Distal reflux esophagitis - what is it? We will understand in this article.
If you do not start acting timely in case of insufficiency of the gastric cardia, which is responsible for preventing refluxing digested food into the esophagus, distal esophagitis will appear.
Characteristic
Distal reflux esophagitis occurs against the background of permanent irritation of the esophagus. Organ tissues located closer to the stomach gradually begin to become inflamed, hyperemia of the mucosa and edema appear.
A feature of the disease is the duration of the course, the initial stages are rarely manifested by any symptoms. As a result, distal esophagitis of a chronic nature develops, which is difficult to treat and often recurs.
The main source of distal inflammation of the esophagus is the failure of the cardia, that is, the circular muscle, which blocks the entrance to the stomach. With a loose closure of the sphincter, the acidic contents of the stomach are transferred to the lower esophagus, causing irritation of the mucosa and severe inflammation.
Often the cause of distal GERD is gastrointestinal diseases, which are accompanied by increased acidity of the stomach, such as gastritis.
Kinds
Distal esophagitis is characterized by varying severity of inflammation of the esophagus mucosa. In accordance with this criterion, the following types of pathology are distinguished:
- Superficial, or catarrhal, - without morphological changes in organ tissues.
- Erosive distal reflux esophagitis - focal red wounds appear on the walls. Appears due to infection with irritating substances and pathogenic microorganisms. If the occurrence of fibrin is added to erosion, then fibrinous esophagitis occurs.
- Edematous - severe swelling of the mucous membrane and hyperemia.
- Hemorrhagic - an extensive lesion of hemorrhages of the esophagus membrane. It appears when a patient is infected with viruses, for example, with typhus and flu.
- Exfoliative and pseudomembranous - the result of scarlet fever or diphtheria.
- Necrotic - tissues die. Appears with a complicated course of infectious diseases.
- Phlegmonous - mechanical inflammation of the submucosal layers and mucous membrane.
- GERD of an allergic nature, which appears with asthma and other lesions of the respiratory system.
- GERD professional occurs when working with pairs of harmful substances (alkalis, acids).
- Rare types of the disease include granulomatous and dysmetabolic esophagitis.
Very often, distal reflux esophagitis appears with repeated cycles of cardia deficiency and occurs against the background of the influence of acidic gastric contents on the esophagus. This ailment by the nature of the lesions can be:
- non-erosive, superficial;
- ulcerative with necrotic foci along the entire surface of the mucosa;
- with inflammation of the layers under the mucosa to deep defects that cause tissue thinning and perforation of the esophagus wall, accompanied by bleeding.
Degrees of distal reflux esophagitis
The ailment of the severity of morphological changes develops with such degrees of severity:
- The first degree is focal mild redness of the mucous membrane, while the latter at the transition to the stomach in the structure with smooth folds is loose. Distal reflux esophagitis of the 1st degree often proceeds without symptoms.
- The second degree is multiple or single erosion of an elongated form, exudate can form. Wounds appear mainly in the mucous folds and affect no more than ten percent of the distal esophagus.
- The third degree - numerous merged erosions that are covered with necrotic tissues and exudate; affected area - more than fifty percent.
- The fourth degree - merged erosion are arranged in a circle, there is a significant exudative-necrotic inflammation; a serious fibrinous lesion covers the entire area above the cardia by five centimeters.
What causes the pathology?
Factors that provoke the development of distal reflux esophagitis are as follows:
- Recurrent reflux into the esophagus from the stomach.
- Infectious inflammation: candida (fungal), herpetic origin (HSV-1 or -2), bacterial infections.
- The defeat of the body by chemicals (solvents, acids, alkalis); erosive esophagitis appears.
However, the most common cause of distal reflux esophagitis is cardiac insufficiency (when the closure between the stomach and esophagus is loose). The process becomes chronic and aggravated.
It can also be caused by a diaphragmatic hernia of the esophagus opening, which causes a sharp pressure drop inside the peritoneum, due to which the region of the cardinal gastric section penetrates into the sternum cavity. Compressed food masses penetrate the esophagus.
Obesity can affect, in which a person leans sharply after eating, and because of this, the pressure inside the organs increases, which comes out through the expansion of the sphincter.
Strengthening the tone of the second sphincter in the gastric pyloric zone is another reason. The result of a spasm is an outpouring of acidic contents in the direction of lower resistance, which causes distal type esophagitis.
Symptomatology
The pathological clinical picture manifests itself in the form of the following symptoms:
- belching with a bitter or sour taste in the oral cavity;
- heartburn with localization behind the sternum; aggravation of burning after eating or overeating, in a prone position, with physical exertion;
- excessive salivation, especially at night;
- hoarseness and hoarseness in the voice;
- pains in the area behind the sternum, resembling sensations with angina pectoris;
- fast satiety after a small amount of food has been eaten;
- cough in which there is no sputum;
- hiccups;
- sore throat during swallowing, in which the process of ingestion of liquid and food is disturbed;
- bad breath.
Certain symptoms decrease or stop after the use of antacids. Esophagitis exfoliative, necrotic or erosive is characterized by a strong manifestation of vomiting with rejection of parts of the tissues of the esophagus, cough.
Diagnostics
Diagnostic measures for distal esophagitis require an analysis of symptoms and the result of a full examination of the gastrointestinal tract, which includes six stages:
- endoscopy of the mucous membrane of the esophagus determines the severity of the pathology;
- X-ray of the esophagus reveals the causes of the disease and determines the frequency of reflux during the introduction of contrast;
- pH in the esophagus calculates the acidity in the lumen of the organ;
- establishing the clearance of the esophagus calculates the degree of protection of the specific mucus that is produced in the wall of the esophagus; this method makes it possible to determine the movement of the medium-pH of the lumen in the necessary direction, while the damage is not done;
- radionuclide scanning clarifies the diagnosis;
- manometry calculates the internal pressure in the gastrointestinal organs, which affects reflux.
What is the treatment for distal reflux esophagitis?
Preventive measures and treatment
The treatment of esophagitis is long, complex and complex. First of all, it is necessary to eliminate the root cause of the inflammation process (of course, with its reliable determination).
Drug therapy of distal esophagitis includes antifungal and enveloping drugs, antacids and antispasmodics. In addition, peloid therapy (mud treatment) and electrotherapy (amplipulse therapy) are well established.
The main goals of the use of medications are to protect the mucosa from the influence of aggressive factors, normalize the degree of acidity, and eliminate pain. Take medicines from four to six weeks.
Recommendations to the patient
- In time to treat concomitant diseases of the gastrointestinal tract, for example gastritis.
- Wearing a free cut, without tight belts.
- Refusal from self-medication of any disease, even ordinary headache.
- Refusal of bad habits - addiction to tobacco and alcohol.
- Rest after eating sitting or upright.
- Avoid wearing heavy weights and torso forward.
- Sleep on the head, raised by 15 centimeters.
Regime and diet therapy
Diet is the main treatment method for diseases of the gastrointestinal tract. Healthy eating requires:
- fractional food intake (at least five times a day);
- small portions (no more than two hundred grams);
- prolonged chewing of food;
- inclusion in the diet of soups, broths and cereals;
- refusal of solid, salty and spicy foods;
- drinking water (at least two liters);
- eating warm food, neither cold nor hot.
Peptic esophagitis
A special type of chronic esophagitis is peptic distal reflux esophagitis, that is, an ailment that occurs due to the repeated regular effect on the mucous membrane of the esophagus from the duodenal or gastric contents.
Gastroesophageal reflux is the spontaneous leakage or throwing of the contents of the stomach into the esophagus without prior vomiting and nausea.
Treatment is determined by the severity of the disease. Conservative treatment and surgical intervention are used. The main areas of therapy are as follows:
- elimination of the esophagus provoking reflux of the primary disease or its compensation;
- a decrease in the acidity of the contents of the stomach, for which drugs are used that inhibit the production of hydrochloric acid and reduce the acidity of the already formed (antacids, H2-histamine receptor blockers);
- the use of drugs with anti-inflammatory function, which restore the damaged mucous membrane;
- optimization of intestinal and gastric peristalsis.