Reflux esophagitis is a chronic disease that consists in the abnormal transfer of gastric contents into the esophagus.
Since there is no protection against such aggressive substances in the mucous membrane, epithelial injuries result from contact with them with further inflammation and, accordingly, painful sensations.
In the case of reflux esophagitis, the level of acidity of the esophagus decreases noticeably due to mixing of the contents of the esophagus with acidic gastric reflux and digestive enzymes. The result of prolonged contact of the mucosa of the esophagus with such an irritant becomes its inflammation and traumatization.
In this article we will consider reflux esophagitis, its first symptoms and the basic principles of treatment, including at home.
Reasons for
Why does reflux esophagitis occur, and what is it? The cause of reflux esophagitis is, as a rule, hidden in the excessive relaxation of the esophageal sphincter at the entrance to the stomach. This muscle should most of the time be in a compressed state. A healthy esophagus relaxes only 6-10 seconds to allow food or liquids to pass through. If the sphincter remains relaxed longer( for patients - up to a minute after each swallowing), this causes regress of the acidic stomach contents into the esophagus.
Often reflux esophagitis accompanies such diseases of the digestive tract as :
- ulcer or stomach cancer;
- lesion of the vagus nerve;
- violation of duodenal patency of the esophagus;
- chronic pancreatitis, cholecystitis;
- pyloroduodenal stenosis;
- hernia of the esophageal opening.
Not infrequently, reflux esophagitis occurs after operations on the stomach. Also, the disease can be the result of smoking, drinking alcohol and a lot of coffee. In some cases, the relaxation of the sphincter occurs in people suffering from a hernia of the esophageal aperture of the diaphragm or from penetration of part of the stomach into the chest. This is observed in obese people, since a large belly increases the pressure on the diaphragm.
Erosive reflux esophagitis
A complicated form of the disease, in which small ulcers( erosions) form on the esophageal mucosa. With erosive reflux esophagitis, all of the above symptoms become more pronounced, giving the patient a palpable discomfort. Manifestations of the disease are intensified after eating, as well as certain medications, such as aspirin.
Degrees
For the course of the disease are characterized by several stages, and gradually the symptomatology increases, and erosive lesion of the esophagus becomes more pronounced.
- degree - manifested by separate non-merging erosions and erythema of the distal esophagus;
- degree - merging, but not engaging the entire surface of mucous erosive lesions;
- degree - manifested by ulcerative lesions of the lower third of the esophagus, which merge and cover the entire surface of the mucosa;
- degree - chronic ulcer of the esophagus, as well as stenosis.
Symptoms of reflux esophagitis
When reflux esophagitis occurs, the symptoms of this disease can be painful sensations behind the sternum, which give to the heart and even to the left shoulder, and can also suck in the pit of the stomach. Very often the patient does not even connect these symptoms with problems with the esophagus, they are taken for an attack of angina pectoris.
So, the main signs of reflux-esophagitis in adults are:
- belching with air or food;
- heartburn;
- nausea;
- regurgitation;
- sour taste in the mouth;
- incessant hiccough.
Symptoms of reflux esophagitis often increase in the prone position( especially after eating) and disappear when sitting.
Chronic reflux esophagitis
Esophagitis in chronic form, with a characteristic change in periods of exacerbation with periods of remission, can either be the result of acute reflux of esophagitis, or develop against the background of alcoholism and the reception of rough, poor-quality food.
On the types of changes in reflux esophagitis can be:
- surface( distal);
- is erosive;
- hemorrhagic;
- pseudomembranous, etc.
Symptoms of reflux esophagitis in the chronic stage, with medical examination using X-rays, can be a malfunction of the mucous membranes of the esophagus, the appearance of ulceration and erosion.
Diagnostics
To detect gastroesophageal reflux, quite different methods are used today. Due to the X-ray of the esophagus, it is possible to fix the contrast from the stomach to the esophagus or to find a hernia of the esophageal aperture of the diaphragm.
A more reliable method is a long pH-metry of the esophagus( measurement of acidity in the lumen of the esophagus with a probe).This allows you to determine the frequency, duration and severity of reflux. And yet the main method of diagnosing reflux-esophagitis is endoscopic. Using it, you can get confirmation of the presence of the disease, and determine the degree of its severity.
In general, the symptoms and treatment of reflux esophagitis depend on the severity of the disease, the age of the patient and the concomitant pathology. At some forms therapy is not appointed or nominated, and at others - operation is required.
How to treat reflux esophagitis
When symptoms of reflux esophagitis appear, treatment consists in eliminating the disease that caused it( gastritis, neurosis, peptic ulcer or gastroduodenitis).Correct therapy will make the symptoms of reflux in adults less pronounced, help reduce the harmful effect of gastric contents thrown into the esophagus, increase the stability of the esophagus mucosa and quickly cleanse the stomach after eating.
Conservative treatment of is indicated in patients with uncomplicated course of the disease. It includes general recommendations:
- after eating food, avoid leaning forward and stay up for 1.5 hours.
- sleep with at least 15 cm of raised bed head,
- do not wear tight clothes and tight belts,
- restrict consumption of food, aggressively acting on the mucous membrane of the esophagus( fats, alcohol, coffee, chocolate, citrus, etc.),
- to quit smoking.
Drug therapy with reflux esophagitis is carried out at least 8-12 weeks with subsequent maintenance therapy for 6-12 months. Assign:
- proton pump inhibitors( omeprazole, lansoprazole, rabeprazole) in usual or double dosage,
- antacids( Almagel, phosphalugel, maalox, gelusil lacquer, etc.) are prescribed usually 1.5-2 hours after meals and overnight,
- prokinetics - domperidone, metoclopramide.
To reduce the occurrence of symptoms in the supine position such as heartburn and chest pain, you should take the right posture - the upper part of the trunk should be slightly elevated, for which you can use several pillows.
Operation
This method of treatment is rarely used. Basic indications for operation :
- Ineffectiveness of prolonged drug treatment.
- Development of Barrett's esophagus with a risk of malignancy( development of esophageal cancer).
- Strictures of the esophagus.
- Frequent esophageal hemorrhage.
- Frequent aspiration pneumonia.
The main method of surgical treatment is Nissen fundoplication, with the normal functioning of the cardiac sphincter restored.
Diet
When reflux-esophagitis diet is strict enough and prohibits eating a certain number of foods. Among them:
- alcoholic beverages, natural fruit juices, carbonated drinks;
- marinated and smoked products, pickles;
- strong soups and soups cooked on them;
- fatty and fried foods;
- fruits( especially citrus fruits);
- spices, sauces;
- chewing gum;
- products that promote increased gassing( cabbage, black bread, milk, legumes, etc.);
- products, relaxing the lower gastric sphincter and provoking stagnant food masses in the stomach( sweets, strong tea, chocolate, etc.).
The diet of a person suffering from reflux should include the following products:
- boiled soft boiled eggs,
- low-fat milk and pureed low-fat cottage cheese,
- sour-milk products,
- porridges,
- meat and fish souffle,
- cutlets and steamed meatballs,
- soaked in water biscuits or stale bread,
- baked apples.
General recommendations:
- nutrition of patients with reflux disease should be divided and include five to six meals a day, the last one - four hours before bedtime.
- portions should be small so that the stomach is filled only by a third of its volume.
- afternoon nap is better replaced by a quiet walk. This contributes to the fact that food will quickly get out of the stomach into the intestine, and throwing acidic contents into the esophagus will not happen.
To reduce gastroesophageal reflux, it is necessary:
- to lose weight,
- to sleep on a bed with a high headboard,
- to observe time intervals between meals and sleep,
- to quit smoking,
- to give up drinking alcohol, fatty foods, coffee, chocolate, citrus fruits,
- eradicate the habit of washing down food with water.
Folk remedies
Treatment of reflux esophagitis by folk remedies can only be carried out as an auxiliary procedure. Folk treatment of reflux esophagitis is based on the reception of broths that calm the mucous membrane of the esophagus, products that stimulate the tone of the sphincter, reduce acidity and fight with heartburn.
Forecast
Reflux esophagitis has, as a rule, a favorable prognosis for work capacity and life. If there are no complications, then it does not shorten its duration. But with inadequate treatment and non-observance of data by the doctors of the recommendations, new relapses of esophagitis and its progression are possible.