Erosive reflux esophagitis: symptoms and treatment. Treatment of esophagitis reflux gastritis Erosive reflux esophagitis

The general well-being of a person and his immunity are very dependent on the state of health and the quality of the work of the gastrointestinal tract. One of the most common diseases of the gastrointestinal tract is reflux esophagitis. From this article you will learn the causes, how the disease manifests itself and how to treat reflux.

What is reflux esophagitis in adults and children?

Reflux esophagitis is a disease of the esophagus. It develops as a result of regular ingestion of food from the stomach or intestines back into the esophagus. A person may not be aware of this phenomenon for a long time, but over time, constant irritation of the walls of the esophagus by the ingress of an unusual environment for it - gastric juice, leads to the appearance of digestive disorders.

If a person overdoes with food, does not adhere to a diet, moves little and lies a lot, this phenomenon becomes permanent and causes considerable discomfort.

Reflux esophagitis can manifest itself in different ways, sometimes the symptoms are completely different from stomach problems. In such situations, the disease can last for several years. For example, often reflux provokes a red throat, cough, dental problems - plaque. The appearance of caries due to the reflux of acid from the stomach into the oral cavity. Most often this happens during sleep.

Video about reflux esophagitis

Causes of reflux esophagitis

The direct reason for the occurrence of reflux is a decrease in the tone of the esophageal sphincter.

The factors provoking the development of the disease include:

• long-term use of drugs that can significantly reduce the tone of the esophageal sphincter (sedatives, hypnotics, cardiac);
• transferred surgical interventions on the opening of the diaphragm or near it (gastric resection, vagotomy, gastrectomy, etc.);
• hiatal hernia;
• ulcer of the stomach and intestines;
• insufficiency of the cardia in the presence of obesity;
• scleroderma;
• the presence of bad habits - alcohol, smoking;
• sedentary work, with a predominant tilt of the body forward;
• sedentary lifestyle;
• eating disorders, heavy meals at night;
• gastritis caused by the bacterium Helicobacter pylori.

Symptoms and signs of reflux esophagitis in children and adults

Symptoms often occur after eating, leaning forward, or lying down.

The most common symptoms of reflux are:

• constant heartburn from almost all products,
• feeling of heaviness in the stomach,
• feeling of fullness
• overeating,
• feeling of a lump in the throat
• constant obsessive eructation of air or sour.

Less likely to worry:

• nausea,
• epigastric pain and stool problems,
• difficulty swallowing
• sensation of a lump in the throat,
• hoarse voice,
• pain in the region of the heart.

Symptoms of reflux in infants: frequent regurgitation after feeding, belching food or air, vomiting milk. Children's reflux is caused by insufficient development of the esophagus and reflux in babies. At the same time, if you keep the child in a vertical position of the body, the symptoms disappear. A preventive measure that parents can take is to raise the head edge of the baby's bed.

Due to the abundance and variety of extraesophageal symptoms, the following classification of reflux is used in medical practice:

There are several types of disease: acute reflux esophagitis, catarrhal, erosive, necrotic and chronic.

Acute symptoms: pain is localized in the upper part of the sternum, unpleasant sensations disturb during meals, swallowing disorders and a feeling of general malaise.

catarrhal: the mucous membrane of the esophagus swells, it hurts to swallow, a constant feeling of a foreign body in the throat.

Erosive: complicated form, characterized by the presence of erosions of different sizes on the walls of the esophagus. Painful eating and medication. Depending on the number and size of ulcers, there are 4 degrees of erosive reflux esophagitis.

Necrotic: characterized by the appearance of deep ulcers on the walls, can be combined with candidiasis, typhoid or scarlet fever.

Chronic: sluggish form of the disease with implicitly expressed symptoms.

Diagnosis of reflux esophagitis

Diagnosis includes an assessment of the patient's complaints, finding out the time period during which the symptoms appear, the number of symptoms, their severity and the measures that were independently taken by the patient.

To definitely determine the presence of reflux esophagitis, a specialist may prescribe you:

• radiography. Allows you to determine the severity of peristalsis of the esophagus, the presence of a hernia and the speed of evacuation;
• ph-metry of the esophagus. Runs 24 hours. Allows you to determine the frequency and severity of acidification of the esophagus ingestion of gastric contents. Makes it possible to draw an analogy between casts and their causes;
• endoscopy. Examination of the esophagus with an endoscope. Helps to determine the form of the disease, the presence or absence of edema, erosion, their number, size and prescribe the appropriate treatment;
• biopsy. This is the taking of cells or tissue for histological examination and diagnosis. Allows you to identify the presence of dangerous degenerating tissues.

Also, the doctor can conduct, depending on the patient's complaints, an examination of the oral cavity, palpation of the abdomen and an electrocardiogram.

How to cure reflux esophagitis: drugs and other treatments

Therapeutic and preventive measures:

• dieting: exclude from the diet carbonated drinks, alcohol, strong tea, coffee, fatty, fried, canned, salty and smoked. Limit the consumption of legumes and cabbage, because they provoke increased gas formation and an increase in pressure in the stomach cavity. If you suffer from heartburn, give up citrus fruits, ketchup and mayonnaise. Try to eat at least four small meals a day to reduce pressure on the cardia. Do not eat three hours before bedtime.
• what you can eat: fermented milk products, boiled eggs and poultry meat, steamed fish, baked fruits and vegetables, various cereals and bran bread. Do not eat too cold or hot food, because it irritates the esophagus;
• lifestyle changes: do not sit down, and even more so do not lie down after eating. It is best to go for a walk to move food into the intestines more quickly. Avoid prolonged sitting in an inclined position. Do not wear tight clothing. Do not lift weights and do not strain the abdominal muscles. Exclude drugs that can help reduce the tone of the sphincter. Eliminate nervous stress and overload;
• raise the end of the bed from the side of the head;
• with significant deviations of body weight from the norm, recommend normalize weight.

Surgical treatment for reflux esophagitis used in cases of ineffectiveness of drug therapy. If erosions on the walls of the esophagus increase in size, increase in number, merge ulcers, the epithelium of the esophagus is scarred, replaced by the tissues of the surface of the stomach (Barrett's esophagus) or the esophagus narrows (stenosis), then, according to indications, erosions are cauterized by endoscopy.

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, during a medical examination with an X-ray, 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 comorbidity. 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.

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 ingress 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.

Heartburn and a feeling of discomfort in the throat are among the main signs of inflammatory processes in the esophageal mucosa, and need to be treated by qualified specialists. Moreover, the symptoms and treatment of reflux esophagitis should be constantly monitored by doctors. This is the only way to avoid irreversible changes in the tissues of the esophagus, and the development of complications requiring surgical intervention.

Let's try to figure out what reflux esophagitis is. "Esophagitis" is an ancient Greek word meaning esophagus. The term "reflux" is borrowed from Latin and translates as "flow back".

Thus, both concepts reflect the process that occurs during the development of the disease - food masses, gastric juice and enzymes move backward from the stomach or intestines, penetrate into the esophagus, irritating the mucous membrane and causing inflammation.

At the same time, the lower esophageal sphincter, which separates the esophagus and stomach, does not properly prevent the movement of acidic masses.

In official medicine, reflux esophagitis is a complication of gastroesophageal reflux disease, which is characterized by the reflux of acidic contents of the stomach or intestines into the esophagus.

Periodically repeated aggressive action gradually destroys the mucosa and epithelium of the esophagus, contributing to the formation of erosive foci and ulcers - potentially dangerous pathological formations that threaten to degenerate into malignant tumors.

Causes

Under certain circumstances, gastroesophageal reflux can also occur in healthy people. Frequent cases of the onset of the disease indicate the development of inflammatory processes in the gastroduodenal region.

Among the possible causes of reflux, gastroenterologists distinguish the following pathological changes in the structure and functionality of the digestive tract:

• decreased tone and barrier potential of the lower esophageal sphincter;
• violation of esophageal cleansing, redistribution and withdrawal of biological fluids from the intestine;
• violation of the acid-forming mechanism of the stomach;
• decrease in mucosal resistance;
• narrowing of the lumen of the esophagus (stenosis);
• an increase in the size of the esophageal opening of the diaphragm (hernia);
• violation of gastric emptying;
• high level of intra-abdominal pressure.

Most often, reflux esophagitis occurs as a result of weakening the tone of the muscles of the esophagus against the background of a full stomach.

Provoking factors

There are several etiological varieties of factors that provoke the reflux of acidic masses into the esophagus: physiological characteristics of the body, pathological conditions, lifestyle.

Reflux is promoted by:

• pregnancy;
• allergies to certain types of products;
• binge eating;
• obesity;
• smoking and alcohol;
• poisoning;
• unbalanced diet;
• stress;
• work associated with frequent torso bending;
• autoimmune diseases;
• taking medications that weaken the muscles of the cardiac sphincter.

In addition, reflux disease can occur as a result of prolonged use of a nosogastric tube.

In men, gastroesophageal reflux is observed more often than in women, although science has not established a direct relationship between the disease and the gender of a person.

Symptoms and signs of the disease

When gastric masses get on the surface of the mucosa, a burning sensation occurs in the esophagus, since exposure to acid causes tissue burns.

With a long course of the disease, the symptoms of esophagitis reflux become more pronounced, and other pathological manifestations are added to heartburn:

• belching sour. May indicate the development of stenosis of the esophagus against the background of erosive and ulcerative lesions of the mucosa. The appearance of belching at night is fraught with acidic masses entering the respiratory tract;
• pain in the sternum, often radiating to the neck and the area between the shoulder blades. Usually occurs when bending forward. According to clinical characteristics, it resembles the symptoms of angina pectoris;
• the appearance of difficulties with swallowing solid foods. In most cases, the problem occurs against the background of a narrowing of the lumen of the esophagus (stenosis), which is considered as a complication of the disease;
• bleeding is a sign of an extreme degree of development of the disease, requiring urgent surgical intervention;
• foam in the mouth is the result of increased productivity of the salivary glands. Rarely observed.

In addition to the standard clinical signs, extraesophageal symptoms may indicate the development of the disease.

Signs of an extraesophageal nature

The occurrence of pathological processes in areas of the body that are not directly related to the gastrointestinal tract is not always associated with pathological processes in the esophagus - especially in the absence of severe heartburn.

In the absence of full-fledged diagnostic studies, adequate treatment of reflux esophagitis is not possible.

Extraesophageal symptoms of inflammatory processes on the esophageal mucosa differ not only in the nature of severity, but also in localization:

• ENT organs. In the early stages of the disease, rhinitis, laryngitis and pharyngitis develop, there is a feeling of a lump or spasms in the throat. As the pathology develops, it is possible to develop ulcers, granulomas and polyps in the vocal cords, as a result of which the patient's voice changes, becomes hoarse and rough. In the later stages of the disease, a cancerous lesion of the ENT organs is possible;
• oral cavity. Erosive foci appear on the tissues of the oral cavity when gastric juice enters, periodontitis, caries and salivation develop. Pathological processes are accompanied by bad breath;
• bronchi. There may be nocturnal attacks of suffocation or severe coughing;
• chest, heart. Pain in the sternum is identical to the manifestations of coronary heart disease. There may be additional signs indicating cardiac pathology - hypertension, tachycardia. Without special diagnostic studies, it is almost impossible to establish the cause of the disease;
• back. Back pain is caused by innervation with the gastrointestinal tract, the source of which is located in the sternal spine.

In addition, symptoms may appear that indicate a violation of the functionality of the stomach - nausea, vomiting, bloating, a quick feeling of fullness.

Degrees of reflux esophagitis

The level of complexity of the course of the disease is determined by the stages of its development. In most cases, the development of gastroesophageal reflux disease takes about three years, during which the pathology acquires one of the four forms classified by WHO.

Reflux esophagitis of the 1st degree is characterized by intense reddening of the epithelium of the esophagus and a relatively small, up to 5 mm, area of ​​the mucosal lesion zone with point erosions.

The second degree of the disease is diagnosed in the presence of erosions and ulcerative areas against the background of edema, thickening and bruising of the mucosa. With vomiting, partial rejection of minor fragments of the mucosa is possible. The total area of ​​lesions occupies about 40% of the surface of the esophagus.

For the third degree of reflux esophagitis is characterized by an increase in the area of ​​the lesion up to 75% of the surface of the esophagus. In this case, ulcerative formations gradually merge into one.

The development of the fourth degree of the disease is accompanied by an increase in the size of ulcerative areas. Pathological formations occupy more than 75% of the mucosal surface and affect the esophageal folds.

In the absence of treatment, necrotic processes develop in the tissues of the esophagus, leading to the degeneration of cells into malignant ones.

Types of disease

The development of reflux esophagitis can take place in acute or chronic form.

The acute form of reflux is the result of a mucosal burn under the influence of gastric juice. It is most commonly seen in the lower esophagus and responds well to treatment.

The chronic form can occur both against the background of an untreated exacerbation, and as an independent primary process. The chronic course of the disease is characterized by periodic exacerbations and remissions.

Diagnostic measures

Despite the possible severity of the clinical manifestations of reflux esophagitis, additional information is needed to make an accurate diagnosis, which is obtained through examination.

The most informative are such studies as:

• blood analysis;
• Analysis of urine;
• radiography of the organs of the sternum;
• endoscopy - a procedure that allows you to identify erosive and ulcerative formations, as well as other pathological changes in the condition of the esophagus;
• biopsy;
• manometric analysis of the state of sphincters;
• scintigraphy - a method for assessing esophageal self-purification;
• pH-metry and impedance pH-metry of the esophagus - methods to assess the level of normal and retrograde peristalsis of the esophagus;
• daily monitoring of the level of acidity in the lower esophagus.

Reflux esophagitis is diagnosed in the presence of histological and morphological changes in the esophageal mucosa.

Treatment of reflux esophagitis

Successful treatment of reflux esophagitis involves an integrated approach - the use of drug therapy against the backdrop of changing the patient's lifestyle.

Drug treatment with drugs

The prescription of medications for gastroesophageal reflux disease has several objectives - improving the self-purification of the esophagus, eliminating the aggressive effects of gastric masses, and protecting the mucosa.

The following drugs are most effective for treating reflux:

• antacids - Phosphalugel, Gaviscon, Maalox;
• antisecretory agents - Omeprazole, Esomeprazole, Rabeprazole;
• prokinetics - Domperidone, Motilium, Metoclopramide.

In addition, the intake of vitamin preparations is shown - pantothenic acid, which stimulates peristalsis and contributes to the restoration of the mucosa, as well as methylmethionine sulfonium chloride, which reduces the production of gastric secretion.

Surgical intervention

With the development of reflux esophagitis of the third and fourth degree, surgical methods of treatment are indicated - an operation that restores the natural state of the stomach, as well as putting on a magnetic bracelet on the esophagus that prevents the reflux of acidic masses.

Folk remedies

For the treatment of reflux with folk remedies, it is recommended to use decoctions and infusions from plant materials.

A teaspoon of crushed dill seeds brewed with boiling water effectively eliminates heartburn and stops inflammation in the esophagus.

During the day, you should take decoctions of herbal preparations from the rhizomes of the mountaineer, plantain leaves, yarrow, oregano and chamomile. Before going to bed, teas from mint leaves, fireweed, calendula flowers and calamus root are shown to be taken.

The rule for preparing decoctions is to pour one tablespoon of the plant mixture with a glass of boiling water and incubate in a water bath for 15 minutes.

Diet for sickness

Therapeutic nutrition is designed to eliminate from the diet products that have an irritating effect on the mucous membrane, as well as enhance the production of gastric secretion.

Good results are brought by a diet for reflux esophagitis, which includes the following products:

• soft-boiled eggs;
• low-fat dairy products;
• liquid and semi-liquid cereals;
• steam fish and meat;
• baked apples;
• white bread crumbs.

Under the ban - coffee, alcohol, soda, any acidic drinks, beans and peas, spicy, fried, smoked and salty foods, chocolate and brown bread.

Prevention

Of great importance for recovery and prevention of relapse of reflux is the correct lifestyle. Patients are advised to maintain physical activity, monitor weight, do not overeat, and after eating take walks in the fresh air.

In addition, any load on the stomach area, including tight clothing and tight belts, should be avoided. Bending after eating is not allowed. The head of the bed for a night's rest must be raised by 10-15 cm.

And most importantly - you need to regularly visit a gastroenterologist and pass all the scheduled examinations in a timely manner.

When examining the esophagus, physicians often find the presence of erosions and ulcers on the mucous membrane. If such symptoms appear as a result of regular ingestion of the contents of the stomach into the esophagus, erosive reflux esophagitis is diagnosed.

Disease pathogenesis

To understand the meaning of such a diagnosis, it is enough to understand the very name of the disease:

Inflammation of the walls of the esophagus is the main feature of esophagitis

• esophagitis - an inflammatory disease of the esophagus;
• reflux - a process associated with the return direction of movement;
• erosive - a type of pathology, accompanied by the formation of erosion.

Erosive reflux esophagitis is a chronic inflammation with the presence of erosions in the esophagus, caused by irritants from the stomach entering it.

Behind the pathology is a whole range of interrelated causes:

• Violation of the locking mechanism of the sphincter located at the border of the esophagus with the stomach, which can occur:

1. with a decrease in the tone of the muscle tissues of the lower sphincter;
2. due to spontaneous one-time relaxations arising from the discharge of excess air or other reasons;
3. with mechanical or destructive changes in the area of ​​​​closing tissues.

• Decrease in the protective abilities of the esophagus, which contributes to the long-term exposure of aggressive components to the mucosa. Such changes may occur:

• Aggressive properties of the refluxant that enters the esophagus and provokes burning symptoms:

1. of hydrochloric acid;
2. bile acid;
3. pepsin.

• Too slow evacuation of the food bolus from the stomach, which occurs:

1. with violations of peristalsis of the stomach;
2. due to weakness or increased tone of the lower gastric sphincter.

• Increased intra-abdominal pressure that appears:

1. during pregnancy;
2. due to intestinal pathologies that cause bloating;
3. with constipation;
4. in overweight people.

During pregnancy, intra-abdominal pressure increases, which can provoke esophagitis

On the physiological side, inflammation in the esophagus is an acid-dependent condition, provoked by a violation of the motility and physiological abilities of all parts of the digestive tract.

Attention! Symptoms of esophagitis may be the first bells reporting pathologies in other parts of the digestive system.

With prolonged or combined aggressive action of the refluxant on the mucous membrane in the esophagus, complicating symptoms occur, which manifest themselves as single or multiple erosions or ulcers. In such cases, an erosive or ulcerative type of pathology is diagnosed.

Symptoms of the disease

The primary symptoms of esophagitis have a nutritional manifestation and often do not cause much concern in patients. It is the ignoring of the symptomatic signs of the disease in combination with aggravating factors, such as an unbalanced diet, smoking, a nervous state, and the abuse of alcohol-containing drinks, that provoke the progress of esophagitis.

Minor, but so important for the diagnosis of the initial symptoms are manifested:

1. Belching, which is more often disturbing after a meal. The discharge of air masses from the stomach may be accompanied by regurgitation of a small amount of food.
2. Heartburn, which is also directly related to meals. Heartburn can be either short-term, which does not require specific treatment, or long-term tormenting the patient.

Initial symptoms are belching and heartburn

In such cases, most patients begin self-treatment with improvised means, which greatly aggravates the situation.

Remember! Treatment of heartburn with soda is strictly prohibited. When soda interacts with gastric juice, carbon dioxide is formed, which contributes to increased production of gastric juice and new attacks of heartburn.

In the future, the symptoms become much brighter and more diverse. The patient may be annoyed by:

• retrosternal pain, which is similar to coronary pathologies;
• pain in the throat and neck;
• increased salivation, as a reaction of the body to reflux;
• dry mouth and a metallic or sour taste;
• problems with swallowing food and a constant feeling of a foreign lump in the throat.

In the form of complications, bronchopulmonary pathologies can be recorded, which are manifested by cough, pneumonia, bronchial obstruction.

In the later stages, striticules, bleeding from ulcers, tissue perforations may appear.

Be carefull! Rapid weight loss, anemia, and progression of dysphagia may indicate adenocarcinoma.

The main directions of treatment

Treatment of the erosive form of reflux esophagitis begins with an extended diagnosis, which allows you to determine not only the stage and type of the underlying disease, but also to find out the cause that provoked the pathology.

Endoscopy before treatment

The main treatment includes:

• drug therapy;
• medical diet;
• physiotherapy procedures.

In case of complications and the absence of the effect of the main therapy, surgical intervention is resorted to.

Medical therapy for esophagitis

Treatment with medications can last up to 12 weeks. After that, maintenance therapy is prescribed, which is advisable to carry out for at least six months.

In the acute period of the disease, the treatment regimen is drawn up individually, depending on the concomitant pathologies and the degree of mucosal damage. Most often, doctors resort to the use of:

Surgical therapy

Surgical treatment is required in rare cases:

• with strictures of the esophagus;
• if conservative treatment has not yielded results;
• in the presence of bronchial asthma, provoked by reflux;
• if there is a hernia of the diaphragm;
• after diagnosing Berrett's esophagus;
• with bleeding and perforation.

After the operation, a strict diet and conservative therapy are prescribed, similar to the acute period of the disease.

Food

The therapeutic diet for esophagitis is not inferior in effectiveness to medications. For patients with chronic or advanced forms of inflammation, a long-term diet is recommended, which is desirable to adhere to during remission.

Doctors also advise patients with esophagitis:

1. After a meal, do not take a horizontal position. The best way to improve digestion is to take leisurely walks.
2. Plan an evening meal no later than a couple of hours before a night's rest.
3. To prevent a night's rest from spoiling another reflux, place your head higher. If the esophagus is higher than the stomach, the risk of reflux is reduced.
4. Do not tighten the stomach and chest with belts and tight clothing. Such actions provoke an increase in intra-abdominal pressure.
5. Don't drink food. Even tea or milk contributes to increased formation of gastric juice.
6. Drink enough water so as not to provoke acidification and improve metabolism.

Preventive measures, consisting of following the rules of rational nutrition, strengthening immune defenses and timely treatment of chronic diseases, will prevent exacerbations of esophagitis.