Reflux esophagitis: symptoms and treatments
Reflux esophagitis can rightfully be considered one of the most common diseases of the esophagus. As of 2010, 5 million people in Russia suffer from it. Adequate therapy for their disease is received by no more than 2 people out of 10. It often occurs due to contact of the mucous membrane of the esophagus with the contents of the stomach. The latter is known to be highly acidic and affects the lower esophagus. As a result, a person experiences pain, heartburn, and other symptoms of indigestion.
Unfortunately, it is impossible to trace the real incidence of reflux esophagitis, because it often proceeds with mild symptoms and people do not seek help from specialists. For patients with reflux esophagitis, persistent heartburn that occurs after eating is a variant of the norm. They relieve discomfort with an Almagel tablet or other familiar means. Such carelessness can cost a person dearly, since reflux esophagitis is not the safest disorder. It often causes severe bleeding and even cancer.
The second category of patients can be called people with persistent, severe symptoms of the disease that require outpatient treatment. The most dangerous are refluxes with complications (ulcers and bleeding). This form of the disease requires hospitalization.
Content:
- GERD and reflux esophagitis
- Reflux Esophagitis Causes
- Reflux esophagitis symptoms
- Reflux esophagitis diagnostics
- The degree and stage of the disease
- Reflux Esophagitis Treatment
- Answers to popular questions
GERD and reflux esophagitis
Reflux esophagitis is often confused with gastroesophageal reflux disease (GERD). These are two different conditions, which differ, first of all, in the approach to therapy. Their main differences are presented in the table.
Differences between reflux esophagitis and GERD
| Comparative characteristics | GERD | Reflux esophagitis |
| Definition of the concept | With a disease, gastric contents are thrown into the esophagus. In this case, the mucous membrane lining it suffers, since it is not adapted to contact with acids. | |
| Are there changes in the esophageal wall? | If the disease has an uncomplicated course, then the mucous membrane retains its normal structure. | The walls of the esophagus are always inflamed. |
| Establishing diagnosis | The doctor makes a diagnosis already during the initial examination of the patient. | The diagnosis can be made only after performing FGS with endoscopic examination of the esophagus. |
| Features of therapy | Drugs are taken only as needed. | A person should regularly take medications that will prevent the narrowing of the esophagus, bleeding, cancerous tumors and other complications. |
Thus, esophagitis is an inflammation of the esophagus, which can be diagnosed during fibrogastroscopy. GERD can develop without esophagitis, but esophagitis is always combined with GERD.
Reflux Esophagitis Causes
The lower esophageal sphincter is a natural barrier between the esophagus and the stomach that prevents its contents from flowing back. The food that the stomach has begun to digest moves lower and does not rise into the esophagus. Sometimes the contents from the stomach are thrown, but this does not happen often in a day and does not cause discomfort in a person, therefore it is considered a variant of the norm. Disease is spoken of when the reflux of gastric contents occurs very often. Moreover, food masses contain a large amount of acid.
Reflux esophagitis has a number of different causes. In young children, it usually occurs due to an underdeveloped neuromuscular apparatus, namely, the cardiac esophagus. This is why babies often burp.
Also, the cause of reflux esophagitis can be gastritis or peptic ulcer: because of them, the pressure inside the stomach increases, and the mobility of the gastrointestinal tract is significantly reduced. In addition to heartburn, the patient experiences spasms, hypertonicity. Stress, obesity, decreased salivation and poor nutrition can disrupt intestinal motility. Among the most dangerous foods are citruses, chocolate, tomatoes, fatty and spicy foods, coffee and alcoholic beverages. Smoking and the use of certain medications, especially sedatives and hypnotics, prostaglandins, nitrates and nitrites, also harm the esophagus and stomach.
Before starting therapy, it is important to establish and eliminate the pathological factor that led to the development of reflux esophagitis. Otherwise, the disease will recur all the time.
| The reason for the development of the disease | The mechanism of development of the disease | Conditions that can provoke reflux esophagitis and GERD |
| Increased pressure on the sphincter of the lower esophagus | High intra-abdominal pressure that causes food to rise. |
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| Weak sphincter of the lower esophagus | If the valve does not work, then the reflux of contents from the stomach into the esophagus occurs very often. |
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Increased acidity of gastric juice |
If the gastric contents contain too much hydrochloric acid, then even a single throw of food into the esophagus can lead to the development of the disease. Sometimes gastric juice has an increased aggressiveness due to the fact that it contains too many enzymes. |
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Reflux esophagitis symptoms
It is very important to pay attention to the first symptoms of reflux esophagitis, which can be divided into two categories. The first category is the esophageal manifestations of reflux esophagitis, and the second category is the extraesophageal clinic.
Esophageal symptoms are caused by damage to the mucous membrane of the organ. They are manifested in the following:
- Heartburn. Heartburn becomes more intense after drinking alcohol, after exercise, after overeating. Although in patients with reflux esophagitis, heartburn can occur at almost any time. The more the esophageal mucosa is affected, the stronger this symptom will be. Certain diseases also affect the incidence of heartburn: inflammation of the gastric mucosa, ulcerative defects in the digestive system, etc.
- Pain. Painful sensations are concentrated behind the chest, and sometimes rise higher. They are almost always associated with heartburn. You can cope with pain if you take an antacid, for example, Rennie or Almagel. Pain has a relationship with food intake. This is what distinguishes it from heart pain, which cannot be controlled with antacids.
- Belching with sour contents. This symptom is indicated by most people suffering from reflux esophagitis. Often, some food comes out during belching.
- Swallowing disorder. This symptom is observed in those patients who have suffered from esophagitis for a long time. The food lump passes through the esophagus with difficulty, this process is accompanied by pain.
In addition to the symptoms described above, patients may suffer from damage to the vocal cords, lungs, bronchi, trachea. The acidic content can enter the respiratory system and cause inflammation. As a result, a person can be treated for a long time for bronchitis, asthma, laryngitis and even pneumonia, and the exact cause of the disturbance of health will not be established.
If reflux esophagitis has a chronic course, then additional symptoms of the disorder are:
- Voice change. He becomes husky.
- Cough that is dry when trachea is involved. If inflammation of the bronchi or lungs occurs, the cough becomes moist.
- A sore throat.
- A runny nose that follows the patient for a long time.
The esophagus and other organs that suffer from the damaging effects of stomach acid will bleed. As a rule, bleeding is minor, but can lead to anemia. Its symptoms are manifested in increased weakness, weakness. You may develop a craving for unusual odors. The condition of nails, skin and hair often deteriorates in patients.
Reflux esophagitis diagnostics
A standard examination is not enough to make a diagnosis. Laboratory diagnostics provide practically no information on the disease. With its help, it will only be possible to assess the general state of human health, as well as identify some of the complications of the disease. When a person comes to the doctor's appointment, he will prescribe him only 3 analyzes: donation of blood, urine and feces. Changes in reflux esophagitis will affect only the blood picture.
| Disturbances in the blood picture with reflux esophagitis | What these violations indicate |
| An increase in the erythrocyte sedimentation rate in women up to 15 mm / hour, and in men up to 10 mm / hour. A decrease in the level of erythrocytes in women to 3.6 * 1012, and in men to 4.4 * 1012. Decrease in hemoglobin level in women to 120 g / l, and in men to 130 g / l or less. | An increase in ESR indicates that there is inflammation in the body. A drop in hemoglobin and erythrocyte levels indicates developing anemia, in which the number of cells carrying oxygen decreases. |
It is possible to make a diagnosis only with the help of such an examination method as FGS - fibrogastroscopy.
Features of the FGS
During the procedure, a thin tube is inserted into the patient's oral cavity, which is equipped with a camera and a working instrument. Before the examination, you need to stop eating 3-4 hours before it starts. Do not drink water 40 minutes before the procedure.
The patient will need to take a towel and a disposable napkin with them. The person is laid on the left side. To reduce the discomfort that occurs when the tube is inserted, an anesthetic solution is sprayed onto the root of the tongue. Then a mouthpiece is inserted into the patient's mouth, it will need to be clamped with lips and teeth.
FGS cannot be called a pleasant procedure, but in time it takes no more than 7 minutes. At this time, the doctor examines the condition of the mucous membranes of the esophagus and stomach. If necessary, a change in tissue is taken. In the future, it is studied under a microscope. The doctor will be able to detect atypical cells, bacteria, thinned epithelial structures in it.
The doctor will be able to make an initial diagnosis immediately after FGS. If a laboratory study of tissues is required, then the data can be obtained after 7-14 days.
Assessment of results
After the examination, the doctor will be able to make the following conclusion:
- Catarrhal reflux esophagitis. This is the most "harmless" variant of the disease. The mucous membrane is loose, full-blooded, there is no serious damage on it. This type of esophagitis is not subdivided into stages.
- Erosive reflux esophagitis. In this case, the esophagus will be covered with ulcers, or thinned areas of the epithelium will be found on it. This condition requires an immediate start of treatment, as it threatens the development of bleeding, can lead to stenosis or complete obstruction of the organ. Ulcerative defects are dangerous degeneration into cancerous tumors. The erosive form of the disease is divided into stages. The doctor must take material for microscopic examination without fail.
- The presence of bleeding, which is complicated by erosive esophagitis. Often in such patients in the course of laboratory diagnostics, anemia is revealed, which is accompanied by the corresponding symptoms (increased fatigue, distorted taste, etc.). A person can undergo outpatient treatment, since there is no threat to his life. However, if cancer cells are found in the tissues taken for analysis, hospitalization is required.
- Fibrin deposits on the walls of the esophagus. This sign indicates that the disease progresses in a person for a long time.
Sore throat after FGS
After FGS, the patient may experience a sore throat. It occurs in 90% of people. Even if the procedure was performed perfectly, it is impossible to exclude the appearance of discomfort. The pain develops due to the fact that the device injures the esophageal mucosa. The stronger they are, the longer the person will be in pain. Sometimes they persist for 14 days after the procedure. The pain will go away when the lining of the esophagus is restored.
If the pain is intense, then you need to see a doctor to make sure that the esophagus has not been severely injured. In the hospital, the patient may have a fluorography or chest x-ray. If free air is found in the organs, this indicates a rupture of the esophageal wall. In this case, the person needs immediate surgery. However, one should not be afraid of FGS, since the described case is a rare exception, which is practically not registered in modern medicine.
As a rule, a sore throat after the procedure does not require any therapy. The mucous membrane of the organ will recover on its own. If the pain causes discomfort, then you can take a drug from the NSAID group, for example, Nimesulide or Meloxicam. They are not capable of harming the digestive system. However, in such cases it is best to consult a doctor.
The degree and stage of the disease
If an erosive form of the disease is found in a patient, then the doctor in the diagnosis will have to indicate the degree and stage of its development. You can understand what exactly the doctor had in mind using the table.
| The degree of development of the disease | Los Angeles disease classification | Stage | Disease classification according to Savary-Miller |
| A | Thinning of the epithelium 1-5 mm long | Single erosion | |
| B | Thinning more than 5 mm | Erosions are confluent, but do not cover the entire esophagus around its circumference | |
| C | Erosion covers 3/4 of the organ | Erosion and inflammation cover the entire circumference of the esophagus | |
| D | More than ¾ part of the organ is affected | There are complications of the disease in the form of stenosis, ulcerative defects, etc. | |
| five | There are symptoms of precancer in the lower esophagus (Barrett's esophagus). | ||
The higher the stage of the disease, the higher the likelihood of complications.
Reflux Esophagitis Treatment
Reflux esophagitis is dangerous because it does not cause intense symptoms, which is why many people do not see a doctor on time. Pathology progresses, which leads to the development of dangerous complications. To prevent this situation, you need to start therapy in a timely manner.
Treatment of reflux esophagitis consists primarily in eliminating the disease that caused it (gastritis, neurosis, peptic ulcer or gastroduodenitis). The right therapy will reduce the symptoms of reflux, help reduce the harmful effects of gastric contents thrown into the esophagus, increase the stability of the esophageal mucosa and quickly clear the stomach after eating.
General recommendations
A person with reflux esophagitis needs not only to take medications, but also to reconsider their lifestyle in general.
Therefore, doctors give all patients the following recommendations:
- Refusal from cigarettes. Nicotine provokes an increase in the acidity of gastric juice, relaxes the walls of the esophagus, which leads to the progression of the disease.
- You can not go to bed immediately after eating. For half an hour after eating, you need to stay in a sitting position, or walk a little at a slow pace. You should not run, lift weights. Any physical activity after eating is prohibited.
- Restrictions on weight lifting after meals are 3 kg for women and 5 kg for men.
- You should stop drinking alcohol 2-3 hours before bedtime. You also need to eat no later than this time.
- To prevent the symptoms of the disease from worsening in the supine position, it is recommended to use an additional pillow to keep the upper body elevated. This will reduce heartburn and sternum pain.
- Clothing should not tighten the abdomen. Do not tighten your belt, corset or belt after eating.
- It is important to focus efforts on getting rid of concomitant diseases: gastritis, obesity, ulcers, etc. If this is not done, then it will not be possible to get rid of reflux esophagitis.
Diet
Diet is a very important part of the treatment for reflux esophagitis. Patients should give up fatty and spicy foods, coffee, chocolate, citrus fruits, tomatoes, alcohol and smoking.
Many people believe that dieting means eating unpalatable foods and restricting everything. In fact, this is not the case. It is important to remove only certain foods from the diet. Using various culinary techniques, you can make your menu varied, delicious and very healthy.
Products such as:
- Drinks that contain caffeine: Coca-Cola, energy drinks, cocktails.
- Sparkling drinks.
- Alcoholic drinks.
- Pastries that increase acid production in the stomach.
- Chocolate and sweets.
- Dairy products.
- Linseed and olive oil, animal fats. Vegetables and fruits that contain acids: radishes, pomegranates, citrus fruits, etc.
Food should not be fried using animal or vegetable fats. Such foods contribute to the overproduction of gastric juice. This entails the progression of the disease. Food should be boiled, steamed, stewed in its own juice.
Tips for preparing healthy and tasty meals:
- Wrapping. With foil or parchment paper, you can make almost any meat product without adding oil. Spices can be replaced with salt, dried herbs, and natural vegetables.
- Using the oven. Baking is the best way to cook for people with esophagitis. At the same time, oil is not added to the dishes, which reduces the fat content of meat products. You can fill the food with water. In one baking sheet, not only meat is cooked, but also a side dish, which allows you to reduce the time spent in the kitchen. It is important to bake food for no longer than 70 minutes. The optimum temperature is 200 ° C.
- Cooking in a double boiler or multicooker. These modern devices can significantly increase the value of any dish, add juiciness to it. Steam processing gives the food a pleasant taste and does not destroy the vitamins contained in it. You can add salt and herbs to dishes.
- Cooking food on an open fire. This method of processing food should be practiced during field trips. Excess fat will leave the meat, while it retains its juiciness and tenderness. It is important not to marinate foods in hot brines.
To get rid of reflux esophagitis, you need to reduce your intake of oil and mayonnaise, ketchup, mustard, and other hot sauces. They negatively affect the condition of the mucous membranes of the gastrointestinal tract, increase the acidity of gastric juice.
Dishes should not be too hot or cold, as they irritate the esophagus.
Taking medications
If the above recommendations do not help, then special medications are prescribed that reduce the acidity of the stomach - antacids. In case of peptic ulcer disease and erosions, it is recommended to take antisecretory drugs (proton pump inhibitors or H2 blockers). This will reduce the pressure inside the stomach, make it resistant to food intake, normalize intestinal motility, and eliminate the symptoms of reflux esophagitis.
Modern proton pump inhibitors are represented by 5 substances: omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole. To decide on the drug, you need to visit a gastroenterologist.
Before starting treatment, it is necessary to study some of the features of proton pump inhibitors (data from 2014-2016).
| Individual characteristics of the patient | Which drug is better to choose? | Why this particular drug and not another? |
| It is required to take drugs that reduce the AP-enzyme (Enalapril, Lisinopril, Captopril, Ramipril, etc.). | Pantoprazole or Rabeprazole | In people who have heart disease or high blood pressure, taking omeprazole and esomeprazole increases the likelihood of heart attack and stroke. These drugs neutralize the protective effect of drugs for the treatment of cardiac pathologies, as they help to reduce the level of the AP enzyme. |
| Pregnant woman after 13 weeks | Lansoprazole, Pantoprazole | The American Medical Association has not found any toxic effects that these drugs could have on the body of a woman or fetus. They are not prescribed earlier than the 13th week of pregnancy, since at this time the basic systems of the future organism are laid. Omeprazole, esomeprazole and rabeprazole are not prescribed during pregnancy. |
| Patients with bronchial asthma | Omeprazole or esomeprazole | Reflux esophagitis and bronchial asthma are related diseases. There is evidence that the listed drugs have a positive effect on the state of the respiratory system. |
| Patients with liver diseases (hepatitis cirrhosis, fatty hepatosis, etc.). | Any drugs, but it is better to give preference to rabeprazole. | The minimum dose of rabeprazole is 10 mg, which is 2 times less than the dosage of other drugs. Scientists believe that this particular drug is less likely to damage the diseased organ than others. |
| It is necessary to quickly and permanently lower the acidity of gastric juice | Lansoprazole, pantoprazole, or rabeprazole. | The effect of taking omeprazole and esomeprazole develops only 3-4 days after the start of treatment. The rest of the drugs take effect from the first day of taking them. |
If, for some reason, patients cannot take proton pump inhibitors, then they are prescribed H2-histamine blockers. They are less effective, so they are taken in high doses. They are used only in extreme cases. These are drugs such as: Famotidine, Ranitidine, Nizatidine and Roxatidine.
It is not enough just to reduce the acidity of gastric juice, it is important to reduce the number of reflux of its contents into the esophagus. This is achieved through the use of prokinetics. These drugs improve the contractility of the digestive tract and help to normalize the process of movement of food through them.
These medicines are represented by the following trademarks:
- Domperidone (Motilak, Motonium, Motilium). These are the drugs of choice for inflammation of the esophageal wall. They allow you to normalize the sphincter, stomach and intestines.
- Cisapride (Coordinax, Peristil). These drugs affect the lower esophageal sphincter, the stomach. Their tone increases and the frequency of reflux decreases.
- Metoclopramide (Raglan, Perinorm, Cerucal). If reflux into the esophagus occurs very often, and other drugs do not reduce their number, then metoclopramide is prescribed. However, it has a number of side effects, including increased fatigue, muscle tics, and weakness.
Any drug must be prescribed by a doctor. All of them have indications and contraindications for admission. They must be taken into account before starting treatment.
To get rid of pain in the esophagus, you need to take antacids. They are also indicated for heartburn. Antacids do not cure esophagitis, but they are excellent at stopping its main symptoms. They have a minimal set of contraindications, so they can be used without a medical prescription.
The most famous antacid is Almagel. He appeared before the others. Modern drugs are significantly superior in efficiency. These medicines include: Gaviscon, Maalox, Rennie, Megalak.
They begin to act faster and remain active longer than Almagel. In addition, such agents are better at lowering the acidity of gastric juice.
Some people take baking soda solution to relieve heartburn. However, this recipe of traditional medicine only harms the sick esophagus and stomach. Soda relieves irritation, but then leads to the fact that acid is emitted several times more, and refluxes become frequent. Therefore, doctors strongly recommend giving up baking soda to get rid of heartburn.
Operation
Most often, the disease can be dealt with by conservative methods. The operation is rarely performed if a person develops serious complications.
You need to go to an appointment with a surgeon in the following cases:
- Bleeding started from the esophagus.
- Food does not move along the esophagus due to its persistent narrowing.
- The sphincter has undergone irreversible changes.
- Pre-cancer was diagnosed.
- Cancer has been diagnosed.
Sometimes it is enough to simply remove the pathological neoplasm, and sometimes it is necessary to remove the entire tube or part of the esophagus. However, the indications for surgery must be serious.
Answers to popular questions
- How to identify reflux esophagitis in a child? Refluxes occur in children 3 times more often than in adults. The esophagus of babies has defense mechanisms against the development of esophagitis, so this condition rarely develops in childhood. Its main symptoms are: unreasonable crying of the baby, increased anxiety after eating, fever, chest pains. It is possible to cope with the disease without drugs. The baby should be held upright after each feed. If this does not help, then you need to use adapted formulas for feeding the baby, which have a thick consistency, for example, Nutrilon, Frisovoy, Enfamila.
- How long does it take to recover from reflux esophagitis? Throughout life, you will need to follow the recommendations regarding lifestyle and nutrition. The duration of the drug intake is determined on an individual basis. As a rule, proton pump inhibitors are drunk in a course of a month. They will need to be repeated 2 times a year.
- What is biliary reflux esophagitis? If a person has diseases of the biliary tract and gallbladder, as well as weakness of the sphincters, then this can lead to the contents of the duodenum being thrown into the esophagus. In this case, the organ will suffer from the destructive action of bile. This disease is often combined with severe gastritis and peptic ulcer disease. The therapy is carried out in a similar way. At the same time, it is important to further direct efforts to the treatment of the biliary system.
- Can esophageal ulcer or organ cancer develop with reflux esophagitis? If the disease exists for a long time without treatment, then the risk of developing these complications is extremely high.
The author of the article: Gorshenina Elena Ivanovna | Gastroenterologist
Education: Diploma in the specialty "General Medicine" received at the Russian State Medical University named after N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.
