Ezofagit - damage of a mucous membrane of a gullet of inflammatory character. As manifestations of an ezofagit burning pain behind a breast, swallowing violations, heartburn, the raised salivation can serve. The peptic ulcer, a stenosis, perforation of a gullet, Barrett's disease can be a complication of an ezofagit. The diagnostic minimum consists of carrying out an ezofagoskopiya, an endoscopic biopsy and a X-ray analysis of a gullet. Treatment is appointed taking into account an etiology of an ezofagit; includes a diet, medicamentous therapy, physical therapy; if necessary – surgical treatment of narrowing of a gullet (a buzhirovaniye, a section cicatricial , etc.).
Ezofagit – an inflammatory disease of a wall of a gullet of a sharp or chronic current. At an ezofagita inflammatory process develops in an internal, mucous membrane of a gullet and when progressing can strike deeper layers. Among diseases of a gullet ezofagit is the most frequent, in 30-40% of cases the disease can proceed without the expressed symptomatology.
Ezofagita can be different consequence of damages mucous a gullet or develop owing to infectious defeat, gastritis, throwing of gastric juice (sometimes with bile) from a stomach. Ezofagit owing to a reflux (throwing) of gastric contents it is allocated as a separate disease – a gastroezofagealny reflux disease.
Classification of ezofagit
Ezofagit on a current can be sharp, subsharp and chronic. On the nature of inflammatory process and its expressiveness in gastroenterology distinguish catarrhal, edematous, erosive, psevdomembranozny, hemorrhagic, eksfoliativny, necrotic and flegmonozny ezofagit.
Catarrhal and edematous ezofagit (the most often found forms) are limited to hyperaemia mucous and its hypostasis. At sharp infectious process, and also chemical and thermal burns of a gullet development of erosion of a mucous membrane is possible (erosive ezofagit). At the heavy course of an infection quite often there is a development of a necrotic form. Hemorrhagic ezofagit is followed by hemorrhages in a gullet wall. At a psevdomembranozny form fibrous exudate is not spliced with submucous fabric unlike an eksfoliativny ezofagit. Gullet phlegmon, as a rule, develops at damage of a wall of a gullet by a foreign matter.
On localization and prevalence of inflammatory process distinguish distalny, proximal and total ezofagit.
Classification of an ezofagit by extent of defeat has distinctions for the sharp and chronic course of a disease. Sharp ezofagita and burns of a gullet divide into three degrees:
- superficial defeat without erosive and ulcer defects;
- defeat of all thickness mucous with ulcer defects and a necrosis;
- defeat extends to submucous layers, deep defects with a possibility of perforation of a wall of a gullet, bleeding are formed. After curing education cicatricial is possible.
Chronic ezofagit on expressiveness of defeat of a wall divide into 4 degrees according to Savary and Miller's classification (classification of endoscopic signs of a chronic ezofagit):
- hyperaemia without erosive defects in disteel departments;
- separate minor erosive defects of mucous;
- erosion mucous merge with each other;
- ulcer defeat mucous, stenosis.
Etiology and pathogenesis
Sharp ezofagit develops owing to the damaging factor of short-term action:
- sharp infectious processes (flu, fungal defeat, diphtheria, etc.);
- physical damage (a burn, traumatizing at introduction of the probe, damage by foreign matters);
- chemical burn (damage by caustic chemicals);
- allergic reaction to foodstuff (as a rule, it is combined with other symptoms of an allergy).
Injuries of a gullet after burns happen the heaviest.
In pathogenesis of an infectious ezofagit decrease in immune properties of an organism is considered a major factor of development of an inflammation.
The reasons of development of chronic ezofagit are also various:
- alimentary ezofagit (the use of very hot, spicy food, strong alcohol);
- professional ezofagit (the work connected with steam inhalation of caustic chemicals);
- stagnant ezofagit (irritation mucous the remains of the accumulated food at any difficulties of evacuation function of a gullet);
- allergic ezofagit (develops in connection with food allergy);
- dismetabolicheskiya ezofagit (it is connected with exchange violations – hypovitaminoses, insufficiency of minerals and a fabric hypoxia, long intoxication of an organism, etc.);
- idiopathic ultserozny ezofagit (a special form of a chronic inflammation of a gullet of not clear etiology, morphologically similar to ulcer colitis and a granulematoz of a gullet (nonspecific regionarny stenoziruyushchiya ezofagit).
As a separate disease allocate peptic, or a reflux-ezofagit. It develops owing to a gastroezofagealny reflux (throwing of gastric contents in a gullet). It is sometimes combined with a duodeno-gastralny reflux. The reflux from a stomach in a gullet can arise for the following reasons: insufficiency of a sebesten (lower esophageal sphincter); hiatalny hernia (hernia of an esophageal opening of a diaphragm); insufficient length of a gullet.
Symptoms of a sharp ezofagit
Expressiveness of symptomatology at a sharp ezofagit has direct dependence on expressiveness of inflammatory process in mucous a gullet. At a catarrhal form ezofagit can proceed without clinical symptoms, being only sometimes shown by hypersensibility of a gullet to hot or cold food. Severe forms of an ezofagit are shown by the expressed painful symptom (the acute, severe, burning pain behind a breast giving to a neck and a back), the disorder of swallowing (dysphagy) because of severe pain, heartburn increased by salivation.
In extremely hard cases – bloody vomiting up to a state of shock. Hard proceeding ezofagit a week later can be replaced by the period of imaginary wellbeing (the sharp stukhaniye of symptoms, is possible even the use of firm food), but without adequate treatment several weeks later (up to 3 months) healing of heavy defects of an esophageal wall can lead to formation of rough hems and a stenosis that will lead to progressing of a dysphagy and regurgitation of food.
Symptoms of a chronic ezofagit
At a reflux-ezofagite the main clinical manifestation is heartburn (burning in the area an epigastriya and behind a breast). As a rule, heartburn amplifies after reception of greasy, spicy food, coffee, carbonated drinks. The overeating also promotes development of symptomatology. Can be other probable symptoms: an eructation (air, sour, bitter with bile impurity); at night the regurgitation can be shown. Accessions of disorders of breath, a laryngospasm, bronchial asthma, frequent pneumonia are frequent. Symptoms of violation of breath are shown, as a rule, at night, in horizontal position of a body.
Chronic ezofagit can proceed with the pains behind a breast around a xiphoidal shoot irradiating in a back and a neck. Moderate expressiveness of a painful symptom is characteristic of a chronic ezofagit.
Insufficiency of a sphincter of a gullet can be diagnosed for children of the first year of life on repeated moderate vomiting right after feeding in horizontal position. At persistent vomiting hypotrophy symptoms can develop.
Complications of an ezofagit
The following diseases and states can become complications of ezofagit:
- the peptic ulcer of a gullet (often develops at Barret's disease), is characterized by formation of deep defect of a wall of a gullet, can lead to rough scarring and shortening of a gullet;
- narrowing (stenosis) of a gleam of a gullet (leads to violation of passing of food to a stomach, decrease in body weight);
- the gullet wall perforation (perforation) – a complication, life-threatening, demands urgent surgical intervention;
- purulent complications of an ezofagit – abscess, phlegmon (as a rule, are a consequence of injury of a gullet by a foreign matter);
- Barrett's disease (at long the reflux-ezofagite without adequate treatment develops regeneration of an epithelium of a gullet – a metaplaziya). Barret's gullet – a precancer state.
Diagnostics of an ezofagit
If sharp ezofagit is shown by clinical symptomatology, then diagnosis of this disease, as a rule, does not make problems – localization of a painful symptom is very specific and characteristic. Poll allows to establish a probable cause of development of an ezofagit. For confirmation of the diagnosis the endoscopic research of a gullet is used (ezofagoskopiya) which shows changes in mucous, their expressiveness. Carrying out endoscopic inspection of a gullet is carried out not earlier than for the sixth day after manifestation of the expressed clinical picture. Indications for endoscopic inspection come to light individually. If necessary take an endoscopic biopsy of mucous and investigate histologically.
Violations of motor function of a gullet come to light by means of an ezofagomanometriya. The X-ray analysis of a gullet allows to reveal changes of contours of a gullet, an ulceration, hypostasis of a wall and a congestion of slime.
Treatment of a sharp ezofagit
Sharp ezofagit owing to a chemical burn demands urgent washing of a stomach for removal of the chemical agent. For treatment of easy forms of sharp ezofagit by the patient it is recommended to abstain from meals 1-2 days, drug treatment consists in reception of antatsid and medicines of group of a famotidin. After the beginning of food exclude the products capable to damage mucous (alcohol, coffee, hot, spicy, rough food) and the food intensifying production of gastric juice (chocolate, fat products). Ezofagity the refusal of smoking is recommended to all patients.
At heavy course of a disease - careful food up to refusal of an enteroalimentation, the enveloping and gel antatsidny medicines. At the expressed intoxication – infusional therapy by means of dezintoksikatsionny solutions. For suppression of infectious process – antibiotic treatment.
At an ulcer ezofagit with the expressed painful symptom anesthesia is registered and washing of a stomach is contraindicated. At unsuccessfulness of massive treatment by antibiotics of the centers of a purulent inflammation (phlegmon, abscess) – surgical sanitation. Also the indication to surgical treatment of an ezofagit is development of the heavy striktura of a gullet which is not giving in to dilatation.
Treatment of a chronic ezofagit
In therapies of a sharp ezofagit major importance plays elimination of a factor of its emergence. The most important component of treatment is strict observance of a diet and diet and way of life. Recommendations about a diet in the period of sharp clinical manifestations: the use of moderate amount of the soft wiped food of room temperature. An exception of a diet of the products rendering irritant action on mucous – the sharp, fat, fried, aerated, alkogolesoderzhashchy products. Also exclude the food containing a large amount of cellulose.
Patients ezofagity need to refuse smoking and reception of the medicines influencing a gullet sphincter tone (sedative medicines, tranquilizers, , prostaglandins, etc.).
Also it is necessary to refuse meals not less than in one and a half-two hours prior to a dream, not to accept horizontal position after food, not to spend much time . It is recommended to sleep on the raised headboard. Not to drag on in a waist.
Medicinal therapy at a chronic ezofagit:
- the medicines reducing acidity of gastric juice (antatsida – the optimum choice are gel antatsida with anesthetics, inhibitors of a protonew pomp, blockers of H2-histamine receptors);
- the medicines strengthening a sebesten tone (the lower sphincter of a gullet and accelerating advance of a food lump from a stomach in a duodenum (blockers of dofa-receptors and a holinomimetika).
- at a reflux-ezofagite the good result is yielded by an amplipulsterapiya;
- decrease in a pain syndrome electrophoresis of ganglioblokator;
- mud cure and balneoterapiya.
At a heavy current a reflux-ezofagita with striktura, ulcers and a stenosis the physical therapy is contraindicated. Operations at a stenosis of a gullet consist in an endoscopic section , expansion or a buzhirovaniye of a gullet. According to indications the resection and plasticity of a gullet is carried out.
Forecast and prevention of an ezofagit
In the absence of complications (a stenosis, perforation, bleeding, a sredosteniye inflammation, etc.) the forecast is favorable. An important factor in the long term of treatment of an ezofagit is strict observance of a diet, way of life and recommendations about a diet.
Prevention of ezofagit means avoiding of the reasons of its development – is hotter than burns food, chemicals, damages by foreign matters, etc. Prevention of a chronic ezofagit – regular dispensary inspection at the gastroenterologist and if necessary – treatment. The sick chronic ezofagit as prevention of aggravations showed sanatorium treatment.