Signs and treatment of erosive reflux esophagitis. Chronic reflux esophagitis: what to do for patients with exacerbations of the disease Reflux esophagitis symptoms and treatment

Inflammation of the mucous membrane of the lower esophagus is understood. Often it occurs with frequent or prolonged casting of aggressive juice from the stomach.

The erosive form is one of the most dangerous, since 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 an ailment that affects the entire membrane of the esophageal mucosa or part of it. According to ICD-10, the disease belongs to the K20-K31 group. These are diseases of the stomach and duodenum.

The disease can go on 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 form of the disease, but also in patients who have undergone gastric resection or.

According to statistics, 2% of adults have reflux esophagitis. It occurs 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,
• dietary errors
• emotional stress,
• wearing tight clothes

Erosions may appear due to the use of medications. Especially when it comes to anti-inflammatory and sedatives.

The erosive form can be the result of acute or chronic inflammation of the esophagus. Erosions are also formed after acids, alkalis and various technical liquids.

A prerequisite for the disease can be severe viral, bacterial or fungal infections, regular use of glucocorticosteroids and nonsteroidal 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, therefore, with timely treatment, it can pass without complications.

Chronic

Occurs if the negative impact on the walls of the esophagus was constant. Develops over a long period of time. Therefore, sometimes it 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 the appearance of inflammation and swelling of the mucosa of the esophagus. Under the influence of negative factors in this form are only the surface layers. Therefore, during the disease there is no significant tissue destruction.

ulcerative

This is a condition in which inflammation not only penetrates the lining of the esophagus, but also causes ulcers to form. This disease requires a serious approach to treatment.

The formation of foci of lesions may begin both with prolonged contact with an irritating factor, and with short-term contact.

Distal

The erosive form can be detected if only the lowest part of the esophagus was affected by ulcers. It connects to the stomach.

Degrees

The erosive form has several forms:

• 1 degree. It is characterized by the manifestation of a separate type of erosion. They don't touch each other. Sometimes erythema is found at this stage. It is most often found in the distal esophagus.
• 2 degree. An erosive lesion, in which erosions have a confluent character. Despite this fact, the lesion does not affect the entire mucosa.
• 3 degree. Its peculiarity lies in the fact that ulcers form in and in the lower part of the esophagus. It turns out that the entire mucosa is one large ulcer with a certain amount of healthy tissue.
• 4 degree. It includes not only the appearance of erosion, but is also accompanied by stenosis. This form, as a rule, has a chronic course.

Symptoms

Characteristic of the disease are pain that occurs in different parts of the esophagus. They may appear during meals. Patients report frequent heartburn, a burning sensation behind the sternum, regurgitation of food or mucus. There may be an eructation with an admixture of blood.

Common symptoms include weakness, anemia, which occurs due to chronic blood loss or dizziness. If the pathological process is supplemented by an infection, then this can lead to inflammation of neighboring organs.

Signs of the disease include:

• Pain of varying intensity. Mostly appears behind the sternum. May be aggravated by eating, at night, or during exercise.
• Heartburn. Occurs when an acidic environment from the stomach enters the esophagus. The condition can occur when the body is in a horizontal position and during physical exertion.
• Belching. It indicates insufficient work of the cardia. In some cases, it is so strong that it resembles vomiting.
• Dysphagia. Appears in severe forms of esophagitis. For a serious condition, sensations of food retention in the region of the xiphoid process are characteristic.

Diagnostics

It is necessary to detect diseases in a timely manner. According to 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 the effective methods is fibrogastroduodenoscopy. During the procedure, the mucosa is examined using an endoscope. The method allows you to identify the presence of redness, the degree of dysmotility and the inflammatory process. If there are narrowings or scars, the method will help to identify them.

Morphological evaluation is given after examining the material under a microscope. Cells are taken in the same way as when conducting. It allows you to exclude malignant degeneration and identify signs of pathology.

X-ray with contrast agent. Before using the X-ray, a suspension of barium is introduced. During the study, erosion is detected. The patient is viewed both in a horizontal and vertical position. This also makes it possible to establish the presence of reflux or diaphragmatic hernia.

How to treat erosive reflux esophagitis?

To cope with the disease, a person is recommended to reconsider his lifestyle, make some adjustments to it.

You should definitely quit smoking, avoid serious physical exertion associated with inclinations. This will cause the contents of the stomach to reflux into the esophagus.

Preparations

Two tactics are used for treatment. The first includes powerful ones. over time, the intensive use of medications is reduced. The second principle is that drugs that have minimal effectiveness are prescribed first. As treatment progresses, the pharmacological effects increase.

One of the effective methods is the use of secretolytics. These are drugs needed to reduce gastric secretion. Reducing acidity reduces the detrimental effect on the delicate esophageal mucosa.

Such medicines include:

• proton pump inhibitors,
• H-blockers,
• M-cholinolytics.

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 soft medicines, various antacids are noted, which neutralize the effect of hydrochloric acid. To increase the stability of the esophageal mucosa, doctors may additionally prescribe drugs for treatment.

Folk remedies

Patients with an erosive form are prescribed that have a wound healing, anti-inflammatory and bactericidal effect. These include nettle, calendula, chamomile, mint and sage.

Among the popular recipes there is a collection of chamomile flowers or flax seeds. These components are taken in two large spoons. Motherwort, licorice root and lemon balm leaves are added to them. The prepared collection is infused for several hours after it is filled with boiling water. Drink ¼ cup three times a day.

To combat heartburn, freshly squeezed potato juice, dry raspberry or blackberry leaves can be used. The latter can simply be chewed.

Diet

With an erosive form, pain can occur even with an insignificant, at first glance, imbalance in food. should be gentle.

Foods that increase the processes of gas formation 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 abuse 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 slices of raw potatoes. This will reduce the production of gastric juice. Potatoes can be replaced with several nuts.

Forecast 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 the likelihood of developing precancerous and cancerous conditions is high.

Prevention of erosive reflux esophagitis is the constant diet. It is important to sleep on an extra pillow so that the head is always higher than the legs. This will not allow, in case of disruption of the work of the cardia, to have a negative impact on the work of the digestive tract.

With reflux esophagitis, there is a pathological ejection of stomach contents into the esophagus. Erosive reflux esophagitis occurs due to chronic irritation of the esophagus with acid: ulcers and erosion appear on the mucous membranes. Reflux esophagitis is characterized by severe pain. Consider the features of the course of reflux esophagitis, the symptoms and treatment of this disease.

The reasons

The main reason for this disease is that acidic contents enter from the stomach into the esophagus. This happens because the esophageal sphincter is in a relaxed state (which should not be normal).

In a healthy organ, the sphincter relaxes for only a few minutes to allow food to pass into the stomach. Further, it contracts, which prevents acid from getting back from the stomach.

Reflux esophagitis occurs in humans with such pathologies of the gastrointestinal tract:

• an ulcer in the stomach (it may appear due to excessive activity of the Helicobacter bacterium);
• cancerous tumors of the stomach;
• pathological conditions of the vagus nerve;
• pathology of the lumen of the duodenum;
• chronic inflammatory disease of the pancreas;
• prolonged inflammatory process in the gallbladder;
  pylorospasm;
• hernia of the esophagus.

Sometimes the reflux of the contents of the stomach into the esophagus occurs after surgical interventions on the stomach. Erosive esophagitis sometimes occurs in those patients who abuse strong alcoholic beverages, smoke a lot, drink excessive amounts of coffee.

In some people, part of the stomach may enter the chest (normally, the organ is entirely in the abdominal cavity). This anomaly occurs in obese individuals.

Pathogenesis

The human esophagus consists of mucous, muscular and external tissues. On the mucous membrane there are several folds that facilitate the process of getting food into the stomach. The muscular layer in the esophagus is necessary to facilitate this process. They form two sphincters, with the lower one located on the border between the two organs. They serve to prevent food from entering the esophagus from the stomach. It can only open when swallowed.

Normally, a person may have several dozen physiological reflux of food into the esophagus. But signs of pathology are not observed. And only when the sphincter system is disrupted, a person may experience symptoms of reflux esophagitis.

The appearance of esophagitis, reflux esophagitis is also associated with impaired functioning of the protective functions of the esophagus. Such conditions are most often created with poor nutrition, mechanical irritations, etc. I must say that a significant part of patients do not know what it is - reflux esophagitis, and do not pay enough attention to the normal process of chewing food. Frequent injuries of the mucosa and lead to disruption of the esophageal sphincter and the development of gastric diseases.

The erosive form is a complicated type of reflux esophagitis. In this case, small sores appear on the mucous membrane of the organ - erosion. Symptoms of reflux become pronounced, bring the patient some discomfort. Due to erosion, the pain increases significantly after eating, consuming Acetylsalicylic acid.

Stages and symptoms

This disease is characterized by several stages.

1. At the first stage, separate erosions form on the mucosa, which do not merge and do not capture a significant part of the esophagus.
2. The second stage is called confluent, because small ulcers and erosion areas become larger and larger. At the same time, they capture a small part of the esophagus.
3. In the third stage, the lower third of the organ is affected.
4. At the fourth stage of the disease, stenosis of the esophagus, a chronic ulcer is observed.

Note! Often in the third or fourth stage of the disease, the patient is recommended surgery. It is associated with certain risks and complications.

To prevent this from happening, you need to contact a specialist immediately after the appearance of unpleasant symptoms of diseases of the abdominal organs. It is especially difficult to treat advanced ulcerative esophagitis.

When esophagitis occurs in adults, there may be discomfort that occurs in the chest cavity. They give to the region of the heart and shoulder. Often, patients may not associate the appearance of such pain with the esophagus and take (most often uncontrolled) heart medications. Naturally, they do not give any result.

Reflux esophagitis has many manifestations. The most characteristic of them are:

• belching (it can be either air or stomach contents);
• painful heartburn;
• nausea turning into vomiting;

• frequent regurgitation (it often happens in children);
• acid taste in the mouth;
• dysphagia (in this case, the patient feels difficulty in the normal swallowing of food);
• a cough that lasts for a long time at night (it occurs due to the so-called microaspiration of small particles of food from the esophagus into the upper respiratory tract);
• damage to the teeth by caries due to the ingress of acid into the oral cavity;
• hiccups.

Important! Without treatment, esophagitis can last for years. His symptoms may get worse. This inevitably leads to the formation of scars on the mucosa of the esophagus.

All manifestations of reflux esophagitis increase significantly after a person lies down. In a standing or sitting position, pain, heartburn or hiccups almost do not bother.

Sometimes the patient may feel signs of pharyngitis, nasal congestion. These signs appear because the acidic contents of the stomach irritate the throat, which makes the patient tickle in the throat.

Features of diagnostics

If a patient is suspected of reflux esophagitis, his treatment is possible only after a correct diagnosis. Diagnosis occupies an important place, because it depends on how to further treat reflux esophagitis, what medications to prescribe to the patient.

Diagnostics consists of the following measures:

1. Interview with the patient. When collecting an anamnesis, the doctor identifies the characteristic complaints of the patient, the duration of the symptoms and the degree of their severity.
2. Examination of the oral cavity. The presence of affected teeth, inflammation of the mucous membranes suggests that the patient may develop reflux.
3. Palpation.
4. FEGDS is the main diagnostic method, on which further treatment will depend. In this case, a thin fiber optic probe is inserted through the patient's mouth. The state of the gastric and esophageal mucous membranes is being studied. Using the latest computer technology, the image is displayed on the screen. With reflux esophagitis, the mucosa is hyperemic and colored in red shades.
5. Radiography is performed using a special contrast agent (barium sulfate). Suspension does not have a pronounced taste, non-toxic to humans. With the pathology under consideration, the movement of barium suspension into the esophagus will be visible.
6. Examination of the acid index of the esophagus. In pathology, it will be reduced, since the penetration of gastric juice into the esophagus "acidifies" its membranes.
7. Esophagomanometry evaluates the normal contractile activity of the lower sphincter. This method clarifies the diagnosis.
8. The cardiogram is carried out for the purpose of differential diagnosis.
9. X-ray of the chest organs is performed to exclude pathologies of the lungs.

Remember that esophagitis can be cured when this disease is most accurately determined.

What is dangerous esophagitis

Do not assume that reflux esophagitis refers to "harmless" and "safe" pathologies. If left untreated, a person may develop the following dangerous diseases:

1. The appearance of ulcers on the esophageal mucosa may be in a patient if he suffers from the disease for a long time. For the treatment of hemorrhages, an endoscopic operation is used, which consists in the fact that with the help of a mini-electrocoagulator, cauterization of the vessel is done.
2. Esophageal stenosis develops in humans due to a chronic inflammatory process on its mucosa. The patient complains of pain during swallowing and the sensation of a lump in the throat. For treatment, a rather complicated surgical operation is performed.
3. Barrett's syndrome is a dangerous risk of developing a malignant neoplasm.

The sooner the patient sees a doctor for the treatment of reflux esophagitis, the easier his treatment will be.

Nutrition and lifestyle

For the treatment of such a disease, diet is very important. Practice shows that drugs to reduce the acidity of gastric juice and other pills will not be effective if the patient eats junk food. It will not bring a healing effect.

Can reflux esophagitis be cured with the right diet? In some cases, it is possible to cure esophagitis forever if you adhere to proper nutrition and take medications prescribed by your doctor.

The way of life of a patient with chronic reflux esophagitis should be like this.

1. It is necessary to completely eliminate all nervous overload.
2. Get enough sleep (at least 8 hours). Moreover, it is necessary to ensure that the head is slightly higher than the body. At the same time, the number of refluxes at night can be significantly reduced.
3. Five meals a day are necessary: ​​it will eliminate long breaks in eating and overeating.
4. In the treatment of erosive reflux esophagitis, it is very important not to lie down after eating. Again, avoiding overeating will not make the patient want to take a nap after dinner. But walking in such cases is useful.
5. To prevent the causes of reflux esophagitis, you do not need to wear tight clothing and belts.
6. It is forbidden to lift weights, because this increases the symptoms of reflux esophagitis.
7. It is necessary to exclude the use of drugs that cause relaxation of the esophageal sphincter.

The following foods and drinks are prohibited:

• alcohol;
• soda;
• coffee, black tea;
• chocolate products;
• seasonings;
• legumes;
• marinades, pickles, smoked products, canned foods;
• fatty food;
• sour juices;
• Rye bread;
• shop sauces, including mayonnaise;
• all snacks and fast food;
• chewing gum;
• all fried foods.

For a patient with reflux esophagitis, the following therapeutic diet is useful:

• sour cream and low-fat milk;
• soft-boiled eggs;
• cottage cheese (preferably low-fat);
• dried bread;
• cereals;
• steamed dishes;
• salads and vegetable stews;
• lean fish, meat.

Note! A diet with this pathology should be followed throughout life. This is the only way to prevent relapses and complications.

Of course, with chronic reflux esophagitis, nutrition is not limited to the above meals alone. There is a large amount of nutritious and tasty food that does not cause an exacerbation of the disease.

Treatment

How can reflux esophagitis be treated with medication?

First of all, we note that people, not knowing why there are exacerbations of reflux esophagitis and what it is, try to choose the “most suitable” medicine for themselves in the pharmacy. This is absolutely impossible to do, because this can only worsen the state of health. Only a doctor can choose a drug. Treatment of reflux esophagitis should not occur on its own.

The causes and treatment of this disease are interrelated: the doctor selects the right medicine only after finding out all the factors that led to it. As a rule, such drugs are prescribed:

1. Prokinetic drugs are needed to improve the tone of the lower esophageal sphincter. This is Motilium, Ganaton.
2. Antacids are needed to effectively reduce the acidity of gastric juice. Among them, many doctors pay attention to Almagel - he effectively fights the manifestations of hyperacidity of gastric juice.
3. Antisecretory agents are represented by hydrogen pump inhibitors (omeprazole or famotidine).

If the patient has symptoms of reflux esophagitis, treatment may continue for up to 6 weeks. It all depends on the severity and stage at which the disease is diagnosed.

Folk methods

How to cure reflux with unofficial remedies? Informal medicine knows many effective ways to treat the disease in question. Before treating reflux esophagitis, you need to contact a therapist: he will help you choose the most effective method for getting rid of the disease.

Consider some ways to treat the manifestations of reflux esophagitis in non-drug ways.

Reduces the intensity of inflammatory phenomena medicinal mixture of chamomile, flax, dog nettle, lemon balm leaf, licorice. To prepare a decoction, you need to take 2 tbsp. l. plants and brew in boiling water, evaporate in a water bath for 10 minutes. Drink a third of a glass, 4 times a day.

A mixture of calamus, anise, yasnitka, oregano, mint leaves, marigolds and fireweed (2 tablespoons) should be poured with water and heated in water. Drink half a cup 6 times a day.

Highlander root, plantain leaf, shepherd's purse, dandelion flowers, chamomile, yarrow grass, oregano are mixed, steamed in water. The decoction must also be consumed the same number of times in the same amount.

This treatment should be combined with drug therapy.

Prevention

It is much easier to prevent this disease than to treat it. It is necessary to adhere to such recommendations:

• avoid emotional stress;
• do not abuse alcoholic beverages, and even better - completely abandon them;
  Do not smoke;
• avoid foods that irritate the esophageal mucosa;
• eat more often and in small portions;
• avoid hypodynamia, do exercises every day, play sports;
• after eating, you do not need to lie down, but walk a little.

So, reflux esophagitis should not be taken lightly. You need to start getting rid of it as soon as possible. Self-medication is extremely dangerous, because it can lead to relapses and complications. Only early and comprehensive diagnosis, a healthy diet will help keep the esophagus in good condition.

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.

Reflux esophagitis - what is it, symptoms and treatment at home

Reflux esophagitis is a disease characterized by the backflow of stomach contents and gastric juices into the esophagus. The first symptoms include burning sensations and discomfort in the esophagus and this disease is becoming more and more common these days.

The risk of getting sick increases with age, the disease should not be underestimated - if not properly treated, traditional dietary habits and lifestyle are not changed, it can lead to damage and chronic inflammation of the esophagus, erosive esophagitis and even cancer of the esophagus.

What it is?

Reflux esophagitis is an inflammatory disease of the esophagus that develops against the background of regular reflux - the reflux of stomach contents into the esophagus. Food along with gastric juice, getting into the esophagus, irritate and injure its mucous membrane. At first, this is manifested only by heartburn, then the patient is tormented by painful sensations.

Causes

The acute form often appears due to some factor of short-term action. It can be:

• damage by caustic chemicals,
• infectious diseases,
• physical impact (when inserting a probe, burn),
• allergic reactions to food.

The most severe consequences occur due to chemical damage. With infectious lesions, the cause is a decrease in the immune forces of the body.

Chronic forms appear on the background of drinking alcohol or spicy food. This effect must be permanent. If a person works with vapors of chemicals without respiratory protection, then professional esophagitis develops.

Chronic forms can be caused by:

• prolonged intoxication,
• unexplained reasons,
• vitamin deficiency,
• violations of the evacuation function of the esophagus.

If there is a reflux of gastric contents into the esophagus, then peptic esophagitis develops.

Degrees and forms

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.

The disease can take the following forms:

Catarrhal reflux esophagitis	with this form, swelling of the mucous membrane of the esophagus occurs. Swallowing causes severe pain, the patient does not leave the sensation of a foreign object in the throat.
Acute reflux esophagitis	for this form of the disease, painful sensations are characteristic only during meals, and the pain is localized in the upper part of the sternum, along the esophagus. Also, acute reflux esophagitis is characterized by impaired swallowing and general malaise.
Erosive reflux esophagitis	a complicated form of the disease, in which small ulcers (erosion) form on the mucosa of the esophagus. 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.

The chronic form is manifested by a regular increase in the symptoms of the disease, alternating with a rest phase. With this form of the disease, chronic inflammation of the walls of the esophagus occurs, which is manifested by a burning sensation behind the sternum, pain "in the pit of the stomach." Chronic reflux esophagitis is accompanied by frequent hiccups, shortness of breath and vomiting.

Symptoms of reflux esophagitis

In adults with reflux esophagitis, the first and main symptom is heartburn, familiar to many. It can manifest itself at different times of the day, immediately after eating or when a person is in a horizontal position.

It is also quite common to experience such symptoms of reflux esophagitis as chest pain, which is often perceived as pain in the heart. In other cases, the symptoms described above may be completely absent, and swallowing disorders appear. This may indicate the development of cicatricial narrowing of the esophagus and the transition of the disease to a more serious stage.

Other symptoms of reflux esophagitis should also be noted:

1. Dysphagia or impaired passage of food, failures of the swallowing reflex.
2. Belching of sour stomach contents or air.
3. Chronic cough or "lung mask" caused by obstruction of the bronchi with viscous secretions. Often this is due to the ingress of small particles into the bronchi from the esophagus.
4. Destruction of tooth enamel due to the reflux of acid into the oral cavity from the esophagus.
5. "Otolaryngological mask" is associated with the development of rhinitis and pharyngitis. The mucous membrane of the nose and pharynx becomes inflamed due to frequent contact with the acidic contents of the stomach, which enters the larynx.

Unfortunately, it is not always possible to clearly determine the presence of reflux disease, as it often "masks" as other diseases.

Diagnostics

To make an accurate diagnosis and determine the degree of damage to the mucous membrane, the patient is given:

• pH meter daily - allows you to assess the level of acidity in the esophagus, the number and duration of reflux per day;
• fibrogastroduadenoscopy - FGDS - one of the most informative methods, allows a specialist to see and assess the condition of the esophageal mucosa and the presence of erosion, inflammation and other changes;
• x-ray diagnostics with contrast agents - this is necessary to detect ulcers, narrowing, inflammatory changes in the esophagus and assess its patency.

Additionally, they can conduct a radioisotope study to assess the motor and evacuation capacity of the esophagus, a morphological study of mucosal cells to exclude malignant degeneration, and other studies.

Treatment of reflux esophagitis

In the event of reflux esophagitis, good results are obtained by complex treatment, which consists not only in taking medications, but also in following a diet, in striving for a general improvement of the body.

Diet and lifestyle of a patient with reflux esophagitis:

1. Dream. It is important to get enough sleep (if possible, 7-8 hours a day).
2. The daily routine should be built in such a way as to exclude nervous overload at work or at home.
3. Try not to lift heavy things, and also less strain your abdominal muscles
4. Avoid taking drugs that reduce the tone of the lower esophageal sphincter (nitrates, β-blockers, aminophylline, sedatives, hypnotics, and others).

You also need to stop wearing tight clothes, belts, corsets. You need to sleep on a high pillow so that your head is higher than the level of your stomach.

Medical treatment

There are several groups of drugs prescribed for reflux disease.

1) Antacids - drugs that reduce acidity by neutralizing it.

• Almagel - 5-10 mg. (1-2 measuring spoons) 3-4 times a day 10-15 minutes before meals.

In case of severe pain after eating, Almagel A is recommended, since in addition to neutralizing the acid, it also relieves pain. The duration of treatment with Almagel A is not longer than 7 days, after which they switch to regular Almagel.

2) Prokinetics - drugs that increase the tone of the lower esophageal sphincter. The active substance is called dopiridone, it is part of drugs such as (motilium, motilac). Or another active ingredient, itopride (genaton).

• Motilium - adults 20 mg. (2 tablets) 3 times a day, 20-30 minutes before meals, when symptoms are present and at night, then at bedtime.

3) Antisecretory drugs - drugs that reduce acidity by suppressing its formation.

• Omeprazole - 20-40 mg (1-2 capsules per day), drinking a capsule with a small amount of water. The capsule must not be chewed.
• Famotidine 20 mg. 2 times a day.

The duration of treatment and the number of drugs depends on the severity of the disease. On average, treatment is carried out with at least 2 groups of drugs (Motilium + Almagel, Motilium + Omeprazole). The duration of treatment is 4-6 weeks. In severe cases, 3 groups of drugs are prescribed for more than 6 weeks.

Surgery

In the absence of the effect of the described non-surgical techniques and frequent relapses of reflux esophagitis, the patient may first be advised endoscopic treatment. It consists in stitching the lower of the esophageal sphincters or in introducing into it various polymeric substances that contribute to the normalization of its barrier function.

Indications for radical surgery are:

• development of complications (repeated bleeding, narrowing, etc.);
• preservation of symptoms and endoscopic manifestations of esophagitis, subject to adequate drug treatment for six months;
• frequent pneumonia developing due to aspiration of gastric acid contents;
• Barrett's esophagus with established severe dysplasia;
• a combination of reflux esophagitis with bronchial asthma that cannot be adequately treated.

In all these situations, surgeons carry out a fundoplication (the lower part of the esophagus is lowered 2-3 centimeters into the abdominal cavity, a kind of cuff is formed from the gastric wall at the junction with the esophagus and sutured to the diaphragm, an overly wide opening in the diaphragm is sutured, and the cuff is moved into mediastinum).

Access can be traditional (when the abdomen or chest is cut) or laparoscopic (all the necessary manipulations are carried out through small holes - punctures through which the necessary endoscopic instruments are inserted into the abdominal cavity).

Diet

A patient with reflux esophagitis is prescribed a very strict diet. The list of prohibited foods is very large:

• rich soups or broths.
• marinades, smoked meats, pickles - also enhance the secretory function of the stomach.
• drinks that increase the acidity of gastric juice - these include any alcohol, carbonated drinks, natural fruit juices.
• sweets, chocolate, strong tea, coffee - these foods relax the lower sphincter of the stomach, causing stagnation of food.
• cabbage, black bread, legumes, peas, fresh milk - these products contribute to gas formation and increased pressure in the stomach.
• fruits, especially citrus fruits, contribute to heartburn.
• fatty and fried foods also slow down digestion and provoke heartburn.
• chewing gum is also banned. It enhances salivation and promotes the production of gastric juice.
• you need to abandon the excessive consumption of spicy foods, spices, mayonnaise and other sauces.

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.

It is undesirable to eat fruits or vegetables raw, it is better to bake them in the oven. Vegetables can be stewed with a little oil, a light vegetable soup with lean meat can be prepared.

You should also pay attention to the meal schedule - it is recommended to eat every 3-4 hours, and portions should be small, dinner should be early - 4 hours before bedtime. Products should not be too hot (so as not to injure the affected walls of the esophagus) or cold (this causes vasospasm). Proper nutrition is the key to successful treatment of reflux esophagitis.

The mucous membrane of the esophagus is not protected from these aggressive substances, so contact with them causes damage to the epithelium, inflammation and causes pain. One of the main causes of reflux esophagitis is hiatal hernia. In this disease, part of the stomach is displaced into the chest cavity through the dilated esophageal opening of the diaphragm.

Causes of reflux esophagitis

The diaphragm is the muscular partition between the thoracic and abdominal cavities. For the passage of various organs from one cavity to another, there are special openings in the diaphragm (including the esophageal opening).

In the case of thinning or underdevelopment of muscle tissue, in combination with increased intra-abdominal pressure, the abdominal organs can be displaced into the chest. This is how the hiatal opening of the diaphragm develops.

A slight displacement of the inlet and upper part of the stomach is called a sliding hernia. The frequency of occurrence of such hernias increases with age in people older than 50 years, it reaches 60%. As a rule, the only manifestation of a sliding hernia of the esophagus is gastroesophageal reflux, eventually leading to reflux esophagitis.

Symptoms of reflux esophagitis

The main symptom of reflux esophagitis is. It can be observed both in the daytime and at night, it can intensify immediately after eating and taking a horizontal position of the body in space, accompanied by belching and hiccups.

In some patients, it is observed that resembles pain in the heart. At the same time, reflux esophagitis can occur without heartburn and chest pain, and manifest itself as a violation of swallowing. As a rule, swallowing disorders are associated with the transition of the disease to a more severe stage with the development of cicatricial narrowing of the esophagus.

Diagnosis of reflux esophagitis

If a hernia of the esophageal opening of the diaphragm is suspected, the following studies are performed:

• x-ray examination of the esophagus with a barium suspension (the study is carried out on an empty stomach, a series of x-rays is taken immediately after the patient swallows the contrast mixture; spontaneous reflux from the stomach into the esophagus indicates severe reflux);
• esophagoscopy (endoscopic examination of the esophagus);
• biopsy (taking a small area of ​​the esophageal mucosa for histological examination; performed during esophagoscopy);
• esophageal pH-metry (measurement of acidity in the lumen of the esophagus and stomach; the contents of the esophagus will be acidic due to the reflux of acidic contents from the stomach).

In some cases, the doctor may prescribe additional research methods and special tests. When the patient complains of chest pain, the patient is sent for examination to a cardiologist to rule out ischemic.

Complications

The most dangerous complications of reflux esophagitis are esophageal ulcers and cicatricial narrowing of the esophagus (stricture). The long course of esophagitis can contribute to the malignant degeneration of mucosal cells and the development of cancer. The most dangerous complication of hiatal hernia is strangulation. Infringement should be suspected when there is a sharp pain in the chest, combined with a violation of swallowing.

What can you do

To reduce gastroesophageal reflux, you should lose weight, sleep on a bed with a head end raised by 10-15 cm, try to observe the time interval between food and sleep. You should stop smoking, eating fatty foods and chocolate, coffee, alcohol, orange juice, as well as the habit of drinking plenty of liquids with food.

Compliance with these rules in combination with drug therapy in most cases reduces the frequency of gastroesophageal reflux and protects the esophageal mucosa from harmful effects.

How can a doctor help

Treatment usually begins with drug therapy. Its main directions are to reduce the acidity of gastric juice, protect the esophageal mucosa from harmful effects, increase the contractile activity of the lower esophageal sphincter and increase the rate of emptying the esophagus. Histamine H2 receptor blockers (, famotidine), proton pump inhibitors (omeprazole, lansoprazole), prokinetics (dommperidone), antacids, etc. are used.

Surgical intervention may be required for complicated forms and the failure of drug therapy.