At the present time, there are active discussions between scientists from different countries about the described disease. The thing is that, on the one hand, this disease is considered as an independent pathology, and on the other hand, as a complication or one of the forms of the course.

This is a disease of the esophagus, which has a chronic course and is manifested by degenerative changes in the wall of this organ in the form of erosive lesions.

So why do many doctors tend to believe that this is not an independent nosology, but a form of manifestation of GERD. This is explained by the fact that common cause the onset of the disease is the reflux of acidic contents from the stomach cavity into the esophagus.

And this is directly related to reflux pathology. In addition, both of these concepts usually accompany each other.

Causes of the disease

The very first group of causes includes those that directly cause gastroesophageal reflux. These include:

1. Conditions under which the closing work of the muscular apparatus of the sphincter between the esophagus and stomach is damaged. As a rule, this is a pathological breakdown at the level of the nervous and hormonal systems. These conditions are:

• central dysregulation nervous system, with various injuries, bruises, poisoning with poisons and chemicals;
• hormonal imbalance, pathological changes in the endocrine system;
• muscle ataxia, paralysis, paresis of sphincters, including the esophageal.

As a result of these pathologies, the sequence of passage of food through the gastric tract is disrupted. Due to incomplete closure of the sphincter valves, the contents of the stomach flow back into the esophagus and cause a destructive effect on its wall.

2. Intermittent failure of the sphincter. Violation of its work is not systematic, regular, but occurs under certain conditions. These conditions are:

• irrational food intake, periods of fasting are replaced by periods of overeating;
• the use of hard foods in the diet that can injure the internal membranes of organs;
• drinking plenty of fluids in a short period of time.

3. "Non-reflux" causes. Among them, changes from other digestive organs are most often distinguished:

• mechanical defects or formations in the stomach cavity: stenosis, postoperative scars, tumors, polyps, diverticula, hernial protrusions, malformations.
• bad habits: smoking, drinking alcohol or psychotropic substances;
• use raw fish or raw meat;
• thermally poorly processed food;
• prolonged fasting;
• prolonged stressful situations, shocks, depressions;
• taking certain drugs: antibiotics, NSAIDs, hormones and others;
• other concomitant chronic diseases: oncological processes, hepatitis, chronic pancreatitis, cholecystitis, food poisoning.

The disease is classified into stages depending on the spread of the erosive process:

1. Stage I - single shallow erosion without signs of confluence and complications.
2. Stage II - erosive lesions with a tendency to unite and merge. At the bottom of the erosions, full-blooded vessels are visible, their edges are edematous, swelling.
3. Stage III - extensive damage by erosive elements, up to ulcerative defects, with signs of complications in the form of bleeding, perforation, malignancy.

According to the severity are distinguished:

• Mild degree - mild symptoms and clinical manifestations. The patient practically does not complain.
• Medium degree - the general condition suffers moderately, performance is impaired, the patient is concerned about the main complaints.
• Severe degree - a pronounced violation of the organ, poor general condition of the patient, painful symptoms, damage to other organs and systems, the presence of complications in the form of bleeding, perforation, perforation.

How to identify a disease

You can't do it without the help of a qualified specialist. The doctor must collect all the necessary information about the complaints, detail them and prescribe the necessary medical examination methods.

• The most informative way to learn about pathology is to conduct an endoscopic examination -. It will reveal the presence of erosions, their characteristics, complications or their absence. In addition, the degree and extent of the lesion is assessed. The endoscopist describes the visual picture, and the doctor, taking into account all complaints and examinations, makes a diagnosis.
• If necessary, resort to the method of pH-metry. This must be done to assess the acid-base composition of the esophagus and to prevent aggressive effects on its wall by an acidic environment.
• To exclude other diseases or to confirm concomitant diseases that could cause esophagitis, prescribe ultrasonography abdominal organs.
• X-ray diagnostics of the esophagus with a contrast agent. Deep erosions can be visualized by this method.
• The use of high technologies - computed tomography and magnetic resonance imaging. With the help of these studies, it is possible to examine in a volumetric version the wall of the organ and its damage.

Symptoms and treatment of erosive reflux esophagitis

Symptoms of the disease are somewhat similar to those of gastroesophageal reflux disease, they are varied and can manifest themselves in different combinations. But some signs have their own essential difference, which helps to identify this form of the disease.

• Pain and discomfort in the upper abdomen. Patients may report chest pain. Sometimes such signs can be masked as diseases of the heart, lungs, mediastinum.
• A very characteristic sign is the sensation of the passage and movement of food through the esophagus and stomach. Due to the fact that the erosion surface contains a large number of pain and sensory receptors, this phenomenon occurs.
• Difficulty swallowing food bolus. The process occurs in severe forms with damage to the uppermost parts of the esophagus.
• Heartburn. The symptom in this disease is more pronounced and painful than in GERD. It is permanent, regardless of what the patient ate when it was. Heartburn attacks can occur even at night. Any physical labor exacerbates the course of the symptom.
• The taste of blood in the mouth. A very important distinguishing feature. Appears with bleeding erosions. It is a formidable symptom, after which you should definitely consult a doctor.
• Belching of gas or undigested food. Among other things, there may be an eructation of sour contents mixed with bile or of hydrochloric acid.
• Indomitable hiccup. Usually, few people pay attention to this symptom. However, do not forget about it. With the described pathology, this phenomenon may be the only sign of the disease.
• Increased production of salivary glands. A person notices an increase in the amount of saliva in oral cavity.
• Sensation of a lump in the throat. This symptom may masquerade as a sore throat.
• Dry cough.
• Decrease in the timbre of the voice.

If you notice one of these symptoms in yourself, you do not need to immediately become sure that you have esophagitis. Only a set of signs and a complete diagnostic examination by a doctor will give you reliable information about your health.

Treatment of the disease

During treatment of this type esophagitis, it is important to consider that the pathologies that contributed to its formation should also be treated. Usually therapy is carried out on an outpatient basis.

In the hospital, severe forms requiring surgical interventions are treated. When prescribing treatment, the doctor must comply with the following criteria:

• therapy should be complex;
• complete;
• correspond to the state, severity and course of the disease;
• there should be a minimum number of side effects;
• aimed at recovery, prevention of complications.

First of all, it is important for the patient to explain that he should change his lifestyle and nutrition in a more correct direction.

The regime of the day, rational nutrition, protective regime of work and rest must be observed. It's important to watch your weight. If there are excess kilograms, you need to gradually get rid of them.

If, on the contrary, the weight is not enough, it must be reached with a balanced diet to the norm. Clothing should be comfortable, loose, and pinching in the abdominal cavity should be avoided. Tight clothing should not be worn.

After eating for 40 minutes, be in a sitting or standing position, do not engage in physical activity during this time. Daily walks in nature should be included in the daily routine.

The diet should be balanced, rich in easily digestible components, correspond to the energy and plastic costs of the body.

We exclude from the diet alcohol, tobacco, bad habits, spicy, fried, raw meat, canned food, chocolate, coffee, soda, concentrated juices.

We add porridge, sour-milk products, boiled, steamed dishes, fish to the diet, chicken breast, fresh vegetables, fruits, except citrus fruits, compote, jelly, tea.

Meals should be divided into 6 time intervals in small portions. The last dose should be 2 hours before bedtime. When expressed, you need to sleep with a raised head end.

Medical therapy

antacid group. The drugs neutralize the acidic contents in the esophagus, reduce the risk of damage to the mucosa, prevent the appearance of new erosions, and promote the healing of the old ones. Most often prescribed maalox, phosphalugel.

Antisecretory drugs. Here the choice is between proton pump inhibitors and H-histamine receptor blockers. Blockers include omeprazole, emanera, lansoprazole and others.

Therapy is carried out for a long time. The course is at least three months. They help reduce acidity. Contribute to the prevention of complications and relapses.

The main group are prokinetics. They have an anti-reflective effect. Cerucal, metoclopramide, domperidone can be used.

They operate at the central level. Eliminate heartburn, nausea, vomiting, bitterness in the mouth. A group of drugs is especially effective when combined with gastroesophageal reflux disease.

In addition, if there are other pathologies on the part of gastrointestinal tract, it is necessary to treat them. Enzymes can be prescribed: mezim, pancreatin; probiotics: linex, normobact, adsorbents: activated carbon, hepatoprotectors: phosphaglyph and others.

Surgical treatment is indicated for severe forms and the course of the disease with complications.

Treatment with folk remedies

Patients do not always believe in the therapeutic effect medicinal herbs. However, when combined with drug therapy, herbs prove to be a very important helper. They enhance the effect of medicines and have their own therapeutic properties.

From this pathology, decoctions of chamomile and dill have an effect.

Ordinary pharmacy chamomile is very good. You can buy ready-made packaged fees or use the loose option. In any case, it is necessary to fill the phytocollection with hot boiled water, let it brew for two hours.

Drink 250 ml daily for at least two weeks. This simple recipe will help relieve pain and heal erosions.

Dill solution is prepared in a similar way. It is best to brew dry.

Sea buckthorn, nettle leaves, aloe, propolis have healing properties.

Many sources describe the healing effect of celery, or rather its juice. Freshly squeezed juice drink 1 tablespoon before meals.

At home, you can independently prepare a collection of chamomile, mint, lemon balm and flax seeds. In equal proportions, tea is brewed from these herbs. Insist in a teapot or thermos and use before going to bed.

Potato juice is effective in mild pathology. The potatoes are thoroughly washed, peeled, rubbed on a grater, squeezed and filtered through cheesecloth. If you get a thick consistency, you can dilute a little with boiled water. Take 1 tablespoon 3 times a day.

Gastroesophageal reflux. It can either be accompanied by clinical manifestations or be asymptomatic. The most common symptoms are heartburn, belching, chest pain and dysphagia.

The disease is manifested by a whole set of symptoms and complications.

Frequency. The number of people suffering from reflux esophagitis is significant (3-4% of the total population). This is due to the growth of gastroduodenal ulcers, hiatal hernia, chronic cholecystitis.

Causes of reflux esophagitis

The degree and severity of damage to the esophagus in reflux esophagitis depends on the frequency and duration of exposure of gastric contents to the esophageal mucosa, on its volume and acidity, and on the ability of the mucosa to withstand the damaging effects and recover.

The development of reflux esophagitis depends on many factors, the main ones are listed below.

Stomach

The volume of gastric contents

• With gastroesophageal reflux, stomach contents are thrown into the esophagus.
• The likelihood and frequency of reflux are related to the volume of gastric contents.
• The volume of gastric contents depends on the following factors.

1. The volume and composition of the incoming food.
2. Rate and volume of gastric secretion.
3. Speed ​​and completeness of gastric emptying.
4. Frequency and magnitude of duodenogastric reflux.

• Ulcers of the pylorus and duodenum can slow down the evacuation of gastric contents.
• Delayed evacuation of gastric contents due to neuromuscular disorders, such as collagenosis, diabetes mellitus, hypothyroidism, or pyloric stenosis, also predisposes to the development of reflux esophagitis.

Irritant effect of gastric contents

• The degree and nature of damage to the esophagus largely depend on the composition of the thrown gastric contents.
• Hydrochloric acid causes damage to the esophageal mucosa due to protein denaturation and back diffusion of hydrogen ions into the deep layers of the mucosa.
• Pepsin (protease), splitting the proteins of the extracellular matrix, causes desquamation of the epithelium.
• With duodenogastric reflux, especially after eating, bile acids and pancreatic enzymes enter the stomach, which can then be thrown into the esophagus. Bile acids can capture lipids from the membranes of the epithelial cells of the esophageal mucosa, thereby increasing the permeability of the mucosa to hydrogen ions. Pancreatic enzymes cause proteolysis.
• Pancreatic enzymes and bile acids cause the most damage in hypochlorhydria and almost neutral gastric contents.

Emptying the esophagus

The severity of damage to the esophagus in reflux esophagitis depends on the degree of irritating effect of gastric contents.

Three processes influence the emptying of the esophagus during reflux.

Content evacuation. Once in the esophagus, gastric contents are removed by gravity, esophageal peristalsis, and salivation.

1. Normal peristalsis of the esophagus - necessary condition his emptying.
2. Primary peristalsis begins with the act of swallowing, and then the contractile wave passes through the entire esophagus, facilitating the evacuation of the contents of the esophagus into the stomach. Normally, in the waking state, waves of primary peristalsis occur approximately once a minute. This is the main movement of the esophagus, removing gastric contents from it. Lack of swallowing and peristalsis during sleep prevents emptying of the esophagus, increasing the risk of mucosal damage. In esophageal motility disorders, an increase in the number of non-propulsive contractions also disrupts the process of emptying the esophagus.
3. Secondary peristalsis occurs when the esophagus is stretched by a food bolus or gastric contents during reflux. It has a weaker effect on the emptying of the esophagus, since the peristaltic wave does not pass along its entire length.

Removal of hydrochloric acid occurs due to the neutralization of hydrogen ions that have fallen on the esophageal mucosa during reflux, under the action of swallowed saliva.

Salivation- the third factor affecting the emptying of the esophagus.

1. In the waking state, a healthy person produces an average of 0.5 ml of saliva per minute.
2. Salivation stimulates the process of swallowing.
3. Salivation increases with sucking, eating, tracheal intubation and under the influence of M-cholino-stimulants.
4. Normal pH of saliva due to the presence of bicarbonate, which acts as the main buffer, is 6-7.
5. When salivation is stimulated, both the volume of secreted saliva and the concentration of bicarbonate increase.
6. At a normal rate of salivation, saliva can only neutralize small amounts of acid in the esophagus (< 1 мл).
7. Saliva helps to remove gastric contents abandoned during reflux from the esophagus, stimulating the process of swallowing and primary peristalsis.
8. Reduced salivation, both primary (eg, in Sjögren's syndrome) and secondary (eg, as a result of taking M-anticholinergics), impairs the removal of acid from the esophagus.

Resistance of the esophageal mucosa to damage. The mucosa of the esophagus has its own mechanisms of protection against damage.

Preepithelial protection

• The surface of the epithelium of the esophagus is covered with a layer of mucus, which both moisturizes and protects the walls of the esophagus from the damaging effects of the contents. This viscous layer prevents the penetration of large protein molecules, such as pepsin, into the mucosa, and slows down the back diffusion of hydrogen ions.
• Under the layer of mucus is the so-called fixed layer of liquid, rich in bicarbonate ions. This layer creates a protective alkaline microenvironment on the surface of the epithelium, which neutralizes hydrogen ions that penetrate through the mucus.
• Mucus and bicarbonate ions are secreted by the salivary and submucosal glands located just behind the upper esophageal sphincter and in the esophagogastric junction. The secretion of the glands increases with the excitation of the vagus nerve and under the influence of prostaglandins.

Post-epithelial protection. Like all tissues, the epithelium needs sufficient blood flow and normal acid-base balance to maintain a normal state. Blood provides epithelial cells with oxygen, nutrients and bicarbonate and removes metabolic products.

Epithelial regeneration

Despite the ability of the esophageal mucosa to withstand damage, prolonged exposure to toxic substances can cause necrosis of epithelial cells. Cell death increases the permeability of the mucosa, closing the vicious circle of its further damage. For the regeneration of the epithelium, it is necessary to protect the dividing cells of the basal layer adjacent to the basement membrane of the epithelium. When this layer is destroyed, ulcers, strictures, and cylindric metaplasia are formed. It has been shown that the damaging effect of hydrogen ions accelerates the destruction and replication of epithelial cells. These data are confirmed by the detection of basal cell hyperplasia in patients with reflux-eaophagitis. Normally, the epithelium of the esophagus is renewed every 5-8 days, and in case of damage - every 2-4 days. This allows him to quickly recover if there is no further damage.

A number of different factors can contribute to the development of reflux esophagitis, so the basis of proper treatment is, first of all, the identification of disorders that led to the development of esophagitis in each case. Treatment should be individualized and may be aimed at increasing pressure in the area of ​​the lower esophageal sphincter, accelerating the emptying of the esophagus and stomach, stimulating salivation, suppressing the secretion of hydrochloric acid in the stomach, binding bile acids and proteolytic enzymes, as well as supporting the epithelium's own defense mechanisms. Gastroesophageal reflux that occurs at night is the most damaging to the esophageal mucosa and requires special attention.

In a number of situations, the sphincter tone decreases with the development of gastroesophageal reflux, which causes prolonged (more than 1 hour per day) contact of the esophageal mucosa with acid (pH< 4) или щелочным (при гастрэктомии) секретом.

Symptoms and signs of reflux esophagitis

Most often, esophageal-gastric reflux is manifested by heartburn, but it is difficult to estimate its prevalence. Most people consider this feeling normal and do not seek medical attention. The most common symptoms of reflux esophagitis are listed below.

Heartburn. Painful burning sensation behind the sternum, radiating upward. After taking antacids, heartburn usually resolves within 5 minutes.

Belching. Serves as a sign of severe reflux.

Dysphagia. Difficulty in swallowing. Dysphagia usually occurs with narrowing or stricture of the esophagus, but it may also be associated with inflammation and swelling that resolves with active medical treatment of reflux esophagitis.

Pain when swallowing. Sometimes it develops with severe esophagitis.

Profuse salivation- sudden filling of the mouth with a large amount of clear, slightly salty fluid, which is not stomach contents, but saliva secreted by the salivary glands in gastroesophageal reflux.

Chest pain. It occurs rarely with reflux esophagitis and resembles the pain of angina pectoris. It may be due to the action of hydrochloric acid on the nerve endings of the elongated papillae of the lamina propria protruding into the surface epithelium, esophagospasm during the reflux of gastric contents into the esophagus, and an attack of angina pectoris provoked by gastroesophageal reflux.

When assessing the effect of gastroesophageal reflux on the cardiovascular system, it was shown that in patients with coronary artery disease, confirmed by angiopulmonography, the flow of hydrochloric acid into the esophagus caused an increase in the load on the heart. Some patients showed signs of myocardial ischemia on the ECG. These data allow us to say that diseases of the esophagus and the heart can not only exist in parallel, but also be interconnected. The standard clinical approach to distinguish between pain associated with the esophagus and pain associated with the heart can oversimplify the situation.

Bleeding may be the first manifestation of esophagitis. It can be both strong, scarlet blood, and small and can lead to the development of iron deficiency anemia.

Signs of lung damage may be the only manifestations of gastroesophageal reflux; they include chronic cough, hoarseness, dyspnea, hemoptysis, bronchial asthma, and recurrent aspiration pneumonia. Although physicians commonly attribute reflux airway symptoms to gastric aspiration, airway resistance may increase without aspiration, probably due to vagus nerve activation.

With nocturnal gastroesophageal reflux, there may be other symptoms eg sleep apnea, sleep disturbances or insomnia, daytime sleepiness.

Dysphagia is formed during the passage of food and indicates the development of the structure of the esophagus. There is nausea, hiccups, anorexia.

Complications of reflux esophagitis

Strictures

Cicatricial strictures of the esophagus with prolonged reflux esophagitis are a consequence of fibrosis that develops when inflammation and damage spread to the submucosal layer. They occur in about 11% of patients. Predisposing factors include prolonged episodes of reflux, reflux in the supine position, the installation of a nasogastric tube, duodenal ulcer, hyperchlorhydria, scleroderma, treatment of achalasia of the cardia. With a circular narrowing of the distal esophagus, the so-called lower mucous stenosis of the esophagus is formed.

Localization. When examining with barium suspension, smooth narrowed areas of various lengths are usually visible. With cylindrical cell metaplasia of the epithelium, strictures can also be located in the middle third of the esophagus, and sometimes in the upper one.

Symptoms. The first symptoms appear, as a rule, only after the narrowing of the lumen of the esophagus to 12 mm or less. At first, it is difficult for patients to swallow only solid food, but as the esophagus narrows further, difficulties appear with swallowing liquids. Often, with the advent of dysphagia, other manifestations of reflux weaken. Some patients even forget that they once had reflux symptoms.

Treatment. After diagnostic studies in order to exclude a malignant tumor, active treatment of reflux esophagitis begins. As the swelling and inflammation decrease, in some cases, the symptoms of narrowing of the esophagus also disappear. However, more often one has to resort to additional measures e.g. esophageal bougienage, surgery, or both.

• Dilation. In the past, to alleviate the condition of patients, the esophagus was dilated using rubber bougies weighted with mercury (for example, Maloney and Hurst bougies), gradually increasing the diameter of the bougie. However, it is more efficient and safer to insert bougie over a guidewire (Savari bougie) or use endoscopy-guided inflatable balloon dilators. Bougie Savari vary in their diameter. First, a conductor is inserted through the manipulation channel of the endoscope, moving it through the constriction zone into the stomach. Then the endoscope is removed, and a bougie is inserted along the guidewire, carefully moving it through the stricture. Then the bougie is removed and the procedure is repeated with a larger diameter bougie. The process is repeated until the lumen of the esophagus expands sufficiently or traces of blood appear on the bougie. The bougie should never be forcefully pushed through the constriction - this can lead to perforation. The procedure is often performed under fluoroscopy guidance. The introduction of balloon dilators is carried out under the control of endoscopy, which allows you to observe the process during the entire procedure. Each balloon catheter can be inflated to three successively larger sizes. The catheter is inserted through the manipulation channel of the endoscope and passed into the constriction zone. The balloon at the end of the catheter is then gradually inflated until the desired diameter of the esophageal lumen is reached. The main complications of bougienage are perforation and bleeding. Perforation is rare, but should be suspected if the patient complains of persistent pain after bougienage. The site of the perforation can be detected by radiographic examination. Surgical drainage of the mediastinum and suturing of the perforation should be performed as early as possible, as the risk of death is high. Esophageal bougienage in combination with medical treatment of reflux gives good results in 65-85% of cases. To maintain the patency of the esophagus, additional bougienage is performed every few weeks or months,
• Surgery. In about 15-40% of cases, bougienage and drug treatment of reflux do not work; in these cases, surgical treatment is indicated. The method of choice is a combination of surgery, such as a fundoplication (Nissen operation), with bougienage of the esophagus before or during surgery. If the stricture cannot be expanded or is too long, the narrowed area is excised and an end-to-end anastomosis is performed, or an esophageal plasty is performed with a section of the large or small intestine. To prevent anastomotic leaks and prevent recurrence of strictures, anastomoses can be combined with a fundoplication.

Esophageal ulcers and bleeding

In a small number of patients, severe reflux esophagitis results in deep ulcers that penetrate the muscular layer of the esophageal wall. These ulcers sometimes perforate or cause heavy bleeding.

In most cases, it is possible to confine ourselves to active drug treatment, but sometimes surgical intervention is required. Often deep ulcers accompany cylindric metaplasia of the epithelium. In these cases, a biopsy is performed prior to treatment to rule out a malignant neoplasm.

Respiratory damage

Reflux esophagitis may be accompanied by laryngitis, hoarseness, chronic cough, bronchial asthma, bronchitis, bronchiectasis, aspiration pneumonia, atelectasis, and hemoptysis. However, in some cases, there are no symptoms characteristic of reflux esophagitis itself.

1. Diagnostics. Aspiration of gastric contents is usually difficult to detect. It is possible to carry out lung scintigraphy with a preliminary introduction of 1c-labeled colloidal sulfur into the stomach. However, a negative result of the study does not completely exclude the possibility of aspiration and the association of lung damage with reflux esophagitis. Sometimes daily pH-metry is also carried out. Numerous studies have confirmed that in patients with bronchial asthma and COPD, the frequency of reflux episodes is higher. Even without aspiration of gastric contents, reflux esophagitis has been shown to lead to an increase in airway resistance, which often requires active treatment with suppression of hydrochloric acid secretion with H+,K+-ATPase inhibitors. In some cases, such as severe bronchial asthma, gastroesophageal reflux-induced apnea attacks and recurrent aspiration pneumonia, a fundoplication is indicated.
2. Treatment. Active treatment in most cases gives positive results. Patients with bronchial asthma require careful monitoring, since many drugs used to treat it reduce pressure in the lower esophageal sphincter area, thereby increasing the likelihood of reflux. The patient should be strongly advised to quit smoking. If treatment with H + K + -ATPase inhibitors fails, surgery is indicated.

Cylindrical cell metaplasia of the esophageal epithelium

Depending on the length of the metaplasia zone, metaplasia of a short (less than 2 cm) and a long segment of the esophagus is isolated. The frequency of cylindric metaplasia reaches 20%. The disease can develop at any age, but most often it is detected after 40 years. It is more common in patients with nocturnal reflux.

The epithelium in cylindric metaplasia is a complex mixture of various types cells and glands, while the surface of the mucosa resembles the structure of the mucous membrane of the small intestine with atrophy of varying severity.

Complications. The main complications of cylinder cell metaplasia are esophageal ulcers, strictures, and adenocarcinoma. Strictures usually form in the middle and lower third of the esophagus, while they are bordered on top by stratified squamous epithelium, and below - to columnar. Epithelial dysplasia and adenocarcinoma of the esophagus develop in cylindrical cell metaplasia in approximately 3-9% of cases. Tumor transformation can be multifocal and probably plays a major role in the development of adenocarcinoma of the lower third of the esophagus and the cardial part of the stomach. Malignant neoplasms should be excluded in every patient with strictures and narrowing in the middle third of the esophagus. However, dysplasia and malignancy are possible in any patient with cylindrocellular metaplasia. Therefore, in order not to miss the development of a malignant tumor, in patients with cylindrical cell metaplasia of the esophageal epithelium, and especially with histologically detected dysplasia, it is necessary to take multiple biopsies and brush scrapings periodically (every 1 to 5 years). Accurate recommendations regarding the frequency of endoscopic examination in cylindrocellular metaplasia, no. However, in the presence of mild dysplasia, endoscopy with biopsy is recommended annually, and in severe cases, once every 3-6 months. Some authors recommend even with severe dysplasia the removal of the epithelium different ways or surgery.

Treatment. As a rule, with cylindrocellular metaplasia, high doses of H + ,K + -ATPase inhibitors are prescribed. However, despite active drug treatment, the state of the epithelium does not return to normal. In severe dysplasia, esophagectomy or mucosal destruction is indicated. For the destruction of the mucosa, endoscopic resection, photodynamic therapy followed by laser destruction, laser surgery, or thermocoagulation with a bipolar electrode are used. All these methods are still not widely used and are available only in specialized medical centers.

Barrett's esophagus promotes erosion and ulceration. Erosions and ulcers lead to bleeding, shortening of the esophagus, stenosis, the formation of hiatal hernia, and the development of esophageal cancer (in 8-10% of cases).

Diagnosis of reflux esophagitis

Depending on the severity of changes detected during endoscopy, the following degrees of severity of reflux esophagitis are distinguished (Savary-Miller classification):

I degree (mild) - there is hyperemia and edema;

II degree (moderately pronounced) - against the background of hyperemia and edema, confluent erosions are detected that do not spread around the entire circumference of the esophagus, the surface of the lesion does not exceed 50%;

III degree (pronounced) - erosions have circular localization, located on an area of ​​more than 50%, there are no ulcers;

IV degree (complicated) - inflammation and erosion go beyond the distal section, are located circularly, there are ulcers of the esophagus, peptic strictures are possible;

Grade V - the development of cylindrical gastric metaplasia in the mucosa of the esophagus. This is what is called Barrett's syndrome.

Diagnostic studies

If the patient complains of intermittent burning sensation behind the sternum or belching, which increase after eating, in the supine position or when bending forward and are eliminated by taking antacids, then it is not difficult to make a diagnosis of reflux esophagitis. However, in an atypical course of the disease, additional studies may be required to confirm the diagnosis and determine the severity of reflux esophagitis.

Informativeness of research. Studies in reflux esophagitis can be divided into 3 groups.

Research pointing to possible presence gastroesophageal reflux

1. Endoscopy.
2. Manometry.

Research to detect the effects of gastroesophageal reflux

1. Bernstein test.
2. Endoscopy.
3. Mucosal biopsy.
4. X-ray examination of the esophagus with double contrast.

Studies to assess the degree and severity of gastroesophageal reflux

1. X-ray contrast study of the upper gastrointestinal tract with barium suspension.
2. Measurement of pH in the lower part of the esophagus.
3. Long-term pH-metry.
4. Scintigraphy of the esophagus and stomach.

X-ray contrast study with barium suspension. It is usually not possible to see damage to the mucosa with a conventional radiopaque examination of the esophagus. Even with double contrast, signs of moderate inflammation may go unnoticed, although the study is more sensitive in severe lesions. Diagnostic features include uneven contours of the esophagus, erosions, ulcers, thickening of the longitudinal folds, incomplete stretching of the walls of the esophagus, and the formation of strictures. It is difficult to identify esophageal motility disorders with it, but it is indicated for all patients with dysphagia to exclude organic causes.

Scintigraphy of the esophagus and stomach. To conduct this study, 300 ml of an isotonic solution containing 99mTc labeled colloidal sulfur is injected into the stomach; and then every 30 s, gradually increasing the intra-abdominal pressure with the help of a bandage, the distribution of the isotope in the esophagus and stomach is assessed. The severity of reflux is assessed on the basis of the percentage of the amount of isotope recorded in the esophagus for a given 30 s to its amount initially entering the stomach. The sensitivity and specificity of this study reach 90%.

Esophageal manometry occupies an insignificant place in the diagnosis of reflux esophagitis. It is carried out in the presence of complaints of chest pain, with the ineffectiveness of drug treatment.

High resolution manometry allows you to get more accurate and complete information about the motility of the esophagus from the pharynx to the lower esophageal sphincter, as well as more accurately measure the pressure in the sphincter zone and assess the intensity of peristalsis.

Wireless pH Monitoring Devices, which are placed in the distal esophagus endoscopically, make it possible to measure within 2-4 days, which allows you to get a more complete picture of the changes in reflux over time, as well as to evaluate the effectiveness of therapy aimed at suppressing the secretion of hydrochloric acid, without re-examinations.

Multichannel intraesophageal impedancemetry allows assessing the severity of gastroesophageal reflux, studying the process of passage of the food bolus through the esophagus (assessment of peristalsis) and determining how high the contents of the stomach are thrown into the esophagus. This method can be combined with esophageal manometry and pH-metry. It allows you to detect reflux regardless of the pH of the content being thrown.

EGDS and mucosal biopsy. Endoscopic examination today is the most common method for examining the esophageal mucosa in esophagitis. Endoscopy can take biopsy material, which reveals histological changes characteristic of reflux esophagitis, and they can be detected even with a normal endoscopic picture.

Endoscopy for reflux esophagitis

• Easy degree. Redness, moderate looseness and swelling of the mucosa with obliteration of small vessels, pronounced unevenness of the Z line.
• Moderately severe degree. Round and longitudinal superficial ulcers or erosions, multiple hemorrhages in the mucosa covered with exudate, as well as deep ulcers Easily circumscribed edges and strictures.

Histological changes. The papillae of the lamina propria protrude into the epithelium by more than 65% of its thickness. In the lamina propria of the mucosa, accumulations of neutrophils and eosinophils can be found, which can also penetrate into the epithelium. There is also an ingrowth of capillaries into the lamina propria of the mucosa.

In about 10-20% of cases, against the background of a long-term reflux esophagitis, cylindric cell metaplasia of the epithelium is detected. Endoscopic examination of the stomach and duodenum helps to exclude other pathological changes in these parts of the gastrointestinal tract.

Conclusion. With the characteristic symptoms of reflux esophagitis - heartburn and belching - empirical treatment is usually prescribed without additional research. Endoscopy and mucosal biopsy are indicated for treatment failure, pain on swallowing, dysphagia, uncharacteristic symptoms, and suspected cylindrocellular epithelial metaplasia. Daily pH-metry and manometry are carried out with atypical symptoms and complaints indicating damage to the respiratory system.

Treatment of reflux esophagitis

The chronic nature of the disease implies the active participation of the patients themselves in achieving good long-term results. Patients need to change their lifestyle, if possible, eliminating the factors that provoke reflux.

Conservative treatment

Raise the head end of the bed by 15 cm, especially if the patient has belching.

Refrain from:

1. smoking.
2. Fatty and fried foods.
3. chocolate.
4. alcohol.
5. Dishes from tomatoes.
6. Citrus fruits and juices from them.
7. Coffee, tea and carbonated drinks.
8. Windmills.
9. Overeating, leading to distension of the stomach.

1. Protein-rich, low-fat diet.
2. Eating 3 times a day in small portions containing all the necessary nutrients. Dinner should not be plentiful and easily digestible.

The last meal should be 4-5 hours before bedtime.

Obesity - weight loss.

Do not wear tight belts and corsets, as they increase intra-abdominal pressure.

If possible, avoid drugs that provoke gastroesophageal reflux:

1. Progesterone and progesterone-containing oral contraceptives.
2. M-anticholinergics.
3. Sleeping pills and opioids.
4. Tranquilizers.
5. Theophylline.
6. β-agonists.
7. Nitrates.
8. calcium antagonists.

Medical treatment

Antacids. Frequent administration of drugs (every 2 hours) is recommended. The most commonly prescribed antacids contain a combination of magnesium and aluminum hydroxides. In renal insufficiency, magnesium intake should be limited, therefore, preparations containing only aluminum hydroxide are used. With a severe restriction of salt intake, preparations with a low sodium content (for example, magaldrate) are indicated.

Means that reduce the secretion of hydrochloric acid. The most commonly used H2-blockers. They are prescribed for patients with intermittent, infrequent and mild symptoms of reflux. With mild to moderate H2 reflux, blockers are effective, but they do not help in the presence of mucosal erosions. They do not completely suppress the secretion of hydrochloric acid, but only reduce it by competitively blocking the histamine receptors of parietal cells. When the concentration of H 2 blockers decreases, histamine binds to the released receptors and the secretion of hydrochloric acid resumes. That is why drugs should be taken constantly and often.

Drugs that increase pressure in the area of ​​the lower esophageal sphincter and accelerate the emptying of the esophagus

1. Metoclopramide, a dopamine antagonist, increases pressure in the area of ​​the lower esophageal sphincter and accelerates the emptying of the esophagus and stomach. It prevents the relaxation of the fundus of the stomach and enhances the motility of the duodenum and small intestine. In addition, it has a central antiemetic effect. Metoclopramide is particularly effective in reflux esophagitis with impaired gastric emptying. Metoclopramide can cause an increase in prolactin levels and galactorrhea.
2. Other prokinetic agents, such as domperidone and cisapride, do not cross the blood-brain barrier and therefore have only peripheral effects of metoclopramide. They have a pronounced stimulating effect on the motility of the gastrointestinal tract and are successfully used in reflux esophagitis. However, cisapride has been withdrawn from the US pharmaceutical market by the manufacturer due to its interaction with drugs that prolong the QT interval, which can provoke the development of arrhythmias. In Canada and other countries, cisapride and domperidone are still sold.

Drugs that increase the resistance of the mucosa to damage.

1. Sucralfate, the main aluminum salt of sucrose octasulfate, promotes the healing of duodenal ulcers due to its cytoprotective effect, but it is not so effective in esophagitis. Nevertheless, the suspension of sucralfate relieves the condition of patients with erosions of the esophageal mucosa and may also play a therapeutic role.
2. Prostaglandin E analogs (eg misoprostol) also act as cytoprotectors.

Supportive care H 2 -blockers does not bring a satisfactory result. Taking cimetidine or ranitidine - either twice or once at bedtime - practically does not reduce, compared with placebo, the frequency of relapses of reflux esophagitis, according to clinical manifestations or according to endoscopy. At the same time, maintenance treatment with omeprazole maintains a state of endoscopically confirmed healing in severe, persistent esophagitis. In some cases, the dose has to be increased to 40 mg. In some patients, there may be a pronounced and persistent increase in the level of fasting serum gastrin. It is important to emphasize that after discontinuation of omeprazole, approximately 90% of patients develop a relapse of the disease within 6 months, and this suggests that long-term treatment in one form or another is necessary. Good results with erosive esophagitis were also obtained with the appointment of other inhibitors of H +, K + -ATPase (lansoprazole, rabeprazole, pantoprazole and esomeprazole, in the same doses.

Endoscopic and surgical interventions

Endoscopic and surgical interventions are indicated only when medical treatment is ineffective, as well as in the presence of complications such as non-healing or bleeding ulcers and persistent strictures of the esophagus.

Endoscopic treatment, due to its less traumatic and invasive nature, is a good alternative to surgical intervention for reflux esophagitis that is not amenable to drug treatment.

When examining the esophagus, physicians often find the presence of erosions and ulcers on the mucous membrane. If such symptoms appear as a result of regular ingestion of the contents of the stomach into the esophagus, erosive reflux esophagitis is diagnosed.

Disease pathogenesis

To understand the meaning of such a diagnosis, it is enough to understand the very name of the disease:

Inflammation of the walls of the esophagus main feature esophagitis

• esophagitis - an inflammatory disease of the esophagus;
• reflux - a process associated with the return direction of movement;
• erosive - a type of pathology, accompanied by the formation of erosion.

Erosive reflux esophagitis is a chronic inflammation with the presence of erosions in the esophagus, caused by irritants from the stomach entering it.

Behind the pathology is a whole range of interrelated causes:

• Violation of the locking mechanism of the sphincter located at the border of the esophagus with the stomach, which can occur:

1. with a decrease in the tone of the muscle tissues of the lower sphincter;
2. due to spontaneous one-time relaxations arising from the discharge of excess air or other reasons;
3. with mechanical or destructive changes in the area of ​​​​closing tissues.

• Decrease in the protective abilities of the esophagus, which contributes to the long-term exposure of aggressive components to the mucosa. Such changes may occur:

• Aggressive properties of the refluxant that enters the esophagus and provokes burning symptoms:

1. of hydrochloric acid;
2. bile acid;
3. pepsin.

• Too slow evacuation of the food bolus from the stomach, which occurs:

1. with violations of peristalsis of the stomach;
2. due to weakness or increased tone of the lower gastric sphincter.

• Increased intra-abdominal pressure that appears:

1. during pregnancy;
2. due to intestinal pathologies that cause bloating;
3. with constipation;
4. in overweight people.

During pregnancy, intra-abdominal pressure increases, which can provoke esophagitis

On the physiological side, inflammation in the esophagus is an acid-dependent condition, provoked by a violation of the motility and physiological abilities of all parts of the digestive tract.

Attention! Symptoms of esophagitis may be the first bells reporting pathologies in other parts of the digestive system.

With prolonged or combined aggressive action of the refluxant on the mucous membrane in the esophagus, complicating symptoms occur, which manifest themselves as single or multiple erosions or ulcers. In such cases, an erosive or ulcerative type of pathology is diagnosed.

Symptoms of the disease

The primary symptoms of esophagitis have a nutritional manifestation and often do not cause much concern in patients. It is the ignoring of the symptomatic signs of the disease in combination with aggravating factors, such as an unbalanced diet, smoking, a nervous state, and the abuse of alcohol-containing drinks, that provoke the progress of esophagitis.

Minor, but so important for the diagnosis of the initial symptoms are manifested:

1. Belching, which is more often disturbing after a meal. The discharge of air masses from the stomach may be accompanied by regurgitation of a small amount of food.
2. Heartburn, which is also directly related to meals. Heartburn can be either short-term, which does not require specific treatment, or long-term tormenting the patient.

Initial symptoms are belching and heartburn

In such cases, most patients begin self-treatment with improvised means, which greatly aggravates the situation.

Remember! Treatment of heartburn with soda is strictly prohibited. When soda interacts with gastric juice, carbon dioxide is formed, which contributes to enhanced production gastric juice and new bouts of heartburn.

In the future, the symptoms become much brighter and more varied. The patient may be annoyed by:

• retrosternal pain, which is similar to coronary pathologies;
• pain in the throat and neck;
• increased salivation, as a reaction of the body to reflux;
• dry mouth and a metallic or sour taste;
• problems with swallowing food and a constant feeling of a foreign lump in the throat.

In the form of complications, bronchopulmonary pathologies can be recorded, which are manifested by cough, pneumonia, bronchial obstruction.

In the later stages, striticules, bleeding from ulcers, tissue perforations may appear.

Be carefull! Rapid weight loss, anemia, and progression of dysphagia may indicate adenocarcinoma.

The main directions of treatment

Treatment of the erosive form of reflux esophagitis begins with an extended diagnosis, which allows you to determine not only the stage and type of the underlying disease, but also to find out the cause that provoked the pathology.

Endoscopy before treatment

The main treatment includes:

• drug therapy;
• medical diet;
• physiotherapy procedures.

In case of complications and the absence of the effect of the main therapy, surgical intervention is resorted to.

Medical therapy for esophagitis

Treatment with medications can last up to 12 weeks. After that, maintenance therapy is prescribed, which is advisable to carry out for at least six months.

In the acute period of the disease, the treatment regimen is drawn up individually, depending on the concomitant pathologies and the degree of mucosal damage. Most often, doctors resort to the use of:

Surgical therapy

Surgical treatment is required in rare cases:

• with strictures of the esophagus;
• if conservative treatment has not yielded results;
• in the presence of bronchial asthma, provoked by reflux;
• if there is a hernia of the diaphragm;
• after diagnosing Berrett's esophagus;
• with bleeding and perforation.

After the operation, a strict diet and conservative therapy are prescribed, similar to the acute period of the disease.

Nutrition

The therapeutic diet for esophagitis is not inferior in effectiveness to medications. For patients with chronic or advanced forms of inflammation, a long-term diet is recommended, which is desirable to adhere to during remission.

Doctors also advise patients with esophagitis:

1. After a meal, do not take a horizontal position. The best way improve digestion - leisurely walks.
2. Plan an evening meal no later than a couple of hours before a night's rest.
3. To prevent a night's rest from spoiling another reflux, place your head higher. If the esophagus is higher than the stomach, the risk of reflux is reduced.
4. Do not tighten the stomach and chest with belts and tight clothing. Such actions provoke an increase in intra-abdominal pressure.
5. Don't drink food. Even tea or milk contributes to increased formation of gastric juice.
6. Drink enough water so as not to provoke acidification and improve metabolism.

Preventive measures, consisting of following the rules of rational nutrition, strengthening immune defenses and timely treatment of chronic diseases, will prevent exacerbations of esophagitis.

- the disease is not easy, so patients need to be attentive to the appearance of symptoms of this disease and be sure to undergo an examination by a specialist.

Only complex therapy will help get rid of reflux esophagitis, so it will be useful for every person who suffers from this disease to know how this disease should be properly treated with the help of a competent doctor.

So let's get started.

Can reflux esophagitis be cured permanently? You can, if you turn to a competent doctor and get modern treatment.

Doctors identify several effective and efficient treatment regimens for reflux esophagitis. All of them are selected strictly on an individual basis for each patient after receiving the results of the examination.

1. Therapy with one drug. This does not take into account the degree of soft tissue damage, as well as complications. This is the least effective treatment regimen for patients, which can lead to poor health.
2. Reinforcing therapy. Doctors prescribe different drugs to patients, which differ in the degree of aggressiveness. Patients need to strictly follow a diet and take antacids.
3. Taking strong proton pump blockers. When the symptoms begin to disappear, patients are prescribed prokinetics. This treatment regimen is suitable for patients diagnosed with severe reflux esophagitis.

Reflux esophagitis: treatment regimen

The classical scheme of treatment of the disease is divided into 4 stages:

1. First degree reflux esophagitis. Patients should take antacids and prokinetics for a long time ().
2. 2 degree of the inflammatory process. Patients need to adhere to proper nutrition and take blockers. The latter contribute to the normalization of the level of acidity.
3. 3 degree of the inflammatory process of a severe form. Patients are prescribed the use of receptor blockers, inhibitors and prokinetics.
4. The last degree of reflux esophagitis is accompanied by pronounced clinical manifestations. Treatment with medicines will not bring a positive result, so patients undergo surgery in combination with a course of maintenance therapy.

How to cure reflux esophagitis permanently? The duration of therapy depends on the degree of damage to the gastrointestinal tract. The initial stage of reflux esophagitis can be cured with a proper and balanced diet. The course of therapy is calculated for each patient individually.

How to treat reflux esophagitis

If the process of digestion of food is disturbed, then the contents of the stomach during a long stay in it causes an inflammatory process and irritation of the walls.

Patients feel heaviness in the intestines, a feeling of fullness in the stomach, nausea and bitterness in the mouth. After eating, the pain becomes severe and becomes acute.

There are several effective methods of treating reflux esophagitis, which are prescribed only by the attending physician after diagnosis and study of the patient's history.

Note! Vitamins for reflux esophagitis are not always prescribed: the need for this is determined by the doctor when choosing therapy, when he decides what to take for reflux esophagitis for you.

Medical treatment

How to get rid of reflux esophagitis? Depending on the form of the course of the disease, doctors prescribe patients to take proton pump blockers or H2-histamine receptor inhibitors. The first group of drugs helps to normalize the work of the glands of the stomach and the mucous membrane of the digestive system. These medications are prescribed to patients for additional protection of the walls of the esophagus, duodenum and stomach.

At correct application blockers begin to recover faster damaged areas of the mucous membrane. Medicines taken for a long time, and if the patient is diagnosed with a severe form of reflux esophagitis, then they are prescribed a double dosage at the initial stage of treatment.

The most effective drugs include:

Features of antacids

These substances help to quickly and effectively cope with the manifestations of heartburn. After using antacids, their main components begin to act on the body after 15 minutes. The main task of such therapy is to reduce the amount of hydrochloric acid, which causes burning and soreness in the chest.

The most effective drugs are:

• Rennie;
• Maalox;
• Gastal;
• Phosphalugel;
• and others.

Alginates

Gaviscon is an effective and safe new generation alginate. After taking this remedy, hydrochloric acid is neutralized, an additional layer is formed to protect the stomach and the functioning of the gastrointestinal tract is normalized.

Prokinetics

The main task of prokinetics is to improve the motor function of the stomach, muscles and upper small intestine. Physicians advise their patients to use metoclopramide And Domeridon. These medicines will reduce the amount of time the esophagus comes into contact with hydrochloric acid.

Physiotherapy procedures

Amplipulse therapy has been used for a long time to treat reflux esophagitis.

The procedure is carried out in a physiotherapy room and is aimed at relieving pain, eliminating foci of inflammation, improving gastric motility and blood circulation.

If the patient has severe acute pain, then electrophoresis is performed with ganglioblocking agents. Microwave therapy is indicated for patients who, along with reflux esophagitis, have been diagnosed with pathological disorders in the liver, gastric and duodenal ulcers.

Also to the most effective methods physiotherapy treatments include applications with sulfide silt mud and electrosleep.

Medical nutrition and diet

It is important for patients to review the diet and diet. Food should be boiled, steamed or stewed with a minimum amount of oil. An important condition is fractional nutrition in small portions. Patients are not allowed to lie down immediately after eating. Compliance with this rule helps to reduce the intensity and number of attacks at night.

Important! It is unacceptable to eat smoked, fried and salty foods. Under the ban are alcoholic beverages, soda, chocolates, citrus fruits, tea, coffee, garlic, tomatoes and onions.

Patients should not overeat, because when the stomach is full, there is an increase in the reflux of contents into the esophagus.

Learn more about how it should be medical nutrition with this disease, you can.

Surgery for reflux esophagitis

Surgical treatment of reflux esophagitis is carried out in the event that when drug therapy fails. The main goal of surgery is the complete cessation of the reflux of stomach contents into the esophagus. Before the operation, patients undergo a complete comprehensive examination, and only after that a fundoplication is performed.

Access to the stomach can be open or laparoscopic. During surgery, the bottom of the stomach is wrapped around the esophagus to create a cuff. The least traumatic method of the operation is laparoscopic, which has a minimum number of complications.

Treatment with folk remedies

Maybe only after consultation with your doctor. It is possible to use collections of plant components only at the initial stage of the development of the disease.

Aloe juice is an effective remedy that envelops the mucosa of the esophagus, reduces inflammation and contact with food.

A decoction of flax seeds acts on the body in a similar way to antacids. After taking such a drug, the level of acidity in the stomach decreases, the esophagus is enveloped and protected.

Breathing exercises for reflux esophagitis

The main feature of this treatment is proper breathing. This technique It can be used on its own or in combination with exercise.

Breathing exercises for reflux esophagitis are performed according to the following scheme:

1. Patients take a comfortable position for themselves - sitting or standing. Take a deep breath and slowly exhale. A person needs to engage the muscles of the abdominal cavity. The optimal number of such approaches is 4 times.
2. A calm breath is taken and a quick exhalation by the abdominal muscles (up to 10 approaches).
3. Patients take a deep breath, hold their breath and squeeze the abdominal muscles strongly. It is necessary to make every effort and pause for up to five seconds. After that, a calm breath is taken.

During breathing exercises, pauses are necessary, because some patients begin to feel dizzy. It is important not to rush and do the exercises consistently. How long reflux esophagitis is treated, so much time and it is recommended to perform these exercises, and in most cases even longer, to ensure the stability of the results.

Gymnastics

The following features of gymnastic exercises for reflux esophagitis can be distinguished:

1. Gymnastics does not help patients get rid of excruciating heartburn. During exercise, the recovery process is accelerated, periods of exacerbation and the number of spasms are reduced.
2. Each patient will be able to choose for himself the optimal set of gymnastic exercises that will provide real help.
3. Classes do not belong to the main method of treatment, so they must be combined with drug therapy.

Yoga for reflux esophagitis

Patients diagnosed with reflux esophagitis can practice yoga. Such exercises are of great benefit to the body and internal organs. Static postures or asanas will allow you to fully activate the circulatory system, as well as strengthen muscle mass body.

You can combine static postures with slow movements of the limbs, which will help improve blood circulation in the muscles and internal organs. This unique technique provides patients with the most effective therapeutic effect.

During yoga, all respiratory centers are activated, the saturation of the body with useful oxygen increases, metabolism accelerates, the functioning of internal organs improves, and absolutely all muscle groups are worked out.

Should you sleep on your left side with GERD or not?

Scientists who have studied the physiological characteristics of the body argue that with reflux esophagitis it is best to sleep on the right side.

This will minimize pressure on the stomach, intestines and liver.

To prevent the reflux of food from the stomach into the esophagus at night in patients it is recommended to sleep on a high pillow.

The scheme of treatment of different types of reflux esophagitis

There are several important rules for the treatment of different forms of the disease, which may differ from each other. How long is reflux esophagitis treated depending on this?

Treatment of reflux esophagitis with low acidity

The main treatment for patients is to take stomach acid tablets with meals. Such drug therapy helps food move faster into the intestines.

It is important to remember that you should not overdo it with taking pills and take them without a prescription from your doctor, because such an attitude towards your own health can lead to a deterioration in overall well-being. This is due to the fact that the acidic contents of the stomach will not be neutralized with the available amount of bicarbonates.

With this form of the disease, it is important for patients to adhere to a strict diet in order to prevent further progression of the disease and serious complications.

Treatment of reflux esophagitis during pregnancy

Pregnant girls need to take care to prevent constipation, follow a strict diet, eat small portions and not overeat. Fried foods, chocolate, red peppers and spicy foods are excluded from the diet. As a drug therapy, antacids are prescribed, which are not absorbed into the blood and envelop the stomach. Surgical treatment during pregnancy is not carried out.

Distal reflux esophagitis: treatment

Occurs as a result of inflammation of the esophagus after the penetration of viral and bacterial infections. In bacterial pathology, patients are prescribed antibiotics.

Only a doctor can select treatment after diagnosing patients, which takes into account the sensitivity of the body to antibiotic drugs. In the complex, patients are prescribed immunostimulating substances and antiviral drugs.

Reflux esophagitis is a serious disease that requires urgent treatment and therapy. Patients are forbidden to self-medicate and buy medicines without a doctor's prescription.

Heartburn and a feeling of discomfort in the throat are among the main signs of inflammatory processes in the esophageal mucosa, and they need to be treated by qualified specialists. Moreover, the symptoms and treatment of reflux esophagitis should be constantly monitored by doctors. This is the only way to avoid irreversible changes in the tissues of the esophagus, and the development of complications requiring surgical intervention.

Let's try to figure out what reflux esophagitis is. "Esophagitis" is an ancient Greek word meaning esophagus. The term "reflux" is borrowed from Latin and translates as "flow back".

Thus, both concepts reflect the process that occurs during the development of the disease - food masses, gastric juice and enzymes move backward from the stomach or intestines, penetrate into the esophagus, irritating the mucous membrane and causing inflammation.

At the same time, the lower esophageal sphincter, which separates the esophagus and stomach, does not properly prevent the movement of acidic masses.

In official medicine, reflux esophagitis is a complication of gastroesophageal reflux disease, which is characterized by the reflux of acidic contents of the stomach or intestines into the esophagus.

Periodically repeated aggressive action gradually destroys the mucosa and epithelium of the esophagus, contributing to the formation of erosive foci and ulcers - potentially dangerous pathological formations that threaten to degenerate into malignant tumors.

Causes

Under certain circumstances, gastroesophageal reflux can also occur in healthy people. Frequent cases of the onset of the disease indicate the development of inflammatory processes in the gastroduodenal region.

Among the possible causes of reflux, gastroenterologists distinguish the following pathological changes in the structure and functionality of the digestive tract:

• decreased tone and barrier potential of the lower esophageal sphincter;
• violation of esophageal cleansing, redistribution and withdrawal of biological fluids from the intestine;
• violation of the acid-forming mechanism of the stomach;
• decrease in mucosal resistance;
• narrowing of the lumen of the esophagus (stenosis);
• an increase in the size of the esophageal opening of the diaphragm (hernia);
• violation of gastric emptying;
• high level of intra-abdominal pressure.

Most often, reflux esophagitis occurs as a result of weakening the tone of the muscles of the esophagus against the background of a full stomach.

Provoking factors

There are several etiological varieties of factors that provoke the reflux of acidic masses into the esophagus: physiological characteristics of the body, pathological conditions, lifestyle.

Reflux is promoted by:

• pregnancy;
• allergies to certain types of products;
• binge eating;
• obesity;
• smoking and alcohol;
• poisoning;
• unbalanced diet;
• stress;
• work associated with frequent torso bending;
• autoimmune diseases;
• taking medications that weaken the muscles of the cardiac sphincter.

In addition, reflux disease can occur as a result of prolonged use of a nosogastric tube.

In men, gastroesophageal reflux is observed more often than in women, although science has not established a direct relationship between the disease and the gender of a person.

Symptoms and signs of the disease

When gastric masses get on the surface of the mucosa, a burning sensation occurs in the esophagus, since exposure to acid causes tissue burns.

With a long course of the disease, the symptoms of esophagitis reflux become more pronounced, and other pathological manifestations are added to heartburn:

• belching sour. May indicate the development of stenosis of the esophagus against the background of erosive and ulcerative lesions of the mucosa. The appearance of belching at night is fraught with acidic masses entering the respiratory tract;
• pain in the sternum, often radiating to the neck and the area between the shoulder blades. Usually occurs when bending forward. According to clinical characteristics, it resembles the symptoms of angina pectoris;
• difficulty swallowing solid foods. In most cases, the problem occurs against the background of a narrowing of the lumen of the esophagus (stenosis), which is considered as a complication of the disease;
• bleeding is a sign of an extreme degree of development of the disease, requiring urgent surgical intervention;
• foam in the mouth is the result of increased productivity of the salivary glands. Rarely observed.

In addition to the standard clinical signs, extraesophageal symptoms may indicate the development of the disease.

Signs of an extraesophageal nature

The occurrence of pathological processes in areas of the body that are not directly related to the gastrointestinal tract is not always associated with pathological processes in the esophagus - especially in the absence of severe heartburn.

In the absence of full-fledged diagnostic studies, adequate treatment of reflux esophagitis is not possible.

Extraesophageal symptoms of inflammatory processes on the esophageal mucosa differ not only in the nature of severity, but also in localization:

• ENT organs. In the early stages of the disease, rhinitis, laryngitis and pharyngitis develop, there is a feeling of a lump or spasms in the throat. As the pathology develops, it is possible to develop ulcers, granulomas and polyps in the area of ​​the vocal cords, as a result of which the patient's voice changes, becomes hoarse and rough. In the later stages of the disease, a cancerous lesion of the ENT organs is possible;
• oral cavity. Erosive foci appear on the tissues of the oral cavity when gastric juice enters, periodontitis, caries and salivation develop. Pathological processes are accompanied by bad breath;
• bronchi. There may be nocturnal attacks of suffocation or severe coughing;
• chest, heart. Pain in the sternum is identical to the manifestations of coronary heart disease. There may be additional signs indicating cardiac pathology - hypertension, tachycardia. Without special diagnostic studies, it is almost impossible to establish the cause of the disease;
• back. Back pain is caused by innervation with the gastrointestinal tract, the source of which is located in the sternal spine.

In addition, symptoms may appear that indicate a violation of the functionality of the stomach - nausea, vomiting, bloating, a quick feeling of fullness.

Degrees of reflux esophagitis

The level of complexity of the course of the disease is determined by the stages of its development. In most cases, the development of gastroesophageal reflux disease takes about three years, during which the pathology acquires one of the four forms classified by WHO.

Reflux esophagitis of the 1st degree is characterized by intense reddening of the epithelium of the esophagus and a relatively small, up to 5 mm, area of ​​the mucosal lesion zone with point erosions.

The second degree of the disease is diagnosed in the presence of erosions and ulcerative areas against the background of edema, thickening and bruising of the mucosa. With vomiting, partial rejection of minor fragments of the mucosa is possible. The total area of ​​lesions occupies about 40% of the surface of the esophagus.

For the third degree of reflux esophagitis is characterized by an increase in the area of ​​the lesion up to 75% of the surface of the esophagus. In this case, ulcerative formations gradually merge into one.

The development of the fourth degree of the disease is accompanied by an increase in the size of ulcerative areas. Pathological formations occupy more than 75% of the mucosal surface and affect the esophageal folds.

In the absence of treatment, necrotic processes develop in the tissues of the esophagus, leading to the degeneration of cells into malignant ones.

Types of disease

The development of reflux esophagitis can take place in acute or chronic form.

The acute form of reflux is the result of a mucosal burn under the influence of gastric juice. It is most commonly seen in the lower esophagus and responds well to treatment.

The chronic form can occur both against the background of an untreated exacerbation, and as an independent primary process. The chronic course of the disease is characterized by periodic exacerbations and remissions.

Diagnostic measures

Despite the possible severity of the clinical manifestations of reflux esophagitis, an accurate diagnosis requires Additional Information obtained through a survey.

The most informative are such studies as:

• blood analysis;
• Analysis of urine;
• radiography of the organs of the sternum;
• endoscopy - a procedure that allows you to identify erosive and ulcerative formations, as well as other pathological changes in the condition of the esophagus;
• biopsy;
• manometric analysis of the state of sphincters;
• scintigraphy - a method for assessing esophageal self-purification;
• pH-metry and impedance pH-metry of the esophagus - methods to assess the level of normal and retrograde peristalsis of the esophagus;
• daily monitoring of the level of acidity in the lower esophagus.

Reflux esophagitis is diagnosed in the presence of histological and morphological changes in the esophageal mucosa.

Treatment of reflux esophagitis

Successful treatment of reflux esophagitis involves an integrated approach - the use of drug therapy against the backdrop of changing the patient's lifestyle.

Drug treatment with drugs

The prescription of medications for gastroesophageal reflux disease has several objectives - improving the self-purification of the esophagus, eliminating the aggressive effects of gastric masses, and protecting the mucosa.

The following drugs are most effective for treating reflux:

• antacids - Phosphalugel, Gaviscon, Maalox;
• antisecretory agents - Omeprazole, Esomeprazole, Rabeprazole;
• prokinetics - Domperidone, Motilium, Metoclopramide.

In addition, the intake of vitamin preparations is shown - pantothenic acid, which stimulates peristalsis and contributes to the restoration of the mucosa, as well as methylmethionine sulfonium chloride, which reduces the production of gastric secretion.

Surgical intervention

With the development of reflux esophagitis of the third and fourth degree, surgical methods of treatment are indicated - an operation that restores the natural state of the stomach, as well as putting on the esophagus magnetic bracelet, which prevents the casting of acidic masses.

Folk remedies

For the treatment of reflux folk remedies it is recommended to use decoctions and infusions from vegetable raw materials.

A teaspoon of crushed dill seeds brewed with boiling water effectively eliminates heartburn and stops inflammation in the esophagus.

During the day, you should take decoctions of herbal preparations from the rhizomes of the mountaineer, plantain leaves, yarrow, oregano and chamomile. Before going to bed, teas from mint leaves, fireweed, calendula flowers and calamus root are shown to be taken.

The rule for preparing decoctions is to pour one tablespoon of the plant mixture with a glass of boiling water and incubate in a water bath for 15 minutes.

Diet for sickness

Therapeutic nutrition is designed to eliminate from the diet products that have an irritating effect on the mucous membrane, as well as enhance the production of gastric secretion.

Good results are brought by a diet for reflux esophagitis, which includes the following products:

• soft-boiled eggs;
• low-fat dairy products;
• liquid and semi-liquid cereals;
• steam fish and meat;
• baked apples;
• white bread crumbs.

Under the ban - coffee, alcohol, soda, any acidic drinks, beans and peas, spicy, fried, smoked and salty foods, chocolate and brown bread.

Prevention

Of great importance for recovery and prevention of relapse of reflux is the correct lifestyle. Patients are advised to maintain physical activity, monitor weight, do not overeat, and after eating take walks in the fresh air.

In addition, any load on the stomach area, including tight clothing and tight belts, should be avoided. Bending after eating is not allowed. The head of the bed for a night's rest must be raised by 10-15 cm.

And most importantly - you need to regularly visit a gastroenterologist and pass all the scheduled examinations in a timely manner.