Chronic ezofagit – inflammatory defeat of an inside layer of a gullet (mucous membrane) which symptoms remain more than half a year. Chronic ezofagit it is shown by a dysphagy, zagrudinny pain, heartburn, vomiting and vomiting. At a chronic ezofagit include a X-ray analysis of a gullet and an ezofagoskopiya with a biopsy in the plan of inspection, a manometriya of a gullet and an ezofagealny rn-metriya, test of sour perfusion across Bernstein, the general blood test, the analysis a calla on the hidden blood. Treatment mainly conservative (medicamentous and non-drug), at its inefficiency and development of complications – quick.
Chronic ezofagit – rather rare disease diagnosed mainly for adults and in most cases caused by a gastroezofagealny reflux disease. There is a set of special forms of a chronic ezofagit, for example, ezofagit the baby (it is caused by a regurgitation), infectious (develops only at persons with a heavy immunodeficiency, tuberculosis, after injuries), allergic (strikes to 50 people on 100 thousand of the population of the developed countries), etc. In the general population chronic ezofagit develops no more than at 5% of people. In risk group on chronic damage of a gullet carry the people who are not observing the mode of healthy nutrition, drinking not enough liquids having addictions (smoking, abuse of alcohol), predisposition to allergies, professional harm, and also suffering from an immunodeficiency.
Classification of a chronic ezofagit
Formation of a chronic ezofagit is possible against the background of sharp or subsharp inflammatory process in a gullet at the insufficient volume or lack of treatment; also pathology can have a primary and chronic origin (at systematic reception of rough dry food, mechanical traumatizing mucous a gullet, reception of some medicines, hard alcoholic drinks etc.). The current of a chronic ezofagit is characterized by periodic episodes of an aggravation and remissions. It is long the existing inflammatory process can lead to emergence of cicatricial changes in a gullet. Etiologichesky classification of a chronic ezofagit is in detail considered in the section of an etiology.
Endoscopic classification allocates four stages of an inflammation at a chronic ezofagit: the first – polnokrovy without ulcerations in final departments of a gullet; the second – the small separately located ulcerations of a mucous membrane; the third – drain erosive surfaces; the fourth – the deep ulcers of a gullet leading to narrowing of its gleam and a stenosis.
On prevalence of process chronic ezofagit can be proximal (strikes initial departments of a gullet), disteel (changes occupy the lower departments of a gullet located before an entrance to a stomach), total (all mucous membrane is affected).
Reasons of a chronic ezofagit
Chronic ezofagit can be caused by various factors. Depending on an etiology allocate the following forms of an ezofagit:
- ezofagit against the background of GERB (the most frequent reason of this pathology);
- alimentary (develops at abuse of too dry, dense, hot and extractive food that leads to regular traumatizing a mucous membrane of a gullet);
- professional (it is caused by constant inhalation of hot air, vapors of acids and alkalis, heavy metals);
- stagnant (it is formed because of a long congestion of food masses at a sebesten akhalaziya, diverticulums, tumors and a stenosis of a gullet);
- allergic (accompanies other allergopatologiya – food allergy, bronchial asthma and so forth);
- specific (develops at TB patients, a sklerodermiya, mycoses, syphilis);
- dismetabolicheskiya (it is formed against the background of heavy anemia, a hypoxia of any genesis, a lack of vitamins and iron, extensive burns, etc.);
- traumatic (the chronic inflammation develops after a trauma, gullet wound the polluted foreign matter).
Separately take out special forms of a chronic ezofagit: ulcer idiopathic and regionarny stenoziruyushchiya. The reasons of formation of an ulcer chronic ezofagit are up to the end not found out, however gastroenterologists note similarity of this pathology to nonspecific ulcer colitis. Perhaps, two of these diseases have the general sources.
Regionarny stenoziruyushchy nonspecific ezofagit is characterized by total granulematozny defeat of all layers of a wall of a gullet, on a morphological picture of change in fabrics remind those at a disease Krone. However, unlike damage of intestines, at a stenoziruyushchy chronic ezofagit do not find in a gullet eosinophils and gigantokletochny elements. Regionarny stenoziruyushchy nonspecific ezofagit strikes equally young women and men of working-age (the beginning of a disease usually is the share of age about 30 years). The researches in the field of gastroenterology devoted to clarification of the reasons of this disease are conducted to this day. Stenoziruyushchy regionarny ezofagit it is necessary to differentiate with stenoses of other etiology, gullet cancer. The disease constantly progresses and within half a year can result in full impassability of a gullet.
Symptoms of a chronic ezofagit
Polymorphism of symptomatology of pathology is caused by the following facts: a clinical picture of those diseases against the background of which chronic developed ezofagit (GERB, chronic gastritis, stomach ulcer of a stomach and DPK, syphilis, tuberculosis, bronchial asthma, etc.); directly clinical picture of a chronic inflammation in a gullet; gullet dyskinesia against the background of an inflammation.
Usually the first signs of a chronic ezofagit are the dysphagy and zagrudinny pains. The disease often is followed by development of hyper motor dyskinesia which is shown by a pristupoobrazny current of a dysphagy. Difficulties when swallowing are described by the patient as feeling of a lump in a throat, overflow of a gullet, a sdavleniye or tightening of a throat. At a typical current of a chronic ezofagit complexity usually arises when passing liquid food, and at a stenoziruyushchy nonspecific ezofagit and other diseases of a gullet – on the contrary, firm that helps to differentiate these states.
Pains at a chronic ezofagit are accurately connected with meal, are always followed by a dysphagy. Usually pain is localized behind a breast, however the beginning of a painful attack from interscapular space with the subsequent distribution on mezhreberye for a breast, in a neck and the lower jaw is possible. If chronic ezofagit developed against the background of a gastroezofagealny reflux disease, then the greatest intensity of pain is noted at throwing of sour contents of a stomach in a gullet (during trunk inclinations forward, an eructation, in a prone position); such pain is followed by heartburn. Usually pain syndrome is removed reception of antatsid.
Such symptoms as regurgitation, eructation and vomiting are characteristic of a chronic ezofagit. All these symptoms are manifestation of one process – retrograde receipt of food from a gullet or a stomach in a mouth. Regurgitation usually arises passively, without nausea, just eaten food comes to a mouth, there can be an aspirirovana in airways. The eructation is characteristic of GERB, at the same time a large amount of air, sometimes together with gastric juice, food masses comes to a mouth from a stomach. Vomiting is most characteristic of alcoholic genesis of a chronic ezofagit, there is in the morning, in emetic masses a large amount of slime. At frequent and persistent vomiting Mellori-Weiss's syndrome develops (anguishes of a mucous membrane of a gullet with development of bleeding).
Diagnostics of a chronic ezofagit
If the patient throughout a long time is periodically disturbed by heartburn, a dysphagy, pain behind a breast, it should be directed to consultation of the gastroenterologist and endoscopist. At suspicion on chronic ezofagit surely the gullet X-ray analysis is carried out: folds of a mucous membrane are thickened, edematous, contours of an esophageal tube uneven, "niches" in the field of localization of ulcers of a gullet can be visible. At an ezofagoskopiya erosion of a gullet and melkotochechny hemorrhages (a stage In), inflammatory exudate is visualized full-blooded mucous (a stage And). The Ezofagealny manometriya and a daily intra esophageal rn-metriya allow to reveal a stomach contents reflux in a gullet. For the purpose of an exception of chronic bleedings against the background of ulcers of a gullet carrying out the analysis a calla on the hidden blood, the general blood test is shown to all patients. For a differentiation with stenokarditichesky pains it is recommended to execute the ECG.
The specific test for identification of a chronic ezofagit is test of sour perfusion across Bernstein: 0,1-molar solution of hydrochloric acid is slowly entered into a gullet via the thin probe. Emergence of zagrudinny pain and heartburn in 20 minutes from the beginning of injection testifies in favor of a chronic ezofagit.
Treatment and forecast of a chronic ezofagit
Treatment of an uncomplicated chronic ezofagit conservative, assumes therapy of the main pathology and use of medicamentous and non-drug techniques. To the patient recommend to adhere to a healthy lifestyle and food; to sleep in a semi-sitting position; not to wear hard belts; to exclude the products provoking an exacerbation of a disease. From medicines use antatsida, the antisekretorny and anesthetizing medicines, pro-kinetics and sedatives.
At emergence of complications (a striktura, a stenosis of a gullet, the profuzny or not stopped chronic bleeding, the repeating aspiration pneumonia) surgery is shown; its look and volume is defined depending on a clinical situation.
The forecast at a timely initiation of treatment of a chronic ezofagit favorable, but development of heavy complications is possible. Once a half-year is required survey of the gastroenterologist with carrying out an ezofagoskopiya. At the heavy course of a disease disability is established. Prevention consists in timely treatment of background pathology and an exception of causal factors (addictions, improper feeding, professional vrednost, etc.).