Esophagitis – what is it? Esophagitis: Symptoms and Treatment
Regardless of the etiology of inflammation of the esophagus, experts define the general term “esophagitis.” What does this pathological condition represent? What symptoms can indicate the presence of ailment? How to deal with it? All this we will discuss in the article.
Types of esophagitis
All cases of inflammation of the esophagus in medicine are systematized, which helps, focusing on the duration of the disease, its severity and the place of the pathological process, to make an accurate diagnosis. So, depending on the nature of the disease, esophagitis is divided into acute and chronic. According to the severity of the disease, catarrhal (that is, superficial) and erosive (in this case, the patient has affected the deep layers of the mucous membrane) esophagitis are distinguished. Depending on the location of the inflamed area in the mucous membrane of the esophagus, the ailment is total (if the entire esophagus is affected), proximal (inflamed upper section) and distal reflux esophagitis (pathology in the lower esophagus).
Acute, Subacute and Chronic Disease
Prolonged inflammation of the walls of the esophagus has a subacute or chronic form. The first can develop with the systematic use of too spicy food, strong alcohol or its surrogate, and the like. A chronic disease is most often caused by reflux (that is, the reverse movement of food from the stomach into the esophagus). Usually, this ailment accompanies a person for many years, gradually leading to serious changes in the work and structure of the esophagus.
Chronic Reflux Esophagitis
This is a burn that occurs due to the constantly repeated release or leakage of gastric juice or intestinal contents into the esophagus. Peptic esophagitis is caused by the relative and sometimes absolute insufficiency of the obstructive possibilities of the cardiac sphincter, which separates the esophagus and the stomach. A rather serious role in the development of this chronic disease is played by constantly increasing intragastric pressure and impaired mobility of the gastrointestinal tract. Often this pathology is combined with a hernia of the food hole in the diaphragm, peptic ulcer or gallstone disease and pancreatitis.
Esophagitis: cardia failure
Separately, I would like to dwell on the concept of “insufficiency of the cardia”. The upper section of the stomach is called cardia. Here is the sphincter, closing the lumen between the esophagus and the stomach. In normal operation, he skips the food lump only in one direction, reliably locking his passage back. At the same time the special valve blocking the movement in the esophagus does not exist. Anatomically, the locking function of the cardia is supported by the following structures:
If any of these structures work poorly, then there is a failure of the cardia. And this is one of the serious aspects for the development of esophagitis. Due to the fact that the pressure in the stomach is normally always higher than in the chest cavity, the sphincter weakened or deformed for some reason allows the contents to go back and burn unprotected esophageal mucosa. And repeated repetition of such a process causes serious pathological changes in this part of the gastrointestinal tract.
Causes of ulcerative esophagitis
If the emissions of acidic contents become chronic, the disease can penetrate deep into the esophageal mucosa, and erosions or ulcers form over time. True, the causes of ulcerative esophagitis are not only emissions, but also surgical interventions, hernia of the diaphragmatic orifice, duodenal ulcers and stomach ulcers, infectious diseases, chemical burns, ingestion of spicy food and damage resulting from the introduction of the probe or during radiation. therapy.
This disease has several degrees that characterize it:
Causes and consequences of candidal esophagitis
The disease occurs not only because of functional disorders in the gastrointestinal tract. It can be caused by infections that have penetrated from the outside, or even by “native” bacteria that have begun to grow rapidly for some reason. If the causative agent of the inflammatory process in the esophagus is candida, candidal esophagitis is diagnosed. This is the same thrush, but located on the walls of the esophagus. Candida fungi take root in human tissues very easily and, in violation of the microflora of the digestive tract, begin rapid development. Alcohol, hormonal (including contraceptive) agents or antibacterial drugs can cause changes in the microflora and, consequently, the development of a fungal infection.
Candida esophagitis, as a rule, is not life-threatening, but causes a lot of trouble. Due to fungal inflammation, scarring can develop and, as a result, shortening of the esophagus. And this situation greatly increases the risk of axial hernia formation in the esophageal opening of the diaphragm. Candida inflammation can cause ulceration, internal bleeding and perforation of the described part of the gastrointestinal tract.
How dangerous is esophagitis?
I would like to emphasize: in no case should you underestimate esophagitis (which is a serious disease, you hopefully already understood). It can not be “endured” or drowned out by taking any potions. The described condition is considered in medicine as the most massive pathology of the esophagus, which leads to serious complications, such as, for example, its narrowing (stenosis, stricture). Later this causes the patient to have difficulty in swallowing and, accordingly, requires reconstructive surgery. Another life-threatening complication also requires surgical intervention – perforation (perforation) of the esophagus wall. Statistics say that ten percent of those with esophagitis develop the so-called Barrett esophagus, which is characterized by the degeneration of the cells of its mucosa into cells characteristic of the intestinal mucosa. A similar condition in medicine is considered precancerous.
How to determine the presence of esophagitis
All of the above types of the disease have common signs that should cause the patient to suspect esophagitis. Symptoms and treatment of this pathology will be discussed below. Therapy should be carried out only under the supervision of a gastroenterologist.
All of these symptoms can worsen, for example, after a cup of coffee, a smoked cigarette, hot, solid or spicy food. Frequent complaints of increased manifestations of the disease in stressful situations. It is clear that the set of signs in different patients may differ. It depends on the severity of disorders in the esophagus, and on the localization of the inflammatory process, and on concomitant diseases.
How to distinguish esophagitis from other diseases
Taking into account that the symptoms characteristic of the disease being described may also be observed in some other pathologies of internal organs that are not related to esophagitis and require completely different treatment, it is necessary to clarify some nuances.
- The pain in esophagitis is not felt in the stomach, but immediately behind the sternum, in the chest.
- Heartburn is usually the main symptom of the disease being described. If, along with a burning sensation in your chest, you develop severe weakness, dizziness and shortness of breath, then it is more accurate to assume that there is no esophagitis.
- If a burning sensation in the chest appears from physical exertion, then this may be a sign of angina pectoris.
When do you need to go to a gastroenterologist?
We hope that esophagitis, the symptoms and treatment of which are discussed in this article, will not entail serious consequences for you. To do this, you must consult a doctor in time! Do not delay with visiting a specialist if heartburn has become permanent and weakly amenable to elimination with drugs; her seizures are not always explicable; you have difficulty swallowing; your voice has changed, and the weight is noticeably reduced; blood appeared in the vomit; the temperature has risen to 38 ° C and higher; you have a long lasting hiccup; fecal masses became liquid and acquired black color.
What diseases may be accompanied by inflammation of the esophagus
By the way, it is necessary to mention, speaking about esophagitis, that this disease often appears in patients who already have some problems with the gastrointestinal tract. As a rule, we are talking about illnesses that stimulate the increased aggressiveness of the gastric juice or are accompanied by its excessive formation. The same applies to the impaired motility of the gastroduodenal region (stomach and duodenum), slowing its emptying. All this contributes to the stretching of the stomach and, as a result, causes reflux.
Diseases that contribute to the development of esophagitis include gastroduodenitis, peptic ulcer or duodenal ulcer, hernia of the diaphragmatic esophageal opening, cholecystitis, and other pathologies. By the way, pregnant women in the late stages of fetal development also have a high risk of developing reflux esophagitis. This is due to an increase in intra-abdominal pressure in women.
What to do if you have concomitant esophagitis
Above it was mentioned that esophagitis is often a complex disease that manifests itself against other problems of the gastrointestinal tract. Therefore, if you have a combined diagnosis of gastritis esophagitis, then the treatment should be comprehensive. The drugs are selected according to the cause of gastritis and the level of acidity associated with this disease. The therapy also includes drugs that stop heartburn, stabilize the motility of the esophagus and stomach, as well as substances that promote the acceleration of healing of the mucous membrane. The same advice applies to the treatment of the diagnosis of gastroduodenitis esophagitis. It is important in the treatment of these diseases compliance with diet number 1, which implies a gentle split meals. At the same time, overeating is strictly prohibited, and the last meal should be made no later than two hours before bedtime.
How is esophagitis diagnosed?
Esophagitis, the symptoms and treatment of which we cover in the article, usually presents no difficulties in diagnosis. After the doctor has listened to your complaints and has studied the history of the disease, he should do some research. These include endoscopy of the esophagus, which will show changes in the mucous membrane, and X-rays using a contrast agent (barium). During the last procedure, a snapshot is taken in which the disorders in the esophagus are clearly visible: its swelling and the presence of a large amount of mucus. And with the development of ulcers visible leaking of a contrast agent in its crater.
How to treat acute esophagitis
The main task – to eliminate the causes of the disease, and in the future the patient must follow a strict diet. We are talking about the use of soft pureed food, which should be at room temperature. All foods that irritate the mucous membrane of the esophagus, including those containing large amounts of fiber, as well as fried foods, soda and alcohol, are excluded from the diet. Smoking for people suffering from this disease is dangerous! Patients diagnosed with esophagitis medications that affect the tone of the esophageal sphincter are prescribed by prior agreement with your doctor. These can be sedatives or tranquilizers, prostaglandins, and so on. It is advisable for patients to sleep on a bed with a high headboard, not to wear tight clothes, try not to go to bed after eating and less often bend over.
Treatment of chronic esophagitis
In the absence of stenosis, perforation, bleeding, and the like, the prognosis for treating the chronic form of the disease is favorable. As a rule, take drugs that block the production of acid, antifungal or antiviral drugs, antibiotics. Pain relievers are also prescribed. Corticosteroids are recommended to reduce the inflammatory process. If there is difficulty in swallowing, the patient is given an intravenous feed. In cases where the disease is caused by the presence of a hiatal hernia in the diaphragm, an operation is performed. Surgical intervention is also justified in case of unsuccessful conservative treatment, the presence of bleeding or stricture complications and the development of such dangerous pathology as Barrett’s esophagus. Conservative therapy is well combined with traditional recipes that help alleviate the patient’s condition.
Treatment of folk remedies
People’s treatment of esophagitis is, as a rule, recipes aimed at relieving inflammation, relieving painful symptoms and eliminating heartburn. So, to restore the mucous membrane of the esophagus, healers recommend taking a decoction of oregano, walnut leaves and oak bark. They are mixed in equal proportions and carefully crushed. One dessert spoonful of the mixture needs to be filled with boiling water and held for fifteen minutes in a water bath. Take this broth warm, two tablespoons before a meal or immediately after it.
In order to relieve swelling caused by the inflammatory process, take a mixture of oregano, alder and willow da Marya. They are mixed in equal quantities and crushed. Just as in the previous recipe, a spoonful of the mixture, filled with hot water, kept in a water bath and taken up to seven times a day.
Perfectly relieves inflammation and aloe. It is used, mixed with honey or without it, simply sucking up a piece of peeled leaf. And although it will not be very tasty, but this tool will help very effectively.
From the pain in the stomach will save the root marsh calamus. One teaspoon of chopped root is poured with a glass of boiling water and allowed to cool. Strain, take still warm for half a glass for half an hour before meals. And remember that during the day you need to drink at least two glasses of this infusion.
Some last tips
In addition to the treatment options described above, to alleviate the condition, some other prescriptions may be recommended to be followed:
food should be soft, not spicy and not sour;
From the article you learned about such a disease as esophagitis, what it is, what are the causes, symptoms and ways to eliminate the disease. Remember: treatment requires discipline. In addition to taking drugs prescribed by a specialist and traditional medicine, the patient must comply with the prescribed diet and stop smoking and alcohol. Only in this way will the disease that prevents you from living fully will recede. Good luck and good health!
What does the appearance of cough with reflux disease
Gastroesophageal reflux disease is also known as GERD. This condition occurs when the contents of the stomach are cast into the lower esophagus. Different pH of the contents of the stomach and esophagus leads to inflammation and damage to the esophageal mucosa. Thus, esophagitis develops.
As a result, mass from the stomach back into the esophagus develops reflux.
As a rule, reflux accompanies heartburn, which the person feels and sees a doctor. This allows you to properly conduct diagnostic procedures and establish the diagnosis of GERD, and then take up the treatment of pathology.
In practice, the body has sufficiently strong defense mechanisms, with the result that heartburn either does not appear at all, or it occurs extremely rarely.
At the same time, most people are confident that coughing is a manifestation of the pathology of the pulmonary system only. Some people know that coughing can also occur with severe cardiovascular disease. However, few people associate the occurrence of this symptom with reflux, while every second person suffering from GERD, the first manifestation of pathology is a cough.
Gastroesophageal reflux disease and its manifestations
In most cases, reflux is accompanied by unpleasant symptoms. The main manifestation of reflux is considered heartburn – a burning sensation behind the sternum or in the upper abdomen. However, reflux is not esophagitis. In order for a disease such as esophagitis to form, the injection of contents from the stomach into the esophagus must be constant.
Reflux often manifests as heartburn.
Constant reflux contributes to the change in pH of the esophagus in the acid side. Normal cells of the esophagus cannot function in such an environment. They die and are replaced by connective tissue or cells of the stomach. In this case, the esophagus loses its main function – the promotion of food.
Casting acidic contents into the esophagus and changing its pH leads to the development of inflammation. This is how GERD is formed. He has his symptoms:
With GERD, a lumpy feeling in the throat appears.
Esophagitis is not always caused by reflux. Symptoms that indicate exactly the reflux of the contents from the stomach – cough and heartburn. However, even if these symptoms are absent, this does not mean that a person has no gastroesophageal reflux disease. Confirm the diagnosis will help fibro-esophage-gastro-duodenoscopy.
It should also be remembered that with esophagitis, discomfort and heartburn develop quite often. Cough is also found in 50% of cases. However, this symptom may be the only manifestation of pathology in 10% of patients with GERD.
Described several options for the appearance of cough with GERD. The main one is considered irritation of the nerve endings. Reflexively acting on the nerve vagus, each reflux causes a cough.
There is another option for the development of cough with esophagitis. The wall of the esophagus begins to change and grow in size. Her puffiness can also be added. Then she just puts pressure on the trachea, causing a cough reflex. However, this situation can occur only in severe and neglected cases of GERD.
Various factors can trigger coughing with GERD.
In the final stages of GERD, Barrett’s esophagus also forms – mucosal cells completely regenerate and become cancerous tumor cells. Such a tumor can grow into the esophagus and cause coughing, as well as difficulty breathing.
How to treat reflux esophagitis
What is reflux esophagitis? This inflammatory process in the human esophagus when hydrochloric acid from the digestive organs gets there when the valve is damaged. Reflux esophagitis may be acute, have a chronic form. It can be combined with other diseases, such as candidiasis. This disease affects both men and women, often revealed esophagitis in children.
Different types and forms of the disease
The illness itself can be divided into several types:
The main causes of esophagitis – the occurrence and danger
The main component leading to the development of the disease is gastro-esophageal reflux. The most common cause of its occurrence is the overflow of food by the stomach or the weakness of the musculature of the valve, which closes the opening between the esophagus and the stomach.
The mucous membrane of the tube, which passes the food, does not have protection against hydrochloric acid, therefore, when gastric juice gets into it, the inflammatory process begins, leading to the development of esophagitis. These are the main reasons for the rapid development of the disease. Relatively rarely, this disease appears in inflammation of the esophagus under chronic exposure to alcohol or trying to drink any chemical solution.
The most rare variant of the onset of esophagitis is exposure to infection. This form of the disease is most often observed in patients with low immunity.
In yeast fungus, such as candida, candidal esophagitis may occur.
The most serious complication of reflux may be a narrowing of the esophagus walls and a change in their structure. This leads to difficulty in swallowing food and the need for surgery.
In 11% of all cases, esophagitis leads to the development of Barrett’s syndrome, which often develops into esophageal cancer.
Main signs and symptoms of esophageal lesions
These are considered to be the following manifestations:
Symptoms characteristic of esophagitis of the esophagus, may be present in other diseases of the gastrointestinal tract. Therefore, in order to distinguish different diseases from each other, one should pay attention to the following:
- In esophagitis (especially if it is a biliary disease), pain occurs immediately behind the sternum, but not in the stomach.
- Heartburn with reflux is considered one of the main symptoms. If a person experiences shortness of breath, weakness, and dizziness, then this is another disease.
- Burning in the chest and pain may occur with the development of angina. When reflux esophagitis symptoms of this type may coincide with signs of the above diseases. Therefore, it is best to consult a doctor.
You also need to be examined in a medical institution in such cases:
Treatment of different types of esophagitis
For short-term attacks of the disease, usually no therapy is required. To do this, it is enough to observe rational nutrition, which eliminates such risk factors as fatty foods, alcohol, spicy dishes, spices, etc. The mucous membrane of the esophagus in this case is quickly restored.
If the attacks of the disease (heartburn, pain) often recur, you should follow these recommendations:
The above types of medications can only be used to alleviate the symptoms of the disease, as they do not cure esophagitis. Independently they should not be selected – it can only aggravate the course of the disease. In a chronic or other form of this disease, the therapeutic effect of drugs depends on the accuracy of the diagnosis. Therapy is to remove all the factors that led to the development of esophagitis.
What medications are taken for esophagitis?
To neutralize the acidity, you can use antacids and coating agents. They are usually taken orally. They reduce the irritation caused by the action of acid on the walls of the esophagus. These drugs include Almagel, Maalox Plus, and the like.
Enveloping drugs form a protective film that prevents gastric juice from damaging the mucous membranes. These drugs include “Liquiriton”, flax seeds and
Drugs that reduce the production of hydrochloric acid by the stomach, are mainly the so-called histamine receptor blockers or proton pump receptors, for example, Ranitidine.
After completing the course of therapy, doctors can prescribe physical therapy and recovery breathing exercises to the patient, which stimulate the increase of immunity of the human body.
The composition of the diet in the development of reflux
Most often, the disease can be managed (with occasional seizures) with the help of a properly selected diet. But you need to follow the following rules:
The approximate composition of food for esophagitis:
Esophagitis in young children and pregnant women
The main reason for his development in a child is the reflux of the gastroesophageal structures. In babies who do not yet have the gift of speech and do not know how to explain what bothers them, the appearance of the disease is clearly seen when feeding. Then the child begins to refuse to eat, for no reason (in the eyes of the parents), crying, coughing at night. The symptomatology at children differs from the standard one a little. It is expressed as follows:
Heartburn and other manifestations of esophagitis are very often seen in pregnant women. They have a sharp increase in the period of gestation of the child intrauterine pressure. When this happens, the muscles and valves that link the esophagus to the gastrointestinal tract relax. All these phenomena contribute to the onset of reflux symptoms of esophagitis. After the birth of the child, all functions of the body are restored again, so the healing process is to eliminate heartburn.
Frequent and persistent heartburn (at least 2-3 times a week for several months or even years) is one of the signs of reflux esophagitis (from Latin refluxus – reverse flow and oisophagos – esophagus), a complex disease that occurs as a result of an infectious lesion or injury to the esophageal mucosa. Burning in the stomach and sour belching are not the only symptoms of reflux esophagitis. The clinical picture of the disease also includes regurgitation, a feeling of overflow and stomach distension.
Manifestations of reflux esophagitis (especially in older people) are somewhat similar to angina attacks: as a result of spasm of the esophagus, chest pain occurs, accompanied by hoarseness, cough and bitterness in the mouth. However, if an attack of angina increases with fast walking or other stress, then physical effort does not have a noticeable effect on the intensity of the reflux.
With reflux esophagitis, frequent attacks of nighttime suffocation, as in bronchial asthma. This happens if the acidic contents of the stomach from the esophagus penetrate into the bronchi, causing persistent bronchospasm. Acceptance of antacids (alkaline drugs) significantly weakens the painful manifestations.
The most serious complication of reflux esophagitis is Barrett syndrome, occurring in 10–20% of patients. With it, the mucosa of the esophagus gradually becomes bare and overgrown with specific cells, which increases the risk of esophageal cancer by about 30-40 times. This conclusion has recently come Swedish scientists from the Karolinska Institute in Stockholm. American oncologists from the Mayo Clinic abstain from such categorical conclusions.
And yet not worth lightly refers to reflux. Doctors advise to pay serious attention to the most seemingly insignificant heartburn: in the event of a burning sensation, immediately take the appropriate medication. People over 40 years old who experience heartburn at least 2 times a week for the past 5 years, as well as anyone who has difficulty swallowing food, should consult with a specialist.
Treatment of reflux esophagitis
Diet for reflux esophagitis
It is not a secret to anyone that the treatment of any gastric disease provides for the diet of a sick person. This is the only way to normalize the full work of the gastrointestinal tract and eliminate many unpleasant symptoms. This rule applies to reflux esophagitis – an extremely common pathology of the digestive system. The main signs of reflux esophagitis are heartburn, belching, pain and burning sensation in the sternum. Symptoms usually worsen after eating or lying down.
We give a list of products that should definitely be excluded from the diet of people suffering from this unpleasant disease. First of all it is fatty, spicy and fried food, chocolate, citrus and their juices, tomatoes, coffee and alcohol. It is also necessary to refuse spices (garlic, all kinds of pepper, cloves and cinnamon), vinegar, rich broths, turnips and cucumbers. All these products irritate the inflamed mucosa of the esophagus and stomach, causing heartburn and other discomfort.
How to eat people with reflux esophagitis? You can certainly find out about this at an individual consultation with a gastroenterologist. But you can bring a few general tips that are sure to become useful and help avoid heartburn.
1. Drinking a glass of boiled cold water before eating, you protect your esophagus, reducing the concentration of gastric acid.
2. To prevent the excess production of acid in the stomach, you can eat a couple of slices of raw potatoes before eating or drinking a quarter glass of potato juice. A small piece of white bread is also suitable.
3. Strongly contraindicated to drink alcohol before the start of the meal.
4. Forget about the night trips to the refrigerator – they only provoke another burning attack.
5. After eating, it is advisable to sit or stroll a little, but do not go to rest. This is explained by the fact that it is easier for the gastric juice to enter the esophagus when lying down. If reflux esophagitis passes with painful painful attacks, you should eat while standing and after that do not go to bed for at least another three hours.
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6. Drink before bedtime camomile extract. A glass of this simple product (1 tablespoon per 250 ml of boiling water) will not only make your sleep stronger, but also have an anti-inflammatory effect on the esophagus and stomach.
7. Tight belts and belts during exacerbation of reflux esophagitis will not give you a good service: pressure on the stomach can cause pushed gastric juice into the esophagus.
8. Meals should be fractional – up to six times a day. Small portions of food should be washed down with boiled water or mineral water without gas, weak tea or sweet juice.
9. The ideal drink for patients with reflux esophagitis is milk or dogrose infusion. Everyone can cook the last one at home: in a liter thermos, brew a couple of tablespoons of dried rosehips for six hours. When the time comes, the medicine is sieved and drunk as tea. Apple compote or dried fruit compote is also suitable.
10. Sour milk products must be included in the diet. Pay special attention to yogurt, low-fat yogurt, ryazhenku, cottage cheese. They will help to normalize intestinal motility, which will positively affect your health.
11. Kashi need to eat lean, giving preference to oatmeal and millet groats.
12. Bananas, peaches, plums and pears will help to cope with heartburn with reflux esophagitis. It is best to eat this sweet fruit in the morning – on an empty stomach or after breakfast.
Reflux esophagitis: symptoms and treatment
Reflux esophagitis is one of the most common and, at the same time, little studied diseases of the upper part of the digestive system. It appears due to inflammation of the mucous membrane of the esophagus, which develops due to the ingress of hydrochloric acid and other components of the gastric juice into the esophagus.
In adolescents and young people, often male, reflux esophagitis acts as an independent disease and is not accompanied by pathological changes in the lower organs. At an older age, the throwing of the acidic contents of the stomach into the esophagus occurs due to chronic diseases of the digestive system: gastric ulcer and intestinal ulcers, cholecystitis, portal hypertension, hernia of the diaphragmatic orifice, and so on.
What is reflux esophagitis and why does it occur?
Reflux esophagitis is an inflammation of the mucous membrane of the esophagus, on which erosions and ulcers are formed, caused by a weakening of the upper gastric or cardiac sphincter. In normal operation of the digestive system, this sphincter opens only when food and water enter from the esophagus into the stomach. The weakening of the sphincter muscle ring leads to the fact that the gastric contents: semi-digested food residues, hydrochloric acid, pepsin and other components of the gastric juice, goes back into the esophagus, irritates its mucous membrane and causes a lot of discomfort in the patient.
Until now, the exact cause of the weakening of the cardiac sphincter has not been identified, but There are a number of predisposing factors that can trigger this pathology. :
- excess weight, overeating, eating habits, eating “on the run” and eating dry food, eating excessive amounts of fatty, fried food, flour, fast food, and so on; smoking and drinking; excessive muscular load and weight lifting; diseases of the digestive system – gastritis, gastric and duodenal ulcers, cholecystitis, and so on; surgery on the abdominal organs; prolonged emotional overstrain; taking certain medications: calcium antagonists, NSAIDs, antidepressants, certain groups of antibiotics, sedatives, hormones, and so on; other factors.
Symptoms of the disease
The clinical manifestations of reflux esophagitis depend on a variety of reasons: the presence of aggravating factors, for example, concomitant diseases of the digestive organs, diet and the patient’s menu, as well as the degree of damage to the mucous membrane of the esophagus. There are 2 types of the main symptoms of the disease: esophageal and non-esophageal.
There are two variants of the clinical course of the disease:
- non-erosive reflux esophagitis – the mucous membrane of the esophagus is not damaged, the examination reveals only redness and swelling of the mucosa. The disease often proceeds hidden, the symptoms appear after the error in the diet and not too pronounced, characterized by the appearance of non-esophageal symptoms; erosive – a more severe variant of the disease, the mucous membrane of the esophagus is damaged significantly, during examination it reveals erosive damage of varying severity and different sizes.
Esophageal symptoms of reflux esophagitis
Esophageal symptoms are considered “classic” for this disease, most often they occur after an error in the diet, overeating, eating too fatty or spicy foods, carbonated drinks, or during physical and psycho-emotional stress.
- Heartburn is one of the main symptoms of reflux esophagitis, develops due to the reflux of the acidic contents of the stomach into the esophagus and the oral cavity and occurs in 75% of patients. Belching food, sour or bitter – for patients with a belching food immediately after eating and the appearance of belching sour or unpleasant taste in the mouth after sleep or a few hours after eating. Nausea and vomiting – a violation of the diet or overeating often provoke attacks of nausea or vomiting of food eaten. Increased salivation — due to an increase in the level of acidity in the esophagus and oral cavity, the salivary glands secrete more saliva than necessary, patients are constantly forced to swallow or spit, and if it is impossible to do so, for example, in a dream, it begins to flow out of the oral cavity — after sleep on the pillow wet traces remain. The pain and disruption of the swallowing process – due to the muscular weakness of the esophageal sphincter, the normal innervation of the esophagus is disturbed, it begins to chaotically decrease, which causes pain in it when swallowing the food lump and the sensation that food “sticks” in the esophagus without moving into the stomach. Stinging pain in the chest – burning, compression and pain in the chest and epigastric region are often caused by inflammation and irritation of the mucous membrane by the acidic contents of the stomach. Such pains are paroxysmal, occur soon after eating and may radiate to the left arm, neck, under the left shoulder blade and the interscapular region, which is why they are often confused with heart pains or even a myocardial infarction attack.
More than half of patients with reflux esophagitis note the appearance of some extra-esophageal symptoms, they often occur at the onset of the disease, against the background of a complete or partial absence of esophageal manifestations, which makes it difficult to make a diagnosis and causes the patient to seek help from various experts.
- Coarsening and hoarseness of the voice – due to the ingress of acid on the vocal cords, the voice of the patient can become rough and hoarse. Cough, pain and “lump” in the throat – irritation of the vocal cords, throat and pharynx with the acidic contents of the stomach often leads to persistent cough, sore throat and difficulty in swallowing, which do not go away after the use of conventional means. Heart rhythm disorders and asthma attacks — irritation of the vagus nerve with acid can cause bradycardia, arrhythmia, or asthma attacks that occur for no apparent reason and go away on their own. Diseases of the oral cavity – gingivitis, stomatitis, caries and other pathologies of the teeth and gums also often develop due to a violation of the acid-base balance of the oral cavity and become chronic. Pain of unknown etiology – reflux esophagitis can manifest pain that occurs in the lower jaw, neck and other organs. Bad breath – persistent, unpleasant smell from the patient’s mouth is one of the characteristic extra-esophageal symptoms of the disease.
To make an accurate diagnosis and determine the extent of damage to the mucous membrane of a patient, they perform:
- X-ray diagnostics with contrast agents – this is necessary to detect ulcers, narrowings, inflammatory changes in the esophagus and assess its patency; daily pH meter – allows you to assess the level of acidity in the esophagus, the number and duration of reflux per day; fibrogastroduodenoscopy – FGDs – one of the most informative methods, allows a specialist to see and assess the condition of the esophageal mucosa and the presence of erosions, inflammation and other changes.
Additionally, a radioisotope study can be conducted to assess the motor and evacuation capacity of the esophagus, a morphological study of mucosal cells to exclude malignant transformation, and other studies.
Treatment of reflux esophagitis begins with a change in the patient’s lifestyle and his prognosis depends on his behavior and compliance with medical recommendations. To facilitate the patient’s condition and normalize digestion, the patient is prescribed:
- lifestyle correction; diet; drug treatment; surgery.
To prevent recurrence of the disease and alleviate the condition, the patient should get rid of excess weight, comply with work and rest regimens, quit smoking, drinking alcohol or any psychoactive substances, avoid increased physical and neuropsychic loads, and adjust medications that aggravate the manifestation of the disease. In particular, with reflux esophagitis, one should not overeat, eat less than 3 hours before bedtime, lift more than 8 kg after a meal and wear tight, squeezing or squeezing abdominals, clothes.
Compliance with the diet and eating healthy foods helps to quickly get rid of the symptoms of reflux esophagitis and prevent their occurrence in the future. The sick should :
- eat fractional, in small portions, at least 4 times a day, with the last meal not earlier than 3 hours before bedtime; eliminate from the diet too fatty, hot and cold dishes, as well as all spicy, salty, smoked, spices and preservatives – any products that can cause mucous irritation and increased production of gastric juice; limit the use of products that lower the tone of the esophageal sphincter – carbonated drinks, strong tea and coffee, any cocoa products, citrus fruits, tomatoes, fatty meats, fish, creamy meats, egg yolks, and so on.
Pharmacotherapy is used in the midst of the disease to alleviate the condition of the patient and accelerate the healing of the damaged esophageal mucosa:
one. Drugs that reduce the secretion of gastric juice – this is the basic therapy of reflux esophagitis, reducing the acidity of gastric juice allows to minimize its damaging effect on the esophagus and gives the opportunity to regenerate the cells of the mucous membrane. To do this, use:
- proton pump inhibitors – the most powerful and effective: omeprazole, esomeprazole, pantoprozole, rabeprazole and others; histamine H2 receptor blockers – ranitidine, famotidine, nizatidine, roxatidine and others; M-cholinolytics – platifillin, metacin – are rarely used with caution, since they can simultaneously reduce the pressure of the esophageal sphincters.
The duration of medication depends on the condition of the mucous, but must last at least 1-2 months, in some cases a year or more. Sometimes this treatment must be carried out for life.
2 Prokinetics – drugs that restore normal motility of the digestive system:
- metoclopramide – cerrucal, raglan and others; Domperidone – motilium, motonix, passengerix and others.
3 Symptomatic treatment – the use of antacid and alginate preparations allows to reduce the harmful effects of hydrochloric acid on the mucous membrane of the esophagus and facilitates the patient’s condition. But these drugs have no effect on the cause of the disease, therefore they bring only temporary relief:
- antacids – inactivate hydrochloric acid and other components of the gastric juice: almagel, phosphalugel, renny, gastal, maalox, rutacid and others; Alginates – form a foam that protects the mucosa from hydrochloric acid: topalkan, Gaviscon and others; coating agents – to speed up the regeneration of the mucous membrane: misoprostol, flaxseed decoction, sucralfate and others.
With the ineffectiveness of drug treatment or serious violations of the patency of the esophagus using surgical treatment: endoscopic or radical surgery.
The success of treatment and prevention of the disease depends largely on the patient: strict adherence to all medical recommendations, lifestyle changes and dieting allow you to quickly get rid of the symptoms of reflux esophagitis. But, one should not forget that this disease is related to diseases of the “lifestyle” and in case of violation of the recommendations, esophagitis recurrences and progression of the pathology can occur very quickly.
Signs and treatment of erosive reflux esophagitis
1 Causes of the disease
This disease is considered to be one of the stages of gastroesophageal reflux disease. Gastric contents – this is food grade, hydrochloric acid, mucus, enzymes for digestive processes, and sometimes pancreatic juice and bile acid. Casting the contents of the stomach into the esophagus is gastroesophageal reflux. Such a problem can occur even in a relatively healthy person. But usually during the day it happens no more than 2 times. Duration is up to 5 minutes. In the daytime, due to food intake, this phenomenon occurs more often. Most people do not even feel reflux.
To prevent such casts in the opposite direction, several protective mechanisms are provided in a healthy organism. This applies to such phenomena:
The causes of reflux esophagitis are very diverse. Various factors can cause this pathology, which will reduce the effect of protective factors or completely suppress them. For example, it may be smoking. The reason may be overweight. Excessive loads also adversely affect, especially if it concerns the abdominal muscles. So with a tendency to such a pathology you should not carry heavy objects. Often the problem lies in the diet, or rather its misuse. In no case can not eat sour dishes. It is very harmful to overeat before bedtime. Often the problem lies in the addiction to alcohol. Stress and emotional stress also harm the human body. You can not wear cramped clothes – corsets, bandages and stuff. They squeeze the body and internal organs, impair blood flow.
Erosive reflux esophagitis can also cause the consequences of surgery or bougienage. A common cause is a hernia in the opening of the esophagus. Due to too wide a lumen the contents of the stomach back out through the sphincter. In addition, often this pathology is provoked by medications that the patient has been taking for too long and without medical supervision. This usually refers to anti-inflammatory drugs, a group of calcium antagonist drugs, antibiotics, nitrates, antidepressants, beta-blockers, theophyllines, quinidine, hormones, sedatives, and narcotic drugs.
Often, reflux esophagitis occurs in pregnant women, but then, after childbirth, it disappears. In addition, in children, this pathology also develops if there are abnormalities in the development of the muscular system and the nervous system. Constipation, which gradually becomes chronic, must also be considered. Another cause is scleroderma.
At first, the enzymes of the stomach, lysolecithin and bile acid simply irritate the walls of the esophagus when cast into it. As a result, the first symptoms appear. Then the inflammatory process develops. If reflux regularly contacts with the mucous membrane, then erosion appears. They further become the cause of strictures (these are deformities of the scar type). The organ often bleeds. In addition, inflammatory processes that are not controlled can cause changes of the precancerous type (Barrett syndrome), and then they degenerate into malignant tumors. As a result, adenocarcinoma develops.
2 Symptoms of the disease
If a patient has reflux esophagitis, the symptoms will differ depending on the form of this ailment. Allocate non-erosive and erosive form. In case of non-erosive type of the disease, only swelling and redness of the walls will be detected during endoscopic examination. When erosive form will be detected erosion with different lengths. The degree is indicated – from the first to the fourth, or a-d. Her doctor determines depending on the degree of organ damage and the prevalence of defects. In addition, it is necessary to determine the presence of complications – ulcers, Barrett’s syndrome, strictures, shortening of the tubular organ.
Signs of reflux esophagitis will differ depending on the degree of organ damage. The disease may occur in a latent form, so that the symptoms do not appear at all. But most often, erosive esophagitis strongly interferes with the person. All clinical manifestations are conventionally divided into extraesophageal and esophageal.
As a rule, the symptoms of the esophageal type occur after overeating, dinner at a later time, errors in diet, drinking alcohol or carbonated drinks, stress, and physical overstrain. Symptoms usually occur when a person is in a horizontal position or is lifting weights. Symptoms of the esophageal type are as follows:
Burning pain is felt in the epigastric region. A person can easily confuse with pain in the heart, heart attack and angina. Then these sensations spread to the neck, chest, the area between the shoulder blades.
All these esophageal symptoms are considered classic. They can appear all together, or only a part of them arises.
As for the symptoms of the extraesophageal type, they are more difficult to associate with reflux esophagitis. For example, the voice becomes hoarse, there is a lump in the throat for a long time. Ulcers and granulomas appear on the vocal cords. For a long time, a person coughs with phlegm and mucus. Sometimes suffocation occurs. Gums can become inflamed. Rarely appear damage to tooth enamel. Sometimes a person feels pain in the lower part of the mouth. Periodically hurts the neck. Rarely appears papillomatosis of the larynx. From the oral cavity smells unpleasant. In some cases, the heartbeat rhythm is disturbed.
3 Treatment Events
For erosive reflux esophagitis, treatment should be started as early as possible. It is recommended to correct the lifestyle, eat properly. Medications are usually prescribed. In severe cases, surgery is required. Usually treatment is carried out on an outpatient basis. Hospitalization is required only when severe complications are found.
Erosive esophagitis occurs due to improper lifestyle, so it is recommended to change it for the better. Required to stop smoking and drinking alcohol. It is better not to lean on carbonated drinks. Be sure to follow your own weight and get rid of extra pounds. The part of the bed where the head is located must be increased by 15 cm. Moreover, the pillows cannot be enclosed – because of them, the pressure inside the abdominal cavity increases. It is impossible to go to bed after eating 3 hours. It is forbidden to wear tight clothes, especially belts, elastic bands, belts, bandages and corsets. You can not lift the weight. Be sure to play sports, walk in the fresh air.
Diet for erosive reflux esophagitis is mandatory. It will help prevent the development of complications. Appointed a sparing diet. You can not overeat, but hunger to starve yourself is also prohibited. Do not lean on fatty milk, cocoa, coffee, egg yolks, butter, margarine, pepper, garlic and onions, tomatoes, chocolate, mint, citrus fruits. All these products reduce the tone of the esophageal sphincters.
4 Drug therapy
Erosive esophagitis should be treated with medicines. Such treatment involves the use of two directions. First you need to use powerful drugs, and then the intensity of drugs decreases. Then the second strategy should increase the pharmacological effect.
Surely prescribed drugs with antisecretory action. They reduce the intensity of secretion in the stomach. Since the level of acidity in the body falls, the contents of the stomach does not affect the esophageal mucosa. These drugs include proton pump inhibitors. H2 blockers and M-cholinolytics are also required. The duration of the course will be determined by the doctor, but it lasts at least a month.
When erosive form requires prokinetics. For example, domperidone, metoclopramide, and more. They can improve motility. Alginates and antacids will be needed. They neutralize the action of hydrochloric acid.
5 Useful recommendations
Erosive and ulcerative esophagitis is a fairly common disease. This disease inflames the mucous membranes of the esophagus in its lower part. This is due to the fact that the gastric contents come back from the organ. As a result, hydrochloric acid and enzymes harm the walls of the body. If the disease is not treated, then erosions and ulcers appear in places of inflammation.
Symptoms and treatment of this disease is determined by the doctor, do not self-medicate.
Causes and treatment of cough with reflux esophagitis
Coughing is not just an unpleasant symptom. It causes any irritation of the inner surface of the larynx, trachea and bronchi. Without finding out the cause of these irritations, it is impossible to begin an adequate treatment and to stop the debilitating painful manifestation.
Nature of reflux
Reflux is the phenomenon of the reverse movement of food soaked in gastric juice. A “discarded” portion of food is called reflux.
The ingress of microscopic portions of food from the stomach into the esophagus is due to the incomplete closure of a particular valve between them. The weakness of this valve, called the lower esophageal sphincter (LES) or cardia, is due to the following reasons:
Reflux episodes that have become systematic in combination with complications and characteristic symptoms (heartburn, pain and a feeling of heaviness in the stomach or behind the sternum) suggest the development of gastroesophageal reflux disease (GERD). The phenomenon of reflux often occurs against the background of a temporary weakening of the PS. But sometimes refluxes occur due to the constant decrease in sphincter muscle tone.
Causes and effects of prolonged cough
The protective role of coughing is that coughing motions remove sputum and foreign particles from the respiratory tract. The most likely causes of coughing are:
A strong, prolonged cough of any etiology leads to an increase in pressure in the chest, impaired blood circulation in the chest cavity and a decrease in the strength of heart contractions. Chronic cough weakens the elasticity of the lung tissue and can lead to the development of emphysema.
Mechanisms of coughing with reflux esophagitis
GERD can cause symptoms that at first glance are difficult to associate with disorders of the digestive tract: a feeling of sore throat, cough, aggravated at night, shortness of breath, pulmonary rales, difficulty breathing, hoarseness or falsetto. An indirect confirmation of the association of GERD and cough is the fact that specific treatment of GERD leads to its disappearance or significant reduction.
There are two causes of cough in GERD:
1) Throwing the smallest particles of gastric contents into the airways is called microaspiration. Reflux microparticles play the role of a chemical stimulus to the respiratory tract.
When particles of reflux enter the larynx (nasopharynx, and when inhaling and then into the trachea), receptors that activate the cough center are irritated. The occurrence of cough, the cause of which is the reflux of gastric contents into the esophagus, is reflex (automatic) in nature and is called an esophageal tracheobronchial reflex. It is called gastric cough.
High acidity of the food mass causes, as a rule, inflammatory changes in the mucous membrane of the stomach and esophagus – gastrointestinal symptoms. But the inflammation of the walls of the esophagus (esophagitis) does not always accompany the course of GERD: it may have a single symptom in the form of cough.
Cough as a result of food micro-aspiration appears after typical symptoms of GERD and is accompanied by clear signs of irritation of the lower respiratory tract, lesion of the vocal cords and inflammatory processes in the larynx.
Signs of cough with reflux esophagitis caused by aspiration of food:
But studies have found that in 30% of cases, cough occurs even when an acidic gastric mass reflux occurs no higher than the lower third of the esophagus (the so-called distal section).
2) When reflux enters the esophagus, special, so-called vagal receptors are located in the lower third of the esophagus. They activate the cough center of the brain and thus stimulate cough: this mechanism is called the vagus-mediated reflex.
The vagus-mediated nature of cough unambiguously confirms the absence of changes in radiographic examination of the chest and the normal state of the laryngeal mucosa. Such a cough, as a rule, anticipates the occurrence of the “classic” symptoms of GERD, does not cause expectoration and lasts for years in the absence of treatment. Infections of the upper respiratory tract against him are more severe, aggravating the cough urge.
Note! One of the main distinguishing features of cough with reflux esophagitis is free nasal breathing.
Diagnosis of cough with reflux esophagitis
The development of therapeutic approaches is impossible without identifying the causes of coughing. One of the main factors determining the etiology of cough is the painstaking work of the doctor to collect history data and detailed medical examination.
History taking involves identifying characteristic symptoms and the relationship of cough with the patient’s lifestyle:
To determine the mechanism of cough caused by GERD, a comparative analysis of acidity in the lower and upper esophageal tube is carried out. Such an analysis is possible only in the course of pH-metry, the most sensitive and specific method of examination, the so-called “gold standard”. It provides the opportunity to make an unambiguous conclusion about the connection between cough and acid reflux.
An assessment of the effects of “acidification” of the esophagus, the state of its mucous membrane and cough suppression factors is also necessary. To do this, conduct a gastroscopic examination, during which the doctor visually assesses the condition of the esophageal mucosa. In most cases, during the examination of patients with complaints of cough, esophagitis of the lower esophagus is detected.
If necessary, fluoroscopy of the lungs is performed in the position of Trededenburg. This method of diagnosis allows not only to fix possible deformations of the esophagus, but also the nature of the distribution of the reflux within the esophageal tube during stimulated reflux of food at the time of the study. This technique allows you to repeatedly increase the information content of the survey. When performing fluoroscopy in the Trendelenburg position, reflux stimulates the patient’s special posture.
Treatment of cough with reflux esophagitis is a long process. Relief of the condition is impossible without a comprehensive treatment approach, depending on the stage of the disease and the state of the mucous membrane of the esophageal wall.
Effective treatment primarily involves an intense and prolonged decrease in the acidity of gastric juice.
Each stage of the disease requires certain therapeutic approaches. Treatment continues for at least 3 months after cessation of the cough with a gradual subsequent withdrawal of drugs according to a certain scheme.
According to the intensity of exposure, cough therapy for reflux esophagitis is conditionally divided into the following stages:
The need for surgical intervention in the form of an open or laparoscopic gastric fundoplication arises in the case of persistent airway lesions on the background of the continuing aspiration of gastric contents.
Note! GERD is a chronic disease, so it may be necessary to repeat long courses of therapy due to cough recurrences at the end of drug therapy.
Strict adherence to a diet and a radical change in lifestyle are prerequisites for long-term remission of the disease, which under certain conditions can be achieved without taking medications. Smoking cessation and adequate exercise are here as part of the treatment process.
The decrease in body weight will reduce intra-abdominal pressure, the load on the diaphragm and the risk of hernia of the esophageal opening. Overeating, clothing, squeezing the stomach, physical exertion after eating slow down the movement of food, increase the pressure inside the peritoneum and, ultimately, lead to the opening of the PS, this physiological “key” that locks the esophagus.
Note! Natural (physiological) reflux in the absence of esophagitis is not able to cause coughing and shortness of breath.
When food bolus enters the stomach, the release of acid occurs reflexively. But alcohol, spicy, spicy and sour food, drinks with gas increase the secretion of acid, increasing the acidity of the contents of the stomach. The diet of a patient suffering from a gastric cough should include a sufficient amount of protein, up to 45 g in a daily diet. Products that stimulate the release of acid, weaken the tone of the PS, should be excluded.
Eating later than 2 hours before bedtime is excluded. Raise the head of the bed by at least 10 cm.
Calls for fractional nutrition – a common place of medical recommendations. But the fractional nutrition should be a behavioral axiom for a patient with a cough caused by reflux esophagitis.
A dry strained cough, caused by GERD, can last for up to several years, in the absence of adequate treatment, finding no resolution and exhausting a person, and can lead to asthma. Reducing the frequency and duration of reflux episodes is the key to successfully overcoming the cough reflex.