Esophageal stenosis is a serious condition requiring immediate intervention. Partial or complete overlapping of the patency of the body deprives the person of the opportunity to swallow not only food, but also saliva.
Sometimes pathology becomes the cause of laryngospasm, because food enters the lumen, causes attacks of severe suffocation or coughing.
What is esophageal stenosis?
With stenosis, there is a significant decrease in the diameter of the lumen. Clinical manifestations are dysphagia, eructation and bleeding.
Note that the diameter of the esophagus is not the same throughout. With him in close contact are such vital organs as the trachea, bronchi, aorta and some others. Therefore, with stenosis, there is a high probability of getting complications.
The disease is detected in both adults and children. Congenital pathology is most often localized in the middle or lower part of the organ. Babies are usually found only when performing a complete examination or against another ailment.
Causes of development
Congenital form - embryonic developmental defect. It is based on the transformation of the muscular membrane, the development in the esophageal wall of the cartilaginous or fibrous rings.
Acquired disease can appear for various reasons. Virtually any disease can be a prerequisite for the formation of stenosis.
Most common causes are:
- scarring of peptic ulcers,
- hernia of the esophageal opening of the diaphragm,
- chronic gastritis,
- toxemia in pregnancy.
Scientists have found a relationship with such serious diseases as diphtheria, scarlet fever, tuberculosis and syphilis.
Sometimes the obstruction is associated with injuries, for example, damage to the walls of the body by a foreign object, a surgical instrument. As a consequence, the disease appears in the case of chemical burns, when conducting bougie or EGDS.
The cause of stenosis may not be in the esophagus, but beyond. Then the organ is squeezed by incorrectly located vessels, tumors, large lymph nodes.
Classification of esophageal narrowing
Classification by degree of lesion is divided into acute and chronic. Esophageal narrowing is:
- superficial without ulceration,
- affecting the entire thickness of the mucosa with the formation of defects and areas of necrosis,
- affecting submucosa.
By the location of the narrowing the forms differ:
Depending on the number of zones of narrowing, the stenoses are single( only one department is affected) or multiple( there are several pathologically altered departments).
Degrees of development
Esophageal stenosis can be of several degrees:
- First. In a narrower area, the diameter of the organ is 11 to 9 mm, the esophagus is available for medium-sized endoscopic instruments.
- Second. Narrowing occurs before the marks of 8-6 mm. The study is carried out through the structure of the fibroblochoscope.
- Third. Diameter is reduced to 5-3 mm.
- Fourth. The lumen is narrowed to 2-11 mm. At this stage, even an ultrathin fibroscope can not pass through the esophagus.
Symptoms of esophageal stenosis
In children, the congenital form is manifested by the introduction of subcorrection and solid food. In addition to constant regurgitation, there is increased salivation, abundant discharge of mucous from the nose.
In adults, at the very first stage, only unpleasant sensations occur when swallowing food. Sometimes there is a feeling of passing a lump. Then the situation is aggravated without treatment - only semi-liquid food can safely move through the esophagus.
In the last stages, even the liquid does not pass in full. Immunity ceases to cope normally with its functions, a person loses weight and weakens.
Several other problems join this.can be detected:
- enhanced salivation,
- vomiting after eating,
First, the doctor makes a diagnosis based on the patient's condition. Then it is confirmed by endoscopic and radiological method.
In the latter case, barium is additionally used. The doctor tracks the passage of the contrast medium. Defects of filling along the entire length of the body are detected.
Esophagoscopy is aimed at establishing the diameter and level of narrowing of the lumen. If necessary, the doctor will be able to examine the mucosa more thoroughly, identify the presence of ulcers or inflamed zones, and also conduct a biopsy to identify the prerequisites for the development of the disease.
This method is rarely applied to children, therefore, if necessary, simply assigns radiography.
Esophageal stenosis is a serious enough disease, so it should be treated with special attention. Drug treatment is often prescribed. They can be supplemented by physiotherapy and folk remedies.
If this scheme does not produce the proper result, a surgical intervention is prescribed.
Video on the treatment of cicatricial esophageal stenosis complicated by perforation:
If stenosis is caused by burns or scar tissue, then bougie or drainage of the esophagus is appointed. Assignment:
- Antispastic medicines.
The main method is to this day bougie, although for the first time this technique was proposed in 1733.
The method, like the balloon dilatation procedure, is applied only at 1 and 2 degrees of disease with the condition of its benign course.
It is assigned if the conservative effect has not yielded the desired results. When reconstructive surgery is being performed, the question of the method of plasty and methods of administering the graft is being addressed. In the first case, the stomach, the small or large intestine can participate in the plastic.
If the disease is caused by tumor processes, then endoprosthetics are prescribed. For this purpose, a self-expanding tool is installed in the lumen. Extended, recurrent processes are treated by resection and esophagoplasty.
In addition, stenosis may be prescribed traditional medicine methods:
- Finely chop or grate potatoes. Then juice is squeezed out of the pulp and small balls are formed. Then they go to the refrigerator for 14 days. After this period, three times a day for 2 tbsp.l eat 20 minutes before eating.
- Treatment is possible and with the help of cabbage juice. In three liters of such a composition is added a glass of sugar. Then it is necessary to give the drink to infuse for 2-3 weeks. It is accepted on 4 items.l.after meal.
- You can diversify your diet with tea with lime honey , which is added a few drops of vinegar.
It is recommended that you consult with your doctor before choosing a remedy.
If an operation was performed, it may be forbidden to take food through the mouth for about a week. Power is supplied through the probe. Then doctors will be allowed to drink liquid food, for example, rose hips or kefir.
All patients are recommended diet number 1.
It includes a reduction of carbohydrates to 300-350, an increase in the diet of proteins and lipids. You can eat dishes that do not irritate the mucous wall of the esophagus. Preference is best given to mashed meat and fish, fruit puree. It is necessary to limit the use of cereals, baked goods, and potatoes.
Features of treating a disease in children
If there is a reflux disease, drugs are prescribed to reduce the acidity of the gastric juice. A special diet and lifestyle is prescribed.
If stenosis is congenital, then an operation is performed for the plasticization of the esophagus or for the removal of those areas that interfere with the normal passage of food.
Children can also be assigned bougie or extension of the organ with the help of special expanders. With extensive stenosis, the esophagus is replaced by the areas of the intestine. In the last few years, special balloon dilators are actively used, which are necessary to expand the narrowed sections of the esophagus.
Video about bougie benign esophageal stenosis in children:
Complications of the disease
If the stenosis is located closer to the upper parts, it is possible to develop chronic forms of bronchitis. This is due to the fact that there is a constant irritation of the mucosa and ingestion of food in the bronchi. Frequent companions are laryngospasm, attacks of coughing and suffocation.
As a prophylaxis for GERD it is necessary to maintain a diet, not overeat, do not allow the formation of scar tissue. The last snack should be done three hours before bedtime. Be sure to eat in a vertical position after eating.
- sleep on a cushion at an angle of 40 degrees,
- abandon narrow clothing and belts,
- not perform an active activity associated with slopes forward.
The prognosis of the disease depends on the causes and methods of treatment. The best results for benign disease and treatment with endoprosthetics. The highest percentage of restenosis is observed after endoscopic dilatation.