Erosive reflux esophagitis is a complicated course of the disease, characterized by the reflux of stomach contents back into the esophagus. It is often localized in the distal part, i.e., in the lower part of the esophagus, and is characterized by the occurrence of ulcers (erosions) on the mucous membrane. With this form of the disease, all the usual symptoms appear more clearly and cause significant discomfort to the person.

The main reasons for the formation of ulcers of various sizes are sliding hiatal hernia, ulcerative gastric stenosis, short esophagus, severe vomiting, as well as complications after surgery on the gastrointestinal tract. Symptoms of such a disorder are considered to be a violation of the process of swallowing food, and depending on the stage of the disease, it can be expressed from a constant feeling of a lump in the throat to complete obstruction of solid or liquid food. Other signs include constant pain, heartburn and belching with unpleasant smell recently consumed food.

Diagnosis of the erosive type of disease is based on the study of the medical history and examination of the patient. The final diagnosis is established on the basis of laboratory tests and instrumental examinations, consisting of radiography, ultrasound, and biopsy. Treatment is complex and consists of prescribing medications, following a strict diet, and using folk remedies. Surgical intervention is sought when the disease is severe.

Etiology

The main factor in the development of such a pathology is the constant reflux of stomach contents into the esophagus, which over time contributes to the formation of single or multiple erosions on the mucous membrane. Predisposing reasons for the occurrence of such a disorder are:

• ulcerative neoplasms of the stomach and duodenum;
• the presence of a hiatal hernia in the diaphragm;
• mechanical damage to the esophagus, for example, when inserting a probe during diagnostics, or for the purpose of feeding seriously ill patients;
• unhealthy diet – addiction to excessively fatty and spicy foods;
• leading an unhealthy lifestyle - nicotine abuse, alcoholic drinks or narcotic substances;
• accidental or intentional ingestion of chemicals into the esophagus;
• acute course of infectious processes in the gastrointestinal tract;
• a complication after medical intervention directly on the esophagus or other organs of the gastrointestinal tract.

Varieties

Medicine knows several classifications of erosive reflux esophagitis, depending on the stage and nature of the course. Thus, there are several forms of the disease:

• acute form– the most common expression of erosive disease. It consists of superficial or deep damage to the mucous membrane. Symptoms of the disease appear suddenly and are clearly expressed. With effective treatment tactics, it is eliminated quite quickly, without complications;
• chronic form– occurs quite often and is characterized by periods of exacerbation and remission. Due to the fact that the disorder has developed over a long period of time, it can become a predisposing factor in the formation of irreversible complications. Chronic erosive esophagitis involves the course of the disease over six months;
• ulcerative form– a pathological form in which erosion affects the deeper layers of the mucous membrane of the esophagus. Ulcerative esophagitis requires long and complex therapy;
• peptic form– the development of the disease occurs due to penetration gastric juice into the esophagus;
• catarrhal form– damage to the upper layers of the mucosa is noted.

Depending on which department the disease affects, there are several types of erosive reflux esophagitis:

• total– damage to the entire esophagus is observed;
• proximal– localization of the pathological process is observed in the upper section;
• distal– the disease affects only the lower part of the esophagus, near its junction with the stomach. This is the most common type of illness that is diagnosed in patients.

In addition, such a disorder is divided as the ulcerative lesion spreads. There are several stages of erosive reflux esophagitis:

• first stage– single erosions, no more than five millimeters in size, begin to appear on the lining of the esophagus;
• second stage– erosions can merge with each other, but the pathology does not penetrate into the deep layers of the mucosa;
• third stage– at this stage the inflammatory process spreads to the entire mucous membrane. Erosion larger than five millimeters can merge with each other, forming ulcers;
• fourth stage– characterized by the presence of chronic ulcers of the distal esophagus and the developing narrowing of its lumen.

Regardless of the type and stage of the disease, it is necessary to begin comprehensive treatment as early as possible.

Symptoms

Experts identify several characteristic features diseases whose presence has diagnostic value. Erosive reflux esophagitis is expressed by the following symptoms:

• difficult process of passing food - in the early stages of the disease it can be expressed by the sensation of a lump or foreign object in the throat, in later stages there is obstruction of solid food and difficulty passing liquids;
• belching with a sour smell and a feeling of aftertaste of recently consumed foods;
• constant heartburn - the intensity of which may increase during or after eating, performing physical activity, or even when bending the body forward;
• pain in the chest area - worsens at night or during physical activity, as well as in a horizontal position of the body.

Other symptoms include slight increases in body temperature, weakness and attacks of dizziness.

Complications

If symptoms are ignored or treatment is not started in a timely manner, a number of serious complications may develop, including:

• penetration of ulcers into the deeper layers of the mucous membrane and tissue of the esophagus;
• severe narrowing of the lumen of the distal section;
• the occurrence of hemorrhages;
• entry of gastric juice into the pharynx or larynx;
• changes in the structure of mucosal cells;
• oncology, .

Diagnostics

The diagnosis of “erosive reflux esophagitis” is established based on studying the patient’s medical history, determining possible reasons the formation of such a disorder, as well as the presence and intensity of signs of the disease. These factors will help the specialist determine the stage of the disease.

Laboratory diagnostic methods include conducting a general and biochemical blood test to detect concomitant pathologies. Examination of stool is necessary to confirm or deny the presence of internal bleeding.

Instrumental diagnostic procedures include:

• manometry – aimed at assessing contractile activity and synchrony of esophageal peristalsis;
• measuring the acidity level of the distal section;
• endoscopic examination of the inner surface of the esophagus and other organs of the gastrointestinal tract. The examination involves a biopsy - taking a small piece of mucous membrane for subsequent histological studies;
• X-rays using a contrast agent;
• breath tests - to determine the presence of the bacterium Helicobacter pylori;
• Ultrasound, MRI and CT are performed to detect changes in the esophagus and concomitant gastrointestinal diseases.

After receiving all the results of tests and examinations of the patient, the specialist prescribes an individual treatment regimen.

Treatment

After confirming the diagnosis of erosive reflux esophagitis, absolutely all patients are prescribed complex therapy, which includes:

• use of medications;
• following a special diet;
• use of traditional medicine;
• surgical intervention.

Drug treatment consists of the use of certain groups of medications aimed at healing erosions, protecting the mucous membrane, normalizing the tone of the lower sphincter muscles and reducing acidity. Such substances include antacids, alginates, PPIs, and in some cases the use of antibiotics is indicated. In addition, medications are prescribed that eliminate the general symptoms of erosive lesions of the mucous membrane and increase the level of the immune system. Choice medicinal product and the duration of the course of its use is determined by the attending physician individually for each patient.

Diet therapy involves eating large amounts of foods containing fiber. This could be potatoes, pasta, cereals, bran bread. You should also completely avoid eating fatty and fried foods, smoked foods, salts and marinades, hot seasonings and mayonnaise. You need to eat small meals six times a day, last appointment food should be three hours before bedtime.

Surgical operations are resorted to extremely rarely, often when other treatment methods are ineffective or in the presence of complications.

Prevention

In order to avoid problems with the formation of erosive reflux esophagitis, you must adhere to simple rules:

• lead a healthy lifestyle;
• maintain proper nutrition;
• promptly treat diseases that may cause illness;
• take place regularly preventive examinations from a gastroenterologist.

Similar materials

Reflux esophagitis is a chronic disorder characterized by the reflux of stomach contents into the esophagus, which is accompanied by irritation of its walls. The peculiarity of the disease is that it is expressed by mild symptoms, so the diagnosis of the disease often occurs when completely different disorders are detected, for example, peptic ulcer or gastritis. Often this pathological condition is one of the signs of a hiatal hernia.

Treatment of reflux esophagitis, like any other ailment of the digestive system, necessarily includes following a special diet. Its main task is to reduce the intensity of symptoms during exacerbation of pathology, and to prevent the development of relapses in the future. In addition, proper and gentle nutrition helps protect the mucous membrane of the esophagus and stomach from the aggressive effects of irritants. An approximate menu for each day (or week) should be drawn up by a qualified nutritionist together with a gastroenterologist. It is important to consume exactly those foods that the doctor allows. In addition to prescribing a diet for reflux esophagitis or gastritis, a nutritionist can also recommend some recipes for preparing tasty and healthy dishes.

Acid-dependent diseases are becoming increasingly widespread. Not only do they occur with severe symptoms and cause discomfort. Acid aggression becomes a factor contributing to the development of dysplastic processes. Thus, chronic reflux esophagitis over a long period of time transforms into a dangerous precancerous disease - Barrett's esophagus. Constant inflammation is supported by acid aggression, so the result is uncontrolled cell division. The article will focus on gastroesophageal reflux disease (GERD). What is reflux esophagitis, as well as erosive esophagitis?

Erosive reflux esophagitis is characterized by prolonged inflammation of the walls of the esophagus with the appearance of erosions on them

The essence of the problem and etiological factors

The esophagus is a hollow tube covered on the inside with flat non-keratinizing epithelium. This is where food comes from the mouth. It is processed by the secretion of the salivary glands, partially by enzyme systems and saprophytic flora. The acidity here is low, closer to an alkaline reaction.

The distal (terminal) part of the esophagus passes into the stomach. The lower esophageal sphincter allows food to pass there. This structure works in such a way that the contents of the stomach do not pass backwards.

If you have a hiatal hernia or connective tissue weakness syndrome, the lower esophageal sphincter stops functioning normally. Aggressive gastric juice enters the cavity of the esophagus. This situation is called gastroesophageal reflux, and the contents are called refluxate. It is often combined with duodenogastric reflux, when intestinal chyme appears from the duodenum through the pylorus into the stomach. When these situations occur together, bile appears in the lumen of the esophagus, and the condition becomes more serious.

The morphological substrate of the disease is the occurrence of defects in the mucous membrane.

We are talking about erosion. They differ from ulcers in the smaller depth of the lesion. For this reason reflux esophagitis also characterized as erosive reflux.

Types of erosion

There is a classification of detected mucosal defects. It was created and approved in Los Angeles. Erosion is assessed by size and extent, as well as by the extent of the folds.

If the erosion has a length not exceeding half a centimeter, then grade A is set. Such reflux is relatively safe. With an increase in the size and localization of erosion within one esophageal fold, there is a degree of B. The most severe degree is D. In this case, the erosion covers ¾ of the circumference of the esophagus.

Symptoms of the disease

The main clinical manifestation of the disease is severe burning sensation in the chest

The most common symptom of GERD is heartburn. Patients subjectively feel a burning sensation in the projection of the xiphoid process or behind the sternum. It spreads from bottom to top.

This symptom is provoked by various foods and a horizontal position taken after eating.

Therefore, patients try not to go to bed after breakfast, lunch and dinner. Sometimes they deliberately limit their food intake and lose weight.

In addition to heartburn, there may be pain. The localization is the same - epigastrium and projection of the xiphoid process. What causes the pain syndrome? Erosion is a defect of the mucous membrane. That is, there is no epithelial covering. The exposed defect, which sometimes bleeds, is affected by acid periodically released from the stomach. This is why pain occurs. It can also be caused by spasms.

A sour taste in the mouth occurs when refluxate enters the oral cavity. This is called regurgitation. Extraesophageal manifestations of GERD include the appearance of caries, exacerbation of sinusitis, ethmoiditis, frontal sinusitis and other sinusitis.

At night, coughing is often bothersome. This symptom is reflexive and chronic. An increase in asthma attacks is possible if there is concomitant bronchial asthma.

Who should I turn to for help?

If you have symptoms, do not hesitate. It is recommended to treat the disease as early as possible, because Barrett's esophagus complicates most situations with GERD.

Only a doctor can prescribe the correct treatment

You can contact your local physician or pediatrician. He will carefully collect anamnesis and evaluate complaints. If necessary, the doctor will refer you to a gastroenterologist or independently prescribe an esophagogastroduodenoscopy.

This method will assess the condition of the mucous membrane not only of the esophagus, but also of the stomach, as well as the duodenum.

During the procedure, biopsy material is taken for a more in-depth histological examination, especially if Barrett's esophagus is suspected. With columnar cell metaplasia, the frequency of control studies increases.

A gastroenterologist, as well as a therapist, prescribes treatment. It can be performed on an outpatient basis or in a day hospital setting.

Treatment approaches

Antibiotics are not used today in the treatment of erosive reflux esophagitis. Some infectious disease specialists even believe that GERD occurs more often against the background of previously treated helicobacteriosis.

To accelerate epithelization, proton pump inhibitors are prescribed. Best effect are provided by modern representatives of the group - Rabeprazole, as well as Pantoprazole. Twice a day, half an hour before meals, take the standard dosage. After epithelialization, you can switch to maintenance therapy. The dose of the drug is reduced by half.

To normalize the functioning of the lower esophageal sphincter, prokinetics are used. The best of these remedies is Gonoton. You can use Itopra or Metoclopramide. Treatment should be combined with diet therapy.

According to 2010 data, about 5 million people in Russia suffer from reflux esophagitis, and only 2 out of 10 people receive proper treatment. Often, the symptoms of this disease become habitual and part of the daily norm. A person does not pay attention to a slight afternoon heartburn that goes away after taking an Almagel tablet or water and soda. Because of this approach, the disease continues to progress and often leads to the development of severe complications such as bleeding or cancer.

GERD and reflux esophagitis

In Internet resources, on television and even in medical literature, these two concepts are often confused. They must be distinguished, since treatment depends on the diagnosis. To explain the subtleties of terminology, just study the table below:

In short, esophagitis is inflammation of the esophagus, which is detected after FGS. GERD can exist without esophagitis, but there is no reflux esophagitis without GERD.

Causes

In a healthy person, there is a muscular flap (lower esophageal sphincter) between the stomach and esophagus, which prevents partially digested food from moving in the opposite direction. During the day, there may be several episodes of reflux of acidic contents, and this is considered normal. The disease develops when the number of these casts increases significantly or the acid concentration in them increases.

The causes of reflux esophagitis can be divided into several groups, depending on the mechanism of development of the disease. This is important because for effective treatment pathological chains need to be broken, and harmful factors eliminate.

Symptoms

Manifestations of the disease are divided into two large groups: esophageal and extraesophageal. The first group includes typical symptoms associated with damage to the mucosa. The most typical of them are:

• . Can occur at any time, worsens after physical work, bending, drinking alcohol or eating large amounts of food. Its intensity depends on the severity of damage to the mucosa and the presence of concomitant diseases (gastritis, peptic ulcer and others);
• Pain . With reflux esophagitis, they are located behind the sternum or slightly higher. In most cases, they are combined with a feeling of heartburn. Distinctive feature for “heart pain” there is an improvement after taking antacid medications (Almagel, Gaviscon, Rennie, etc.) and a connection with food intake;
• Sour belching. Is typical sign illness, often accompanied by regurgitation of small amounts of food;
• Swallowing disorder. The symptom develops with a prolonged course of the pathology. It may be accompanied by both difficulty passing a bolus of food and the occurrence of painful sensations when swallowing.

In addition to the listed symptoms of reflux esophagitis, the patient may show signs of damage to the bronchi, lungs, vocal cords and trachea. Acid reflux can enter the respiratory tract and cause inflammation of these organs. As a result, a person can be treated for a long time and unsuccessfully for chronic bronchitis, asthma, laryngitis, recurrent pneumonia, etc.

In this case, chronic reflux esophagitis can manifest itself:

• Hoarseness or change in voice timbre;
• Constant cough. It will be dry when the trachea is affected and wet due to inflammation of the bronchi or lung tissue;
• Sore throat;
• Long running runny nose.

It should be remembered that damage to the esophagus and surrounding organs can lead to minor bleeding. They do not manifest themselves externally, but a person may feel weakness, weakness, craving for specific odors (gasoline, paint, glue, etc.), peeling skin and brittle nails.

Diagnostics

Before treating reflux esophagitis, the doctor must confirm the diagnosis and determine the extent of the disease. This can only be done with the help of additional diagnostics. Laboratory methods are practically uninformative for this purpose - they only allow one to assess the condition of the patient’s body and suspect the presence of complications. When a person applies, he is required to undergo three tests: general tests of urine, feces and blood. Against the background of esophagitis, changes can be noted only in the last study.

The final diagnosis can be made only based on the results of one examination - Fibrogastroscopy (FGS).

How is FGS carried out?

This is a special examination in which a thin device in the form of a small elastic tube, with a camera and a working instrument at one end, is inserted through the oral cavity. Preparing for it is quite simple - you should not eat food 3-4 hours before the test, and it is not recommended to drink 30-40 minutes before the test.

Before FGS, a person may be asked to bring with him a small towel and a disposable napkin, which is sold at any pharmacy. The procedure is performed in the “lying” position, usually on the left side. To facilitate its implementation, the patient can be sprayed with a solution of an anesthetic drug on the soft palate (in the area of ​​the uvula). Next, the patient is asked to hold the mouthpiece in his mouth, through which the device will be advanced.

Fibrogastroscopy is an unpleasant procedure, but it lasts no longer than 3-7 minutes. During this time, the doctor has time to examine the mucous membranes of the esophagus and stomach and, if necessary, remove a small “piece” of tissue for examination under a microscope. The laboratory technician will determine the presence of bacteria, cancer cells, or areas of thinning of the epithelium in the material.

The doctor gives the first FGS results immediately after the study. They describe the data that he was able to see through the endoscope. The laboratory's conclusion comes within 1-2 weeks.

Interpretation of FGS results

If the doctor discovers a pathology during an endoscopic examination, he must describe the nature of the damage to the walls. The doctor may find:

1. Catarrhal reflux esophagitis. The easiest option, in which the mucous membrane of the organ is full-blooded, loose, but has no obvious signs of damage. The stage of the disease is not included in the diagnosis;
2. Erosive reflux esophagitis. This diagnosis implies the presence of ulcers or areas of thinning of the mucous membrane on the wall of the organ. If an erosive process is detected, it is necessary to begin treatment immediately, as it can cause bleeding, lead to narrowing or complete obstruction of the esophagus, and cause cancer. The stage and degree of the disease must be determined, and a section of the mucous membrane (biopsy) is taken for examination;
3. Signs of bleeding. This complication is often observed in the erosive form. It is often the cause of anemia, which causes the patient to feel constant weakness, decreased performance and perversion of taste. It can be treated at home, as it does not lead to life-threatening conditions. The exception is bleeding in oncology;
4. Presence of fibrin. The formation of fibrin plaque, in most cases, indicates long-term inflammation. Does not affect treatment tactics or severity of the disease.

Sore throat after FGS

This is the most common complication of fibrogastroscopy, which worries 70-90% of people after the procedure. It can occur even with proper advancement of the device and technique for performing FGS. Pain occurs due to additional damage to the mucosa, its intensity and duration depends on the strength of this damage. The pain syndrome can persist from several days to 2 weeks, which corresponds to the period of complete restoration of the epithelium.

To make sure that there is no serious damage to the wall of the organ, it is enough to go to the clinic, where the person should undergo fluorography/radiography of the chest. Detection of free air will indicate a wall rupture, which requires emergency surgery. It should be noted that such cases are of a casuistic nature and practically never occur.

Sore throat does not require additional treatment; the epithelium will recover on its own without medical intervention. To eliminate pain, you can take an NSAID tablet, after consulting with your doctor. Meloxicam or Nimesulide are more preferable, as they have fewer side effects on the digestive system.

Degrees and stages of esophagitis

In the erosive form, the endoscopist must describe the pathology in detail in the diagnosis. He does this using alphabetic (A-D) and numerical (I-V) signs, which reflect the degree of reflux esophagitis and its stage. To decipher this data, you can use the tables below.

A thorough interpretation of the study results is not obligatory for the patient. The main thing to know is that the higher the stage/degree of the disease, the longer the duration of therapy and the higher the risk of complications.

Treatment

The insidiousness of esophagitis lies in the absence of pronounced symptoms, which is why most patients neglect the recommendations of doctors. As a result, the disease continues to develop and causes dangerous complications. To prevent this outcome, treatment for reflux esophagitis should be started in a timely manner, which consists not only of regularly taking medications, but also of changing lifestyle.

General events

Before you start taking medications and adjusting your diet, you need to make certain lifestyle changes. Following simple guidelines has been shown to significantly reduce the incidence of reflux and damage to the valve muscle. For patients with inflammation of the esophagus, it is fundamentally important to perform the following measures:

1. Stop smoking. Nicotine not only increases the acidity of gastric juices, but also has a relaxing effect on muscles digestive tract. The combination of these effects leads to increased symptoms of esophagitis;
2. Do not lie down after eating. It is recommended to sit in a comfortable position or walk leisurely for 30 minutes after eating. Lifting weights, running and even brisk walking should also be avoided immediately after lunch;
3. Limit physical activity. To reduce the severity of symptoms, women should not lift more than 3 kg, and men should not lift more than 5 kg;
4. It is necessary to avoid eating and drinking alcoholic beverages 2-3 hours before bedtime;
5. It is necessary to sleep on a high pillow or with the head end raised by 15-20 cm;
6. Refuse to wear constricting clothing, including belts, corsets, girdles, etc.;
7. If there are concomitant diseases (obesity, gastritis, peptic ulcer, Ellison-Zollinger syndrome and others), it is necessary to carry out their full treatment. Otherwise, treatment of reflux esophagitis will be ineffective.

Diet

Nutrition is an important component of therapy and prevention of complications. For most people, diet treatment is associated with tasteless food and constant restrictions. Indeed, with this disease there is a need to eliminate certain foods from the diet. However, with the help of simple culinary techniques, you can make almost any dish from permitted products. We will show you how to make a diet for reflux esophagitis enjoyable, complete and tasty.

What products are not allowed?

To reduce the number of reflux and acidity of gastric juice, it is necessary to exclude from the diet:

• Caffeine-containing drinks: energy drinks, coffee, Coca-Cola, some cocktails, etc.;
• Carbonated drinks;
• Alcohol;
• Any flour dishes, as they increase the secretion of acid in the stomach;
• Limit intake of chocolate and sweets;
• Fermented milk products;
• Olive and linseed oil, animal fats;
• “Sour” fruits and vegetables: citrus fruits, radishes, pomegranates, radishes, etc.;

What's the best way to prepare food?

First of all, you should avoid fried foods in vegetable or animal oils. Such products lead to a massive release of gastric juice and the appearance of aggressive reflux. Preference should be given to boiled food, steamed or stewed in own juice. For this purpose, you can use not only classic methods cooking, but also modern gadgets.

Here are some tips on how to prepare tasty and low-fat meat dishes:

1. Wrap. In almost any chain store you can purchase special sets with paper bags/sheets. Their use allows you to cook almost any meat dish without a drop of oil. Instead of the spices that come with the kit, you can use a sufficient amount of salt, fresh or dried herbs (dill, parsley, basil) and natural chopped vegetables ( Bell pepper, cucumbers, eggplants, zucchini, a small amount of onions and garlic);
2. Baking in the oven. This is the optimal way to prepare any dish for the patient. The absence of additional oil, in addition to what is present in the meat, allows you to prepare any low-fat dish. The water with which the ingredients are poured makes them soft and easy to digest. The ability to cook a side dish and a main dish in one baking sheet/frying pan saves a lot of time. However, it should be remembered that the minimum duration of such baking is 60-70 minutes. Recommended temperature 180-200 o C.
3. Microwave cooking. Modern models make it possible to cook almost any type of meat or fish using exclusively wave radiation. Contrary to popular belief, it does not in any way affect the quality and safety of food, which is confirmed by scientific research by Western doctors. At the same time, the food turns out to be low-fat and quite tasty. The main thing is to follow the cooking regime, which is described in the instructions. This will protect food from harmful microorganisms and save time on selecting the optimal cooking scheme;
4. Using a steamer/multi-cooker. To prepare delicious and healthy dish With the help of these gadgets, you need to add juicy vegetables such as carrots, onions, tomatoes or pumpkin pieces to the meat or side dish. Thanks to steaming, they produce abundant juice that permeates dishes and gives it a pleasant taste. Also, do not forget to add salt to your food to taste and add spices(dill, coriander, parsley, etc.);
5. Cooking over an open fire. This method is not suitable for daily use, but when you go out into nature, it will be indispensable. Since the fire evaporates all excess fat from the food and does not add extra oil, the meat turns out lean and quite tasty. It is suitable for a patient with esophagitis under one condition - if no spicy marinade was used to treat it.

When dressing dishes, you should limit the amount of mayonnaise and oils. You should also avoid ketchup, mustard and hot sauces. They not only damage the mucous membrane, but also increase acid secretion in the organ. Food consumed should be at room temperature - too hot or cold food also has a negative effect on the digestive organs.

Pharmacotherapy

Medicines to reduce acidity of reflux

Various groups of drugs can be used to treat reflux esophagitis, but one of them is prescribed to almost all patients - proton pump inhibitors (PPIs). These medications effectively reduce the acidity of gastric juice. By influencing the cells that produce hydrochloric acid, they reduce its concentration. Thanks to this effect, the reflux of gastric contents causes less damage to the mucous membrane.

At the moment, there are 5 main types of PPIs: omeprazole, esomeprazole, lansoprazole, rabeprazole, pantoprazole. To choose the optimal drug for yourself, you need to contact a competent therapist or gastroenterologist. He will assess the condition of the body and the course of the disease, and then prescribe therapy.

According to modern research (2014-2016), some pump inhibitors have features of action that are important to consider before taking them. We list the most important of them below:

Only if PPIs are intolerant or ineffective, a group of H2 histamine blockers is used to reduce acidity. They have been proven to be less effective and require larger doses, so they are prescribed only as a last resort. These include famotidine, ranitidine, nizatidine, roxatidine.

Medicines to improve gastrointestinal motility

In addition to reducing the aggressiveness of reflux, it is necessary to reduce their number. Not only lifestyle changes, but also some medications can help with this. They belong to the group of prokinetics - drugs that improve the motility of the digestive tract and facilitate the movement of the food bolus. These include:

• Domperidone (Motilium, Motilak, Motonium) is the optimal means with inflammation of the esophageal mucosa. Allows you to improve the functioning of sphincters, peristalsis of the stomach and intestines;
• Cisapride (Coordinax, Peristil) - the drug has a targeted effect on the lower sphincter of the esophagus and stomach, increasing their tone and reducing the frequency of reflux;
• Metoclopramide (Raglan, Perinorm, Cerucal) – is used when other drugs are ineffective and there are frequent discharges. Not recommended as a starter drug due to frequent side effects such as constant fatigue, weakness, muscle twitching, etc.

Only the attending physician can prescribe a drug for treatment. Each of them has its own contraindications and side effect which must be taken into account before starting therapy.

Antacids

For immediate relief of heartburn or esophageal pain, this group of medications is perfect. Antacids do not cure the disease, but they can temporarily relieve its symptoms. They have virtually no contraindications, so they can be taken without a doctor's prescription.

Almagel is the most famous antacid, which was one of the first to appear on the market. At the moment, it is significantly inferior in effectiveness to such drugs as:

• Gaviscon;
• Rennie;
• Maalox;
• Megalac.

According to latest research, the listed pharmacological agents begin to act faster, retain their effect longer and more strongly reduce the acidity of gastric juice.

A few words need to be said about an aqueous solution of soda, which is widely used to relieve heartburn. Such treatment with a folk remedy only has a negative effect on the organs. When alkali first passes through the esophagus, irritation of the mucous membrane occurs. In response to immediate alkalization of the stomach, a strong release of acid occurs and reflux becomes more aggressive. Doctors strongly recommend not using soda, but using regular antacids.

When is surgery needed?

Esophagitis is almost always treated without surgery. Surgery is a last resort measure that is used in the event of severe complications. Consultation with a surgeon to determine the need and extent of surgery is recommended in the following situations:

• If there is constant bleeding from the esophageal vessels;
• Against the background of persistent narrowing of the esophageal tube (stricture), which prevents the passage of food;
• With irreversible damage to the esophageal sphincter;
• A precancerous condition of the mucous membrane is degeneration and random proliferation of cells. This condition is called “Barrett's esophagus”;
• Esophageal cancer stages 1-2.

In each of these cases, the decision on the type of operation is made individually. Removal of a pathological formation, removal of part of the esophageal tube, or restoration of the integrity of the organ using the remaining part of the esophagus or intestines can be carried out. These operations combine two common features– all of them are carried out for health reasons and each is quite difficult for the patient to tolerate.

FAQ

Question:
How to detect reflux esophagitis in a small child?

Normally, in children the number of casts is 2-3 times greater than in adults. Their digestive organs are adapted to this condition, so they rarely develop esophagitis. An incipient illness may be indicated by “causeless” crying or anxiety, especially after eating. A slight fever may appear; the child may point to the middle of the chest to indicate the location of pain.

Treatment of esophagitis in infants is usually carried out without the use of medications. First of all, “position therapy” is recommended. During feeding, the baby is held more vertically - at an angle of 50-60 degrees. This helps reduce the number of casts. If this measure is ineffective, the baby is transferred to feeding with adapted formulas, which have a thicker consistency. These include “Nutrilon”, “Enfamila”, “Frisov”, “Lemolaka”.

The feeding regimen, type of formula and other medical prescriptions are determined exclusively by a pediatrician or neonatologist. It is strongly recommended not to influence the health of a small patient without consulting a doctor.

Question:
How long should therapy be continued?

Recommendations for changing lifestyle and diet must be followed constantly throughout your life. The need for medications is determined individually, depending on the severity of the disease and the presence of concomitant diseases. For moderate cases, as a rule, a course of PPI is prescribed for 2-4 weeks, 2 times a year.

Question:
What is biliary reflux esophagitis?

When a disease of the biliary system and weakness of the muscular septa are combined, reflux into the esophagus from the initial section of the intestine - the duodenum - may occur. In this case, bile, and not gastric juice, has a damaging effect on the mucous membranes. Biliary reflux is often accompanied by severe gastritis or the formation of ulcers. The principles of treatment for this form are the same as for the classic course of the disease, however, it is important to eliminate the cause of the pathology - that is, to cure the disease of the biliary system.

Question:
Can esophagitis lead to the formation of esophageal ulcers, cancer or other complications?

With a long course of pathology or high aggressiveness of reflux, the likelihood of complications developing is quite high.

The mucous membrane of the esophagus has no protection from these aggressive substances, so contact with them causes damage to the epithelium, inflammation and causes pain. One of the main causes of reflux esophagitis is a hiatal hernia. With this disease, part of the stomach is displaced into the chest cavity through the enlarged esophageal opening of the diaphragm.

Causes of reflux esophagitis

The diaphragm is the muscular partition between the thoracic and abdominal cavities. For the passage of various organs from one cavity to another, the diaphragm has special holes(including the esophageal opening).

In case of thinning or underdevelopment of muscle tissue in combination with increased intra-abdominal pressure, a displacement of the abdominal organs into the thoracic cavity may occur. This is how the esophageal opening of the diaphragm develops.

A slight displacement of the inlet and the top of the stomach is called a sliding hernia. The incidence of such hernias increases with age in people over 50 years of age; it reaches 60%. As a rule, the only manifestation of a sliding hiatal hernia is gastroesophageal reflux, ultimately leading to reflux esophagitis.

Symptoms of reflux esophagitis

The main symptom of reflux esophagitis is. It can be observed both during the day and at night, can intensify immediately after eating and taking a horizontal position of the body in space, and be accompanied by belching and hiccups.

Some patients experience pain reminiscent of heart pain. At the same time, reflux esophagitis can occur without heartburn and chest pain, but manifest itself as a swallowing disorder. As a rule, swallowing disorders are associated with the transition of the disease to a more severe stage with the development of cicatricial narrowing of the esophagus.

Diagnosis of reflux esophagitis

If a hiatal hernia is suspected, the following tests are performed:

• X-ray examination of the esophagus with a barium suspension (the study is carried out on an empty stomach, a series of X-ray images are taken immediately after the patient swallows the contrast mixture; spontaneous reflux from the stomach into the esophagus indicates severe reflux);
• esophagoscopy (endoscopic examination of the esophagus);
• biopsy (taking a small section of the esophageal mucosa for histological examination; performed during esophagoscopy);
• esophageal pH-metry (measurement of acidity in the lumen of the esophagus and stomach; the contents of the esophagus will be acidic due to the reflux of acidic contents from the stomach).

In some cases, the doctor may prescribe additional research methods and special tests. If a patient complains of chest pain, the patient is referred for examination to a cardiologist to rule out ischemic pain.

Complications

The most dangerous complications of reflux esophagitis are esophageal ulcers and cicatricial narrowing of the esophagus (stricture). A long course of esophagitis can contribute to the malignant degeneration of mucosal cells and the development of cancer. The most dangerous complication of a hiatal hernia is strangulation. Infringement should be suspected when sharp pain in the chest appears in combination with difficulty swallowing.

What can you do

To reduce gastroesophageal reflux, you should lose weight, sleep on a bed with the head end raised 10-15 cm, and try to maintain a time interval between eating and sleeping. You should give up smoking, eating fatty foods and chocolate, coffee, alcoholic drinks, orange juice, and the habit of drinking plenty of liquid with your meals.

Compliance with the listed rules in combination with drug therapy in most cases reduces the frequency of gastroesophageal reflux and protects the esophageal mucosa from harmful effects.

How can a doctor help?

Treatment usually begins with drug therapy. Its main directions are reducing the acidity of gastric juice, protecting the esophageal mucosa from harmful influences, increasing the contractile activity of the lower esophageal sphincter and increasing the rate of esophageal emptying. Histamine H2 receptor blockers (famotidine), proton pump inhibitors (omeprazole, lansoprazole), prokinetics (domperidone), antacids, etc. are used.

Surgical intervention may be required in complicated forms and failure of drug therapy.