should be raised by 25-30º.
• Refusal of corsets and slimming underwear.
• Don't lift weights.
• Eufillin, nitrates, β-blockers, hypnotics and sedatives aggravate the course of reflux esophagitis and make it difficult to treat. Avoid them if possible.

Diet food

A diet for reflux esophagitis excludes all foods that can increase the acidity of the stomach and cause bloating. What not to eat when sick:

• drinks - alcohol, strong tea, soft drinks, coffee;
• pickles, smoked meats, all canned foods;
• legumes, black bread;
• mushrooms, fresh/sauerkraut;
• fast food, chips;
• fried and spicy dishes;
• sauces - ketchup, mayonnaise;
• gum.

The menu for reflux esophagitis should be composed of the following products:

• milk, low-fat cottage cheese and sour cream;
• chicken, soft-boiled eggs;
• cereals boiled in water;
• dried white bread;
• lean meat, steamed, in the oven;
• boiled vegetables;
• boiled lean fish;
• compotes, kissels from sweet fruits.

Surgery

Surgery for reflux disease is performed with the ineffectiveness of conservative therapy, the development of Barrett's esophagus, bleeding, severe adhesive narrowing of the esophagus.

Severe hypotonicity of the esophageal sphincter, which does not recover within 6 months of complex treatment of reflux esophagitis, also requires the intervention of surgeons.

However, even a successful operation, the patient must regularly repeat prophylactic courses of taking proton pump inhibitors (omeprazole, etc.).

Forecast

Although conservative treatment of reflux esophagitis is quite successful, any violation of the diet can cause an exacerbation. Each patient should remember: after a course of drug therapy, usually lasting 2 weeks, reflux disease is not eliminated!

Only treatment with regular medication courses, lifelong dieting and exclusion of provoking factors can prevent the development of relapses of the disease and its complications in the form of perforation of ulcerative areas and bleeding, adhesions.

Due to the constant reflux of gastric contents (sometimes along with the contents of the duodenum), the mucous membrane of the esophagus is injured. A serious disease develops - reflux esophagitis. It is dangerous with severe bleeding from and erosion, degeneration into Barrett's esophagus,. With reflux esophagitis, treatment is long, since it is necessary to eliminate not only the symptoms, but also the cause of gastroesophageal reflux.

Symptoms of reflux esophagitis

Inflammation of the esophagus, caused by irritation of the mucous membrane with the acidic contents of the stomach, is manifested by esophageal dyspepsia. The most characteristic symptoms for reflux esophagitis are:

1. . Describing this condition, patients put their hand on the sternum, indicating the location of the burning sensation. Sometimes it radiates to the neck, shoulder blade. If the heartburn is mild, it goes away 3 to 5 minutes after taking antacids. It is possible to eliminate it by drinking a glass of milk. Increases with overeating, bending over, after taking alcohol, carbonated drinks.
2. Belching. Patients complain of regurgitation. An unpleasant sour or bitter taste appears in the mouth. Belching indicates the development of stenosis of the esophagus. Especially dangerous is nocturnal regurgitation during sleep (the contents of the esophagus enter the respiratory tract).
3. Pain behind the sternum. It is burning, intense, aggravated in the lying position, with the torso leaning forward. Irradiates to the interscapular region, neck, lower jaw. According to the clinical manifestation, pain with reflux esophagitis is similar to.
4. Dysphagia. At the initial stages, patients complain of difficulty swallowing solid food (bread, meat). If the disease progresses, the lumen of the esophagus narrows significantly (becomes less than 13 mm), then even saliva is difficult to swallow.
5. Esophageal bleeding. This is an extremely dangerous symptom that requires urgent surgical intervention.
6. The appearance of foam in the mouth. An extremely rare sign of reflux esophagitis. It occurs due to the intensive production of secretions by the salivary glands (up to 10 ml per minute), in response to the esophago-salivary reflex.

In addition to the standard clinical esophageal manifestations, patients complain of other symptoms. Sometimes a completely different disease is treated for a long time and persistently, since dysphagia, heartburn are less pronounced than extraesophageal symptoms:

1. Dental. Due to the ingress of gastric juice into the mouth, erosions appear on the tongue, teeth are destroyed, develops,. Patients complain of salivation.
2. The ENT organs become inflamed (nasopharyngitis, rhinitis, etc. develop). Patients are concerned about the feeling of a lump, spasm in the throat. Ulcers, granulomas, polyps appear on the vocal cords. The patient's voice becomes hoarse, rougher. Reflux esophagitis contributes to the development of cancerous lesions of the pharynx, vocal cords, and larynx.
3. bronchopulmonary symptoms. With reflux esophagitis in 6–10% of patients, the disease manifests itself with an exceptionally persistent cough, asthma attacks, which occur mainly at night.
4. Pseudocardial. Pain behind the sternum with reflux esophagitis is difficult to distinguish from "angina pectoris". It even irradiates in the same way as with angina pectoris. This is due to the innervation of the esophagus and the heart by the same nerve. These symptoms occur in 70% of patients. They initially turn to a cardiologist, but do not show deviations.
5. Cardiac symptoms. Patients, especially the elderly, complain of tachycardia, with attacks of pain caused by reflux. Due to the pathology of the esophagus, reflex angina pectoris, myocardial ischemia develops.
6. Signs of damage to the stomach. Patients complain of pain and heaviness in the abdomen, aggravated after eating, rapid satiety, nausea.

People with reflux esophagitis often have hiccups. They even complain about and unsuccessfully treat the spine.

Diagnostics

It is possible to identify the entry of bile into the esophagus according to the patient's complaints of a bitter taste in the mouth, especially in the morning, a yellowish coating on the tongue. Duodenal reflux is finally determined by analyzing the scraping of the tongue for the presence of bile acids.

Some clinical manifestations are not enough to establish the diagnosis of "reflux esophagitis". This disease is accompanied by serious changes in the mucous membrane of the esophagus. Therefore, before treating reflux esophagitis, it is necessary to differentiate it from other diseases. The doctor prescribes such additional studies:

• , esophagus, stomach;
• test with proton pump inhibitors.

The final diagnosis is made after the procedure, if appropriate histological and morphological changes in the esophageal mucosa are detected. In the presence of ulcers, erosion, a biopsy is necessary.

Treatment

Medicines

If the disease is not started, complications (bleeding, ulcers, etc.) are not detected, conservative treatment is carried out. Prescribe medications:

• prokinetics;
• antisecretory agents;
• antacids.

Prokinetics improve the functioning of the lower esophageal sphincter, reduce the number of refluxes.

Among antisecretory drugs for healing erosions, proton pump inhibitors (PPIs) are preferable. Only they must be taken correctly (half an hour before meals), otherwise the effect of their use will be minimal.

With resistance of patients to PPIs, monotherapy with antacids is carried out. In severe cases, a complex is prescribed:

• blockers of H 2 -histamine receptors;
• antacids.

Occasionally, PPI resistance occurs in patients with esophageal hypersensitivity. Therefore, proton pump inhibitors are prescribed with drugs that reduce sensitivity:

• tricyclic antidepressants (amitriptyline);
• selective serotonin reuptake inhibitors (fluoxetine, paroxetine).

Antacids reduce the effect of hydrochloric acid and other components of the reflux on the mucosa of the esophagus.

If it is revealed that, in addition to gastric juice, the contents of the duodenum enter the esophagus, drugs that neutralize bile acids are prescribed:

• ursodeoxycholic acid;
• antacids;
• cholestyramine.

Tablets, so as not to damage the esophagus even more, should be taken sitting or standing, washed down with plenty of water (100-150 ml).

Diet and lifestyle

In addition to medication, patients with reflux esophagitis must definitely change their lifestyle. There are certain rules that must be followed in order to reduce the number of refluxes:

1. Skip the afternoon break. Do not eat 3 hours before bedtime. After eating, it is better not to take a horizontal position, but to take a walk in the fresh air or just sit, walk around the room for half an hour.
2. Do not wear tight clothing. Underwear that tightens the stomach is strictly contraindicated. No pulling belts, tight belts, corsets.
3. You need to go to bed so that the head of the bed is raised by 15 cm.
4. Reduce the load on the abdominal muscles, especially after eating. It is impossible to destroy the extra calories eaten instantly by pumping the press, making forward bends. Set aside these exercises for 2 hours.

Mandatory for reflux esophagitis diet. With an exacerbation of the disease, treatment table No. 4 is shown. As you recover, most of the restrictions are removed, but the following remain banned:

• alcohol;
• carbonated drinks;
• strong tea with coffee;
• spicy, salty.

Sometimes patients with reflux esophagitis do not tolerate citrus fruits, tomatoes, apples - they cause heartburn. It is also better to refuse these products.

Surgery

Surgical treatment is necessary for:

• strictures of the esophagus;
• frequent bleeding;
• relapses of aspiration pneumonia;
• transformation of the disease into Barrett's esophagus;
• ineffectiveness of drug therapy.

For surgical treatment, they resort to fundoplication - circular suturing of the bottom of the stomach to the esophagus. This method is necessary so that in the future food from the stomach does not fall back into the esophagus.

Erosive reflux esophagitis, also called peptic, distal or "", is an inflammatory disease of the mucous membrane of the distal esophagus.

The disease develops as a result of periodic reflux of the secret of the stomach or pancreas into the lower esophagus. The acids contained in the gastric juice adversely affect the mucous membrane of the esophageal tube.

Initially, hyperemia of the epithelium appears, but with further exposure of the secretion of the stomach to the mucosa erosions, ulcers, and after - scars are formed. These are single or multiple ulcerations and scarring.

The most common is distal erosive reflux esophagitis: what is it? This is a form of the disease in which erosion on the mucous membrane of the esophagus occurs in the distal, that is, the lowest part of it, close to the stomach.

The disease develops due to dysfunction of the sphincter of the lower esophagus.

If the muscle ring does not close tightly, then favorable conditions are created for the entry (reverse reflux) of the secret of the stomach into the distal esophageal tube.

Patients should not expose the body to excessive physical exertion, do not wear tight clothing, especially in the abdominal area.

If a patient has a confirmed mucosal change that has a high risk of degeneration into cancer, then if heartburn occurs, they urgently need to contact their doctor.

In the presence of "Barrett's esophagus" it is necessary to conduct an endoscopic examination with obligatory sampling of material for histology once a year, and according to indications - even more often.

Summing up

A successful outcome of the disease depends on the timely start of therapy, as well as on how conscientiously the patient will follow the doctor's recommendations regarding diet, work and rest. In case of any undesirable manifestations, it is necessary to consult a specialist.