Digestive system pathologies are often found among the population. Diseases associated with reflux are common. What are their features?
Reflux esophagitis
The disease is a chronic inflammation of the esophagus, which occurs due to the constant ingestion of the acidic contents of the stomach. Pathology is associated with insufficiency of the lower esophageal sphincter, which normally protects the esophagus from the penetration of gastric juice.
Acute Biliary Reflux Gastritis
This form is characterized by the development of acute inflammation in the mucous membrane as a result of exposure to bile in the food lump. There are several options for acute gastritis:
- Catarrhal gastritis, the main manifestation of which is a slight hyperemia and swelling of the wall of the stomach. It thickens and becomes covered with a layer of thick mucus. The mucous membrane has spot hemorrhages and slight erosion.
- Fibrinous gastritis, in which zones of epithelial necrosis are formed in the wall, infiltrated with fibrinous-purulent exudate. The manifestation of this phenomenon is a thin fibrin film on the surface of the affected areas of the mucous membrane. Superficial gastritis is characterized by the friability of this film, and with deep inflammation it grows together with the epithelium.
- Necrotic gastritis, in which in addition to the epithelium, other layers of the mucous membrane are affected. Under the necrosis is understood the death of cells under the influence of aggressive factors.
- Purulent gastritis is the most severe form of inflammation. All layers of the stomach can be involved in the process, which poses a threat of perforation. The manifestation of this option is the presence of purulent exudate, as well as intense infiltration of the mucous membrane by leukocytes.
Chronic biliary reflux gastritis
This type is characterized by a combination of inflammatory and dystrophic phenomena. Regular ingestion of bile and pancreatic enzymes into the stomach leads to the development of chronic inflammation. Also, this form may be the outcome of acute gastritis. As a result of alkalization, the amount of histamine in the mucous membrane increases, which makes it swollen and hyperemic.
Pathogenesis
Between the stomach, its antrum, and the duodenum there is a sphincter, which is called the pylorus. The work of this muscle is aimed at moving the chyme (food lump) from the stomach to the intestines for further digestion and subsequent absorption of nutrients. Disruption of the sphincter can lead to the development of biliary reflux gastritis, the treatment of which requires a combination of medications and proper nutrition. The delayed opening of the sphincter leads to this disease, as a result of which the lump of food, to which the bile produced by the liver joins, returns back to the stomach. The composition of bile has a detrimental effect on the state of its mucous membrane. It contains salts, acids and enzymes, which are attributed to aggression factors.
Etiology
The reasons for the development of biliary reflux gastritis are associated with a violation of the normal functioning of the sphincter - the pylorus. This may result in any kind of surgery that affects the motility of the gastrointestinal tract. Among etiological factors, diseases such as hepatitis, cholecystitis and chronic duodenitis can be distinguished. Weakness of the sphincter muscles and increased pressure in the intestines are often the causes of the development of gastritis, and a number of gastrointestinal pathologies can lead to this. An important role is predisposing factors. For example, constant stress reduces the protective properties of the mucous membrane, and it is less resistant to the action of irritating factors. The same applies to non-steroidal anti-inflammatory drugs, which increase the risk of developing gastritis several times. These drugs affect the synthesis of prostaglandins, and they perform an important function - stimulating the formation of mucus by goblet cells, which increases the protective properties of the mucous membrane. Anti-inflammatory drugs block the enzyme cyclooxygenase, as a result of which the amount of prostaglandins and, consequently, the amount of mucus are reduced.
Ascites leads to the formation of reflux esophagitis, which results in increased pressure in the abdominal cavity, narrowing of the pyloroduodenal opening. Additional factors may include malnutrition, tight clothing, medication, stress, and smoking. Such a phenomenon can occur during pregnancy, then it is not associated with pathology.
Biliary reflux gastritis and reflux esophagitis: symptoms
The main symptoms of reflux esophagitis are heartburn and sour belching, which usually occur after eating, as well as when leaning forward. Complementing this is discomfort in the epigastric region.
A more saturated clinic is characterized by biliary reflux gastritis. Symptoms of this disease include pain and other disorders. Often patients are worried about a feeling of fullness and bloating, as well as heaviness in the epigastric region. Pain usually appears on an empty stomach, and their intensity can be different - from severe acute to aching. Often there is vomiting.
Diagnostics
Diagnosis of biliary reflux gastritis is carried out after special studies and history taking. Complaints alone are not enough, they only help suggest the development of the disease. First of all, the patient is sent for the delivery of feces, in which experts reveal hidden blood. FGDS is also mandatory, which will help to visually assess the condition of the mucous membrane, detect pathologically altered foci. An increase in pressure in the duodenum can be detected by manometry.
Reflux esophagitis is diagnosed mainly by the x-ray method using a contrast medium. This method allows you to track the time of throwing the contents of the stomach into the esophagus. It is also recommended to conduct an endoscopic examination, which will assess the condition of the mucosa and take biological material for further research.
Treatment
Biliary reflux gastritis and reflux esophagitis require immediate treatment. This will help improve the patient's condition and avoid possible complications. If esophagitis is found, you should abandon bad habits, as well as intense physical exertion on the abdominal zone.
Drug therapy is based on the appointment of antacids, which will reduce the aggressive effect of gastric juice on the mucous membrane of the esophagus. Among them can be distinguished "Almagel", "Maalox", applied by the course. They envelop the walls of the stomach and reduce acidity.
In addition, it is recommended to use drugs that reduce the secretion of gastric juice (Omeprazole). Prokinetics can improve the tone of the sphincter, which is a protection against casting acidic contents. Among these drugs, one can distinguish Motilium and Motilak. If conservative therapy does not produce a result, surgery may be necessary, which is carried out using endoscopic equipment.
How is the treatment of a disease such as biliary reflux gastritis? Symptoms and treatment of this pathology are inextricably linked. Patients require a set of pharmacological and non-drug measures that will improve the condition, relieve clinical manifestations. First of all, you should normalize your lifestyle - giving up bad habits, proper nutrition. Among medications, histamine receptor blockers are usually prescribed to reduce secretion. Do not do without gastroprotectors - they will accelerate the healing of lesions of the mucous membrane. In addition, the binding of bile acids is necessary , which is done using ursodeoxycholic acid. Such drugs as Domperidone and Metoclopramide will help prevent chyme into the stomach.
Prevention
Proper nutrition and timely diagnosis of pathological processes will help prevent the formation of biliary reflux gastritis and esophagitis. It is recommended for the purpose of prevention to conduct regular endoscopic examinations that will help identify the disease at an early stage. This will increase the effectiveness of conservative therapy and avoid surgical interventions and the occurrence of serious complications.
In addition, the protective properties of the mucous membrane should be increased. To do this, it is recommended to abandon bad habits (or reduce them to a minimum), try to eat healthy foods and avoid stressful situations.
Another predisposing factor is the frequent use of non-steroidal anti-inflammatory drugs, which reduce mucus formation in the stomach, as a result of which the mucous membrane becomes vulnerable. An important role is played by the prevention and timely treatment of concomitant diseases.
The problem of the occurrence of biliary reflux gastritis and esophagitis is relevant, as these pathologies can not only worsen the patient's condition, but also cause complications. Timely diagnosis will allow you to start treatment on time.