Sharp ezofagit – damage mucous a gullet of inflammatory character which can be provoked by various factors. Typical symptoms are pain behind a breast, swallowing violation, the dispepsichesky phenomena. The main methods of diagnostics – roentgenoscopy of a gullet and an ezofagoskopiya. Treatment is defined by a disease form: the local anti-inflammatory, knitting, enveloping, analgetic medicines are appointed, antibacterial and antiviral therapy is carried out. In certain cases (when forming not giving in to a buzhirovaniye , bleedings, perforation) treatment surgical.
Sharp ezofagit – an acute inflammation of a gullet which, according to the criteria accepted in gastroenterology lasts no more than three months; in most cases - from several days to one weeks. Prevalence of a sharp ezofagit makes about 3-5 cases on 100 people, and the most part of patients is made by immunokomprometirovanny persons. Depending on morphological changes, allocate 4 stages of this pathology. The first is characterized by hypostasis and hyperaemia mucous. At the second stage against the background of the same changes single erosion are formed. The third stage proceeds with the expressed hypostasis, extensive erosion, the mucous membrane bleeds. Emergence of the bleeding centers is the main sign of the fourth stage at the slightest touch of the endoscope to mucous.
Reasons of a sharp ezofagit
The etiology of a sharp ezofagit is very various. Depending on the damaging factor allocate several types of pathological process: alimentary, professional, stagnant, allergic, radiation, medicinal, infectious, etc.
Alimentary sharp ezofagit develops owing to influence of excessively hot or spicy food, and also hard alcoholic drinks. Injury of a gullet by vapors of caustic alkalis or acids, salts of heavy metals, and also other substances used on production carry to professional ezofagita. The inflammation mucous stagnant type arises at her irritation the accumulated food in case of a stenosis or an akhalaziya of a sebesten, gullet diverticulums. At change of reactivity of an organism, especially at children's age, allergic sharp is formed ezofagit (most often such state develops at bronchial asthma, food allergy). Mucous a gullet it can also be damaged under the influence of radiation exposure. Reception of some medicines (nonsteroid resolvents, a tetratsiklin, doxycycline and others) provokes medicinal ezofagit (in fact, it is chemical, without burn).
To cause sharp ezofagit also infectious agents can. Most often cases of an inflammation mucous a gullet, the diphtherias caused by activators, scarlet fevers, measles, a cytomegalovirus, a herpes virus, tuberculosis mikobakteriya are registered. Against the background of oppression of immune system cytostatic or radiation therapy, reception of immunodepressants or at HIV infection causative agents of flu, paraflu, adenoviruses, sort Candida mushrooms can cause this pathological process. Also the massive throwing of contents of a stomach and duodenum can be the cause of a sharp ezofagit at persistent vomiting, in case of a long intubation. Heavy chemical damage arises at reception of acids and alkalis, the concentrated potassium permanganate solution (usually such cases arise at children at storage of dangerous substances in a zone of their access, and also at patients with suicide attempts). Also sharp ezofagit develops at a gullet travmatization foreign matters, damage by vapors of anesthetics when performing an inhalation anesthesia.
Symptoms of a sharp ezofagit
Sharp ezofagit develops owing to action of very diverse factors. It affects not only pathogenesis of a disease, but also morphological changes and a clinical picture.
The catarrhal inflammation is the most common and easiest form of a sharp ezofagit. This process can develop owing to almost all above-mentioned reasons. A morphological substratum are hypostasis, hyperaemia and lymphocytic infiltration mucous. Serve as the main symptoms of a catarrhal ezofagit burning sensation behind a breast, heartburn; seldom the pricking or burning pains behind a breast are registered. All specified signs amplify during food owing to what patients sometimes refuse meal. The gipersalivation, an eructation is also characteristic. The general condition of the patient does not suffer. In most cases the clinic of a catarrhal sharp ezofagit independently regresses even without performing treatment.
Erosive sharp ezofagit is a consequence of progressing catarrhal. On a surface mucous the erosion of the different sizes sometimes getting into a submucous layer are formed. The symptomatology is similar that at a catarrhal form, but manifestations more intensive. In hard cases defects of mucous lead to development of bleedings.
Hemorrhagic sharp ezofagit develops at serious infectious diseases with bacteremia. On mucous a gullet the multiple centers of microhemorrhages are formed, the hemorrhagic ekssudation is characteristic. The clinical picture is defined by bleeding symptoms from the top departments of a GIT: bloody vomiting, a melena, plentiful vomiting by slime with blood are characteristic. There can be zhizneugrozhayushchy profuzny bleeding. Classical symptoms of an ezofagit (pain, a dysphagy) also take place, but fade into the background.
Psevdomembranozny sharp ezofagit is formed at diphtheria, scarlet fever. Characteristic of this form of a disease is formation of the fibrinozny exudate forming a gray film on the surface of a gullet. In hard cases exudate impregnates all mucous membrane and a submucous layer. The prevailing symptoms – the expressed zagrudinny pain, swallowing violation. During vomiting films separate, at the same time the surface of erosion becomes bare and there are bleedings.
Eksfoliativny sharp ezofagit most often takes place at chemical injury of a gullet. On the surface of a mucous membrane the dense films soldered to the subject fabrics are formed. Their rejection leads to an exposure of large ulcers. The main symptoms – the expressed dysphagy, intensive pain and bleedings.
Flegmonozny sharp ezofagit develops at damage of a wall of a gullet by a foreign matter (for example when mucous is punctured by a fish bone). This form is heavy as surrounding fabrics and bodies, including a sredosteniye are involved in pathological process. In a zone of damage the center of a purulent inflammation is formed, the submucous layer melts, mucous nekrotizirutsya, its peeling is possible. The intensive pain syndrome is followed by intoxication defining a condition of the patient; the gipersalivation, vomiting, a neck swelling on the party of damage, restriction of its mobility is characteristic. The risk of perforation of a gullet is extremely high.
Necrotic sharp ezofagit is the most severe form, develops at patients with the weakened immunity owing to infectious damage. On mucous the multiple centers of a necrosis which are torn away with an exposure of extensive are formed it is long not healing ulcers. Plentiful is formed it is purulent - hemorrhagic exudate. The clinic is defined by the course of the main disease against the background of which there are expressed pains and a dysphagy.
Diagnostics of a sharp ezofagit
In diagnosis of this disease an important role is played by consultation of the gastroenterologist, studying of the anamnesis that in most cases allows to suspect a certain kliniko-morphological form. The researches given laboratory methods are not specific, reveal inflammation signs ( with neytrofilny shift, acceleration of SOE). The roentgenoscopy of a gullet gives the chance to reveal roughness of its contours, hypostasis of folds mucous, existence of ulcer defects, and also motility violation, expansion of a gleam owing to decrease in a tone. At a flegmonozny sharp ezofagit the expanded shadow of a sredosteniye, decrease in mobility of a trachea at breath is defined, at perforation of body – symptoms of emphysema of a sredosteniye.
The most informative method of diagnostics – an ezofagoskopiya. Depending on a form of pathology hypostasis and hyperaemia of a mucous membrane of a gullet, mucous, purulent or fibrinozny raids, dot hemorrhages, various sizes ulcer defects, the fibrin films which are easily removed (comes to light at a psevdomembranozny form) or soldered to the subject fabrics (in case of eksfoliativny option). At suspicion on flegmonozny sharp ezofagit carrying out this research dangerously in connection with high risk of perforation of body.
Treatment of a sharp ezofagit
Treatment of a sharp ezofagit depends on a process etiology. Elimination of the damaging factor, therapy of the main pathology is extremely important. Load of a gullet has to be most lowered: the diet No. 1 or full refusal of per os food is appointed. At easy forms the pharmacotherapy consists in purpose of antatsid, antisekretorny medicines, the prokinetik knitting and the enveloping means; at the expressed pain syndrome apply analgetics. Local anti-inflammatory medicines (silver nitrate, tannin, colloidal silver) are surely used.
In case of the confirmed infectious nature of a sharp ezofagit the corresponding etiotropny treatment (antibiotics, antiviral medicines) is carried out. At the options of a disease which are followed by massive damage mucous (a flegmonozny, necrotic ezofagit), full transition to parenteral food and introduction of medicines is expedient; massive antibacterial and dezintoksikatsionny therapy is appointed. Removal of the foreign matter which injured a gullet, drainage of the centers of a purulent inflammation (is carried out at their existence). In case of formation a gullet the buzhirovaniye is made. At inefficiency of conservative therapy, development of complications (massive bleedings, perforation), and also an unsuccessful buzhirovaniye treatment surgical – is carried out an ezofagoplastika.
Forecast and prevention of a sharp ezofagit
The forecast at the diagnosed sharp ezofagit depends on weight of damage. In case of catarrhal, erosive option the absolute recovery comes for several days while a flegmonozny and necrotic form are life-threatening and are followed by high risk of complications (massive bleedings, perforation of a gullet, aspiration pneumonia). There is no specific prevention of this pathology; timely treatment of diseases which can become the reason of a sharp ezofagit is important.