Reflux esophagitis

The reasons

Degrees of reflux

Manifestations

Diagnosis of reflux esophagitis

Treatment

Reflux esophagitis is the development of an inflammatory lesion of the esophagus due to repeated reflux of gastric contents into the esophagus.

Manifestations of the disease are detected in almost half of the adult population, endoscopic signs – in more than 10% of individuals subjected to endoscopic examination. Berrett’s esophagus develops in 20% of patients with reflux esophagitis (0.4% of the population).

The reasons

  • Surgical interventions on or near the esophageal opening of the diaphragm (vagotomy, resection of the cardial section of the stomach, esophagogastrostomy, resection of the stomach, gastrectomy)
  • Hernias of the esophageal opening of the diaphragm
  • Peptic ulcer and duodenal ulcer
  • Pilorospasm or pyloroduodenal stenosis
  • Scleroderma
  • Smoking
  • Alcohol
  • Pregnancy
  • Drugs that can reduce the tone of the lower esophageal sphincter
  • Sphincter insufficiency with obesity
  • Gastritis associated with Helicobacter pylori

Degrees of reflux

  • Grade A – one (or more) lesion of the mucous membrane less than 5 mm, limited to the limits of the fold of the mucous membrane
  • Grade B – one (or more) lesion of the mucous membrane more than 5 mm, limited to the limits of the fold of the mucous membrane
  • Grade C – one (or more) lesion of the mucous membrane, extending over 2 or more folds of the mucous membrane, but occupying less than 75% of the circumference of the esophagus
  • Grade D – one (or more) lesion of the mucous membrane, extends to 75% or more of the circumference of the esophagus.

Manifestations

  • Heartburn is the most characteristic symptom of reflux esophagitis (experiencing 83% of patients), resulting from prolonged contact of the acidic gastric contents with the mucous membrane of the esophagus. Heartburn increases with errors in diet, alcohol intake, carbonated beverages, physical exertion, inclinations and in a horizontal position.
  • Belching, worse after eating, taking carbonated drinks
  • Regurgitation of food, aggravated by physical exertion
  • Swallowing disorder
  • Pain in the epigastric region or behind the sternum – appear shortly after eating, aggravated by bending the body, in a horizontal position
  • Less commonly, there is a feeling of a coma in the throat when swallowing, pain in the ear and lower jaw, chest pain that can be provoked by physical exertion.

Extraesophageal manifestations – chronic cough, pneumonia , hoarseness, caries teeth, etc.

Diagnosis of reflux esophagitis

  • X-ray examination lying on the back or upright with a strong patient tilting anteriorly: throwing barium sulfate into the esophagus
  • Endoscopic examination with biopsy
  • Esophagotonography (manometry)
  • Daily pH-metry – the main method of monitoring the effectiveness of treatment.
  • Bilimetry is performed to identify alkaline (biliary) reflux.
  • Scintigraphy is shown to identify motor-evacuation disorders of the esophagus
  • Omeprazol test
  • Bernstein test

Treatment

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In the treatment of reflux esophagitis, complex therapy gives good results, which consists not only in taking medications, but also in keeping to a diet, in the quest for general improvement of the body.

  • Smoking cessation
  • Normalization of body weight
  • Raise the head end of the bed
  • Avoiding loads on the abdominal muscles, working with the torso, wearing tight belts, belts
  • Undesirable medications that reduce the tone of the esophageal sphincter (nitrates, calcium antagonists, theophylline, progesterone, antidepressants)

Diet in the treatment of reflux esophagitis

Diet includes

  • restriction of products that enhance gas formation;
  • avoid spicy, very hot or cold foods;
  • avoidance of alcohol, foods that reduce the tone of the lower esophageal sphincter (onions, garlic, pepper, coffee, chocolate, etc.);
  • avoiding overeating, the last meal – no later than 3-4 hours before bedtime.

Drug therapy

Drug therapy is carried out for at least 8-12 weeks, followed by maintenance therapy for 6-12 months.

Apply

  • proton pump inhibitors (omeprazole, lansoprazole, rabeprazole) in usual or double dosage,
  • antacids (almagel, phosphalugel, maalox, gelusil varnish, etc.) are usually prescribed 1.5–2 hours after meals and at night,
  • prokinetics – domperidone, metoclopramide.

Surgery

Indications for surgical treatment:

  • complications of reflux esophagitis (esophageal strictures, repeated bleeding, Berrett’s esophagus),
  • the ineffectiveness of drug therapy (for 6 months) in young patients,
  • combination with bronchial asthma.

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