Esophagitis is the most common disease of the esophagus of an inflammatory and degenerative nature. Basically, E is a secondary disease and accompanies a disease of the esophagus itself or other organs and systems. Etiology.
- In case of damage by caustic substances (Eco-Foliative E);
- Damage to foreign bodies (Phlegmonous E);
- With tumors P, Achalasia of Cardia, Diverticulum P, (Catarrhal or Erosive E) ;
- With chronic diseases of the bronchopulmonary apparatus, chronic circulatory failure, chronic cholecystitis, pancreatitis , etc.
- E zophagitis almost always accompanies HPOD (reflux esophagitis) ;
- Agranulocytosis, fungal infection cause Necrotic E ;
- Measles, diphtheria, scarlet fever – Pseudomembranous E;
- Many acute pathological states (hypertonic crisis, myocardial infarction), a variety of endo- and exogenous intoxication (burn disease, ketoatsidoticheskaya precoma and coma, renal failure, alcoholism) may occur in addition to the main symptoms, erosive and erosive hemorrhagic e .
- Esophagitis is also one of the important manifestations of metabolic diseases (sideropenic E-Plemmer-Winson syndrome with iron deficiency anemia), systemic (systemic scleroderma, Sjögren’s syndrome) or congenital (Randu-Osler cider) nature.
Over the course of the Esophagitis are: Acute, Subacute, Chronic. Symptoms
- The main complaints of Dysphagia (difficulty swallowing, disturbances in the holding of the food lump), especially when taking irritating or rough foods,
- Odinophagy (painful passage of the food lump through the damaged area) ,
- Burning sensation, dull pain , more often behind the sternum. Pain can radiate to the left or right to the chest, neck, lower jaw, upper limbs, more often to the left.
With hemorrhagic esophagitis, there is esophageal-gastric bleeding or the appearance of “melena”; With phlegmanous – a picture of acute inflammation of the mediastinum (pain behind the sternum, a feeling of tightness in the chest, asphyxiation, fever, signs of intoxication, leukocytosis, etc.). In all its manifestations , reflux esophagitis resembles the clinical picture of HPOD (dysphagia, pain 15-30 minutes after eating, heartburn and pain, especially when lying down, at night, etc.). With the appearance of erosive or ulcerative Esophagitis against the background of reflux esophagitis, the pain becomes constant, painful. After scarring of ulcers, pain, heartburn, they worry less or stop, but dysphagia increases. Complications of esophagitis
- Perforation in the mediastinum or pericardium,
- Cicatricial fusion of the esophagus with neighboring organs. With the latter, shortening of the organ or the formation of diverticulums of the esophagus may occur.
The diagnosis is based on:
- anamnesis and complaints of the patient;
- data of esophagoscopy and, if necessary, performed targeted biopsy (elements of inflammation, atypia, the appearance of tumor cells, etc.)
- the results of the X-ray method of research, which reveals dysphagia, its level, possible cause;
- Bernstein’s test is positive;
- positive results of sowing wash water from P to bacteria and fungi (with phlegmanous E);
- a general blood test, which can detect agranulocytosis as a cause of necrotic E; hypochromic anemia as a result of bleeding or a possible cause of E with iron deficiency anemia; leukocytosis with phlegmanous E, etc.
TREATMENT OF ESOFAGITIS.
Since Esophagitis is mainly a secondary disease, it is necessary to treat the underlying disease first.
Diet and diet.
- Providing the physiological needs of the body with food. If it is not possible through the esophagus, then parenterally.
Food should be chemically, mechanically, thermally (cold, hot liquids impossible) sparing, fractional nutrition, 4-5 meals a day.
In acute conditions (erosive, hemorrhagic, phlegmanous E), it is recommended to refrain from eating for 1-5 days.
As the acute process subsides or with subacute conditions, diet No. 1a – 1b and No. 1 (sequentially) according to Pevzner are shown.
In chronic pathological conditions, diet No. 5 is acceptable as being richer in nutrients and more pleasant for patients than 1 table, but retaining the principle of chemical and mechanical sparing.
- Physical and emotional peace is recommended. After eating avoid horizontal posture.
1. Antacids and enveloping preparations: it is preferable to take them in a horizontal position of the body, in which contact with the mucous membrane of the esophagus is longer. Drugs are more often taken in 10-15 minutes. before meals and (or) with concomitant peptic ulcer and after meals at various time intervals depending on the location of the ulcer (Almagel, Gafikon, Phospholugel, etc.)
2. Preparations that promote the regeneration of the mucosa P: Sea buckthorn oil is prescribed for 1-2 teaspoons in 5-10 minutes. after eating, but previously taken 2-3 sips of warm water without gas. Oil intake is recommended at night, before bedtime. Better to take in a horizontal pose. Solcoseryl can also have a restorative mucosal effect. It is administered intravenously in 6-8 ml. 4-5 days, then switch to intramuscular injection of 2-4 ml, 1-2 times a day for 7-10 days.
3. Drugs that reduce spasm.
- Anticholinergics. Atropine sulfate, metacin, which is more effective. Assign 1-2 (0.002-0.004 g) tab. 2-3 times a day or 1-2 ml of a 0.1% solution subcutaneously, intramuscularly or intravenously.
- Myotropic antispasmodics. No-shpa, Halidor – can be effective in cramping the esophagus.
- Nitrates. Nitroglycerin and others . effective in some cases. A more noticeable effect is the combination of esophageal disease with coronary heart disease. You can combine nitrates with antispasmodics in 5-10 minutes. before meals 4-5-6 times how much the patient eats.
- Beta-adrenostimulants – their administration parenterally (alupent) or inhalation (alupent, astmopen) causes relaxation of the muscles of the lower third of the esophagus.
4. Regulators of the tone of the cardiac sphincter. Increases the tone of the cardiac sphincter, and on the other hand, opens the pylorus, and also weakens the gastroesophageal reflux, vomiting. Raglan, Tserukal, Motilium, take 1 / 2-2 tab. (5-10 mg) 2-3 times a day for 20-30 minutes. before meals, as well as 1-2 (5-10 mg) in / m or / in.
5. Antibacterial drugs: Antibiotics or sulfonamides in depending infection.
6. Enzyme preparations. Panzinorm-forte, Oraza, Creon-1, Festal, Digestal, Liobil, Pancreatin, Cholensim.
1. Hemostatic and antianemic drugs. A solution of Epsilon-aminocaproic acid 20% irrigate the mucous membrane of the esophagus through an endoscope. Also Dicinon 12.5%, a solution of 1-2 amp. (2-4 ml) intravenously and, if necessary, repeat after 4-6 hours, the introduction of iv or iv. With varicose veins of the esophagus – it is advisable to transfuse blood products or blood products, inject oxytocin 1-2 amp. in 300-500 ml. 10% iv glucose solution , drip, at a speed of 20-30 cap. per minute. Vitamins gr. B, B12, folic acid, iron preparations (ferroplex, ferrum-lek), in some cases, the introduction of whole blood or red blood cells.
2. Sedatives. An extract of valerian, motherwort, trioxazine, mezapam, phenazepam, and at night – elenium, relanium (seduxen), sleeping pills.
3. Herbal medicine. Calendula, St. John’s wort, sea buckthorn, chamomile, which have anti-inflammatory and regenerative effects; Marshmallow, which has an anti-inflammatory effect and reduces the production of HCI in the stomach ; Origanum ordinary, eliminating constipation and flatulence; Yarrow, Hemophilia officinalis (hemostatic effect), etc. Phytopreparations are preferably prescribed in the form of decoctions and water infusions. Alcohol infusions irritate P.’s mucosa. Then, spa treatment is desirable. Treatment of abscesses, phlegmon, lesions P by foreign bodies is treated surgically.
Achalasia of the cardia (AK) is a violation of the motor function of the Esophagus, in which the extinction of the primary peristaltic wave occurs at the level of the middle and lower third of the Esophagus. The basis of AK is not a spasm, but a loss of the ability of the muscles of the lower esophagus to relax (achalasis – non-relaxation) and not lock up. The progressive narrowing of the cardiac section leads to a gradual expansion of the remaining sections of the esophagus. The volume of the organ increases 10-15 times (2-2.5 liters) compared with the norm (100-150 ml) Symptoms:
- Esophageal vomiting – regurgitation in a horizontal position and when the body is tilted forward (a symptom of “tying shoelaces”).
- Dysphagia, which is of a regressive nature – at first it is difficult to swallow solid food, then liquid.
- Putrid breath.
- Feeling of heaviness, especially when lying down and after eating.
- A crowded esophagus presses on the trachea, gate of the lungs, coronary arteries. After eating cough, suffocation, signs of angina pectoris appear . After eating, pain appears behind the sternum with concomitant esophagitis or ulcer of the esophagus.
- The appearance of fistulas.
- Aspiration of food masses (broncho-pulmonary syndrome: chronic bronchitis, pneumonia, abscess and gangrene of the lung).
- Depletion of the patient – asthenization (neuro-vegetative). The patient closes in himself.
- Percussion revealed the expansion of the zones of the sternal and interscapular dullness, especially to the right;
- X-ray – an increase in the cavity P, a varying degree of narrowing of the cardiac section up to complete obstruction.
- Esophagoscopy also reveals an increase in the cavity P, a narrowing of the cardiac section, E, and sometimes ulcer P.
TREATMENT OF ACHALASIA CARDIA.
- In the initial stages of AK, you can: Sedatives, Nitroglycerin (before meals) or Prolonged nitrates, Cholinolytics (atropine, metacin) .
- Cardiodilation with metal or air dilators that mechanically tear muscle fibers of a narrowed area is more effective . But in 20-30% of cases, this method also does not help, and surgery is needed.
HERNIA OF THE ESOPHAGODIC DIAPHRAGM DEPARTMENT (HAP)
Hernia of the diaphragm (HAP) is the protrusion of part of the stomach into the chest through the esophagus of the diaphragm. There are 2 main types of HPOD.
- Sliding (axial hernia) GPOD. With this option, the abdominal esophagus of the esophagus due to shortening of the organ (congenital short esophagus, cicatricial shortening, frequent spasms of the longitudinal muscles of the organ, etc.) moves into the chest and pulls along the vertical axis part of the stomach. The functioning of all elements of the cardia is disrupted.
- Perioesophageal (paraesophageal hernia) HPOD. In this view, part of the stomach protrudes through the enlarged esophageal opening of the diaphragm into the chest.
- Pain-dyspeptic syndrome. Manifested by pain in the epigastrium, heartburn, regurgitation, hiccups (the latter – due to irritation of the terminal branches of the phrenic nerve). Symptoms worsen immediately after eating, especially plentiful and fluid, in a horizontal position.
- Anemic hemorrhagic syndrome.
It manifests itself mainly as iron deficiency hypochromic anemia due to latent bleeding as a complication of erosive hemorrhagic or ulcerative E. There may be B12-deficient anemia.
- Heart syndrome. Most patients have a pseudo-coronary syndrome – burning pains behind the sternum, in the region of the heart, radiating to the neck, left arm. The pain intensifies when lying down, leaning forward, after spicy, plentiful food. The pain decreases in an upright position after taking antacids. Nitroglycerin has no noticeable effect. A combination of coronary heart disease and HPOD is not ruled out.
- Medical history and complaints;
- X-ray examination, especially important in the position of Trendelenburg and with holding the breath in the phase of deep inspiration;
- Esophagoscopy reveals changes in the mucous membrane of the esophagus – esophagitis, ulcers, hemorrhages;
- An ECG is necessary for the differential diagnosis of coronary heart disease and HPOD;
- A blood test reveals hypo- or less commonly hyperchromic anemia;
- Fecal blood reaction may be positive;
TREATMENT OF GHP.
It is necessary to avoid eating in a large volume, especially liquid. The last meal 2-3 hours before bedtime. Avoid horizontal body position after eating. At night they should sleep with a raised headboard.
Patients should avoid hard work, pregnancy, wearing tight, wide belts, constipation, flatulence, etc., increasing intra-abdominal and intragastric pressure.
- Antacids and Envelopes (vicalin, almagel, silver nitrate, etc.). Assigned in 5-10 minutes. before meals and, if necessary, after 30-40 minutes after eating.
- With concomitant spasms, antispasmodics, anticholinergics are indicated .
- Large HPPs, persistent symptomatology (periesophagitis, adhesions) or ulcers, narrowing, and frequent bleeding are surgically treated.
Esophagospasm (Es) is a functional disease, manifested by a local or diffuse increase in P.’s tone. It mainly accompanies diseases of P. (E., HPP, P. diverticula, etc.), as well as organs that are in direct contact with P. and nearby it. It is observed in people of senile age without any pathology with increased sensitivity of the nervous system. Symptoms: Es mainly manifests itself at the time of ingestion during its passage. There is a feeling of food jam at any level of P. and pain behind the sternum. Getting up, walking, burping, sometimes regurgitating a small amount of food bring relief. Sometimes pain can appear outside of food intake, localized behind the sternum and can resemble angina pain, especially when combined with coronary artery disease.
- Medical history and complaints;
- The X-ray shows a segmental increase in P.’s tone and interruption of the peristaltic wave at this level and below.
TREATMENT OF ESOPHAGOSPASM.
Treatment of the underlying disease leading to functional impairment.
Food should be taken leisurely, avoid cold, hot, hard foods, alcohol.
- Nitroglycerin tablet under the tongue in 1-2 minutes. before meals or sustained-release nitrates,
- Antispasmodics of myotropic action (no-shpa, metacin, halidor, etc.) .
Tumors of the esophagus.
Benign tumors of the Esophagus are represented by leiomyomas, fibromas, papillomas, etc. The main symptoms are dysphagia, a sensation of a foreign body at a certain level, sometimes regurgitation. A feature of these tumors is their slow progression.
Diagnosis is based on x-ray and esophagoscopy.
Malignant tumors of the Esophagus Precancerous
diseases include narrowing of P of various origins (AK, traumatic post-burn narrowing, etc.), chronic E, benign epithelial tumors. Cancer P can last for a long time without metastases. In 40% of deaths from cancer, P metastases are not detected. Tumor P can spread to neighboring organs (pericardium, bronchi) with the formation of fistulas with further bleeding, purulent processes.
Any complaint to the esophagus gives rise to suspect a tumor.
The leading symptom is dysphagia, first when taking thick, hard foods, then with the progression of the disease, when taking semi-liquid, liquid foods. But with the decay of the tumor, dysphagia decreases. All other complaints inherent in diseases of the Esophagus may be present.