Chronic distal erosive reflux esophagitis-what is it: symptoms, degrees, treatment

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Distal esophagitis can be an independent disease or one of the concomitant complications of the gastrointestinal tract. This form arises when exposed to irritating factors on the esophagus. The lesion can affect a particular area of ​​the esophagus or the whole organ at once.

Distal esophagitis - what is it?

When an aggressive or irritating substance is applied to the esophagus, swelling of the tissues and inflammation of the mucous membrane appear. If a person ate a sharp meal, then these manifestations are temporary. With the weakening of protective functions, there is persistent inflammation.

There are several zones where there may be a mucosal structure disorder:

  1. Total defeat. It seizes the entire esophagus.
  2. Proximal. It is localized in the initial department of the organ.
  3. Distal. It occurs in the inflammation of the lower part of the esophagus adjacent to the stomach.

Causes of

Inflammation in the distal esophagus may result from chemical or mechanical effects on the mucosa.

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Often occurs after previous infections, for example, diphtheria, scarlet fever, measles or influenza. Sometimes the prerequisite is allergic reactions.

The main cause is the weakening or inconsistency of the cardia, the upper part of the stomach. Between the latter and the esophagus there is a closing sphincter. If it works poorly, the contents of the stomach together with the aggressive juice penetrates into the lower parts of the esophagus.

Because of this, there is an increase in intragastric pressure and a decrease in the peristalsis of VCT.

Lead to distal esophagitis can:

  • Attitudes to coffee, alcohol and tobacco.
  • Pregnancy and factors provoking increased intra-abdominal pressure.
  • Other diseases, for example, non-productive cough, gastritis, peptic ulcer.

If the distal esophagitis is caused by infections in the body, then a hemorrhagic variant of the disease arises.

Classification of forms and degrees

The effectiveness of treatment depends on how correctly diagnosed and precisely defined the form and type of the disease. The classification of the distal form is quite large. Each variety requires a special approach to the development of a treatment plan and the choice of medications.

Three types of process are distinguished:

  • acute,
  • subacute,
  • chronic.

The latter appears in the event that the acute process was not cured or cured, but not until the end.

The nature of the changes occurring are:

  • Catarrhal. This is the initial form, which appears against the background of a trauma in the lower part of the esophagus with a solid or spicy food, a constant intake of medications.
  • Ointment. The edema increases if the initial treatment does not begin.
  • Erosive. There is an increase in the inflammatory process, the mucosa becomes loose, ulcers appear.
  • Exfoliative. This species accompanies scarlet fever or diphtheria. Characterized by bouts of pain and cough with bloody impurities. At this stage, the destruction of the esophagus membrane is characteristic.
  • Pseudomembranous. Appears against the background of some infections, the mucous membrane is covered with a fibrin film.
  • Phlegmonous. It is a complication of infectious diseases and lesions of the walls with a foreign object.
  • Necrotic. The form is accompanied by severe diseases. With it, the submucosal tissues are involved in the inflammatory process.

The disease can go through 4 stages:

  • First. The looseness of the membrane of the distal part is noted.
  • Second. Single ulcers appear on the folds of the mucosa. At this stage, the disease can extend beyond the distal segment.
  • Third. Multiple ulcers appear. They can merge, create necrotic areas. Affect more than half of the distal part.
  • Fourth. Changes affect the entire department or body, penetrate into the deep layers.

Symptoms of

In 40% of distal esophagitis does not cause discomfort or pain. Sometimes there is a belch, difficulty swallowing or burning sensation. In addition, there is a feeling of constant weakness or nervousness.

Symptomatic symptoms may occur in the supine position and disappear when sitting or standing.

Belching can occur even before pathological changes occur. If you adjust your lifestyle, you can avoid further complications. Dysphagia in the early stages of the disease is poorly expressed. As the progression increases, the intensity increases.

Diagnosis

The distal form is examined using a variety of instrumental methods:

  • Radiography. With its help, it is possible to identify the main cause of the development of the disease and determine the probability of getting from the stomach into the esophagus of the contents.
  • Endoscopy. The method reveals the severity of the disease. With the help of a camera attached to the end of a special endoscope, the doctor will see the presence of ulcers and the locality of the inflammatory process.
  • Intra-esophageal pH-metry. The study, which allows using the probe to show the acidity of the esophagus environment.

Sometimes a manometric or radionuclide method is used for diagnosis. The first one is designed to detect abnormalities in the work of the organ, and the second determines the level of radioactivity in the esophagus.

Treatment of distal reflux esophagitis

First, all manipulations are aimed at eliminating the source of irritation. The patient is then given a special diet.

Its essence is to eliminate the ration of irritating foods. The doctor appoints a fractional diet with small portions. To exclude necessarily it is necessary coffee, the aerated drinks, spices, alcohol, sharp dishes.

The course of treatment with medication starts in the appointment of various antacid preparations. They envelop the mucous and reduce the acidity of the gastric juice.

In addition, medicines are prescribed that can reduce the production of gastric juice. Treatment with such tablets is about 4-6 weeks.

In addition prokinetics are prescribed. They increase the tone of the distal sphincter of the esophagus, accelerate the digestive process. Thanks to them, food quickly falls from the stomach into the intestines, not having time to be thrown into the esophagus.

Surgical treatment is prescribed only if:

  • has no persistent effect with conservative treatment,
  • has frequent pneumonia,
  • appears bleeding,
  • develops Barrett's esophagus.

The operation is aimed at the formation of an artificial esophageal valve. Due to this, the casting of gastric contents into the esophagus ceases.

Prognosis and prevention

The prognosis for the initial stages of the disease is favorable. But 80% of people are chronic, so it requires constant maintenance therapy.

Avoid stress. Distal esophagitis sometimes occurs against the background of severe nervous disorders. Therefore, you need to carefully monitor your status. Chronic forms require constant observation. Patients with this form are recommended to undergo regular treatment in a spa.

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