Reflux esophagitis - the development of inflammatory lesions of the esophagus as a result of repeated casting in the esophagus of gastric contents.
Manifestations of the disease detected in almost half of the adult population, endoscopic signs - more than 10% of those who underwent endoscopy. Berretta's esophagus develops in 20% of patients with reflux esophagitis (0.4% of the population).
Causes
- Surgeries on hiatal or near the (vagotomy, resection of the cardia of the stomach, esophagogastrostomy, gastric resection, gastrectomy)
- Hiatal hernia
- Gastric ulcer and duodenal ulcer
- pilorospazm or pyloroduodenal stenosis
- scleroderma
- Smoking
- Alcohol
- Pregnancy
- The medicaments capable of reducing the tone of the lower esophageal sphincter
- sphincter insufficiency in obesity
- GastritisAssociated with Helicobacter pylori
the degree of reflux
- Grade A - one (or more) of the mucosa damage of less than 5 mm, outside the limited mucosal folds
- Degree - one (or more) mucosal lesion greater than 5 mm, outside the limited mucosal folds
- Degree C - one (or more) mucosal lesion, extending to two or more mucosal folds, but is less than 75% of the circumference of the esophagus
- Degree D - one (or more) mucosal lesion extends to 75% or more of the circumference of the esophagus.
manifestations
- Heartburn - most characteristic symptom of reflux esophagitis (83% of patients tested) is a result of prolonged contact with acidic gastric contents of the esophageal mucosa. Heartburn is amplified at errors in the diet, alcohol, carbonated beverage, physical exertion, and inclinations in the horizontal position
- Belching, worse after eating, receiving carbonated drinks
- Regurgitation of food, enhanced by physical exertion
- swallowing disorder
- Pain in the epigastric region or behind the breastbone - appear soon after eating, worse when bending the body in a horizontal position
- Less commonly, there are a feeling of a lump in the throat when swallowing, pain in the ear and lower jaw, chest pain, which can be triggered by exercise
Vnepischevodnye symptoms - chronic cough, pneumonia, Hoarseness, caries teeth, etc.
Diagnosis of reflux esophagitis
- X-ray examination supine or upright with a strong inclination patient anteriorly: casting a barium sulfate in the esophagus
- Endoscopy with biopsy
- Ezofagotonokimografiya (manometry)
- Esophageal pH monitoring - the main method of monitoring the effectiveness of treatment.
- Bilimetriyu performed to detect alkaline (bile) refluxes
- Scintigraphy is indicated for the detection of motor-evacuation disorders of the esophagus
- omeprazole test
- Bernstein test
Treatment
In the treatment of reflux esophagitis good results are obtained by complex therapy, which consists not only in taking medicine, but also in dieting, in the pursuit of the overall improvement of the body.
- smoking Cessation
- Normalization of body weight
- Raising the bed head end
- Avoidance of stress on the abdominal muscles, with an inclination of the body, wearing tight belts,
- Not Recommended intake of drugs that lower esophageal sphincter tone (nitrates, calcium antagonists, theophylline, progesterone, antidepressants)
Diet in the treatment of reflux esophagitis
The diet includes
- restriction products reinforcing flatulence;
- avoiding sharp, very hot or cold food;
- avoidance of alcohol intake, products that reduce the tone of the lower esophageal sphincter (onion, garlic, pepper, coffee, chocolate, etc.);
- avoidance of overeating, the last meal - at least 3-4 hours before bedtime.
More about nutrition with esophagitis
drug therapy
Drug therapy is carried out for at least 8-12 weeks followed by maintenance therapy for 6-12 months.
apply
- proton pump inhibitors (omeprazole, lansoprazole, rabeprazole) in a conventional dosage or double,
- antacids (Almagelum, Aluminum phosphate gel, Maalox, Gelusil varnish, etc.) designate usually 1.5-2 hours after meals and at bedtime,
- prokinetics - domperidone, metoclopramide.
Surgery
Indications for surgery:
- complications of reflux esophagitis (esophageal stricture, recurrent bleeding, esophagus Berretta)
- the ineffectiveness of drug therapy (for 6 months) in young patients,
- combination with asthma.
