Causes of reflux esophagitis in adults. Erosive reflux esophagitis: symptoms and treatment

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

Symptoms of reflux esophagitis

One of the characteristic symptoms of reflux esophagitis is heartburn.

Inflammation of the esophagus caused by irritation of the mucous membrane by the acidic contents of the stomach is manifested by esophageal dyspepsia. Most characteristic symptoms for reflux esophagitis:

. When describing this condition, patients put their hand to the sternum, indicating the location of the burning sensation. Sometimes it radiates to the neck and shoulder blade. If the heartburn is mild, it goes away within 3-5 minutes after taking antacids. It can be eliminated by drinking a glass of milk. Intensifies with overeating, bending over, after drinking alcohol, carbonated drinks.
Belching. Patients complain of regurgitation. An unpleasant sour or bitter taste appears in the mouth. Belching indicates the development of esophageal stenosis. Nocturnal regurgitation during sleep is especially dangerous (contents from the esophagus enter the Airways).
Pain behind the sternum. It is burning, intense, intensifies in a lying position, when bending the body forward. Irradiates to the interscapular region, neck, lower jaw. According to the clinical manifestation, pain with reflux esophagitis is similar to.
Dysphagia. At the initial stages, patients complain of difficulty swallowing solid food (bread, meat). If the disease progresses, the lumen of the esophagus narrows significantly (becomes less than 13 mm), then even saliva is difficult to swallow.
Esophageal bleeding. This is extremely dangerous symptom requiring urgent surgical intervention.
Foam appears in the mouth. An extremely rare sign of reflux esophagitis. Occurs due to intense production salivary glands secretion (up to 10 ml per minute), in response to the esophageal-salivary reflex.

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

Dental. Due to hit gastric juice Erosion appears on the tongue in the mouth, teeth are destroyed, and... Patients complain of drooling.
The ENT organs become inflamed (nasopharyngitis, rhinitis, etc. develop). Patients are bothered by the sensation of a lump or spasm in the throat. Ulcers, granulomas, and polyps appear on the vocal cords. The patient's voice becomes hoarse and rougher. Reflux esophagitis contributes to the development of cancer of the pharynx, vocal cords, and larynx.
Bronchopulmonary symptoms. With reflux esophagitis, in 6–10% of patients, the disease manifests itself exclusively as a persistent cough and attacks of suffocation, occurring mainly at night.
Pseudocardiac. Pain behind the sternum with reflux esophagitis is difficult to distinguish from “angina pectoris”. It even radiates in the same way as with angina pectoris. This is due to the innervation of the esophagus and heart by the same nerve. Such symptoms occur in 70% of patients. They initially contact a cardiologist, but do not show any abnormalities.
Cardiac symptoms. Patients, especially older ones, complain of tachycardia during attacks of pain caused by reflux. Due to pathology of the esophagus, reflex angina and myocardial ischemia develop.
Signs of stomach damage. Patients complain of pain and heaviness in the abdomen, worsening after eating, rapid satiety, and nausea.

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

Diagnostics

The doctor makes the final diagnosis based on the results of FGDS.

The entry of bile into the esophagus can be detected by the patient’s complaints of a bitter taste in the mouth, especially occurring in the morning, or a yellowish coating on the tongue. Duodenal reflux is finally determined by analyzing tongue scrapings for the presence of bile acids.

Clinical manifestations alone are not enough to establish a diagnosis of reflux esophagitis. This disease is accompanied by serious changes in the mucous membrane of the esophagus. Therefore, before treating reflux esophagitis, it is necessary to differentiate it from other diseases. The doctor prescribes these additional research:

, esophagus, stomach;
inhibitor test proton pump.

The final diagnosis is made after testing if corresponding histological and morphological changes in the mucous membrane of the esophagus are identified. If there are ulcers or erosions, a biopsy must be performed.

Treatment

Medicines

If the disease is not advanced, complications (bleeding, ulcers, etc.) are not identified, conservative treatment is carried out. Prescribed medications:

prokinetics;
antisecretory agents;
antacids.

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

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

If patients are resistant to PPIs, monotherapy with antacids is administered. In severe cases, a complex is prescribed:

H2-histamine receptor blockers;
antacids.

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

tricyclic antidepressants (amitriptyline);
selective serotonin reuptake inhibitors (Fluoxetine, Paroxetine).

Antacids reduce exposure of hydrochloric acid and other components of reflux onto the mucous membrane of the esophagus.

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

ursodeoxycholic acid;
antacids;
Cholestyramine.

To prevent further damage to the esophagus, the tablets should be taken sitting or standing, washed down with plenty of water (100–150 ml).

Diet and lifestyle

In addition to medications, patients with reflux esophagitis must make lifestyle changes. There are certain rules that must be followed to reduce the number of reflux:

Skip the afternoon rest. Do not eat 3 hours before going to bed at night. After eating, it is better not to take a horizontal position, but to take a walk fresh air or just sit and walk around the room for half an hour.
Don't wear tight clothes. Underwear that tightens the stomach is strictly contraindicated. No tugging belts, tight belts, or corsets.
You should go to bed with the head of the bed raised by 15 cm.
Reduce the load on the abdominal muscles, especially after eating. You cannot instantly destroy the excess calories you eat by pumping up your abs or bending forward. Time with these exercises for 2 hours.

A diet is mandatory for reflux esophagitis. In case of exacerbation of the disease, it is indicated treatment table No. 4. As you recover, most of the restrictions are lifted, but the following remain prohibited:

alcohol;
carbonated drinks;
strong tea and coffee;
spicy, salty.

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

Surgery

Surgical treatment is necessary for:

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

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

Reflux esophagitis is a chronic disease that involves pathological reflux of gastric contents into the esophagus.

Since the mucous membrane does not have protection against such aggressive substances, contact with them causes epithelial damage with further inflammation and, accordingly, painful sensations.

When reflux esophagitis occurs, the acidity level of the esophagus drops noticeably due to the mixing of the contents of the esophagus with acidic gastric refluxate and digestive enzymes. The result of prolonged contact of the esophageal mucosa 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.

Causes

Why does reflux esophagitis occur, and what is it? The cause of reflux esophagitis usually lies in 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 longer (for patients - up to a minute after each swallow), this causes a regression of the acidic contents of the stomach into the esophagus.

Often reflux esophagitis accompanies gastrointestinal diseases such as:

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

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

Erosive reflux esophagitis

A complicated form of the disease in which small ulcers (erosions) form on the esophageal mucosa. With erosive reflux esophagitis, all of the above symptoms become more pronounced, bringing significant discomfort to the patient. Manifestations of the disease intensify after eating, as well as certain medicines, for example, aspirin.

Degrees

The course of the disease is characterized by several stages, with gradually increasing symptoms and erosive damage to the esophagus becoming more pronounced.

degree - manifested by individual non-merging erosions and erythema of the distal esophagus;
degree - merging, but not covering the entire surface of the mucous membrane of erosive lesions;
degree - manifested by ulcerative lesions of the lower third of the esophagus, which merge and cover the entire surface of the mucosa;
degree - chronic ulcer of the esophagus, as well as stenosis.

Symptoms of reflux esophagitis

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

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

belching of 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 taking a sitting position.

Chronic reflux esophagitis

Esophagitis in chronic form, with a characteristic alternation of periods of exacerbation with periods of remission, can either be a consequence of acute untreated reflux esophagitis, or develop against the background of alcoholism and consumption of rough, low-quality food.

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

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

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

Diagnostics

To detect gastroesophageal reflux, today they use enough different methods. Thanks to x-rays of the esophagus, it is possible to record the penetration of contrast from the stomach into the esophagus or to find a hiatal hernia.

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 determine the frequency, duration and severity of reflux. And yet, the main method for diagnosing reflux esophagitis is endoscopic. With its help, you can obtain 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 patient's age and concomitant pathology. In some forms, no therapy is prescribed, while in others, surgery is required.

How to treat reflux esophagitis

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

Conservative treatment indicated for 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 of the bed raised at least 15 cm,
do not wear tight clothes and tight belts,
limit the consumption of foods that have an aggressive effect on the mucous membrane of the esophagus (fats, alcohol, coffee, chocolate, citrus fruits, etc.),
quit smoking.

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

proton pump inhibitors (omeprazole, lansoprazole, rabeprazole) in regular or double dosage,
antacids (Almagel, phosphalugel, Maalox, Gelusil-lac, etc.) are usually prescribed 1.5-2 hours after meals and at night,
prokinetics - domperidone, metoclopramide.

To reduce symptoms such as heartburn and chest pain when lying down, you should take correct posture – top part The body should be slightly elevated, for which you can use several pillows.

Operation

This treatment method is rarely used. Basic indications for surgery:

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

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

Diet

For 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 products, pickles;
strong broths and soups cooked with them;
fatty and fried foods;
fruits (especially citrus fruits);
spices, sauces;
chewing gum;
foods that increase gas formation (cabbage, brown 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 pureed low-fat cottage cheese,
dairy products,
porridge,
meat and fish soufflé,
steamed cutlets and meatballs,
crackers or stale bread soaked in water,
baked apples.

The diet of patients suffering from reflux disease should be divided and include five to six meals a day, the last one four hours before bedtime.
portions should be small so that the stomach is filled to only a third of its volume.
It is better to replace the afternoon nap with a quiet walk. This helps food move faster from the stomach into the intestines, and acidic contents will not be refluxed into the esophagus.

To reduce gastroesophageal reflux, you must:

lose weight,
sleep on a bed with a high headboard,
maintain time intervals between eating and sleeping,
quit smoking,
stop drinking alcohol, fatty foods, coffee, chocolate, citrus fruits,
Eliminate the habit of drinking water with food.

Folk remedies

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

Forecast

Reflux esophagitis, as a rule, has a favorable prognosis for work ability and life. If there are no complications, then it does not shorten 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 is a chronic disorder characterized by the reflux of stomach contents into the esophagus, which is accompanied by irritation of its walls. The peculiarity of the disease is that it is expressed by mild symptoms, so the diagnosis of the disease often occurs when completely different disorders are detected, for example, peptic ulcer or gastritis. This is often the case pathological condition is one of the signs of a hiatal hernia.

In addition to the above diseases, the reasons for the progression of such a disease may be: excessively high body weight of a person, introduction nasogastric tube, which is necessary for nutrition in some diseases, is not managed healthy image life, the presence of gastritis, taking medications aimed at reducing sphincter tone. In addition, this disorder can be caused by an incorrect or unbalanced diet, as well as some individual foods. For example, for children it is chocolate, citrus fruits and tomatoes. For adults, additional caffeinated drinks and alcohol may be considered.

The characteristic signs of the disease are constant heartburn, pain and burning in the chest area, especially during meals, impaired swallowing, belching with an unpleasant odor, and the presence of a sour taste in the mouth. In addition, various pathological processes are observed in other internal organs.

Diagnosis of reflux esophagitis consists of a set of measures, which includes studying the medical history and examination of the patient, laboratory tests, in particular blood from the veins, instrumental examinations aimed at studying the structure and identifying lesions of the esophagus. The disease can be treated with a combination of drug therapy and diet or without the use of drugs.

Etiology

The main reason for the progression of this disorder in children and adults is a disruption of the normal functioning of the lower esophageal sphincter, as well as a decrease in the tone of its muscles. The esophageal sphincter is always open or widened, causing stomach contents to flow freely into the esophagus. Other predisposing factors to the development of reflux disease include:

period of bearing a child;
consumption of spices, coffee and chocolate;
the person is overweight;
prolonged position of the body with a forward bend;
taking certain medications;
peptic ulcer of the stomach or duodenum;
a disorder such as systemic scleroderma;
a probe inserted through the nose into the stomach, necessary for carrying out the process of human nutrition in severe disorders, among which are coma and anorexia;
gastritis caused by the bacterium Helicobacter pylori;
soy protein intolerance or cow's milk– a reason characteristic only for newborn children.

Even such a factor as a simple forward bend can lead to the manifestation of such a disorder. Many causes of the disease can be identified using a blood test from the veins.

Varieties

There are several classifications of such a disease as reflux esophagitis in adults and children. The first of them involves division depending on the degree of spread of the disease process and the expression of symptoms:

initial– there is one or more damage to the mucous membrane (erosion), which does not merge with each other and is superficial. Their length is no more than five millimeters;
average– erosive lesions tend to merge, however, without covering the entire surface of the mucous membrane. Unpleasant symptoms are expressed only after eating;
moderate severity – violation of the integrity of the lining of the esophagus. Each damage exceeds five millimeters and is characterized by spreading to more than half of the mucosa. Characteristic signs of the disease are expressed regardless of food consumption;
heavy– chronic ulcer and stenosis are observed. Progression pathological process covers almost the entire mucous membrane. Characterized by the possibility of complications and malignant neoplasms.

Depending on the form of the disease, the disease is divided into:

acute form– characterized by a sudden onset of symptoms and their persistence;
chronic reflux esophagitis– expressed by periods of exacerbation and subsidence of the expression of symptoms. Often this type of disorder is accompanied by gastritis;
catarrhal reflux– during diagnosis, swelling of the esophageal mucosa is detected, while a person may feel the presence of a foreign object in the throat;
erosive course– complicated course of reflux esophagitis, in which ulceration of the mucous membrane occurs;
biliary reflux esophagitis– is a manifestation of a chronic course. The main difference is that bile plays a certain role in pathogenesis;
non-erosive reflux– differs in that ulcers do not form. Manifested by heartburn and pain.

They will help to identify one or another form of the disease. instrumental studies and studying a blood test from a vein.

Symptoms

Reflux esophagitis has a distinct clinical picture, which can be divided into several groups. Signs of the esophagus are:

heartburn. Intensity increases as you perform physical exercise, overeating fatty foods, in horizontal position, as well as when bending the body forward;
feeling painful spasms and burning in the chest area, often manifests itself after eating food, regardless of its temperature and severity. Such symptoms disappear after taking medications aimed at reducing the acidity of the juice produced by the stomach;
constant sour taste in the mouth;
disruption of the process of swallowing or passing food;
the appearance of belching with unpleasant sour smell recently consumed foods.

Gastritis is often considered a sign of this disease.

Extraesophageal manifestations of the disease in children and adults are:

various dental lesions, in particular caries and enamel defects;
inflammatory processes of others internal organs- larynx, pharynx and sinuses.

Other symptoms of reflux esophagitis are:

the occurrence of cough, often during sleep, due to blockage of the bronchi with viscous secretions;
pain in the heart area;
feeling of lack of air;
heart rhythm disturbance.

Due to the fact that this disorder has a large number of various clinical manifestations, a person may not realize for many years that he has a similar disease. Without timely treatment reflux esophagitis signs of the disease will only intensify over time. The above symptoms are characteristic of the disease not only in adults, but also in children.

Complications

In situations where adults ignore the expression of symptoms and children do not talk about their presence, as well as in the absence of any therapy, serious complications can form. These include:

ulceration of the mucous membrane of the esophagus;
narrowing of the lumen lower section this body;
the occurrence of hemorrhages;
chronic gastritis– this is not only a symptom, but also a complication of esophagitis;
progression of disturbances in the process of swallowing and passing food;
changes in the structure of mucosal cells;
oncological neoplasms of the esophagus.

Due to the occurrence of such severe consequences, it is necessary to immediately seek help from specialists when the first symptoms appear. The presence of complications is determined during instrumental diagnostics, as well as by drawing blood from veins.

Diagnostics

As with any other disease diagnostic measures for reflux esophagitis, they begin with a detailed questioning of the patient for the presence characteristic features and the degree of intensity of their manifestation. In addition, the specialist needs to familiarize himself with the medical history and life history of the patient. This is necessary to search for possible factors in the progression of the disease. After the conversation, the patient is examined.

In addition, diagnosis of such a disorder includes laboratory research, such as:

study of a general blood test - should be carried out to detect the inflammatory process, identify possible anemia and determine the level of leukocytes (with such an illness the indicators will be increased);
performance biochemical analysis blood taken from veins - mandatory procedure necessary to identify comorbid disorders;
analysis feces– carried out to detect undigested food particles, as well as to exclude internal hemorrhage.

Instrumental diagnostic techniques for adults and children include:

esophageal manometry – necessary to assess the contractility of the esophagus and the synchrony of its muscle contractions;
measuring acidity directly in the lower part of this organ;
Endoscopy – performed to examine and assess the condition inner surface and the mucous membrane of the esophagus and other organs of the gastrointestinal tract. During this procedure, a mandatory biopsy is required;
respiratory diagnostics – to determine the presence of Helicobacter pylori bacteria in the patient’s body;
X-rays of the esophagus using a contrast agent;
ECG - performed to exclude heart disease;
Ultrasound, CT and MRI of organs abdominal cavity.

After receiving all the results of tests and examinations, the specialist needs to decide on the most effective tactics for treating reflux esophagitis.

Treatment

When diagnosing reflux esophagitis in adults and children good results shows complex therapy. One of the stages of therapy is the prescription of medications aimed at reducing the production of hydrochloric acid by the stomach, neutralizing it or reducing acidity, accelerating the process of transferring food from the stomach to the duodenum. Medicines can be taken as tablets or injections.

Surgical treatment of reflux esophagitis is necessary if unsuccessful drug therapy, progression of the process of erosion of the walls of the esophagus, its narrowing, or with profuse hemorrhage. In such situations, endoscopic operations are performed to cauterize erosions and dilate the esophagus.

In addition, in order to cure such a disorder, you need to follow special diet. Its basic rules:

limiting the consumption of foods that increase gas formation;
complete rejection of overly spicy, hot and fatty foods;
Strict avoidance of alcoholic beverages.

The diet includes complete abstinence from:

sweet carbonated drinks and natural juices;
marinades, smoked meats and pickles;
fatty soups or broths;
legumes, cabbage, black bread and fresh milk;
sweets, caffeinated drinks;
citrus fruits;
hot seasonings and mayonnaise;
chewing gum.

Can be consumed in any quantity:

dairy products;
boiled eggs;
lean meats and fish, cooked in the oven or steamed;
any porridge;
yeast-free bread.

You should also follow a proper diet, eating small portions five times a day. In this case, the last snack should be no later than three hours before bedtime.

Prevention

In order for adults and children to never have such a problem as reflux esophagitis, and also to get rid of the disease forever, you must adhere to the following rules:

maintaining a healthy lifestyle and completely avoiding bad habits;
wearing only loose clothing that does not restrict movement and does not compress the anterior wall of the abdominal cavity;
compliance correct mode nutrition;
take place several times a year preventive examination and donate blood from veins for testing;
exclusion of severe physical activity;
sleep so that your head is several degrees higher than your feet;
avoiding overeating, especially before bed.

In addition, it is necessary to promptly treat diseases of the gastrointestinal tract, in particular gastritis, and contact specialists when the first symptoms of reflux esophagitis occur. The sooner professional therapy begins, the higher the likelihood of a favorable prognosis and the absence of complications.

Regardless of the causes of inflammation of the esophagus, doctors define the disease with the general term “esophagitis.” The esophagus is the first section that belongs to digestive tract. It is closely related to oral cavity, throat. Therefore, when diseases occur in the esophagus area, the functions of the respiratory system are often affected.

Concept

Esophagitis is a pathological disease affecting the mucous membrane of the esophagus. The process can be acute, subacute or chronic.

If left untreated, the disease affects not only the mucous membrane, but also the deeper layers.

The disease is common, but in 40% of cases clinical manifestations are not detected. As it progresses, life-threatening complications appear, including the formation.

The disease occurs in 20% of the population. In adults, the first sign is heartburn, but many people do not show up to see a doctor when such an unpleasant symptom is detected. Symptoms occur in equal numbers in men and women. The disease code according to ICD-10 is K20.

Classification

There are several types that are differentiated on various grounds. The most common are catarrhal and edematous. In this case, hyperemia of the mucous membrane and swelling occurs.

If acute infectious process, chemical or thermal burns, then the consequence may be, which is characterized by the appearance of erosions. If their formation does not occur, then doctors talk about a non-erosive form.

Photo of erosive reflux esophagitis

The following forms of esophagitis are distinguished:

. The mucous membranes are damaged by fungi of the genus Candida. The disease is rare, and the course is often similar to other ailments of the initial parts of the esophagus. If the inflammation is caused by other types of fungus, then they talk about fungal esophagitis or mycotic (mycotic).
Peptic. It occurs against the background of constantly repeated exposure to the mucous membrane from gastric or duodenal contents. In some cases, the mucous membrane is also influenced by the duodenum.
Eosinophilic. Appears in the background autoimmune diseases. This form is characterized by an increase in the number of eosinophils in the mucosa. Food or respiratory allergies are common causes.
Fibrous. It is usually a complication when proliferation of connective tissue fibers occurs. This leads to fibrous degeneration of the walls of the esophagus. It can be limited and diffuse, leading to narrowing of the lumen of the esophagus and shortening of the organ.
Terminal. In children it is associated with the work of immature muscles of the organ digestive system. In adults, they form against the background of relaxation of the sphincter, which separates the esophagus from the stomach. The result is swelling of the organ membrane and hyperemia of some areas, which is expressed in the appearance of pinpoint hemorrhages.
Biliary. Inflammation of the mucous membrane occurs due to exposure to bile in the bolus of food. Constant exposure of the mucous membrane to bile and pancreatic enzymes leads to the development of inflammation. Because of this, histamine increases.
Post-radiation and radiation. Develop after passing radiation therapy for the treatment of cancer of the esophagus, lungs and other organs. The frequency and severity of these forms depends on the increase in radiation dose, as well as the passage of drug therapy and radiation.
Atrophic. This form refers to precancerous diseases. Develops in advanced diseases of the esophagus. Under the influence of negative factors, mucosal cells atrophy and cease to perform their functions.
Erythematous. This form can be acute or chronic. It is characterized by a large accumulation of erosions that merge into a single erythema. There is a pronounced tendency to hemorrhage and bleeding.

Causes

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

infectious diseases,
physical impact (during insertion of a probe, burn),
damage from caustic chemicals,
allergic reactions to food products.

Most severe consequences arise due to chemical damage. At infectious lesions The cause is a decrease in the body's immune forces.

Chronic forms appear due to consumption of alcohol or spicy foods. This impact must be permanent. If a person works with couples chemical substances Without respiratory protection, occupational esophagitis develops.

Chronic forms can be caused by:

for unknown reasons
vitamin deficiency,
prolonged intoxication,
disorders of the evacuation function of the esophagus.

If gastric contents reflux into the esophagus, peptic esophagitis develops.

Signs of reflux esophagitis in adults and children

The main symptom in adults is the appearance of heartburn. It can develop while eating, changing position, or lifting heavy objects. In advanced stages, this symptom is permanent.

Additional symptoms are:

sour belching,
nausea,
vomit,
pain while swallowing,
heaviness in the stomach.

Sometimes pain appears in the chest area. They may then be confused with symptoms of angina.

In young children, frequent belching is a cause of concern. As you get older, you may vomit frequently. Sometimes pain appears in the stomach area. This disease also has a bad effect on teeth. Since acidic gastric juice is refluxed, the proper formation of enamel is disrupted.

In children, esophagitis leads to bronchial hyperreactivity. Since the esophagus is short, the constant reflux of food from the stomach and hydrochloric acid when changing position not only leads to irritation of the mucous membrane. A small amount of juice can enter the respiratory tract, which leads to frequent bronchitis.

Acute symptoms

In the acute form, symptoms depend on the nature and extent of damage to the esophagus. If the disease is superficial, then there may simply be discomfort when eating sour or hot food.

In severe forms of the disease, severe pain, which radiate to the sternum, back, and neck.

In rare cases, difficulty swallowing and severe heartburn may occur. If the lesions of the esophagus are especially severe, then bloody vomiting and a state of shock appear.

Symptoms of the chronic form

The chronic form develops against the background of constant irritation of the esophagus or with an untreated acute form.

The symptoms are as follows:

Frequent belching of air and bad smell from mouth.
Forms on the tongue white coating, which almost never disappears.
An obsessive cough appears. The result is hoarseness and bronchitis.
Chest pain may disappear and reappear.

There is a rapid development of caries. Due to gastric juice, the composition of saliva changes. Acidic components corrode tooth enamel.

Video on how to cope with symptoms of reflux esophagitis:

Features of the disease during pregnancy

During pregnancy, the cause of the development of the disease is impaired motility of the esophagus and stomach, as well as the aggressiveness of gastric contents. Develops more often in the 2-3 trimester.

Almost 75% of pregnant women suffer from heartburn, which occurs mainly when changing position, after eating fatty or spicy foods. Heartburn can last from a couple of minutes to several hours.

During pregnancy, intra-abdominal pressure increases. At the same time, the muscles that close the passage from the stomach to the esophagus are in a relaxed state. This leads to the development of reflux, inflammation of the esophagus. During pregnancy, the only treatment is to relieve symptoms of heartburn with medication.

Degrees of development

In the acute form, there are 4 degrees of damage:

First. Usually of a superficial nature. The formation of ulcers and erosive defects does not occur. Hyperemia and swelling are noted. Symptoms at this stage are absent or mild.
Second. Extensive erosions form on the thickness of the mucosa, which may be accompanied by necrosis. The size of erosions is more than 5 mm. Heartburn appears when eating, a burning sensation in the chest after eating.
Third. The walls of the esophagus change as the lesion affects all layers. The ulcers begin to bleed and scars begin to form. Ulcers cover less than 75% of the esophagus. The stage is characterized by severe symptoms.
Fourth. Ulcers cover almost the entire esophagus. A sour taste appears in the mouth. Swallowing becomes painful, and discomfort spreads to the chest and abdomen. At this stage, the risk of developing stenosis and esophageal cancer increases.

Complications of esophageal disease

Complications include the appearance. They may bleed. To eliminate this pathology it is prescribed endoscopic surgery.

All treatment is aimed at:

elimination of the disease that caused esophagitis,
ensuring a reduction in the load on the diseased organ,
prescription of anti-inflammatory medications,
elimination of complications.

Typically, oral medications are reduced as much as possible or eliminated altogether. Therefore, patients receive the necessary chemical compounds through droppers or injections. In particular severe conditions exclude food and water intake for 2-3 days. The body's needs are met through the use of parenteral nutrition.

Treatment of chronic pathology

As in the treatment of the acute form, a diet is prescribed and the factor causing the problem is eliminated. During exacerbations, moderate consumption of pureed food at room temperature is recommended.

It is necessary to exclude products that irritate the mucous membrane. It is also recommended to stop smoking and taking medications that affect sphincter tone.

Drug therapy includes:

, reducing the acidity of gastrointestinal juice.
Drugs that stimulate cardiac tone.

Additionally, physiotherapeutic methods may be prescribed, for example, amplipulse, electrophoresis. In extreme cases, surgery is prescribed, including resection and plasty of the esophagus.

Prognosis and prevention

If the course of the disease is without complications, then the prognosis is favorable. Necessary for a long time comply, adhere the right image life.

As a preventative measure, it is recommended to avoid stress, not to smoke, and not to eat too spicy, smoked or sour foods. Food portions should be small. You should not lie down immediately after eating. In the chronic form, regular visits to a gastroenterologist are required. In this case, annual spa treatment is indicated.

With reflux esophagitis, a pathological release of stomach contents into the esophagus occurs. Erosive reflux esophagitis occurs due to chronic irritation esophagus with acid: ulcers and erosions appear on the mucous membranes. Reflux esophagitis is characterized by sudden painful sensations. Let us consider the features of the course of reflux esophagitis, symptoms and treatment of this disease.

The main reason for this disease is that acidic contents enter the esophagus from the stomach. This occurs because the esophageal sphincter is relaxed (which should not normally be the case).

IN healthy organ The sphincter relaxes for just a few minutes to allow food to pass into the stomach. Then it contracts, which prevents acid from entering back from the stomach.

Reflux esophagitis occurs in humans with the following gastrointestinal pathologies:

an ulcer located in the stomach (it may appear due to excessive activity of the Helicobacter bacteria);
stomach cancer;
pathological conditions of the vagus nerve;
pathologies of the lumen of the duodenum;
chronic inflammatory disease pancreas;
long-term inflammatory process in the gallbladder;
pylorospasm;
hiatal hernia.

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

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

Pathogenesis

The human esophagus consists of mucous, muscular and external tissues. The mucous membrane has several folds that facilitate the process of food entering the stomach. The muscle layer in the esophagus is necessary to facilitate this process. They form two sphincters, with the lower one located at the border between the two organs. They serve to prevent food from entering the esophagus from the stomach. It can only open at the moment of swallowing.

Normally, a person may have several dozen physiological reflux of food into the esophagus. But no signs of pathology are observed. And only when the sphincter system is disrupted, a person may develop symptoms of reflux esophagitis.

The appearance of esophagitis, reflux of esophagitis is also associated with work disorders protective functions esophagus. Such conditions are most often created when poor nutrition, mechanical irritations, etc. It must be said 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 to the mucous membrane 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 ulcers - erosions - appear on the mucous membrane of the organ. Symptoms of reflux become pronounced and bring some discomfort to the patient. Due to erosions, pain increases significantly after eating or consuming Acetylsalicylic acid.

Stages and symptoms

This disease is characterized by several stages.

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

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

To prevent this from happening, you need to contact a specialist immediately after unpleasant symptoms of abdominal diseases appear. Advanced ulcerative esophagitis is especially difficult to treat.

When esophagitis occurs in adults, it may appear discomfort, arising in chest cavity. They radiate to the area 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 typical of them are:

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

frequent regurgitation (this often happens in children);
acidic taste in the mouth;
dysphagia (in which the patient feels difficulty swallowing food normally);
cough that continues 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);
dental caries damage due to acid entering the oral cavity;
hiccups

Important! Without treatment, esophagitis lasts for years in humans. Its symptoms may become increasingly worse. This inevitably leads to the formation of scars on the esophageal mucosa.

All manifestations of reflux esophagitis intensify significantly after a person lies down. In a standing or sitting position, pain, heartburn or hiccups hardly bother you.

Sometimes the patient may feel signs of pharyngitis and nasal congestion. These signs appear because the acidic contents of the stomach irritate the throat, causing the patient to have a sore throat.

Diagnostic features

If a patient is suspected of having reflux esophagitis, its treatment is possible only after a correct diagnosis. Diagnostics plays an important role, since it determines how to further treat reflux esophagitis and what medications to prescribe to the patient.

Diagnostics consists of the following measures:

Conversation with the patient. When collecting anamnesis, the doctor identifies the patient’s characteristic complaints, the duration of symptoms and the degree of their severity.
Examination of the oral cavity. The presence of affected teeth and inflammation of the mucous membranes suggests that the patient may develop reflux.
Palpation.
FEGDS is the main diagnostic method, on which further treatment will depend. In this case, a thin fiber optic probe is inserted into the patient through the mouth. The condition 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 mucous membrane is hyperemic and colored red.
X-rays are performed using a special contrast agent (barium sulfate). The suspension has no pronounced taste and is non-toxic to humans. With the pathology under consideration, movement of barium suspension into the esophagus will be visible.
Examination of the acid level of the esophagus. With pathology, it will be reduced, since the penetration of gastric juice into the esophagus “acidifies” its membranes.
Esophagomanometry evaluates the normal contractile activity of the lower sphincter. This method clarifies the diagnosis.
A cardiogram is performed for the purpose of differential diagnosis.
X-ray of the chest organs is performed to exclude lung pathologies.

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

Why is esophagitis dangerous?

You should not assume that reflux esophagitis is a “harmless” and “safe” pathology. If left untreated, a person may develop the following dangerous diseases:

A patient may develop ulcers on the esophageal mucosa if he has been suffering from the disease for a long time. To treat hemorrhages, endoscopic surgery is used, which involves cauterizing the vessel using a mini-electrocoagulator.
Esophageal stenosis develops in humans due to a chronic inflammatory process in its mucosa. The patient complains of pain during swallowing and a sensation of a lump in the throat. For treatment, a rather complex surgical operation is performed.
Barrett's syndrome is dangerous with the risk of developing a malignant neoplasm.

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

Nutrition and lifestyle

Diet is very important for the treatment of such a disease. Practice shows that drugs to reduce the acidity of gastric juice and other tablets will not be effective if the patient uses junk food. Therapeutic effect it won't bring it.

Is it possible to cure reflux esophagitis 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.

It is necessary to completely eliminate all nervous overload.
You need to 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.
Five meals a day are necessary: it will eliminate long breaks in eating and overeating.
In the treatment of erosive reflux esophagitis, it is very important not to lie down after eating. Again, eliminating overeating will not make the patient want to take a nap after lunch. But walking in such cases is useful.
To prevent the causes of reflux esophagitis, you do not need to wear tight clothes and belts.
It is forbidden to lift weights because this increases the symptoms of reflux esophagitis.
It is necessary to avoid taking medications 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 foods;
sour juices;
Rye bread;
store-bought sauces, including mayonnaise;
all snacks and fast food;
chewing gum;
all fried foods.

A patient with reflux esophagitis may benefit from the following therapeutic diet:

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

Note! A diet for 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 dishes mentioned above. 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 medications?

First of all, we note that people, not knowing why exacerbations of reflux esophagitis occur and what it is, try to independently choose the “most suitable” medicine at the pharmacy. This absolutely cannot be done, because this can only worsen your health. Only a doctor can choose medicine. Treatment of reflux esophagitis should not occur independently.

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

Prokinetic medications are needed to improve the tone of the lower esophageal sphincter. This is Motilium, Ganaton.
Antacid medications are needed to effectively reduce the acidity of gastric juice. Among them, many doctors pay attention to Almagel - it effectively combats manifestations of hyperacidity of gastric juice.
Antisecretory agents are represented by hydrogen pump inhibitors (Omeprazole or Famotidine).

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

Traditional methods

How to cure reflux using unofficial means? Unofficial medicine knows a lot effective ways treatment of the disease in question. Before treating reflux esophagitis, you need to consult a therapist: he will help you choose the most effective technique getting rid of the disease.

Let's look at some ways to treat manifestations of reflux esophagitis using non-drug methods.

Reduces the intensity of inflammatory phenomena medicinal mixture from chamomile, flax, dog nettle, lemon balm leaf, licorice. To prepare the 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, marigold, oregano, mint leaves, marigold and fireweed (2 tablespoons) should be poured with water and heated in water. Drink half a glass 6 times a day.

Polygonum root, plantain leaf, shepherd's purse, dandelion flowers, chamomile, yarrow herb, oregano are mixed and steamed in water. The decoction should also be consumed the same number of times in the same quantity.

This treatment should be combined with drug therapy.

Prevention

Preventing this disease is much easier than treating it. The following recommendations must be followed:

avoid emotional stress;
do not abuse alcoholic beverages, or even better, give them up completely;
no smoking;
avoid foods that irritate the esophageal mucosa;
eat more often and in small portions;
avoid physical inactivity, do exercises every day, play sports;
After eating you don’t need to lie down, but walk around a little.

So, there is no need to take reflux esophagitis lightly. It is necessary to start getting rid of it as early as possible. Self-medication is extremely dangerous because it can lead to relapses and complications. Only early and comprehensive diagnostics, a healthy diet will help keep the esophagus in normal condition.