Diseases of the esophagus: classification, symptoms, causes, diagnosis, treatment

click fraud protection

The main purpose of the esophagus, which is an anatomical extension of the pharynx, is the delivery of a swallowed food coma to the stomach.

Despite the relative simplicity of the physiological structure, the esophagus is prone to a mass of inflammatory diseases, as the structures of its mucous membranes are extremely sensitive to the influence of harmful substances that make up some food products.

Special attention should be paid to the fact that in most cases the signs of a beginning illness are attributed to any organ: heart muscle, stomach and even spine, but not just a problem esophagus. In order not to see the beginning of the pathological process, it is necessary to know the list of its characteristic manifestations.

Classification of diseases of the esophagus

With the help of the classification it is possible to form a clear idea of ​​the variety of diseases and malformations of the esophagus, which are divided into groups:

1. The first group includes congenital anomalies of the esophagus, detected even in infancy.

Esophagus in a child may have congenital:

• enlargement( a rare anomaly due to underdevelopment of ganglion cells localized in the distal part of the walls of this organ);
• aberrant tissues and cysts localized in the body cavity or attached to the esophageal wall;
• tracheoesophageal fistulae are pathological openings located between the trachea and esophagus;
• diverticula - persistent sack-shaped protrusion of the walls directed towards the mediastinal cavity;
• stenosis - pathological( in addition to five natural) narrowing of the internal lumen of the esophageal tube.

In addition to this, the esophagus in children can:

• be completely absent;
• is abnormally short( in such cases it is said about the formation of the "thoracic" stomach);
• should be doubled( doubling - full or partial - can lead to the appearance of an additional esophagus, and can touch only one of the three departments of this organ).

2. This group includes specific and nonspecific ailments of the esophagus. For convenience they are divided into:

• diverticula;
• inflammatory diseases( represented by acute, infectious and chronic esophagitis, stenosis and peptic ulcer);
• vascular disease( it refers to cases of hemorrhagic angiomatosis, varicose veins and angioma of the esophagus).

3. A group of pathologies that lead to a disruption of the normal functioning of the esophagus( the so-called neuromuscular dysfunction) includes:

• esophagospasm is a disease that leads to a sharp, albeit short-term spasm of the esophageal tube muscles, which does not generally cause severe violations of the swallowing function anddoes not interfere with the patient's nutrition;
• paralysis and atony - pathological conditions, accompanied by a loss of muscle tone and a violation of peristaltic esophageal contractions;
• achalasia is a relatively rare neuromuscular pathology, which causes problems with the esophagus passing through the esophagus( due to the decrease in its peristalsis) and its entry into the stomach due to the unsealing of the lower sphincter( cardia), which functions as a valve between the esophagus and the stomach.

4. Tumors of the esophageal tube are divided into:

• benign( represented by rhabdomyomas, myxomes, lipomas, leiomyomas, angiomas, fibromas, neurinomas);
• malignant( represented by sarcoma and epithelioma - cancer).

5. This group includes all possible damages of the esophagus, which are divided into:

• trauma( internal and external), capable of leading to organ perforation;
• chemical burns( during their healing the muscular tissues of the esophageal tube are replaced by connective ones, as a result burns strictures are formed at this place);
• foreign bodies - objects or pieces of poorly chewed food, stuck in places of esophageal tube narrowing. Their ingression into the esophagus can be either accidental or deliberate( small children left unattended often swallow the objects that interested them: buttons, small details of toys and even nails).

Symptoms of esophageal diseases

Almost every disease of the esophagus is accompanied by:

• Heartburn is a very unpleasant burning sensation that occurs behind the sternum and spreads to the neck area. In most cases, heartburn is accompanied by the ejection of acidic stomach contents( regurgitation) into the esophagus and a sensation of rolling to the throat of a warm wave. After eating, heartburn can intensify if the patient takes a horizontal position, will perform work that requires physical effort or leans forward. You can slightly reduce the intensity of heartburn symptoms by swallowing saliva or water( by making several vigorous drinks), and also with antacid preparations neutralizing the action of hydrochloric acid contained in the digestive juice. The frequent occurrence of severe heartburn resulting from reflux of hydrochloric acid or bile indicates that there are undoubted problems with the functioning of the esophageal tube and can be a consequence of esophagitis( inflammation of the mucous membranes) or insufficient elasticity of its structures.
• Odonophagia is a soreness accompanied by ingestion of food and arising behind the sternum. The presence of loneliness indicates a violation of the integrity of the mucous surfaces of the esophagus. Odynophagy has nothing to do with spastic pain in the chest, due to the need to push hard food coma, so these feelings should be distinguished. Being a nonspecific symptom, lonely phagia can not pinpoint exactly which ailment provoked pain when swallowing. Odinophagy is always observed with esophagitis of infectious etiology( especially with herpetic and candidiasis).Odinophagia is always accompanied by cases of cancer, ulcers and chemical burns of the esophagus.
• Atypical chest pain that manifests itself differently from loneliness or heartburn. Atypical pains - unlike loneliness - often accompany esophagospasm( violation of the esophageal motility) and reflux-esophagitis, and they can arise spontaneously, and in the process of eating. Painful and persistent pain in the esophagus can result from the development of an ulcer or even cancer of the esophagus. The nature of atypical pains( patients often can not describe in words the feelings that arise in them) is so unpredictable that during the day it can be completely different for one and the same patient. In cases where atypical pains are caused by disorders of the esophageal motility, patients suffer from depression, anxiety, psychosomatic and panic disorders;their behavior may be unpredictable.
• Regurgitation( it is often referred to as esophageal vomiting or eructation) - reverse movement of food from the esophagus into the oral cavity, not accompanied by vomiting or active contraction of the diaphragm. This symptom is an essential companion of heartburn. Most often, regurgitation is observed in the presence of diverticula and strictures of the esophagus, and with gastro-food reflux patients feel a strong bitter or sour taste in the mouth due to the weakness of the esophageal sphincters. The main danger of regurgitation is the possibility of ingestion of food masses into the cavity of respiratory organs, fraught with coughing and suffocation. In some cases, regurgitation can cause aspiration pneumonia.
• Dysphagia - obstructed passage of a food coma along the esophagus. Occurring from time to time, dysphagia can be provoked by eating foods rich in fiber. The paradox of this symptom is that the passage of solid foods can be easier than passing the liquid.

Causes of development of

Diseases of the esophagus can occur under the influence of congenital, mechanical, chemical, infectious and thermal factors.

• The category of congenital pathologies includes diseases that arise during fetal development and are due to the influence of genetic abnormalities, the characteristics of difficult pregnancy and the diseases of the mother's body.
• The group of mechanical causes of include damage caused by the esophagus as a result of contact with a variety of objects( as a rule, not subjected to grinding).Very often, the culprits of such damage are fish bones. It is equally harmful for the esophagus to disregard the norms of proper nutrition: eating dry, hasty, lack of habit to thoroughly chew food.
• The chemical factors , which provoke the appearance of pathological processes, include the influence on the esophagus tissues of too salty, acidic and acute dishes, long-term medicines, alcoholic beverages, tobacco smoke( when they are abused), large quantities of coffee and chocolate.
• To the category of infectious factors are listed many poorly healed infectious diseases. Strange as it may seem, even an innocuous seemingly inflammation of the tonsils can present a danger to the health of the esophagus, if its therapy was carried out hastily and did not end with the complete restoration of the organism.
• The thermal factor is the regular use of excessively cold or hot dishes and drinks.

Diagnostics

In modern clinics, the condition of the esophagus is examined using high-tech equipment.

The most informative methods are:

• Contrast fluoroscopy. During the procedure, the specialist performs a whole series of photographs: both before the adoption of the radiopaque substance( in its role the suspension of barium sulfate is used most often) and after it. For the examination of the esophagus, only images made in oblique projections are suitable, since in the anterior and posterior projections the shading of the esophageal tube stratifies to the shadow left by the mediastinum. With the help of this procedure it is possible to obtain information about the localization of the esophagus in the chest cavity, its size, the diameter of the lumen, the condition of the walls( the pictures may reflect the symptomatology of the niche or the filling defect of the organ under investigation).Of particular importance is the possibility of identifying possible difficulties in the passage of food( for example, gastroesophageal reflux).To identify the paraeophageal hernia, determine its type and size, perform provoking tests, taking pictures of the body that has taken a horizontal position( it is called Trendelenburg position) and when the body is tilted forward. The researcher's view reveals the existing pathologies( the presence of polyps, diverticulum and ulceration).
• Esophagoscopy is an endoscopic procedure performed on an empty stomach with the help of a fibro-esophagoscope, equipped with a whole set of tools for performing targeted biopsies and extracting foreign bodies. The study is conducted in a specially equipped office. The patient is placed on a special table and local anesthesia is performed. In the course of the study, the condition of the mucous membranes of the esophageal tube is carefully examined. Having found inflammation or erosion, evaluate their distribution, localization and, after performing a biopsy, send tissue samples to a histology. Using the technique of esophagoscopy, the specialist draws a conclusion about the degree of patency of the esophageal tube and its sphincters. In some cases, perform the procedure of bougie, which allows to expand the lumen of the esophagus, narrowed due to the presence of cicatricial strictures. Buzhirovanie carried out by means of rigid or flexible rods( bougie).The procedure of esophagoscopy is appointed to identify the causes of dysphagia, with suspicion of a tumor of the esophagus and when a foreign body enters the cavity of the esophagus.
• Daily pH-metry. With the help of a special sensor( pH probe), variable values ​​of acid-base balance in the lower third of the esophageal tube are recorded throughout the day. The results are processed on a computer. This technique is successfully used to determine the character( it can be bile, alkaline pancreatic or acidic gastric) of gastroesophageal reflux and its total duration.
• Computed tomography. Indication for the use of this diagnostic technique is the suspected presence of an endophytic tumor of the esophageal tube. In the course of the procedure, the condition of the adjacent regional lymph nodes and adjacent organs is assessed in passing.
• Functional X-ray diagnostics of the esophagus, used for violations of esophageal motility( up to the development of dysphagia) against the background of increased sphincter tone.
• Ezofagotonokimografii - a high-tech technique performed using a whole complex of high-precision instruments: kymograph, pressure sensors, polycardiograph, Marey capsules. This technique is applied to patients suffering from different types of esophageal dyskinesia. Measuring the partial pressure in different parts of the esophageal tube( not excluding sphincters), establish areas in which the tone of the esophagus and its sphincters is disturbed. Measurements are made during the swallowing act, and when the patient is at rest.
• Functional testing used to detect gastroesophageal reflux. A standard set of diagnostic techniques consists of a Stepenko test, an acid test of Baker and Bernstein, a standard reflux acid test and gastric sounding using methylene blue.
• Radioisotope study using the 32R isotope used for the early detection of malignant tumors.

Treatment of

Diseases of the esophagus are so diverse that the tactics of treatment will be different in each case.

• The treatment of achalasia( or cardiospasm) of , a severe neuromuscular disease accompanied by a difficult opening of the cardiac sphincter opening the access to the stomach, requires either the use of a cardiodilation procedure( expansion of the sphincter with a balloon) or the surgical operation of a cardiomyotomy consisting of muscle dissectionproblematic sphincter. Medication therapy in this case is given only an auxiliary value.
• In the treatment of esophagospasm , compliance with a sparing diet and administration of antispasmodic, antibacterial drugs( with this nitrofurans cope) and sedative action are of great importance. In the presence of serious disorders in the functioning of the sphincter resort to surgery or to the procedure of balloon dilatation.
• Tactics of treatment of patients with reflux esophagitis - a chronic disease due to insufficiency of the lower sphincter, primarily aimed at normalizing nutrition. During the exacerbation of the disease, the doctor prescribes the use of antacids( phospholugel, maalox), drugs that block H2-histamine receptors( famotidine, ranitidine), cisapride - a drug that improves the motor skills of the esophagus sphincter and decoction of flaxseed. If drug therapy has not been successful, a surgical operation aimed at eliminating reflux is performed.
• The first step in the treatment of chronic esophagitis , accompanied by severe pain behind the sternum and intolerable heartburn, is fasting( duration not more than 48 hours).After that appoint a sparing diet. We also recommend the use of chilled drinks. The main task of drug therapy in the period of exacerbation of the disease is anesthesia of its manifestations. This task is carried out with drugs of antispasmodic action or novocaine. In the most difficult cases, morphine is used. After the withdrawal of pain resort to symptomatic treatment. For the prevention of antibiotics.